Ministério da Saúde
Secretaria de Atenção à Saúde
Departamento de Atenção Básica
Coordenação-Geral de Alimentação e Nutrição
EDUCATION FOR CHILDHOOD OBESITY
PREVENTION: A LIFE-COURSE
APPROACH
National Programs
The Brazilian experience
WORKSHOP EDUCATION FOR CHILDHOOD OBESITY PREVENTION:
A LIFE-COURSE APPROACH
Brazilian Nutritional Scenario
National surveys since (1970, 1980, 1990, 2003, 2006
& 2009)
Overweight
Undernutrition
ENDEF 1974-75; PNSN 1989; PNDS 1996 e 2006; POF 2008-2009; VIGITEL 2006 a 2009.
Nutritional status – children under 5 years
Demographic Health Survey (DHS - 1996, 2006)
16
14
13.4
12
10
8
6.8
7.3
7.4
1996
6
2006
4
2.5
2
1.6
0
Déficit
de altura para a
Stunting
idade
Excesso
de peso
overweight
Déficitwasting
de peso para a
idade
Trends of overweight – children and adolescents
(1974 – 2009)
Adolescents
Children de 5 to 9 years
boys
girls
Stunting
boys
girls
Overweight
boys
girls
Obesity
boys
girls
Undernutrition
boys
girls
Overweight
boys
girls
Obesity
Trends of overweight and obesity
among adults (1974 – 2009)
Male
Female
Undernutrition
Male
Female
Overweight
Male
Female
Obesity
Evolução da prevalência de adultos (18 ou mais anos de idade)
com excesso de peso e obesidade, Vigitel 2006 a 2010.
47.2
52.1
38.5
44.3 42.7
48.1
11.4
masculino
feminino
total
14.4
masculino
excesso de peso
2006
11.4
15.5
feminino
11.4
15
total
obesidade
2007
2008
2009
2010
Excesso de peso: aumento populacional médio de 1,08% ao ano
Obesidade: aumento populacional médio de 0,72% ao ano
Prevalence of overweight and obesity – beneficiaries
from “Bolsa Família” Brazilian cash transfer program
45.0
(Brasil - SISVAN, 2010)
27.2
23.5
18.1
16.2
17.3
9.5
8.1
15.7
13.0
9.9
4.0
Meninas
Meninos
girls
boys
Menores
5 anos
Under 5deyears
Meninas
Meninos
girls
boys
anos
5 5– a99years
overweight
Excesso
de peso
Feminino
female
Feminino
female
Adolescentes
Adultos
adolescents
obesity
Obesidade
adults
Brazilian Nutritional Scenario
• Nutritional carency:
• Anemia
• Vitamin A deficiency
• Vitamin B deficiency
• Special feeding necessities
GUIDELINES OF NATIONAL POLICY OF FOOD AND NUTRITION
4. Management of
Food and Nutrition
Actions
5. Social
control and
Participation
7. Research, Innovation
and Knowledge in
foodand nutrition
3. Food and
Nutrition
Surveillance
2. Healthy Diet
Promotion
6. Workforce
Qualification
1.
Organization
of Nutritional
Care
8. Food Control and
Regulation
9. Cooperation and Articulation for Food and Nutrition Security
National Strategies to Promote Breastfeeding
and Healthy Complementary Feeding
+
Between 2008 and 2011, the two strategies
have capacitated over 4,000 tutors and involved
over 30,000 primary health care professionals
in Brazil.
New National Strategy for Breastfeeding and
Healthy Complementary Feeding Promotion
What is intended?
Encourage the nutritional guidance as routine
practice in health services, contemplating the
formation of healthy eating habits from
childhood, with the introduction of
complementary feeding in a timely and
quality, while respecting the cultural identity
and food from various regions of Brazil
Inadequate feeding
practices during the
first years of life:
Overweight and their
comorbidities in
childhood and adulthood
.
Infectious diseases,
respiratory diseases,
dental caries,
malnutrition,
micronutrient
deficiencies.
Formation of unhealthy
eating habits.
Median of exclusive breastfeeding (in days) children under 6 months.
Brazilian cities, 2008
Brasil: 54,11
Belém
Exclusive breastfeeding
Median
1999 – 23,4 days
2008 – 54,1 days
Florianópolis
Campo Grande
Distrito Federal
Macapá
Vitória
Teresina
João Pessoa
Curitiba
Porto Velho
Palmas
Boa Vista
Natal
São Luís
Rio de Janeiro
São Paulo
Belo Horizonte
Porto Alegre
Aracaju
Manaus
Recife
Rio Branco
Goiânia
Salvador
Maceió
Fortaleza
Cuiabá
0
10
20
30
40
50
60
70
80
90
100
School Health Program
Schools: 56,848
Students: 11 946 .778
Primary Health Care Teams: 14,439
How the school could contribute?
Important determinant in the
formation of habits of life,
including food
Health promotor place to
prevent and treatment of
obesity and other related
chronic diseases
School
Should be a protector
and healthy place
Schoolars, teachers,
professionaols, families, health
service and comunity should be
involved in the educative process.
School Health Program
Intersectoral Politcs between Ministries of education and Health
Decreto presidencial Nº. 6.286/2007
Integral attention (prevention, promotion and care) to the heatlh children and
adolescents of brazilian public schools
Actions articulated between school team and health team.
School and Basic Care Units – Family Health program
PRINCIPLES
The program is basead in the garanty of rights, right of life and it´s
grounded in 3 principles:
1) Intersectoral: performed by the challenge of shared management, in which
scientific knowledge, popular and places are taken into consideration,
including the subjects and participation in a dialogic exchange (dialogue), a
meeting that is produced again.
2) Territoriality: respect for local diversity, the local languages​​, local foods, to art
sites, with the inclusion of what is diverse and different and the face of
security vulnerabilities / territories vulnerable
3) Integrality: knowledge gathering guided by policies ensuring the health and
education as a universal right.
Program actions
Component I – Health conditions evaluation Avaliação
condições de saúde
Component II – Actions of prevention and promotion
das
Component III – Permanent education
Component IV – Monitoring and evaluation of health conditions
Component V - Monitoring and evaluation of the program
Annual week of mobilization School Health Program
2012 – prevention of obesity at school context
Target of the week: start the actions that will be developed durind all
the year.
Annual week of mobilization School Health Program
March/2012 – prevention of obesity at school context
Target of the week: start the actions that will be developed during
at the year.
• Cities: 1.938
• schools: 22.096
• Health teams: 10.240
• Schoolars: 9.651.985
MATERIAIS DE DIVULGAÇÃO DA SEMANA DE MOBILIZAÇÃO SAÚDE
NA ESCOLA (ENCARTE PARA REVISTA VOLTADA AOS PROFESSORES)
MATERIAIS DE DIVULGAÇÃO DA SEMANA DE MOBILIZAÇÃO SAÚDE
NA ESCOLA (MATERIAL PARA ORIENTAR NAS ATIVIDADES)
School meal program
• Laws that restricit the participation of
processed food on the school meal program
(30%)
• Increase of fresh food from familiar
agriculture at the school meal program (30%)
• Nutritional parameters from menus
Agreement between Health Ministry
& Private schools federation
Goal:
joining forces to work together and
implement actions aimed at promoting
quality of life and prevention factors and / or
limitations of diseases and health
problems in the school environment
Specific Objectives:
I-planning, implementation and
evaluation strategies with these approaches;
II - plan and implement public campaigns and
information on health and quality of
life aimed at the whole school community;
III - develop, define and implement protocol
for healthy eating for school canteens,
including improving the nutritional quality
of meals and snacks offered;
IV - establish and define strategies for the
recognition of healthy school canteens.
FOOD AND NUTRITION SURVEILLANCE
FOOD AND NUTRITION SURVEILLANCE
Allows the analysis of the population’s food and nutrition
situation since the 1970s
OVERWEIGHT
MALNUTRITION
ENDEF 1974-75; PNSN 1989; PNDS 1996 and 2006; POF 2008-2009; VIGITEL 2006 to 2009.
Monitoring the beneficiaries of the Bolsa
Familia Program
Food and Nutrition Surveillance
in Health services
Commitment of the beneficiary families + Commitment of SUS
Regulation on food advertisement:
Establishing specific regulation to the
advertising of food, especially for children.
• Publication of RDC No. 24/2010 - Provides for the offer, advertising,
publicity, information and other related practices of foods with high
amounts of sugar, saturated and trans fat, sodium, and beverages of low
nutritional value.
• Placement of consumer alerts visible, legible, prominent and
contextualized in printed pieces, television, internet, samples and other
advertising materials:
•“The (name / trademark of food) contains lots of sugar and, if consumed in large quantities, increases the
risk of obesity and tooth decay”.
•“The (name / trademark of food) contains too much saturated fat and, if consumed in large quantities,
increases the risk of diabetes and heart disease”.
•“The (name / trademark of food) and contains a lot of trans fat, if consumed in large quantities, increases
the risk of heart disease”.
•“The (name / trademark of food) contains too much sodium, and if consumed in large quantities,
increases the risk of high blood pressure and heart disease”.
•“The (name / trademark food or set) contains a lot (a) [nutrients that are present in high quantities], and
is consumed (as) in large amounts increase the risk of obesity and heart disease”.
Regulation of advertising of unhealthy
foods
• Suspension of RDC No. 24/2010 by the Federal Court
of Brasilia in favor of theABIA, ANR; ABIR; AFREBRAS; Brazilian
Association of Chocolate, Cocoa, Peanut, Candy
and Derivatives; ABIMA; CNT; Industry Union of
Corn, Soybean and derivatives in the state
of SP; ANIB; ABESI and ABF.
• AGU Agency recommended the suspension for the
same reason
Regulation of advertising of unhealthy
foods
Other movements:
• WHO Regional Consultation on Recommendations for the
marketing of food andnonalcoholic beverages to children
(Brasilia, Jun / 2009)
• Release Front in Defense of Food Regulatory Advertising (New
York, Dec / 2011)
• Launch of publication "Recommendations of the Expert
Consultation of PAHO on the Promotion and Advertising of
Foods and Non-Alcoholic Beverages to Children in the
Americas"