Laura I. González-Zapata

Mapping public policy options responding to obesity: the case of Spain

This study assesses the opinions of the main Spanish stakeholders from food and physical exercise policy networks on public policy options for responding to obesity. We followed the multi‐criteria mapping methodology in the framework of the European project ‘Policy options in responding to obesity’ (PorGrow), through a structured interview to 21 stakeholders. A four‐step approach was taken: options, criteria, scoring and weighting, obtaining in this way a measure of the performance of each option which integrates qualitative and quantitative information. In an overall analysis, the more popular policy options where those grouped as educational initiatives: include food and health in the school curriculum, improve health education to the general public, improve the training of health professionals in obesity care and prevention, incentives to caterers to provide healthier menus and improve community sports facilities. Fiscal measures as subsidies and taxes had the lowest support. The criteria assessed as priorities were grouped as efficacy and societal benefits. Obesity in Spain can be approached through public policies, although the process will not be easy or immediate. The feasibility of changes requires concerned public policymakers developing long‐term actions taking into account the map of prioritized options by the stakeholders.

Advertising of ultra-processed foods and beverages: children as a vulnerable population

La rapida transicion nutricional en America Latina tiene como resultado el aumento pronunciado de sobrepeso y obesidad en los ninos. Evidencia reciente muestra que la publicidad de comidas y bebidas ejerce gran influencia en las preferencias alimenticias de los ninos. Esta poblacion se torna centro de atencion para la industria de alimentos ultra procesados y bebidas, productos comercializados agresivamente. En los paises de America Latina, solo existen reglamentos ineficientes para la publicidad de bebidas y alimentos ultra procesados, y el discurso de auto regulacion prevalece sobre los reglamentos legales. Este comentario explora el importante papel de la publicidad en el desarrollo de patrones de dietas no saludables y en la obesidad de ninos en America Latina, asi como la necesidad de accion gubernamental y participacion social en la resolucion de este problema de salud publica.A rapida transicao nutricional na America Latina tem como resultado o aumento pronunciado de sobrepeso e obesidade nas criancas. Evidencia recente mostra que a publicidade de comidas e bebidas tem grande influencia nas preferencias alimentares das criancas. Essa populacao torna-se alvo da industria de alimentos ultraprocessados e bebidas, produtos comercializados agressivamente. Nos paises da America Latina, so existem regulamentos ineficientes para a publicidade de bebidas e alimentos ultraprocessados, e o discurso de auto-regulacao prevalece sobre os regulamentos legais. Este comentario explora o papel importante da publicidade no desenvolvimento de padroes de dietas nao saudaveis e na obesidade das criancas na America Latina, bem como a necessidade de acao governamental e participacao social na resolucao desse problema de saude publica.The rapid nutrition transition occurring in Latin America has resulted in a sharp increase of childhood overweight and obesity. Recent evidence has shown that food and beverage advertising has a great influence on childrens eating behavior. This population has become a key target market for the ultra-processed foods and beverages industry, which is marketing products in an aggressive way. Evidence shows that Latin American countries have poor regulation of ultra-processed foods and beverages advertising, where the discourse of self-regulation still prevails over statutory regulations. The following commentary explores how advertising might play an important role in developing unhealthy dietary patterns and obesity in Latin American children, as well as the urgent need for government action and the involvement of civil society to tackle this public health issue.

Relación en España de la duración de la gestación y del peso al nacer con la nacionalidad de la madre durante el período 2001-2005

Relation-ship in Spain of the Length of the Gestation and the Birth Weight with Mother’s Nationality during the Period 2001-2005

The potential role of taxes and subsidies on food in the prevention of obesity in Europe

Background Obesity implies costs not only for the individual but also for society. The authors explore the opinions of stakeholders on the potential of taxes or subsidies, as measures for tackling obesity in Europe. Methods Structured interviews were conducted using Multicriteria Mapping, a computer-based, decision-support tool, with 189 interviewees drawn from 21 different stakeholder categories across nine members of the EU interviews, to appraise 20 predefined policy options aimed at reducing obesity, including ‘taxing obesity-promoting foods’ and ‘subsidising healthy foods.’ A four-step approach involved selecting options, defining criteria, scoring options quantitatively and weighting criteria to provide overall rankings of options. Interviews were recorded and transcribed to yield qualitative data. Results Compared with other policy options appraised, taxation and subsidies were not favourably received, mainly because they were considered difficult to implement. Overall, trade unions rated both options more favourably than all other stakeholder groups. As anticipated, both options received their lowest scores from representatives of the farming, food processing and advertising industries. Nutritional/obesity advisory experts and public sector caterers gave the most positive ratings to subsidies overall. Along with public health professionals, large commercial retailers were most in favour of taxation. Conclusions Taxation and subsidies were poorly appraised compared with other policy measures, with stakeholders expressing reservations mainly focussed on the practicalities and cost of introducing such measures. Although applying taxes/subsidies could be useful to combat obesity, the study suggests that most stakeholders still need to be convinced of their viability and acceptability when compared with other measures.

Policy options for obesity in Europe: a comparison of public health specialists with other stakeholders

OBJECTIVE To explore policy options that public health specialists (PHS) consider appropriate for combating obesity in Europe, and compare their preferences with those of other stakeholders (non-PHS). DESIGN Structured interviews using multicriteria mapping, a computer-based, decision-support tool. SETTING Nine European countries. SUBJECTS A total of 189 stakeholders. Twenty-seven interviewees were PHS and non-PHS included food, sports and health sectors. MEASUREMENTS A four-step approach was taken, i.e. selecting options, defining criteria, scoring options quantitatively and weighting the criteria to provide overall rankings of options. Interviews were recorded and transcribed to yield qualitative data. RESULTS The PHS concur with other stakeholders interviewed, as all emphasised the importance of educational initiatives in combating obesity, followed by policies to improve community sports facilities, introduce mandatory food labelling and controlling food and drink advertising. Further analyses revealed several significant differences. The non-PHS from the private sector ranked institutional reforms favourably; the PHS from non-Mediterranean countries supported the option of medicines to prevent obesity; and those PHS from Mediterranean countries endorsed the use of activity monitoring devices such as pedometers. As far as appraisal criteria were concerned, PHS considered efficacy and the economic impact on the public sector to be the most important. CONCLUSION There is clear consensus among PHS and other stakeholders concerning the need for a package of policy options, which suggests that European-wide implementation could be successful. However, it would be advisable to avoid more contentious policy options such as taxation until future changes in public opinion.

Exceso de peso, aspectos económicos, políticos y sociales en el mundo: un análisis ecológico

This study analyzed prevalence rates for excess weight in adults based on body mass index (BMI) and the association with various demographic, socioeconomic, and political variables (democracy index). An ecological design was used, including a total of 105 countries, with BMI data from 2000 to 2006. Other variables were obtained by proximity to the year of nutritional status. The study used the World Health Organization (WHO) classification for BMI. Spearman correlation coefficients and multiple logistic regression models were used. In both genders, overweight and obesity were correlated with calorie availability and the human development index (HDI) and its component variables. As for the variables related to democracy, there was an inverse correlation with weight, stronger in men than women. In conclusion, better living conditions in countries were directly associated with higher rates of excess weight in the population, with different patterns according to gender.

Metabolic syndrome in healthcare personnel of the university of Antioquia-Colombia; LATINMETS study.

INTRODUCTION Hypertension (HTN), atherogenic dyslipidemia, an increased glycemia in a fasting state, and abdominal obesity (AO), constitute a cluster of risk factors for cardiovascular disease named metabolic syndrome (MS). OBJECTIVE To analyze the prevalence and distribution of MS and its components in healthcare personnel from the University of Antioquia. METHODOLOGY Cross-sectional study conducted between 2010 and 2011. The collected data included anthropometrical, biochemical, socio-demographic, and lifestyle variables. The MS was diagnosed using the harmonized IDF/AHA definition. Descriptive and analytical statistical analyses were performed, including χ2 tests, and a = 0.05. RESULTS 285 volunteers (29.1% men) with ages between 20 and 61 years were included. 31.6% of participants were overweight with a Body Mass Index higher than 25 kg/m2 (BMI). AO (29.8%) and HTN (29.8%) were the most frequent components of MS. Global prevalence of MS was 17.5% (95%CI: 13.1; 22). There was a lower presence of MS among women (OR 0.328; 95%CI: 0.175; 0.614; p < 0.05), and a positive gradient with age and income. Likewise, the prevalence of MS was higher among smokers and those who are overweight (p < 0.05). After adjusting for age, MS was associated with sex (OR 0.348; 95%CI: 0.178; 0.680) and being overweight (OR 14.592; 95%CI: 6.343; 33.570). CONCLUSION The most frequently observed components of MS in the studied sample were AO and HTN. BMI, sex, and socio-economic status are important independent risk factors associated with MS.

Incidence of overweight and obesity in a Mediterranean population-based cohort: The Cornellà Health Interview Survey Follow-up Study (CHIS.FU)

OBJECTIVE To study the changes in body mass index (BMI) in a population-based cohort and their relationship with sociodemographic variables in a Mediterranean-country. METHOD A prospective population-based cohort with 8-year follow-up. The data used derive from the Cornellà-Health-Interview Survey Follow-up (CHIS.FU). 1008 people aged > or = 20 years (females=508; males=500) were interviewed in 1994 and in 2002, providing self-reported weight and height data. The BMI was compared using the Wilcoxon test for paired data. Changes in the BMI were calculated and their relationship with sociodemographic-variables and lifestyles using multivariate Breslow-Cox regression. RESULTS 28.1% of participants had changed from normal-BMI in 1994 to overweight in 2002 (women=25.6%; men=31.6%). 16.8% increased from overweight to obesity (women=25.8%; men=11.2%). The cumulative incidence of overweight: women=26.4%; men=34.0%. The cumulative incidence of obesity: women=29.9%; men=13.1%. The cumulative age and sex-adjusted incidence of overweight showed a significant relationship with marital-status (married: RR=2.0; 95% CI: 1.2-3.4, divorced/widowed: RR=4.0; 95% CI: 1.7-9.3) and moderate alcohol-consumption (RR=1.86; 95% CI: 1.1-3.1). We observed a decreased age-adjusted risk in the incidence of obesity for men (RR=0.49; 95% CI: 0.3-0.8). CONCLUSION The observed changes in the increase in the incidence of obesity and overweight indicated a similar evolution in the obesity epidemic regardless of Mediterranean dietary patterns in our population.

Criterios de valoración de políticas públicas para la obesidad en España según sus actores principales

Objetivos: Explorar los argumentos utilizados por los actores clave para valorar las politicas publicas en Espana orientadas a reducir la obesidad en la poblacion. Metodos: Mapeo por multicriterios, en el marco del proyecto europeo Opciones de Politicas para Responder al Desafio de la Obesidad (PorGrow), mediante una entrevista estructurada individual a 21 actores principales, lideres del sector publico y privado en la alimentacion y el ejercicio fisico en Espana. Se integro en el analisis informacion de tipo cuantitativo y cualitativo. Los entrevistados justificaron sus posiciones en pro y en contra de las diferentes iniciativas de politicas, aspectos que se denominaron «criterios», que fueron ponderados segun su importancia relativa y documentados mediante textos y «perlas» del discurso de los entrevistados. Resultados: Se identificaron 93 argumentos para la seleccion de politicas en los 21 entrevistados. Los argumentos mas utilizados y valorados por su importancia fueron: eficacia (n = 18), beneficios sociales (n = 17) y aceptabilidad social (n = 14). Los costes economicos fueron considerados poco relevantes tanto para el sector publico como para los individuos. El impacto economico para el sector comercial no fue incluido por ninguno de los entrevistados. Segun el area de actuacion, los criterios mas relevantes fueron la eficacia y los beneficios sociales, para el sector privado y publico, respectivamente. Conclusiones: Quiza porque Espana se encuentra al comienzo del proceso de desarrollo de politicas de obesidad y aun no hay ni «ganadores» ni «perdedores» entre los afectados, los costes financieros aparecen como una cuestion de bajo perfil para los entrevistados, lo que abre una ventana de oportunidad para ensayar politicas de regulacion.

Development of a Food Frequency Questionnaire for Assessing Dietary Intake in Children and Adolescents in South America: Development of a Food Frequency Questionnaire

This study aimed to describe the development of a food frequency questionnaire (FFQ) to assess dietary intake in South American children and adolescents.