Rocío Ortiz-Moncada

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.

¿Quiénes y qué pueden hacer en salud pública? Las competencias profesionales como base para la elaboración de programas en el Espacio Europeo de Educación Superior

OBJECTIVE To conform a frame of reference for the organization of the public health teaching in university degrees in Spain, in agreement with the directives of the European Space for Higher Education. METHODS Specific professional competencies in public health have been extracted from the Libros blancos published by the ANECA (National Agency of Quality Evaluation) for the degrees on medicine, pharmacy, nursing, human nutrition and dietetics, optics and optometry, veterinary, social work, occupational relations, teacher training, and environmental sciences. Following the framework proposed by the Working Group on professional competencies in public health in Spain, we have selected those competences that enable future professionals to participate in the development of the public health from their field of activity. We have also identified and correlated the specific competences of each degree with the corresponding activities and functions. RESULTS All the studied degrees have competences in public health functions. The majority has also defined activities in community health analysis, design and implementation of health interventions and programmes, promotion of social participation and citizens control of their own health. CONCLUSIONS There is academic space for the multidisciplinary development of the public health in Spain beyond the health professions. The identification of the specific competencies of each degree related with activities on public health reveal what are the contents to be in included in each syllabus.

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.

Intended or Unintended Doping? A Review of the Presence of Doping Substances in Dietary Supplements Used in Sports

Introduction: The use of dietary supplements is increasing among athletes, year after year. Related to the high rates of use, unintentional doping occurs. Unintentional doping refers to positive anti-doping tests due to the use of any supplement containing unlisted substances banned by anti-doping regulations and organizations, such as the World Anti-Doping Agency (WADA). The objective of this review is to summarize the presence of unlabeled doping substances in dietary supplements that are used in sports. Methodology: A review of substances/metabolites/markers banned by WADA in ergonutritional supplements was completed using PubMed. The inclusion criteria were studies published up until September 2017, which analyzed the content of substances, metabolites and markers banned by WADA. Results: 446 studies were identified, 23 of which fulfilled all the inclusion criteria. In most of the studies, the purpose was to identify doping substances in dietary supplements. Discussion: Substances prohibited by WADA were found in most of the supplements analyzed in this review. Some of them were prohormones and/or stimulants. With rates of contamination between 12 and 58%, non-intentional doping is a point to take into account before establishing a supplementation program. Athletes and coaches must be aware of the problems related to the use of any contaminated supplement and should pay special attention before choosing a supplement, informing themselves fully and confirming the guarantees offered by the supplement.

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.

Análisis de la política de nutrición en Colombia

Objective Assessing the nutritional policy formulated in the 1996-2005 Colombian Food and Nutrition National Plan (FNNP) using key informants (KI), policy-makers and civil servants. Material and Methods A descriptive cross-sectional structured survey of 77 KI: 17 policy-makers and 60 civil-servants from PNAN. Variables studied: determinant food factors, the existence of a nutritional policy, assessing policies involved with food security and organisational variables implicit in the policies. A Position Index (PI) was constructed for quantifying KI assessment (0-0.33 = positive evaluation, 0.34-0.67 = partial/readjusted, 1=0.68-1= negative evaluation). Results 79 % of KI coincided in stating that there was a Nutritional Policy but that it should be readjusted (IP=0.50 policy-makers, IP=0.54 civil servants). KI did not agree about institutional coordination whilst policy-makers said that there was coordination between a reduced group of institutions, including themselves (IP=0.33); civil servants said that there was no coordination between any of the institutions (IP=0.75). They also said that the research strategy had been unsuccessful (IP=0.73). Conclusions Ten years after the Nutritional Policy was introduced into Colombia KI say that it should be readjusted. Strategies such as coordination and research could be optimised so that their objectives can be reached.

What can be done and by who in Public Health?Professional competencies as a base for the design of University degrees curricula in the European Space for Higher Education

OBJECTIVE To conform a frame of reference for the organization of the public health teaching in university degrees in Spain, in agreement with the directives of the European Space for Higher Education. METHODS Specific professional competencies in public health have been extracted from the Libros blancos published by the ANECA (National Agency of Quality Evaluation) for the degrees on medicine, pharmacy, nursing, human nutrition and dietetics, optics and optometry, veterinary, social work, occupational relations, teacher training, and environmental sciences. Following the framework proposed by the Working Group on professional competencies in public health in Spain, we have selected those competences that enable future professionals to participate in the development of the public health from their field of activity. We have also identified and correlated the specific competences of each degree with the corresponding activities and functions. RESULTS All the studied degrees have competences in public health functions. The majority has also defined activities in community health analysis, design and implementation of health interventions and programmes, promotion of social participation and citizens control of their own health. CONCLUSIONS There is academic space for the multidisciplinary development of the public health in Spain beyond the health professions. The identification of the specific competencies of each degree related with activities on public health reveal what are the contents to be in included in each syllabus.

Influence of economic crisis on dietary quality and obesity rates

Abstract The objective was to investigate how socio-economic changes have modified body mass index values and dietary patterns in the Spanish population. A comparative cross-sectional analysis of the last two iterations of the Spanish National Health Survey (SNSH) was done. The independent variables were sex, age, education level, employment situation, and social class. Outcome variables were: poor diet quality and obesity. Economic crisis increases the probability to become obese and to have a poor diet and employment situation is the variable that showed the greatest differences between years. While in 2006 to be unemployed did not represent a risk to have a poor diet [odds ratio (OR): 0.74; p<.005], in 2012 it did (OR: 1.27; p<.005). Economic changes can modify diet quality and nutritional status, increasing the risk to have a poor diet or to be obese.