Yves Kameli

Developing national obesity policy in middle-income countries: a case study from North Africa

Background The prevalence of overweight and obesity is a rapidly growing threat to public health in both Morocco and Tunisia, where it is reaching similar proportions to high-income countries. Despite this, a national strategy for obesity does not exist in either country. The aim of this study was to explore the views of key stakeholders towards a range of policies to prevent obesity, and thus guide policy makers in their decision making on a national level. Methods Using Multicriteria Mapping, data were gathered from 82 stakeholders (from 33 categories in Morocco and 36 in Tunisia) who appraised 12 obesity policy options by reference to criteria of their own choosing. Results The feasibility of policies in practical or political terms and their cost were perceived as more important than how effective they would be in reducing obesity. There was most consensus and preference for options targeting individuals through health education, compared with options that aimed at changing the environment, i.e. modifying food supply and demand (providing healthier menus/changing food composition/food sold in schools); controlling information (advertising controls/mandatory labelling) or improving access to physical activity. In Tunisia, there was almost universal consensus that at least some environmental-level options are required, but in Morocco, participants highlighted the need to raise awareness within the population and policy makers that obesity is a public health problem, accompanied by improving literacy before such measures would be accepted. Conclusion Whilst there is broad interest in a range of policy options, those measures targeting behaviour change through education were most valued. The different socioeconomic, political and cultural contexts of countries need to be accounted for when prioritizing obesity policy. Obesity was not recognized as a major public health priority; therefore, convincing policy makers about the need to prioritize action to prevent obesity, particularly in Morocco, will be a crucial first step.

African stakeholders' views of research options to improve nutritional status in sub-Saharan Africa

BACKGROUNDnSetting research priorities for improving nutrition in Africa is currently ad hoc and there is a need to shift the status quo in the light of slow progress in reducing malnutrition. This study explored African stakeholders views on research priorities in the context of environmental and socio-demographic changes that will impact on nutritional status in Africa in the coming years.nnnMETHODSnUsing Multi-Criteria Mapping, quantitative and qualitative data were gathered from 91 stakeholders representing 6 stakeholder groups (health professionals, food Industry, government, civil society, academics and research funders) in Benin, Mozambique, South Africa, Tanzania, Togo and Uganda. Stakeholders appraised six research options (ecological nutrition, nutritional epidemiology, community nutrition interventions, behavioural nutrition, clinical nutrition and molecular nutrition) for how well they could address malnutrition in Africa.nnnRESULTSnImpact (28.3%), research efficacy (23.6%) and social acceptability (22.4%) were the criteria chosen the most to evaluate the performance of research options. Research on the effectiveness of community interventions was seen as a priority by stakeholders because they were perceived as likely to have an impact relatively quickly, were inexpensive and cost-effective, involved communities and provided direct evidence of what works. Behavioural nutrition research was also highly appraised. Many stakeholders, particularly academics and government were optimistic about the value of ecological nutrition research (the impact of environmental change on nutritional status). Research funders did not share this enthusiasm. Molecular nutrition was least preferred, considered expensive, slow to have an impact and requiring infrastructure. South Africa ranked clinical and molecular nutrition the highest of all countries.nnnCONCLUSIONnResearch funders should redirect research funds in Africa towards the priorities identified by giving precedence to develop the evidence for effective community nutrition interventions. Expanding research funding in behavioural and ecological nutrition was also valued and require multi-disciplinary collaborations between nutritionists, social scientists, agricultural and climate change scientists.

The acceptability to stakeholders of mandatory nutritional labelling in France and the UK – findings from the PorGrow project

BACKGROUNDnImplementing a European Union (EU)-wide mandatory nutrition labelling scheme has been advocated as part a multi-pronged strategy to tackle obesity. The type of scheme needs to be acceptable to all key stakeholders. This study explored stakeholders viewpoints of labelling in two contrasting food cultures (France and the UK) to see whether attitudes were influenced by sectoral interests and/or national context.nnnMETHODSnUsing Multi Criteria Mapping, a decision analysis tool that assesses stakeholder viewpoints, quantitative and qualitative data were gathered during tape-recorded interviews. In France and the UK, 21 comparable stakeholders appraised nutritional labelling with criteria of their own choosing (i.e. feasibility, societal benefits, social acceptability, efficacy in addressing obesity, additional health benefits) and three criteria relating to cost (to industry; public sector; individuals). When scoring, interviewees provided both optimistic (best case) and pessimistic (worst case) judgements.nnnRESULTSnOverall, mandatory nutritional labelling was appraised least favourably in France. Labelling performed worse under optimistic (best case) scenarios in France, for five out of eight sets of criteria. French stakeholders viewed labelling as expensive, having fewer benefits to society and as being marginally less effective than UK stakeholders did. However, French interviewees thought implementing labelling was feasible and would provide additional health benefits. British and French stakeholders made similar quantitative judgements on how socially acceptable mandatory labelling would be.nnnCONCLUSIONSnThere is agreement between some stakeholder groups in the two different countries, especially food chain operators. However, cultural differences emerged that could influence the impact of an EU-wide mandatory labelling scheme in both countries.