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NUTRITION IN OBESITY AND NCD CONTROL
- THE ROLE OF CIVIL SOCIETY
FITZROY HENRY
CFNI(PAHO/WHO)
HEALTHY CARIBBEAN CONFERENCEBarbados
October, 2008
OUTLINE OF PRESENTATION
• WHAT IS THE NUTRITION GOAL?
• WHAT ARE THE GLOBAL & LOCAL CHALLENGES FOR CIVIL SOCIETY?
• WHAT IS THE STRATEGIC APPROACH?
• SOME KEY ROLES FOR CIVIL SOCIETY TO ADVANCE THIS STRATEGY?
The Prevalence of Obesity (BMI ≥30) Hypertension and
Diabetes in Caribbean Countries
0
5
10
15
20
25
30
35P
erce
nt
%
Belize
Jamaica
Guyana
St Kitts
/Nevis
Trinidad/Tobago
Obesity
Hypertension
Diabetes
Trends in Fat Consumption in the Caribbean1961-2003
0
100
200
300
400
500
600
700
800
1961-63 1971-73 1981-83 1991-93 2001-2003
Calo
ries/c
aput
/day
Imported
Local
GOAL
Trends in Sugar Consumption in the Caribbean1961-2003
0
50
100
150
200
250
300
350
400
450
500
1961-63 1971-73 1981-83 1991-93 2001-2003
Calo
ries/c
aput
/day
Local Imported GOAL
Trends in Fruit and Vegetable Consumption in the Caribbean1961-2003
0
50
100
150
200
250
300
350
400
1961-63 1971-73 1981-83 1991-93 2001-2003
calor
ies/ca
put/d
ay
Local Imported Goal
Energy (Caloric) Availability in the Caribbean 1961-2003
1500
1700
1900
2100
2300
2500
2700
2900
19961-63 1971-73 1981-83 1991-93 2001-2003
Calo
ries/c
aput
/day Average Energy supply
RDA
Average caloric availability is increasing globally
2,000
2,200
2,400
2,600
2,800
3,000
3,200
3,400
1965 1975 1985 1998 2015 2030year
per
capi
ta e
nerg
y su
pply
Africa South ofSahara
South Asia
Latin America& Caribbean
Near East and NAfrica
East Asia
World
Source: FAOSTATSource: FAOSTAT
Can Civil Society impact Global Forces, National Policies & Individual Choice?
•Fats
•Sugars
•Fruits and Vegetables
Where can Civil Society best Influence Nutrition
MACRO LEVEL (National/International)
WTO, EPA, CET Agreements- Alters Food availability,Type & Prices. Etc
MESO LEVEL (Public & Private sectors)
Aggressive Food MarketingQuality Standards, LabelingDietary Guidelinesetc.
MINI LEVEL(Community/Household)
Food Access: More food at lower cost Media influence etc.
MICRO LEVEL(Individual)
No. & Type of dietPassive over-consumptionetc.
Can Civil Society Influence the Major Factors Affecting Food Choices in the
Caribbean?
1. TASTE
2. COST
3. CONVENIENCE
4. NUTRITION/HEALTH VALUE
5. TRADITION / CULTURE
CAN CIVIL SOCIETY ACTION IMPACT ON KEY DRIVERS OF
OBESITY/NCDs?…..• Our domestic agriculture policy lacks
adequate incentives for the production of fruits and vegetables
• Our local and cable networks heavily advertise fast foods, especially on children’s programs
• Many schools canteens and vendors promote high energy dense foods with little nutrient value
• Our food imports encourage the consumption of high energy dense foods, even trans fats
4.6
11.1
22.2
3.35
12.5
28.5
3.4
11.514.5
45.4
8.7
17.8 18.9
39
15
0
10
20
30
40
50
China India Malaysia Thailand
Gra
ms
per
capi
ta p
er d
ay 1965 1975
1985 1995
Increased Vegetable Oil Consumption is key component of
nutrition transition in Asia
Source: Food Balance data, FAO
0
5
10
15
20
25
30
Grams/person/
day
Trends in Vegetable Oil and Animal Fat Consumption in the Caribbean
Vegetable Oil
Animal Fat
100
80
60
40
20
0
-20
-40
1%E 2%E 3%E 4%E 5%E
Trans
Sat
Mono
Poly
% C
han
ge in
CH
D
Dietary Intake (% Change in Energy)
Among 80,082 women followed for 14 years (939 cases). Multivariate-adjusted for other risk factors and dietary habits. Hu et al. NEJM 1997
0.6
0.8
1
1.2
1.4
Q1 Q2 Q3 Q4 Q5
Saturated Fat
Mono
Poly
Trans
Multivariate RR’s of type 2 diabetes according to quintiles of Multivariate RR’s of type 2 diabetes according to quintiles of specific types of dietary fat (mutually adjusted)specific types of dietary fat (mutually adjusted)
(Salmeron et al, 1999)
Quintiles of Fat Intake
Mu
ltiv
aria
te R
R
25.004
ON DIET & NCDs- 3 Critical Questions
• CAN SPECIFIC NUTRIENTS (e.g. SUGAR, FAT, SALT)BE TARGETED SUCCESSFULLY?
• CAN THIS APPROACH MAKE A SIGNIFICANT DIFFERENCE?
• WHAT ARE THE SUCCESS FACTORS?
Changes in dietary consumption in Norway Changes in dietary consumption in Norway (1970 – 1993)(1970 – 1993)
(Norwegian Nutrition Council, 1995)(Norwegian Nutrition Council, 1995)1970 1993
Energy (kcal) 2860 2980
Fat (g) 128 112
Fat (%) 40 34
Carbohydrate (g) 352 392
Carbohydrate (%) 49 53
Of which sugars (%) 16 17
Total TFA content in the soybean oil, Costa Rica 1995-2004
0
5
10
15
20
25
1995-96 2000-01 2002 2003 2004
To
tal
TF
A i
n s
oyb
ean
oil
(%
)
(Baylin A, et al. .JFCA.2006)
Adipose tissue TFA among soybean oil consumers
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Before 2000 2000 2001 2002 2003
Ad
ipo
se ti
ssu
e (
g/1
00g
)
Total trans-fatty acid among soybean oil users, Total trans-fatty acid among non-soybean oil users,
P-test for trend p<0.001
(Colón-Ramos U, et al. J Nut, 2006)
Other Intervention studies(some of the nearly 50-100 projects in
the literature) Stanford Three-Community study (USA) Stanford Five-City project (USA) Minnesota Heart Health Program (USA) German Cardiovascular Prevention study Kilkenny Health Project (Ireland)
Mirame project in Chile Tianjin Project in China Mauritius –WHO Inter-Health (1987-
1992)
Experience from FinlandExperience from Finland(North Karelia Project 1972 -(North Karelia Project 1972 -
1992)1992)Important aspects of the
successful public policy:
Inter-sectoral collaboration Presence of a responsible agency –
national focal point Nutrition education programmes Support for voluntary organisations Food labelling and food pricing policies Research and demonstration International collaboration
PUBLICFOOD
ACTION POINTS TO COMBAT OBESITY
NATIONALMULTI-SECTOR
COMMUNITY/CIVIL SOCIETY
FOOD POLICY
AGRICULTURE/IMPORTED FOOD
HEALTH POLICY
EDUCATIONPOLICY
LABOUR/TRANSPORT
POLICY
FOOD INTAKE:NUTRIENT DENSITY ENERGY EXPENDITURE
LEISUREACTIVITY
FACILITIES
WORKSITEEXERCISE
SCHOOLEXERCISE
WORKSITEFOOD
SCHOOLFOOD
OBESITY
CIVIL SOCIETY INSTITUTIONS CAN MAKE A BIG DIFFERENCE viz….
SUSTAIN MEDIA CAMPAIGNS
USE TALK SHOWS ETC. TO INFORM PUBLIC
ON DANGERS OF SAT FATS, TRANS FAT,
EXCESS SUGAR, SALT, ETC.
PROTEST UNACCEPTABLE
NUTRITION POLICIES/PRACTICES
BYPUBLIC SECTOR
ORPRIVATE SECTOR
FORCE LEGISLATIVE CHANGES
REQUIRE CAL & FAT INFO ON MARKETED FOODS
- LABELING STANDARDS- USE DIETARY GUIDELINES
DEMAND HEALTHY MEALS
THROUGH PTAs, CORPORATE BOARDS,
AND COMMUNITY COMMITTEES- PUSH FOR HEALTHY DIETS
IN SCHOOL/WORKSITE CANTEENS & VENDORS
ADVOCATE FOR FISCAL CHANGE
DISINCENTIVES FOR OBESOGENIC FOODS
SUBSIDIES FOR LOCALNUTRITIOUS FOODS
INCENTIVES FOR DIET/WEIGHT MANAGEMENT PROGRAMS
OPPORTUNITIES FOR CIVIL SOCIETY ACTION IN NUTRITION TO COMBAT
OBESITY/NCDs
PROMOTE HEALTHYFOODS IN COMMUNITY
USE FAITH-BASED, OTHER NGOsTO DEMONSTRATE PREPARATION, USE
AND VALUE OF HEALTHY FOODS
MULTI-SECTOR FOOD & NUTRITION APPROACH MULTI-SECTOR FOOD & NUTRITION APPROACH
Memberstates
Memberstates
Civil SocietyCivil
SocietyPrivate sectorPrivate sector
FAOPAHOCARDI
IICA
FAOPAHOCARDI
IICAPh
ase
II FULLY IMPLEMENT FOOD & NUTRITION ACTIONS FULLY IMPLEMENT FOOD & NUTRITION ACTIONS
NATIONAL PLANSNATIONAL PLANS
CCHCCHCARICOMCARICOMCFNICFNIP
has
e II
I
HOG SUMMIT ON OBESITY & NCDsSEPTEMBER 2007
HOG SUMMIT ON OBESITY & NCDsSEPTEMBER 2007
Ph
ase
I