1
|
Kunihiro S, da Silva Vernasque JR, da Silva C, dos Santos MF, Cremasco CP, Gabriel Filho LRA. Intersectoral Actions for the Promotion and Prevention of Obesity, Diabetes and Hypertension in Brazilian Cities: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13059. [PMID: 36293640 PMCID: PMC9602621 DOI: 10.3390/ijerph192013059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
This study showed the effectiveness of biomedical interventions in obesity, diabetes and hypertension (NCDs), but innovative and intersectoral elements in the fight against obesity, type 2 diabetes and hypertension were rare. BACKGROUND Is it possible to find effective and innovative actions to promote health and prevent NCDs in Brazilian municipalities? Can they be replicated? OBJECTIVE Our objectives were to identify innovative and effective intersectoral actions for promoting and preventing NCDs in Brazilian municipalities. METHODS This is a systematic review in an exploratory theoretical essay with a qualitative and quantitative approach. It is descriptive and analytical in terms of reporting findings and results. Inclusion and exclusion criteria favored health promotion work. Bias risk assessments was performed using the Cochrane GRADE and bias risk, with meta-analyses using RevMan and Iramuteq. RESULTS Meta-analysis of biometric markers resulted in -4.46 [95% IC; -5.42, -3.49], p = 0.00001, indicating a reduction in NCD risk rates. The textual meta-analysis revealed P(r) ≈ 83% (Reinert), meaning low connectivity between the 'halos'. CONCLUSIONS There is evidence of the effectiveness in interventions, but innovative and intersectoral elements to combat and prevent NCDs were barely seen. While evidence of intervention effectiveness was observed, innovative and intersectoral elements to combat and prevent NCDs were barely noticed.
Collapse
Affiliation(s)
- Stephen Kunihiro
- School of Sciences and Engineering, São Paulo State University (UNESP), Tupã 17602-673, Brazil
| | - Juliana Ribeiro da Silva Vernasque
- Faculty of Medical and Biological Sciences, São Paulo State University (Unesp), Botucatu 18618-687, Brazil
- Marília Medical School, FAMEMA, Marília 17519-030, Brazil
| | - Celso da Silva
- School of Sciences and Engineering, São Paulo State University (UNESP), Tupã 17602-673, Brazil
- Maurício de Nassau College—Dean’s Office, Maurício de Nassau University Center (UNINASSAU), Recife 52011-220, Brazil
- The Regional Council of Administration—CRA/SP, São Paulo 01427-001, Brazil
| | | | - Camila Pires Cremasco
- School of Sciences and Engineering, São Paulo State University (UNESP), Tupã 17602-673, Brazil
| | | |
Collapse
|
2
|
Moriguchi Watanabe L, Bernardes Pereira Delfino H, Augusta de Souza Pinhel M, Noronha NY, Maria Diani L, Cintra do Prado Assumpção L, Ferreira Nicoletti C, Barbosa Nonino C. Food and Nutrition Public Policies in Brazil: From Malnutrition to Obesity. Nutrients 2022; 14:nu14122472. [PMID: 35745202 PMCID: PMC9227558 DOI: 10.3390/nu14122472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
“Nutrition transition” describes the shifts in dietary consumption and energy expenditure influenced by economic, demographic, and epidemiological changes at a population level. This phenomenon has been associated with rising obesity rates worldwide, especially in developed countries. In Brazil, the historical analysis of temporal trends between malnutrition and obesity characterized the nutrition transition in the country and interweaved it with the formulation and implementation of public food and nutrition policies. Such analysis is crucial for understanding certain principles in each context. Thus, this review contextualized the consolidation of obesity as a critical health and public policy issue in Brazil. Our review suggested that the country may still be at the initial stage of care for obesity, and more efforts are needed to contain the advance of the disease in Brazil.
Collapse
Affiliation(s)
- Ligia Moriguchi Watanabe
- Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (L.C.d.P.A.); (C.B.N.)
- Correspondence:
| | - Heitor Bernardes Pereira Delfino
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (H.B.P.D.); (M.A.d.S.P.); (N.Y.N.); (L.M.D.)
| | - Marcela Augusta de Souza Pinhel
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (H.B.P.D.); (M.A.d.S.P.); (N.Y.N.); (L.M.D.)
- Department of Molecular Biology, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto 15090-000, Brazil
| | - Natália Yumi Noronha
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (H.B.P.D.); (M.A.d.S.P.); (N.Y.N.); (L.M.D.)
| | - Luisa Maria Diani
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (H.B.P.D.); (M.A.d.S.P.); (N.Y.N.); (L.M.D.)
| | - Lucca Cintra do Prado Assumpção
- Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (L.C.d.P.A.); (C.B.N.)
| | - Carolina Ferreira Nicoletti
- Applied Physiology & Nutrition Research Group, Rheumatology Division, Medical School FMUSP, University of Sao Paulo, Sao Paulo 01246-903, Brazil;
| | - Carla Barbosa Nonino
- Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (L.C.d.P.A.); (C.B.N.)
| |
Collapse
|
3
|
Vecchi M, Elf P, Ueno A, Dilmperi A, Dennis C, Devereux L. Shall We Dance? Recreational Dance, Well-Being and Productivity
Performance During COVID-19: A Three-Country Study. JOURNAL OF INTERNATIONAL MARKETING 2022; 30:56-72. [PMCID: PMC9133908 DOI: 10.1177/1069031x221079609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Mental health issues are increasingly prevalent worldwide, emphasizing the need
to research antecedents and consequences of well-being. Prior research shows
that within organizations, higher levels of subjective well-being (SWB) promote
productivity performance. Building on this research, the authors hypothesize
that recreational dance positively influences productivity through higher SWB.
Survey data from Brazil, Italy, and the United Kingdom reveal that recreational
dancers are more productive than nondancers due to their higher intrinsic
motivation and SWB. Dancing has an additional direct effect on productivity,
beyond the mediating role of SWB. The results indicate well-being and
productivity improvements in all three countries, although they show a
moderating effect such that the relationship between recreational dance and SWB
is stronger when social norms are perceived to be looser. This study indicates
potentially far-reaching benefits that could be achieved by including
recreational dance in corporate well-being programs. International dance
organizations could market dance classes as a pathway to increase productivity
at work and explore synergies with public health marketing to promote the
benefits of recreational dance in joint international campaigns.
Collapse
Affiliation(s)
| | | | | | | | - Charles Dennis
- Michela Vecchi is Associate Professor of
Economics, Research Leader, Middlesex University Business School, London, UK
(). Patrick Elf is Research Fellow
Social and Sustainable Business, Middlesex University Business School, London,
UK (). Akiko Ueno is Senior Lecturer in
Marketing, Middlesex University Business School, London, UK (
). Athina Dilmperi is Senior Lecturer in
Marketing, Middlesex University Business School, London, UK (
). Charles Dennis is Professor of
Consumer Behaviour, Middlesex University Business School, London, UK (
). Luke Devereux is Lecturer in Marketing,
Middlesex University Business School, London, UK (
)
| | | |
Collapse
|
4
|
Ferrari G, Giannichi B, Resende B, Paiva L, Rocha R, Falbel F, Rache B, Adami F, Rezende L. The economic burden of overweight and obesity in Brazil: perspectives for the Brazilian Unified Health System. Public Health 2022; 207:82-87. [DOI: 10.1016/j.puhe.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/06/2023]
|
5
|
Gupta P, Sachdev HS. The Escalating Health Threats from Ultra-processed and High Fat, Salt, and Sugar Foods: Urgent Need for Tailoring Policy. Indian Pediatr 2022. [PMID: 35315348 PMCID: PMC8964373 DOI: 10.1007/s13312-022-2463-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
With its colonial past, and a glaring problem of poverty and hunger, India oft fails to acknowledge a new, rapidly growing problem of overnutrition. With the economic boost and entry of various foreign players from the food industry, Indian citizens have been increasingly exposed to ultra-processed, high in sugar, salt and fat foods (HFSS foods). The last decade or so has seen an exponential rise in the consumption of such foods, leading to increasing prevalence of overweight- and obesity-related illnesses like diabetes, hypertension, etc. In this scenario, examining the efficacy of policy-related measures in reducing consumption of these harmful foods and preventing the associated health issues is paramount. Across the globe, several countries have explored options from taxation on HFSS foods to restricting marketing to children, as well as different practices for front of the pack labeling. In the context of India and its increasing burden of preventable, diet-related illnesses, the urgent need of instituting these preventive policies at national scale cannot be neglected.
Collapse
|
6
|
Chung A, Zorbas C, Riesenberg D, Sartori A, Kennington K, Ananthapavan J, Backholer K. Policies to restrict unhealthy food and beverage advertising in outdoor spaces and on publicly owned assets: A scoping review of the literature. Obes Rev 2022; 23:e13386. [PMID: 34783421 DOI: 10.1111/obr.13386] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 01/25/2023]
Abstract
Unhealthy food marketing influences attitudes, preferences, and consumption of unhealthy foods, leading to excess weight gain. Outdoor advertising is highly visible (often displayed on publicly owned assets), but the evidence supporting regulation is unclear. This systematic scoping review of academic and grey literature aimed to (1) describe potential health and economic impacts of implementing government-led policies that restrict unhealthy food advertising in outdoor spaces or on public assets (including studies examining prevalence of advertising, associations with health outcomes and interventional studies); (2) identify and describe existing policies; and (3) identify factors perceived to have influenced policy implementation. Thirty-six academic studies were eligible for inclusion. Most reported on prevalence of unhealthy food advertising, demonstrating high prevalence around schools and in areas of lower socioeconomic position. None examined health and economic impacts of implemented policies. Four jurisdictions were identified with existing regulations; five had broader marketing or consumer protection policies that captured outdoor food marketing. Facilitators of policy implementation included collaboration, effective partnerships, and strong political leadership. Barriers included lobbying by food, media, and advertising industries. Implementation of food marketing policies in outdoor spaces and on public assets is feasible and warranted. Strong coalitions and leadership will be important to drive the policy agenda forward.
Collapse
Affiliation(s)
- Alexandra Chung
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina Zorbas
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Devorah Riesenberg
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | | | | | - Jaithri Ananthapavan
- Global Obesity Centre, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| |
Collapse
|
7
|
Gómez EJ. The politics of ultra-processed foods and beverages regulatory policy in upper-middle-income countries: Industry and civil society in Mexico and Brazil. Glob Public Health 2021; 17:1883-1901. [PMID: 34555297 DOI: 10.1080/17441692.2021.1980600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACTAddressing the politics of corporate political activity and policy interference in response to non-communicable diseases (NCDs) is a new area of scholarly research. The objective of this article is to explain how, in Mexico and Brazil, the ultra-processed foods and beverages industry succeeded in creating the political and social conditions conducive for their on-going regulatory policy influence and manipulation of scientific research. In addition to establishing partnerships within and outside of government, industry representatives have succeeded in hampering civic opposition by establishing allies within academia and society. Ministries of Health have simultaneously neglected to work closely with civil society, while legislative representatives have continued to benefit from industry campaign contributions. Findings from this article suggest that ultra-processed foods and beverages industries wield on-going regulatory policy influence in Mexico and Brazil, and that government is still not fully committed to working with civil society on these issues.
Collapse
|
8
|
Fisher L, Dahal M, Hawkes S, Puri M, Buse K. Barriers and opportunities to restricting marketing of unhealthy foods and beverages to children in Nepal: a policy analysis. BMC Public Health 2021; 21:1351. [PMID: 34238256 PMCID: PMC8268610 DOI: 10.1186/s12889-021-11257-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt ("unhealthy foods") to children is contributing to increasing child obesity. However, many countries have not implemented WHO recommendations to restrict marketing of unhealthy foods to children. We sought to understand the absence of marketing restrictions and identify potential strategic actions to develop and implement such restrictions in Nepal. METHODS Eighteen semi-structured interviews were conducted. Thematic analysis was based on Baker et al.'s 18 factor-framework for understanding what drives political commitment to nutrition, organised by five categories: Actors; Institutions; Political and societal contexts; Knowledge, evidence and framing; Capacities and resources. RESULTS All factors in Baker et al.'s framework were reported to be acting largely as barriers to Nepal developing and implementing marketing restrictions. Six factors were identified by the highest number of respondents: the threat of private sector interference in policy-making; lack of international actor support; absence of well-designed and enacted policies and legislation; lack of political commitment to regulate; insufficient mobilisation of existing evidence to spur action and lack of national evidence to guide regulatory design; and weak implementation capacity. Opportunities for progress were identified as Nepal's ability to combat private sector interference - as previously demonstrated in tobacco control. CONCLUSIONS This is the first study conducted in Nepal examining the lack of restrictions on marketing unhealthy foods to children. Our findings reflect the manifestation of power in the policy process. The absence of civil society and a multi-stakeholder coalition demanding change on marketing of unhealthy food to children, the threat of private sector interference in introducing marketing restrictions, the promotion of norms and narratives around modernity, consumption and the primary role of the individual in regulating diet - all have helped create a policy vacuum on marketing restrictions. We propose that stakeholders focus on five strategic actions, including: developing a multi-stakeholder coalition to put and keep marketing restrictions on the health agenda; framing the need for marketing restrictions as critical to protect child rights and government regulation as the solution; and increasing support, particularly through developing more robust global policy guidance.
Collapse
Affiliation(s)
- Laura Fisher
- Indo-Pacific Centre for Health Security, Canberra, Australia
| | - Minakshi Dahal
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Sarah Hawkes
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, England.
| | - Mahesh Puri
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Kent Buse
- Global Healthier Societies Program, The George Institute, Newtown, Australia
| |
Collapse
|
9
|
Rosa MLG, Mesquita CT, Albuquerque LZD, Silva WDDS, Alves VDPV, Jordan RFR, Matos RCD, Silva ALGDFE, Souza Filho EMD. Recent Trends in Cardiovascular Mortality in Rio de Janeiro State Health Regions and Capital. Arq Bras Cardiol 2021; 116:763-771. [PMID: 33886725 PMCID: PMC8121409 DOI: 10.36660/abc.20190742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/16/2020] [Indexed: 12/20/2022] Open
Abstract
Fundamento: A mortalidade por doenças cardiovasculares (DCV) vem mostrando tendência à estabilização em alguns países, incluindo o Brasil e o estado do Rio de Janeiro, após décadas de queda. Não encontramos análises detalhadas dessa tendência para o estado do Rio de Janeiro. Objetivo: Analisar as tendências da mortalidade prematura e tardia por doenças do aparelho circulatório (DAC), doença isquêmica do coração (DIC) e doença cerebrovascular (DCBV) por sexo nas regiões de saúde do estado do Rio de Janeiro e capital (1996-2016). Métodos: Dados de óbitos e população foram obtidos no DATASUS/MS. Taxas foram compensadas por códigos mal definidos, corrigidos pelos códigos cardiovasculares mal definidos e ajustadas por sexo e idade pelo método direto. O Joinpoint Trend Analysis Software foi empregado para calcular a variação percentual anual (APC) e variação percentual anual média (AAPC). Foram consideradas para o estudo APC e AAPC significativamente diferentes de zero, calculadas por um teste de student com significância de 5%. Resultados: A mortalidade por DIC estabilizou ou até aumentou em pelo menos 50% das localidades analisadas (EAPC ≥0). Nas regiões Norte e Noroeste, nenhuma mudança foi observada. Para DCBV, apenas uma região apresentou estabilidade na mortalidade (EAPC próximo a 0). Para as outras regiões, a taxa continuou a diminuir (APC <0) até 2016. Conclusão: Esses resultados observados no Rio de Janeiro devem se repetir em várias regiões brasileiras e apontam para a necessidade de uma resposta na abordagem dos comportamentos no estilo de vida. Os médicos da atenção primária devem estar familiarizados com a tendência desfavorável da doença isquêmica do coração entre os adultos mais jovens e rastrear ativamente os fatores de risco para DCV, com atenção especial às mulheres.
Collapse
Affiliation(s)
- Maria Luiza Garcia Rosa
- Universidade Federal Fluminense - Departamento de Epidemiologia e Bioestatística, Niterói, RJ - Brasil
| | - Claudio Tinoco Mesquita
- Universidade Federal Fluminense Faculdade de Medicina - Departamento de Radiologia, Niterói, RJ - Brasil
| | | | | | | | | | - Ricardo Cardoso de Matos
- Universidade Federal Fluminense - Departamento de Epidemiologia e Bioestatística, Niterói, RJ - Brasil
| | | | - Erito Marques de Souza Filho
- Universidade Federal Fluminense - Departamento de Medicina Clínica, Niterói, RJ - Brasil.,Universidade Federal Rural do Rio de Janeiro - Departamento de Tecnologias e Linguagens, Nova Iguaçu, RJ - Brasil
| |
Collapse
|
10
|
de Oliveira AM, Fonseca FMF, Reis ST, Viana NI, Oliveira EM, Leiria LO, Leite KRM, Nahas WC, Srougi M, Antunes AA. Physical activity effects on bladder dysfunction in an obese and insulin-resistant murine model. Physiol Rep 2021; 9:e14792. [PMID: 33904660 PMCID: PMC8077148 DOI: 10.14814/phy2.14792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To investigate the role of physical activity in functional and molecular bladder alterations in an obese and insulin‐resistant murine model. Methods Wistar rats were randomized into 1. physical activity and standard diet; 2. physical activity and high‐fat diet; 3. no physical activity and standard diet; and 4. no physical activity and high‐fat diet. Groups 1 and 2 were subjected to a 10‐week swimming protocol. Urodynamic study (UDS) was performed, and the expression of genes in the bladder tissue related to the insulin pathway (IRS1/IRS2/PI3K/AKT/eNOS) was assessed using quantitative real‐time polymerase chain reaction. Results Groups 1 and 2 presented lower body weight gains than groups 3 (213.89 ± 13.77 vs 261.63 ± 34.20 grams (g), p = 0.04) and 4 (209.84 ± 27.40 vs 257.57 ± 32.95 g, p = 0.04), respectively. Group 4 had higher insulin level (6.05 ± 1.79 vs 4.14 ± 1.14 ng/ml, p = 0.038) and higher homeostasis model assessment of insulin resistance (HOMA‐IR) index (1.95 ± 0.73 vs 1.09 ± 0.37, p = 0.006) than group 1. On UDS, group 4 had greater number of micturition (13.6 ± 4.21 vs 6.0 ± 1.82, p = 0.04), higher postvoid pressure (8.06 ± 2.24 vs 5.08 ± 1.23, p = 0.04), lower capacity (0.29 ± 0.18 vs 0.91 ± 0.41 ml, p = 0.008), and lower bladder compliance (0.027 ± 0.014 vs 0.091 ± 0.034 ml/mmHg, p = 0.016) versus group 1. High‐fat diet was related to an underexpression throughout insulin signaling pathway, and physical activity was related to an overexpression of the pathway. Conclusions The insulin signaling pathway may be involved in the pathogenesis of bladder dysfunction related to a high‐fat diet. Physical activity may help to prevent bladder disfunction induced by a high‐fat diet through the insulin pathway.
Collapse
Affiliation(s)
- André Matos de Oliveira
- Laboratory of Medical Research - LIM 55, Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Sabrina Thalita Reis
- Laboratory of Medical Research - LIM 55, Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Nayara Izabel Viana
- Laboratory of Medical Research - LIM 55, Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Luiz Osório Leiria
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Katia Ramos Moreira Leite
- Laboratory of Medical Research - LIM 55, Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William Carlos Nahas
- Laboratory of Medical Research - LIM 55, Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miguel Srougi
- Laboratory of Medical Research - LIM 55, Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Alberto Azoubel Antunes
- Laboratory of Medical Research - LIM 55, Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| |
Collapse
|
11
|
Morgan C, de Wildt G, Prado RBR, Thanikachalam N, Virmond M, Riley R. Views and Experiences of Adults who are Overweight and Obese on the Barriers and Facilitators to Weight Loss in Southeast Brazil: A Qualitative Study. Int J Qual Stud Health Well-being 2020; 15:1852705. [PMID: 33250018 PMCID: PMC7717597 DOI: 10.1080/17482631.2020.1852705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Obesity in Brazil is increasing with 54% of the Brazilian population being overweight, of which 20% is obese. Obesity is a risk factor for non-communicable diseases such as cardiovascular disease: the leading cause of mortality in Brazil. This study aims to identify the barriers and facilitators to weight loss as perceived by patients with a view to reducing the burden of obesity-related diseases on patients and healthcare services. Methods: Fifteen qualitative, semi-structured, in-depth interviews were conducted in the preventive medicine department in a private health clinic in Bauru, Southeast Brazil. Inductive thematic analysis was conducted. Results: The barriers and facilitators were classified into three themes: lifestyle, motivation and education. Barriers include cost of a healthy lifestyle, time management, personal safety, mobility, junk food advertising, sustaining weight loss, mental health, lack of support and health education. Facilitators include change in eating habits, sleep quality, cooperative food networks, access to the multidisciplinary team and expert patients as health educators. Conclusion: Expert patients should be utilized as an education method, as they increase motivation, promote the facilitators and provide realistic expectations of the weight loss process. Barriers such as junk food advertising and accessibility to treatment need to be addressed. Abbreviations: BMI: Body Mass Index; NCD: Non-Communicable Disease; SUS: Sistema Único de Saúde; WHO: World Health Organization.
Collapse
Affiliation(s)
- Caroline Morgan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gilles de Wildt
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Nisha Thanikachalam
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marcos Virmond
- Research Institute, Instituto Lauro De Souza Lima, Bauru, Brazil
| | - Ruth Riley
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
12
|
de Azeredo Passos VM, Champs APS, Teixeira R, Lima-Costa MFF, Kirkwood R, Veras R, Nascimento BR, Nogales AM, Schmidt MI, Duncan BB, Cousin E, Naghavi M, Souza FM. The burden of disease among Brazilian older adults and the challenge for health policies: results of the Global Burden of Disease Study 2017. Popul Health Metr 2020; 18:14. [PMID: 32993668 PMCID: PMC7524597 DOI: 10.1186/s12963-020-00206-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brazil is the world's fifth most populous nation, and is currently experimenting a fast demographic aging process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. METHODS The estimates were derived from data obtained through the collaboration between the Brazilian Ministry of Health and the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60+ years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), from 2000 to 2017. RESULTS LE at birth significantly increased from 71.3 years (95% UI to 70.9-71.8) to 75.2 years (95% UI 74.7-75.7). There was a trend of increasing HALE, from 62.2 years (95% UI 59.54-64.5) to 65.5 years (95% UI 62.6-68.0). The proportion of DALYs among older adults increased from 7.3 to 10.3%. Chronic noncommunicable diseases are the leading cause of death among middle aged and older adults, while Alzheimer's disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain, and hearing or vision losses are among the leading causes of disability. CONCLUSIONS The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.
Collapse
Affiliation(s)
- Valéria Maria de Azeredo Passos
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil. .,, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | | | - Renato Teixeira
- Postgraduate Program on Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Renata Kirkwood
- School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renato Veras
- Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce Bartholow Duncan
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ewerton Cousin
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Washington, USA
| | - Fatima Marinho Souza
- Postgraduate Program on Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
13
|
Felisbino-Mendes MS, Cousin E, Malta DC, Machado ÍE, Ribeiro ALP, Duncan BB, Schmidt MI, Silva DAS, Glenn S, Afshin A, Velasquez-Melendez G. The burden of non-communicable diseases attributable to high BMI in Brazil, 1990-2017: findings from the Global Burden of Disease Study. Popul Health Metr 2020; 18:18. [PMID: 32993699 PMCID: PMC7525961 DOI: 10.1186/s12963-020-00219-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The prevalence and burden of disease resulting from obesity have increased worldwide. In Brazil, more than half of the population is now overweight. However, the impact of this growing risk factor on disease burden remains inexact. Using the 2017 Global Burden of Disease (GBD) results, this study sought to estimate mortality and disability-adjusted life years (DALYs) lost to non-communicable diseases caused by high body mass index (BMI) in both sexes and across age categories. This study also aimed to describe the prevalence of overweight and obesity throughout the states of Brazil. METHODS Age-standardized prevalence of overweight and obesity were estimated between 1990 and 2017. A comparative risk assessment was applied to estimate DALYs and deaths for non-communicable diseases and for all causes linked to high BMI. RESULTS The prevalence of overweight and obesity increased during the period of analysis. Overall, age-standardized prevalence of obesity in Brazil was higher in females (29.8%) than in males (24.6%) in 2017; however, since 1990, males have presented greater rise in obesity (244.1%) than females (165.7%). Increases in prevalence burden were greatest in states from the North and Northeast regions of Brazil. Overall, burden due to high BMI also increased from 1990 to 2017. In 2017, high BMI was responsible for 12.3% (8.8-16.1%) of all deaths and 8.4% (6.3-10.7%) of total DALYs lost to non-communicable diseases, up from 7.2% (4.1-10.8%), and 4.6% (2.4-6.0%) in 1990, respectively. Change due to risk exposure is the leading contributor to the growth of BMI burden in Brazil. In 2017, high BMI was responsible for 165,954 deaths and 5,095,125 DALYs. Cardiovascular disease and diabetes have proven to be the most prevalent causes of deaths, along with DALYs caused by high BMI, regardless of sex or state. CONCLUSIONS This study demonstrates increasing age-standardized prevalence of obesity in all Brazilian states. High BMI plays an important role in disease burdens in terms of cardiovascular diseases, diabetes, and all causes of mortality. Assessing levels and trends in exposures to high BMI and the resulting disease burden highlights the current priority for primary prevention and public health action initiatives focused on obesity.
Collapse
Affiliation(s)
- Mariana Santos Felisbino-Mendes
- Nursing School, Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Postgraduate Program in Nursing, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ewerton Cousin
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Deborah Carvalho Malta
- Nursing School, Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Postgraduate Program in Nursing, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ísis Eloah Machado
- Postgraduate Program in Nursing, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- School of Medicine, Department of Family Medicine, Mental and Public Health, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Antonio Luiz Pinho Ribeiro
- School of Medicine, Department of Internal Medicine and Hospital das Clínicas, Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruce Bartholow Duncan
- Postgraduate Program in Nursing, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Inês Schmidt
- Postgraduate Program in Nursing, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Scott Glenn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Gustavo Velasquez-Melendez
- Nursing School, Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Postgraduate Program in Nursing, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
14
|
Brandão AL, Reis ECD, Silva CVCD, Seixas CM, Casemiro JP. Estrutura e adequação dos processos de trabalhos no cuidado à obesidade na Atenção Básica brasileira. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este artigo analisa a disponibilidade de estrutura e adequação do processo de trabalho no cuidado à obesidade na Atenção Básica (AB) no Brasil e regiões. Para tanto, realizou-se um estudo descritivo, transversal, de abordagem quantitativa a partir dos dados secundários do componente da avaliação externa disponíveis no PMAQ-AB, ciclo 2. A análise de dados partiu de três dimensões: vigilância alimentar e nutricional; coordenação do cuidado e assistência; e ações de promoção e educação em saúde. Os resultados revelam valores elevados no que se refere à disponibilidade de infraestrutura para cuidado à obesidade, embora nenhuma das variáveis atinja 100%. Quanto à adequação de processos de trabalho no cuidado à obesidade, no entanto, identificaram-se proporções mais reduzidas, indicando um desempenho incipiente nas três dimensões. As análises sugerem que o cuidado à obesidade se beneficiou do provimento de recursos para estruturação de Unidades Básicas de Saúde e que sustentar esse investimento na AB é relevante para a manutenção da estrutura e para a qualificação de processos de trabalho. O desenvolvimento de estudos avaliativos nesta temática pode cumprir papel importante para o planejamento de ações.
Collapse
|
15
|
Khandpur N, de Morais Sato P, Neto JRG, Scagliusi F, Jaime PC. Developing and refining behaviour-change messages based on the Brazilian dietary guidelines: use of a sequential, mixed-methods approach. Nutr J 2020; 19:66. [PMID: 32631339 PMCID: PMC7339497 DOI: 10.1186/s12937-020-00585-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/01/2020] [Indexed: 12/23/2022] Open
Abstract
Background Dietary Guidelines are an important tool for population health promotion efforts. However, current surveillance data suggest that only a small minority of the population meet the 2014 Brazilian Dietary Guidelines (BDG) recommendations. Translating recommendations into practice may not be immediately clear and behavior-change messages guiding the behaviors that need to be changed and identifying substitute practices to meet a specific recommendation, are required. This study details the methods undertaken to develop and refine messages supporting the adoption of healthy dietary choices and behaviors in adults, as outlined in the BDG. Methods A sequential, five-step, mixed-methods approach, determined a priori, was followed for designing and refining messages. These included: (1) content extraction; (2) audience analysis; (3) input from an expert review panel; (4) message development and message refinement; and a (5) test of content validity. Results The content extraction process led to the identification of 63 excerpts from the BDG, organized into themes. The audience analysis highlighted barriers to healthy eating that included lack of time (to eat, to cook), difficulty in accessing healthy food, the convenience and the ubiquitous marketing of ultra-processed foods. Twenty of the 63 DG excerpts reviewed by the expert panel were identified as being a priority for message development and total of 111 messages were developed. Messages were short, structured to be one-sided, conveyed the most important information at the beginning (anticlimactic), used simple language and were explicit in the information they relayed. They were positive and gain-framed and used an empathetic, solution- or substitution-based tone and were presented in the active voice. The messages focused on goals and skill development, behavior regulation, incentivized positive practices as time and/or cost saving. Content validity testing helped further messages and reduced the number of messages from 111 to 40. Conclusions This study provides the blue-print for the phase-wise development of messages that synthesize the key recommendations of the food-based BDG and communicate the adoption of behaviors and goals that are consistent with it’s message. It details methods which could be adapted and replicated for message development in other contexts.
Collapse
Affiliation(s)
- Neha Khandpur
- Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, 01246-904, Brazil. .,Center for Epidemiological Studies in Health and Nutrition (NUPENS), Faculty of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, 01246-904, Brazil. .,Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Priscila de Morais Sato
- Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, 01246-904, Brazil.,Center for Epidemiological Studies in Health and Nutrition (NUPENS), Faculty of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, 01246-904, Brazil
| | - Jose Ribeiro Gouveia Neto
- Center for Epidemiological Studies in Health and Nutrition (NUPENS), Faculty of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, 01246-904, Brazil
| | - Fernanda Scagliusi
- Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, 01246-904, Brazil.,Center for Epidemiological Studies in Health and Nutrition (NUPENS), Faculty of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, 01246-904, Brazil
| | - Patricia Constante Jaime
- Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, 01246-904, Brazil.,Center for Epidemiological Studies in Health and Nutrition (NUPENS), Faculty of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, 01246-904, Brazil
| |
Collapse
|
16
|
Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes. PLoS One 2020; 15:e0229543. [PMID: 32134921 PMCID: PMC7058346 DOI: 10.1371/journal.pone.0229543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/08/2020] [Indexed: 12/12/2022] Open
Abstract
Few reports have described the clinical and prognostic characteristics of endometrial cancer, which is increasing worldwide, in large patient series in Brazil. Our objective was to analyze the clinicopathological characteristics, prognostic factors, and outcomes of patients with endometrial cancer treated and followed at a tertiary Brazilian institution over a 10-year period.This retrospective study included 703 patients diagnosed with endometrial cancer who were treated at a public academic tertiary hospital between 2008 and 2018. The following parameters were analyzed: age at diagnosis, race, body mass index, serum CA125 level before treatment; histological type and grade, and surgical stage. Outcomes were reported relative to histological type, surgical staging, serum CA125, lymph-vascular space involvement (LVSI), and lymph-node metastasis. The median patient age at diagnosis was 63 (range, 27–93) years (6.4% were <50 years). Minimally invasive surgeries were performed in 523 patients (74.4%). Regarding histological grade, 468 patients (66.5%) had low-grade endometrioid histology and 449 patients (63.9%) had stage I tumors. Tumors exceeded 2.0 cm in 601 patients (85.5%). Lymphadenectomy was performed in 551 cases (78.4%). LVSI was present in 208 of the patients’ tumors (29.5%). Ninety-three patients (13.2%) had recurrent tumors and 97 (13.7%) died from their malignant disease. The robust prognostic value of FIGO stage and lymph node status were confirmed. Other important survival predictors were histological grade and LVSI [overall survival: hazard ratio (HR) = 3.75, p < 0.001 and HR = 2.01, p = 0.001; recurrence: HR = 2.49, p = 0.004 and HR = 3.22, p = 0.001, respectively). Disease-free (p = 0.087) and overall survival (p = 0.368) did not differ significantly between patients with stage II and III disease. These results indicate that prognostic role of cervical involvement should be explored further. This study reports the characteristics and outcomes of endometrial cancer in a large population from a single institution, with systematic surgical staging, a predominance of minimally invasive procedures, and well-documented outcomes. Prognostic factors in the present study population were generally similar to those in other countries, though our patients’ tumors were larger than in studies elsewhere due to later diagnosis. Our unexpected finding of similar prognoses of stage II and III patients raises questions about the prognostic value of cervical involvement and possible differences between carcinomas originating in the lower uterine segment versus those originating in the body and fundus. The present findings can be used to guide public policies aimed at improving the diagnosis and treatment of endometrial cancer in Brazil and other similar countries.
Collapse
|
17
|
REIS LCD, JAIME PC. Scale for evaluating food and nutrition education practices in Primary Health Care. REV NUTR 2020. [DOI: 10.1590/1678-9865202033e190231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To develop, validate and analyse intra- and inter-raters’ agreement and reliability of a scale for the evaluation of food and nutrition education practices in primary health care. Methods Three theoretical references were used for the development of items with answers on a 4-point scale (not observed, partially/satisfactorily/fully observed): the Brazilian Dietary Guidelines, the Interprofessional Collaborative Practice and the Family Health Strategy as models for organizing primary health care. The scale was submitted for content and face panel validation and it was further reevaluated online. Thirty specialists used the scale for the rating of 4 videos produced for the study showing food and nutrition education practices in primary health care settings. Intra- and inter-raters agreement and reliability were analyzed by test at one time point and retest 30 days later. Results The scale initially included 72 items but was reduced to 17 items after content and face validation, together with a fill-out manual that was reviewed by experts. In the re-evaluation, all 17 items were maintained, and content adjustments were made in the manual. Thirty raters applied the scale to the videos in the test, and 28 in the retest. All videos obtained combined kappa values of >0.4. In the test-retest, 19 raters showed >80% agreement; in the inter-rater evaluation, 14 raters generated kappa values >0.75. Conclusion The scale underwent content and face validation and showed to be useful to diagnose the absence and the full addressing of the Brazilian Dietary Guidelines content with good intra- and inter-rater agreement and reliability in different settings of Primary Health Care.
Collapse
|
18
|
Identifying Overweight and Obesity in Brazilian Schoolchildren, 2014. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:204-210. [PMID: 28832437 DOI: 10.1097/phh.0000000000000650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT For any intervention in a population, we need to understand population characteristics and needs. The School Health Program (PSE) is a Brazilian national proposal for the improvement of schoolchildren's quality of life by integrating health and education areas to address vulnerabilities that affect the development of students from public schools. OBJECTIVE To describe the prevalence of overweight and obesity in school-aged children and adolescents and to expound methods to evaluate the nutritional status deviation. DESIGN Cross-sectional study. SETTING Schools in Itatiba, Sao Paulo, Brazil, participating in PSE. PARTICIPANTS A total of 6829 schoolchildren aged 6 month to 15 years. MAIN OUTCOME MEASURES Nutritional status and standard percentile curves for body mass index (BMI) for gender. RESULTS In children younger than 5 years, the prevalence of being overweight was 13.9%; for those between 5 years or older and younger than 10 years, it was 33.9%; and for those 10 years or older, it was 34.0%. In males, obesity and severe obesity were more present (10.7% and 3.7%, respectively) than in girls (9.5% and 1.9%, respectively). Regarding location, it was found that the region with the highest income showed a higher prevalence of overweight children. Compared with the World Health Organization reference BMI curves, our reference percentile curve showed a higher standard for the cutoff points between normal range and overweight. CONCLUSION From our results, we found that age and measures of weight and height in schoolchildren could contribute, in a cheap and simple way, to the assessment of nutritional status in a region. This is helpful in providing health monitoring and assisting in making public health decisions, as well as serving in comparison with other scientific studies. Partnership between education and health systems can facilitate and improve the quality of health management among schoolchildren.
Collapse
|
19
|
Abstract
AbstractObjective:To describe malnutrition (undernutrition and excess weight) by income, education and race/ethnicity in the Brazilian population.Design:Cross-sectional study.Setting:Brazil.Participants:Children aged <5 years (n 14 580), adolescents aged 11–19 years (n 31 892) and adults aged 20–49 years (n 84 660).Results:Among children, prevalence of excess weight, wasting and stunting was 16·9, 2·8 and 6·0 %, respectively. Differences related to income, education and race/ethnicity were verified, except for prevalence of wasting by education level. Girls and boys presented 18·4 and 20·5 % of excess weight, 2·8 and 3·7 % of underweight and 5·5 and 7·3 % of stunting, respectively. Prevalence of excess weight was lower among poorer, lower-educated (only for boys) and white adolescents, while stunting was lower among higher-income, higher-educated and white adolescents. Over three-quarters of women and almost half of men presented excess weight. Among adults, 3·9 % of women and 1·7 % of men were underweight, and 5·7 % of women and 0·2 % of men presented short stature. Prevalence of excess weight for women was higher among lower education and black, while for men it was higher among higher income and education and white. Short stature was more prevalent among black and mixed-race, low-educated and low-income women. Underweight prevalence was higher among low-educated, black and mixed-race women.Conclusions:In Brazil, the prevalence of excess weight was at least threefold higher than that of undernutrition for children and adolescents and at least sevenfold higher for adults. Social inequalities were observed in the distribution of malnutrition across the lifespan and by gender.
Collapse
|
20
|
Sampaio C, Magnavita G, Ladeia AM. Effect of Healing Meditation on Weight Loss and Waist Circumference of Overweight and Obese Women: Randomized Blinded Clinical Trial. J Altern Complement Med 2019; 25:930-937. [PMID: 31373827 DOI: 10.1089/acm.2019.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate the effect of healing meditation on weight loss and waist circumference for women undergoing a standard weight loss treatment. Design: We conducted a randomized, parallel-controlled, blinded clinical trial. Randomization was stratified by body mass index category and based on blocks of four. Setting: An outpatient clinic in Brazil. Subjects: Women with overweight and obesity. Intervention: For 8 weeks, in addition to the standard weight loss treatment, the intervention group underwent a healing meditation program, and the control group participated in a two round table just to observe the treatment compliance. Outcome measures: The primary outcome was the percentage of weight loss, blindly assessed regarding the allocation group. Results: Of 121 women interested in participating in the study, 55 were included and randomized, 27 for the intervention group and 28 for the control group. Baseline characteristics were similar between groups. After 8 weeks, the intervention group had the highest relative reduction to initial body weight (-2.9% [interquartile range {IQR} -4.4 to -1.6] vs. -0.7% [IQR -1.1 to -5.0], p < 0.001). Waist circumference outcome was also significantly reduced in the intervention group (5 cm [IQR -6.0 to 4.0] vs. -1 cm [IQR -2.0 to 0.0], p < 0.001). The result of the intervention group was maintained until the 16th week. Between 8th and 16th week, the control group underwent meditation and presented significant weight reduction (-1.95 kg [IQR -3.2 to -1.1], p < 0.001 and -2.3% [IQR -4.1 to -1.3], p < 0.001), showing similar effect to the intervention group (p = 0.428). Conclusion: The addition of healing meditation to the standard weight loss treatment may reduce weight and waist circumference over a short period in overweight or obese women.
Collapse
Affiliation(s)
- Cynthia Sampaio
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Guilherme Magnavita
- Psychiatry Service, University Hospital, Universidade Federal da Bahia, Salvador, Brazil
| | | |
Collapse
|
21
|
Montzel DRVB, Costa BVDL, Silva FM. Weight gain in public hospital workers: a retrospective cohort study. CIENCIA & SAUDE COLETIVA 2019; 24:2453-2460. [PMID: 31340264 DOI: 10.1590/1413-81232018247.17272017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 10/06/2017] [Indexed: 11/22/2022] Open
Abstract
This study assessed changes in the nutrition profile of public hospital workers over a period of three decades and the association between nutritional status and occupational factors. A retrospective cohort study was conducted with staff taken on in 1980, 1990, and 2000 still working in the hospital in 2013. The following data was obtained from staff records: sociodemographic characteristics; and body weight and height, recorded during pre-employment and periodic medical examinations. The latter was used to calculate body mass index (BMI).The final sample consisted of 386 workers (76.4% women and 88.1% white) with a mean age of 29.3 ± 7.3 years. Mean body weight and BMI at admission were highest in the 2000 cohort (W = 66.3 ± 12.5kg; BMI = 21.3 ± 2.5 kg/m2), compared to 1980 (W = 56.7 ± 10.2 kg; BMI = 21.3 ± 2.5 kg/m2)and 1990 (W = 62.2 ± 11.5 kg; BMI = 22.9 ± 3.3 kg/m2) cohorts. Variation in weight and BMI between the pre-employment examination and final periodic examination was highest in the 2000 cohort. When stratified by sex, this difference in variation was observed only in men. No association was found between variation in body weight and BMI and work shift and occupation. The increase in weight and BMI reflects the nutritional transition in Brazil, underscoring the need for nutritional surveillance and the implementation of health education programs directed at staff.
Collapse
Affiliation(s)
- Denise Renani von Brixen Montzel
- Nutricionista da Saúde do Trabalhador, Hospital Nossa Senhora da Conceição. Av. Francisco Trein 596, Cristo Redentor. 91350-200 Porto Alegre RS Brasil.
| | - Bruna Vieira de Lima Costa
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Flávia Moraes Silva
- Departamento de Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre. Porto Alegre RS Brasil
| |
Collapse
|
22
|
Azeredo CM, de Rezende LFM, Mallinson PAC, Ricardo CZ, Kinra S, Levy RB, Barros AJD. Progress and setbacks in socioeconomic inequalities in adolescent health-related behaviours in Brazil: results from three cross-sectional surveys 2009-2015. BMJ Open 2019; 9:e025338. [PMID: 30904861 PMCID: PMC6475167 DOI: 10.1136/bmjopen-2018-025338] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Despite some progress, Brazil is still one of the most unequal countries, and the extent of socioeconomic inequalities in adolescent health is unclear. We assessed trends in socioeconomic inequalities in adolescent's health-related behaviours in Brazil between 2009 and 2015. DESIGN We used cross-sectional data from the Brazilian National Survey of School Health carried out in 2009, 2012 and 2015. SETTING Brazilian state capitals. PARTICIPANTS Students attending ninth grade from public and private schools in Brazilian state capitals in 2009 (60 973 students), 2012 (61 145 students) and 2015 (51 192 students). MAIN OUTCOME MEASURE We assessed 12 health-related behaviours (irregular fruit, vegetables and bean consumption; regular soft drink consumption; irregular physical activity; alcohol, drug and tobacco use; unsafe sex; involvement in gun fights; bullying victimisation and domestic violence victimisation), under the broad domains of lifestyle risk behaviours, engagement in risky activities and exposure to violence. Socioeconomic status was assessed through an asset-based wealth index derived from principal component analysis. Absolute and relative inequalities in these health behaviours and inequalities trends were investigated. RESULTS From 2009 to 2015, prevalence of certain harmful health-related behaviours increased, such as unsafe sex (21.5% to 33.9%), domestic violence (9.5% to 16.2%), bullying victimisation (14.2% to 21.7%) and irregular consumption of beans (37.5% to 43.7%). Other indicators decreased: alcohol use (27.1% to 23.2%), irregular physical activity (83.0% to 75.6%) and consumption of soft drinks (37.2% to 28.8%). Over the period, we found consistent evidence of decreasing health inequalities for lifestyle behaviours (fruit, bean and soft drink consumption) and alcohol use, set against increasing inequalities in violence (domestic violence, fights using guns and bullying victimisation). CONCLUSION Socioeconomic inequality increased in the violence domain and decreased for lifestyle behaviours among Brazilian adolescents. Widening gaps in violence domain urge immediately policy measures in Brazil.
Collapse
Affiliation(s)
- Catarina Machado Azeredo
- Curso de Nutrição, Faculdade de Medicina, Universidade Federal de Uberlandia, Uberlandia, Brazil
| | - Leandro F M de Rezende
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Poppy Alice Carson Mallinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Camila Zancheta Ricardo
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Renata B Levy
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Aluisio J D Barros
- Postgraduate Programme in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Brazil
| |
Collapse
|
23
|
Wagner KJP, Boing AF, Cembranel F, Boing ACDS, Subramanian SV. Change in the distribution of body mass index in Brazil: analysing the interindividual inequality between 1974 and 2013. J Epidemiol Community Health 2019; 73:544-548. [PMID: 30782854 DOI: 10.1136/jech-2018-211664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/17/2018] [Accepted: 01/19/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Brazil is among the 10 countries with the highest prevalence of overweight in the world. The aim was to analyse the changes in the dispersion of body mass index (BMI) in the Brazilian population from the 1970s to 2013 in specific population groups. METHODS Data were extracted from five national household surveys between 1974-1975 and 2013, including adults aged 20 to 64. We calculated SD, median, fifth and 95th percentiles of BMI for each sociodemographic category (sex, age, schooling) and survey year in order to explore whether changes in mean BMI are followed by changes in dispersion. RESULTS During the period the mean BMI ranged from 22.7 kg/m2 to 26.6 kg/m2, with a much higher variation in the 95th percentile (+6.1 kg/m2) when compared with the fifth percentile (+1.8 kg/m2). The within-group differences increased over time. The SD increased in all categories analysed and was higher among women, lower schooling groups and the oldest group. An increase of 1.0 kg/m2 in the BMI mean was associated with an increase of 0.32 kg/m2 in the SD, 0.45 kg/m2 in the fifth percentile and 1.50 kg/m2 in the 95th percentile of BMI. CONCLUSIONS Population changes occurred in BMI are more complex than the simple increase of its average. Concomitant to the increase in BMI, there was an increase in the within-group differences, showing that growing inequalities are not driven solely by sociodemographic factors.
Collapse
Affiliation(s)
| | - Antonio Fernando Boing
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianopolis, Brazil.,Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, Massachusets, USA
| | - Francieli Cembranel
- Department of Nutrition, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Alexandra Crispim da Silva Boing
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianopolis, Brazil.,Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, Massachusets, USA
| | - S V Subramanian
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, Massachusets, USA
| |
Collapse
|
24
|
Bump JB. Undernutrition, obesity and governance: a unified framework for upholding the right to food. BMJ Glob Health 2018; 3:e000886. [PMID: 30364379 PMCID: PMC6195135 DOI: 10.1136/bmjgh-2018-000886] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/13/2018] [Accepted: 06/16/2018] [Indexed: 11/10/2022] Open
Abstract
This paper addresses the need for conceptual and analytic clarity on nutrition governance, an essential underpinning of more effective approaches for undernutrition, the 'single greatest constraint to global development' and obesity, which already accounts for 4% of the world's disease burden and is growing rapidly. The governance of nutrition, which is essential to designing and implementing policies to realise the right to food, is among the most important and most defining duties of society. But research and action on nutrition governance are hampered by the absence of conceptual rigour, even as the continuing very high burden of undernutrition and the rapid rise in obesity highlight the need for such structures. The breadth of nutrition itself suggests that governance is both needed and sure to be complicated. This analysis explores the reasons attention has come to governance in development policy making, and why it has focused on nutrition governance in particular. It then assesses how the concept of nutrition governance has been used, finding that it has become increasingly prominent in scholarship on poor nutritional outcomes, but remains weakly specified and is invoked by different authors to mean different things. Undernutrition analysts have stressed coordination problems and structural issues related to the general functioning of government. Those studying obesity have emphasised international trade policies, regulatory issues and corporate behaviour. This paper argues that the lack of a clear, operational definition of governance is a serious obstacle to conceptualising and solving major problems in nutrition. To address this need, it develops a unified definition of nutrition governance consisting of three principles: accountability, participation and responsiveness. These are justified with reference to the social contract that defines modern nations and identifies citizens as the ultimate source of national power and legitimacy. A unified framework is then employed to explore solutions to nutrition governance problems.
Collapse
Affiliation(s)
- Jesse B Bump
- Department of Global Health and Population, Takemi Program in International Health, and FXB Center for Health and Human Rights, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
25
|
Popkin BM, Reardon T. Obesity and the food system transformation in Latin America. Obes Rev 2018; 19:1028-1064. [PMID: 29691969 PMCID: PMC6103889 DOI: 10.1111/obr.12694] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/01/2018] [Accepted: 03/16/2018] [Indexed: 02/06/2023]
Abstract
The Latin America and the Caribbean (LAC) region faces a major diet-related health problem accompanied by enormous economic and social costs. The shifts in diet are profound: major shifts in intake of less-healthful low-nutrient-density foods and sugary beverages, changes in away-from-home eating and snacking and rapid shifts towards very high levels of overweight and obesity among all ages along with, in some countries, high burdens of stunting. Diet changes have occurred in parallel to, and in two-way causality with, changes in the broad food system - the set of supply chains from farms, through midstream segments of processing, wholesale and logistics, to downstream segments of retail and food service (restaurants and fast food chains). An essential contribution of this piece is to marry and integrate the nutrition transition literature with the literature on the economics of food system transformation. These two literatures and debates have been to date largely 'two ships passing in the night'. This review documents in-depth the recent history of rapid growth and transformation of that broad food system in LAC, with the rapid rise of supermarkets, large processors, fast food chains and food logistics firms. The transformation is the story of a 'double-edged sword', showing its links to various negative diet side trends, e.g. the rise of consumption of fast food and highly processed food, as well as in parallel, to various positive trends, e.g. the reduction of the cost of food, de-seasonalization, increase of convenience of food preparation reducing women's time associated with that and increase of availability of some nutritious foods like meat and dairy. We view the transformation of the food system, as well as certain aspects of diet change linked to long-run changes in employment and demographics (e.g. the quest for convenience), as broad parameters that will endure for the next decades without truly major regulatory and fiscal changes. We then focus in on what are the steps that are being and can be taken to curb the negative effects on diet of these changes. We show that countries in LAC are already among the global leaders in initiating demand-related solutions via taxation and marketing controls. But we also show that this is only a small step forward. To shift LAC's food supply towards prices that incentivize consumption of healthier diets and demand away from the less healthy component is not simple and will not happen immediately. We must be cognizant that ultimately, food industry firms must be incentivized to market the components of healthy diets. This will primarily need to be via selective taxes and subsidies, marketing controls, as well as food quality regulations, consumer education and, in the medium term, consumers' desires to combine healthier foods with their ongoing quest for convenience in the face of busy lives. In the end, the food industry in LAC will orient itself towards profitable solutions, ie those demanded by the broad mass of consumers.
Collapse
Affiliation(s)
- B M Popkin
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Reardon
- Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
26
|
Cureau FV, Sparrenberger K, Bloch KV, Ekelund U, Schaan BD. Associations of multiple unhealthy lifestyle behaviors with overweight/obesity and abdominal obesity among Brazilian adolescents: A country-wide survey. Nutr Metab Cardiovasc Dis 2018; 28:765-774. [PMID: 29843935 DOI: 10.1016/j.numecd.2018.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Physical inactivity, unhealthy diet, smoking and heavy drinking are four key unhealthy lifestyle behaviors (ULB) that may influence body weight and obesity development. More recently, sedentary time has been recognized as another potentially emerging ULB related to obesity. We therefore investigated the association of multiple ULB with overweight/obesity and abdominal obesity among Brazilian adolescents. METHODS AND RESULTS This cross-sectional study involved 62,063 students (12-17 years). Physical inactivity, high screen time, low fiber intake, binge drinking and smoking were self-reported and combined to a ULB risk score, ranging from zero to five. Participants were classified as overweight/obese or with abdominal obesity using sex and age-specific cut-off points for BMI and waist circumference, respectively. Poisson regression models were used to examine the associations between ULB with overweight/obesity and abdominal obesity, adjusted for socio-demographic variables. Overall, 2.3%, 18.9%, 43.9%, 32.3% and 2.6% of participants reported zero, one, two, three and four/five ULB, respectively. Higher ULB risk score was associated with overweight/obesity and abdominal obesity in a dose-response gradient. Among 32 possible combinations of ULB, the three most prevalent combinations (physical inactivity + low fiber intake; high screen time + low fiber intake; physical inactivity + high screen time + low fiber intake) were positively associated with general and abdominal obesity. CONCLUSIONS Our findings suggest a synergistic relationship between ULB and general and abdominal obesity. Preventive efforts targeting combined ULB should be sought to reduce the prevalence of general and abdominal obesity in Brazilian youth.
Collapse
Affiliation(s)
- F V Cureau
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; National Institute of Science and Technology for Health Technology Assessment, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - K Sparrenberger
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - K V Bloch
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - U Ekelund
- Department of Sports Medicine, Norwegian School of Sports Science, Oslo, Norway
| | - B D Schaan
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
27
|
Jaime PC, Delmuè DCC, Campello T, Silva DOE, Santos LMP. Um olhar sobre a agenda de alimentação e nutrição nos trinta anos do Sistema Único de Saúde. CIENCIA & SAUDE COLETIVA 2018; 23:1829-1836. [DOI: 10.1590/1413-81232018236.05392018] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/01/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo A alimentação e a nutrição são requisitos básicos para a promoção e a proteção da saúde. A vigilância nutricional e a orientação alimentar estão inclusas no campo de atuação do Sistema Único de Saúde (SUS), conforme estabelecido na Lei Orgânica da Saúde nº 8.080 de 1990. O presente artigo apresenta e discute a agenda de alimentação e nutrição no SUS e sua interface com a Segurança Alimentar e Nutricional, seus marcos históricos, avanços e desafios. Este ensaio foi orientado por pesquisa biográfica e documental e, sobretudo, no resgate das experiências e percepções das autoras que, em diferentes momentos e contextos, foram e são sujeitos da agenda de alimentação e nutrição no Brasil. Reforçamos assim a ideia do SUS, com suas conquistas e imperfeições, como um sistema vivo e derivado do compromisso técnico-ético-político dos gestores, dos trabalhadores, da academia e da sociedade como um todo. Desta forma, buscamos contribuir com o debate sobre a trajetória brasileira de construção de um sistema público de proteção social que se comprometeu com o direito humano à saúde e à alimentação adequada.
Collapse
|
28
|
Leal DB, Assis MAAD, Conde WL, Lobo AS, Bellisle F, Andrade DFD. Individual characteristics and public or private schools predict the body mass index of Brazilian children: a multilevel analysis. CAD SAUDE PUBLICA 2018; 34:e00053117. [PMID: 29846407 DOI: 10.1590/0102-311x00053117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 10/02/2017] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to determine the contribution of individual and school characteristics to the variability in body mass index (BMI) z-scores of 7 to 10 years old children. Anthropometric and sociodemographic data from two cross-sectional studies conducted with schoolchildren from the 2nd to the 5th grades of elementary schools were analyses (n = 2,936 in 2002, and n = 1,232 in 2007). Multilevel modeling was used to estimate variations in BMI at child and school levels. The contribution of the school context to the overall variability of BMI z-score was small but significant in 2002 (3.3%-4.4%) and in 2007 (2.4%-5.3%), showing that schoolchildren from private schools had a higher BMI compared to those from public schools. The monthly family income showed, in general, a negative association with BMI z-score in 2002 and a positive association in 2007, for both sexes. The consumption of sweets showed a negative effect in the BMIs of children. In both surveys, overweight/obese mothers and excessive birth weight were positively associated with BMI z-score. Mother's weight status had a higher influence on the overall variability of BMI in both surveys. In conclusion, school and child characteristics contributed to the variance in children's weight status. The results imply that overweight/obesity childhood prevention programs should focus on strategies of family engagement to be more effective.
Collapse
|
29
|
Lima PV, Lopes AOS, Duarte SFP, Oliveira ASD, Correa GTB, Reis LAD. Profile of the body mass index and associated factors in active elderlies. Rev Bras Enferm 2018; 71 Suppl 2:876-883. [PMID: 29791622 DOI: 10.1590/0034-7167-2016-0683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 12/09/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Identifying the profile of Body Mass Index and associated factors in active elderlies. METHOD This is an analytical type of research with cross-sectional design and quantitative approach, with sample represented by 105 elderly people. The research instrument consisted of Cognitive assessment, Sociodemographic data, Health conditions and Motor performance evaluation. The data were analyzed by using descriptive analysis and binary logistic regression. RESULTS The elderlies without partners have 7.753 times the chance of presenting excess weight when compared to those with partners. Having an income higher than a minimum wage represents 6.014 times the chance of being overweight. Not having health problems amounts to 0.015 times the chance of being overweight. In the motorperformance, not presenting limitation of balance represents 6.785 times the possibility of being affected by excess weight.
Collapse
Affiliation(s)
- Pollyana Viana Lima
- Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista, Bahia, Brazil
| | | | | | | | | | | |
Collapse
|
30
|
Goh ZY, Lee PY, Lai YF. Patterns of fruit and vegetable intake and physical activity among community-ambulant patients in Singapore: A cross-sectional study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105818769682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Many modifiable risk factors for chronic diseases are related to dietary patterns and physical activity. This study aims to establish the prevalence of adequate fruit and vegetable intake and physical activity among community-ambulant patients in Singapore. Methods: A cross-sectional study was conducted among community-ambulant patients using convenience sampling. Data were collected through a survey questionnaire, covering self-reported level of physical activity and daily fruit and vegetable intake. Demographic information, awareness and adherence to recommendations were summarised using descriptive statistics. To identify factors influencing awareness and behaviour, exploratory logistic regression analyses were performed. Results: Three hundred and eighty-five complete responses were analysed. For intake of fruits and vegetables, 29.1% and 21.3% of participants were aware of and adherent to the fruit and vegetable intake recommendation respectively. For physical activity, 21.3% and 26.8% of study participants were aware of and adherent to the recommendation respectively. Only 4.7% and 5.5% of participants were aware of and practising both recommendations respectively. Gender, age, ethnicity and body mass index were found to have significant influence on the awareness of the recommendations. However, there was no significant factor found to be contributing to the adherence to the recommendations. Conclusion: Awareness of and adherence to lifestyle recommendations among patients remain low despite ongoing publicity efforts. Many are not fully aware of and adherent to the dietary and physical activity recommendations publicised. Apart from intensifying public outreach on every possible occasion and delivering messages in manners understandable by our older patients, strategies targeting the knowledge–behaviour disconnect among working middle-aged patients also deserve continued attention in the near future.
Collapse
Affiliation(s)
- Zhi Yin Goh
- School of Applied Science, Temasek Polytechnic, Singapore
| | - Pei Ying Lee
- Department of Pharmacy, Sengkang Health, Singapore
| | - Yi Feng Lai
- Department of Pharmacy, Sengkang Health, Singapore
| |
Collapse
|
31
|
França EB, Passos VMDA, Malta DC, Duncan BB, Ribeiro ALP, Guimarães MDC, Abreu DMX, Vasconcelos AMN, Carneiro M, Teixeira R, Camargos P, Melo APS, Queiroz BL, Schmidt MI, Ishitani L, Ladeira RM, Morais-Neto OL, Bustamante-Teixeira MT, Guerra MR, Bensenor I, Lotufo P, Mooney M, Naghavi M. Cause-specific mortality for 249 causes in Brazil and states during 1990-2015: a systematic analysis for the global burden of disease study 2015. Popul Health Metr 2017; 15:39. [PMID: 29166948 PMCID: PMC5700707 DOI: 10.1186/s12963-017-0156-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background Reliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015. Methods We describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states. Results There was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country’s Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI. Conclusions A widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly. Electronic supplementary material The online version of this article (10.1186/s12963-017-0156-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Elisabeth B França
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação em Saúde Pública, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil.
| | | | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Materno Infantil, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Bruce B Duncan
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, R. Ramiro Barcelos 2600/414, Porto Alegre, 90035-003, Brazil
| | - Antonio Luiz P Ribeiro
- Universidade Federal de Minas Gerais, School of Medicine, Av. Alfredo Balena, 190., Belo Horizonte, 30130-100, Brazil
| | - Mark D C Guimarães
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação em Saúde Pública, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Daisy M X Abreu
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Nescon, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Ana Maria N Vasconcelos
- Universidade de Brasília, Programa de Pós-graduação em Desenvolvimento, Sociedade e Cooperação Internacional, Asa Norte, Brasília, 70910-900, Brazil
| | - Mariângela Carneiro
- Universidade de Federal de Minas Gerais, Instituto de Ciências Biológicas, Departamento de Parasitologia. Avenida Antônio Carlos, 6670, Belo Horizonte, MG, 31270-901, Brazil
| | - Renato Teixeira
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação em Saúde Pública, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Paulo Camargos
- Universidade Federal de São João Del Rei, Faculdade de Medicina. Praça Frei Orlando, 170, Centro, São João del-Rei, 36307-352, Brazil
| | - Ana Paula S Melo
- Universidade Federal de São João Del Rei, Faculdade de Medicina. Praça Frei Orlando, 170, Centro, São João del-Rei, 36307-352, Brazil
| | - Bernardo L Queiroz
- Universidade Federal de Minas Gerais, Faculdade de Ciências Econômicas, Departamento de Demografia, Av. Antônio Carlos, 6670, Belo Horizonte, 31270-901, Brazil
| | - Maria Inês Schmidt
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, R. Ramiro Barcelos 2600/414, Porto Alegre, 90035-003, Brazil
| | - Lenice Ishitani
- Universidade Federal de Minas Gerais, Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde-GPEAS, Av. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Roberto Marini Ladeira
- Fundação Hospitalar do Estado de Minas Gerais, Alameda Alvaro Celso 100/231, Belo Horizonte, 30150-260, Brazil
| | - Otaliba L Morais-Neto
- Universidade Federal de Goiás, Departamento de Saúde Coletiva. Instituto de Patologia Tropical e Saúde Pública. Rua 235, S/N, Setor Universitário, Goiânia, Goiás, 74605050, Brazil
| | - Maria Tereza Bustamante-Teixeira
- Universidade Federal de Juiz de Fora, Programa de Pós-graduação em Saúde Coletiva, Campus Universitario da UFJF, Rua José Lourenço Kelmer, S/n, Martelos, Juiz de Fora, 36036-330, Brazil
| | - Maximiliano R Guerra
- Universidade Federal de Juiz de Fora, Programa de Pós-graduação em Saúde Coletiva, Campus Universitario da UFJF, Rua José Lourenço Kelmer, S/n, Martelos, Juiz de Fora, 36036-330, Brazil
| | - Isabela Bensenor
- Universidade de São Paulo. Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Av. Lineu Prestes, 2565 / 3° andar, São Paulo, 05508-000, Brazil
| | - Paulo Lotufo
- Universidade de São Paulo. Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Av. Lineu Prestes, 2565 / 3° andar, São Paulo, 05508-000, Brazil
| | - Meghan Mooney
- Institute for Health Metrics and Evaluation, 2301 5th Avenue, Suite 600, Box 358210, Seattle, WA, 98121, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, 2301 5th Avenue, Suite 600, Box 358210, Seattle, WA, 98121, USA
| |
Collapse
|
32
|
Malta DC, Santos MAS, Andrade SSCDA, Oliveira TP, Stopa SR, de Oliveira MM, Jaime P. [Time trend in adult obesity indicators in Brazilian state capitals, 2006-2013]. CIENCIA & SAUDE COLETIVA 2017; 21:1061-9. [PMID: 27076005 DOI: 10.1590/1413-81232015214.12292015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/10/2015] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to analyze time trends in excess weight (overweight, obesity and class III obesity) among adults (≥ 18 years of age) in Brazilian capitals between 2006 and 2013. It is a study of temporal trends in excess weight indicators using data from the telephone-based Surveillance System of Risk and Protective Factors for Chronic Non-Communicable Diseases (Vigitel). The Prais regression model was performed. In 2013, the following statistics were observed in the adult population: overweight in 32.2%; obesity in 17.5%, and class III obesity in 1.5%. From 2006 to 2013, there was a significant increase in major indicators, for sex, age group, level of schooling (years) and regions. Overweight and obesity indicators demand attention since they result in a burden on the individual, society and health services.
Collapse
Affiliation(s)
- Deborah Carvalho Malta
- Departamento Materno Infantil e Saúde Pública, Escola de Enfermagem, UFMG, Belo Horizonte, MG, Brasil,
| | - Maria Aline Siqueira Santos
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasil
| | | | - Taís Porto Oliveira
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasil
| | | | | | - Patrícia Jaime
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
33
|
Kline L, Jones-Smith J, Jaime Miranda J, Pratt M, Reis RS, Rivera JA, Sallis JF, Popkin BM. A research agenda to guide progress on childhood obesity prevention in Latin America. Obes Rev 2017; 18 Suppl 2:19-27. [PMID: 28741906 PMCID: PMC5560467 DOI: 10.1111/obr.12572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/03/2017] [Indexed: 11/27/2022]
Abstract
Childhood obesity rates in Latin America are among the highest in the world. This paper examines and evaluates the many efforts underway in the region to reduce and prevent further increases in obesity, identifies and discusses unique research challenges and opportunities in Latin America, and proposes a research agenda in Latin America for the prevention of childhood obesity and concomitant non-communicable diseases. Identified research gaps include biological challenges to healthy growth across the life cycle, diet and physical activity dynamics, community interventions promoting healthy child growth, and rigorous evaluation of national food and activity programs and regulatory actions. Addressing these research gaps is critical to advance the evidence-based policy and practice in childhood obesity tailored to the Latin American context that will be effective in addressing obesity.
Collapse
Affiliation(s)
- L Kline
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - J Jones-Smith
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M Pratt
- University of California, San Diego School of Medicine, Institute for Public Health, La Jolla, CA, USA
| | - R S Reis
- George Warren Brown School of Social Work, Washington University in St. Louis, Saint Louis, MO, USA
| | - J A Rivera
- National Institute of Public Health, Cuernavaca, Mexico
| | - J F Sallis
- Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - B M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
34
|
Corvalán C, Garmendia ML, Jones-Smith J, Lutter CK, Miranda JJ, Pedraza LS, Popkin BM, Ramirez-Zea M, Salvo D, Stein AD. Nutrition status of children in Latin America. Obes Rev 2017; 18 Suppl 2:7-18. [PMID: 28741907 PMCID: PMC5601284 DOI: 10.1111/obr.12571] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/03/2017] [Indexed: 12/30/2022]
Abstract
The prevalence of overweight and obesity is rapidly increasing among Latin American children, posing challenges for current healthcare systems and increasing the risk for a wide range of diseases. To understand the factors contributing to childhood obesity in Latin America, this paper reviews the current nutrition status and physical activity situation, the disparities between and within countries and the potential challenges for ensuring adequate nutrition and physical activity. Across the region, children face a dual burden of undernutrition and excess weight. While efforts to address undernutrition have made marked improvements, childhood obesity is on the rise as a result of diets that favour energy-dense, nutrient-poor foods and the adoption of a sedentary lifestyle. Over the last decade, changes in socioeconomic conditions, urbanization, retail foods and public transportation have all contributed to childhood obesity in the region. Additional research and research capacity are needed to address this growing epidemic, particularly with respect to designing, implementing and evaluating the impact of evidence-based obesity prevention interventions.
Collapse
Affiliation(s)
- C Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - M L Garmendia
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - J Jones-Smith
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | | | - J J Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L S Pedraza
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - B M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala
| | - D Salvo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.,Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, Austin Campus, Austin, TX, USA
| | - A D Stein
- Hubert Department of Global Health of the Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
35
|
Popkin BM. Relationship between shifts in food system dynamics and acceleration of the global nutrition transition. Nutr Rev 2017; 75:73-82. [PMID: 28395033 PMCID: PMC5914433 DOI: 10.1093/nutrit/nuw064] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/03/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Barry M. Popkin
- B.M. Popkin is with the Department of Nutrition and the Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA. Correspondence: B.M. Popkin, Carolina Population Center, University of North Carolina, 137 E. Franklin St. Chapel Hill, NC 27516, USA. . Phone: +1-919-962-6139
| |
Collapse
|
36
|
Lentsck MH, Saito AC, Mathias TADF. DECLINE IN HOSPITALIZATION TREND FOR CARDIOVASCULAR DISEASES SENSITIVE TO PRIMARY HEALTHCARE. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017003170015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: was to analyze the trend of hospitalizations for cardiovascular conditions sensitive to primary healthcare from 2000 to 2011. Method: an ecological study of the tendency of hospitalization rates for cardiovascular diseases by residence, aged between 35 and 74 years, according to the main diagnoses of hospitalization, gender and age, with data from the Hospital Information System of the Brazilian National Unified Health System (Sistema de Informações Hospitalares do Sistema Único de Saúde) and using polynomial regression models. Results: an average annual decline of 5.6 per 10,000 inhabitants ( r2 =0.9; p<0.001) of hospitalization rates by cardiovascular diseases was observed. Decreasing trends for hypertension, heart failure and cerebrovascular diseases were also identified, while hospitalization rates by angina remained stable. The decrease in admission rates due to cardiovascular conditions was similar between both genders, although these rates were higher for men aged 55 to 74 years. Conclusion: the decline in hospitalization rates for primary care-sensitive cardiovascular diseases indicates, in addition to other factors, improved access and quality of primary healthcare actions, especially for residents aged 55-74 years, and also for women whose decline was more pronounced. The health team should implement actions to prevent chronic disease complications, and consequently hospitalizations for men and for angina, in order to eliminate health disparities.
Collapse
|
37
|
Gittelsohn J, Trude A. Diabetes and obesity prevention: changing the food environment in low-income settings. Nutr Rev 2017; 75:62-69. [PMID: 28049750 PMCID: PMC5207007 DOI: 10.1093/nutrit/nuw038] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Innovative approaches are needed to impact obesity and other diet-related chronic diseases, including interventions at the environmental and policy levels. Such interventions are promising due to their wide reach. This article reports on 10 multilevel community trials that the present authors either led (n = 8) or played a substantial role in developing (n = 2) in low-income minority settings in the United States and other countries that test interventions to improve the food environment, support policy, and reduce the risk for developing obesity and other diet-related chronic diseases. All studies examined change from pre- to postintervention and included a comparison group. The results show the trials had consistent positive effects on consumer psychosocial factors, food purchasing, food preparation, and diet, and, in some instances, obesity. Recently, a multilevel, multicomponent intervention was implemented in the city of Baltimore that promises to impact obesity in children, and, potentially, diabetes and related chronic diseases among adults. Based on the results of these trials, this article offers a series of recommendations to contribute to the prevention of chronic disease in Mexico. Further work is needed to disseminate, expand, and sustain these initiatives at the city, state, and federal levels.
Collapse
Affiliation(s)
- Joel Gittelsohn
- J. Gittelsohn and A. Trude are with the Department of International Health, Center for Human Nutrition, Global Obesity Prevention Center at Johns Hopkins, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Angela Trude
- J. Gittelsohn and A. Trude are with the Department of International Health, Center for Human Nutrition, Global Obesity Prevention Center at Johns Hopkins, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
38
|
Ribeiro ALP, Duncan BB, Brant LCC, Lotufo PA, Mill JG, Barreto SM. Cardiovascular Health in Brazil: Trends and Perspectives. Circulation 2016; 133:422-33. [PMID: 26811272 DOI: 10.1161/circulationaha.114.008727] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brazil is a large country, with an evolving economy, but marked social inequalities. The population is formed by an admixture of native Brazilians, Europeans, and Africans; is predominantly urban; and faces rapid aging. Time trends related to health behaviors show a substantial reduction in smoking rates, but a rising prevalence of overweight and obesity, unhealthy eating habits, and insufficient physical activity. The high prevalence of hypertension and the increasing prevalence of diabetes mellitus are also causes for concern. Cardiovascular disease (CVD) has been the leading cause of mortality since the 1960s and has accounted for a substantial percentage of all hospitalizations. In 2011, CVD was responsible for 31% of all deaths, with ischemic heart disease (31%) and cerebrovascular diseases (30%) being the leading CVD causes. Despite an increase in the overall number of CVD deaths, the age-adjusted mortality rates for CVD declined 24% between 2000 and 2011. Health care delivered by Brazil's universal public health system, which focuses on primary prevention, has contributed to this achievement. However, the decline in age-adjusted mortality differs according to race, sex, and socioeconomic status with black individuals and lower-income populations sustaining the greatest impact of CVD, especially at younger ages. With one of the world's largest public health systems in terms of population coverage, Brazil has the means to implement actions to confront the high burden of CVD, focusing on health promotion and comprehensive care. Insufficient funding, low education levels, and social inequalities remain as the main barriers to be overcome.
Collapse
Affiliation(s)
- Antonio Luiz P Ribeiro
- From Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.P.R., L.C.C.B., S.M.B.); Faculdade de Medicina and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (B.B.D.); Faculdade de Medicina and Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil (P.A.L.); Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Brazil (J.G.M.); and ELSA-Brasil Cohort Study (A.L.P.R., B.B.D., L.C.C.B., P.A.L. J.G.M, S.M.B.).
| | - Bruce B Duncan
- From Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.P.R., L.C.C.B., S.M.B.); Faculdade de Medicina and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (B.B.D.); Faculdade de Medicina and Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil (P.A.L.); Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Brazil (J.G.M.); and ELSA-Brasil Cohort Study (A.L.P.R., B.B.D., L.C.C.B., P.A.L. J.G.M, S.M.B.)
| | - Luisa C C Brant
- From Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.P.R., L.C.C.B., S.M.B.); Faculdade de Medicina and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (B.B.D.); Faculdade de Medicina and Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil (P.A.L.); Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Brazil (J.G.M.); and ELSA-Brasil Cohort Study (A.L.P.R., B.B.D., L.C.C.B., P.A.L. J.G.M, S.M.B.)
| | - Paulo A Lotufo
- From Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.P.R., L.C.C.B., S.M.B.); Faculdade de Medicina and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (B.B.D.); Faculdade de Medicina and Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil (P.A.L.); Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Brazil (J.G.M.); and ELSA-Brasil Cohort Study (A.L.P.R., B.B.D., L.C.C.B., P.A.L. J.G.M, S.M.B.)
| | - José Geraldo Mill
- From Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.P.R., L.C.C.B., S.M.B.); Faculdade de Medicina and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (B.B.D.); Faculdade de Medicina and Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil (P.A.L.); Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Brazil (J.G.M.); and ELSA-Brasil Cohort Study (A.L.P.R., B.B.D., L.C.C.B., P.A.L. J.G.M, S.M.B.)
| | - Sandhi M Barreto
- From Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.P.R., L.C.C.B., S.M.B.); Faculdade de Medicina and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (B.B.D.); Faculdade de Medicina and Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil (P.A.L.); Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Brazil (J.G.M.); and ELSA-Brasil Cohort Study (A.L.P.R., B.B.D., L.C.C.B., P.A.L. J.G.M, S.M.B.)
| |
Collapse
|
39
|
Malta DC, Andrade SC, Claro RM, Bernal RTI, Monteiro CA. Trends in prevalence of overweight and obesity in adults in 26 Brazilian state capitals and the Federal District from 2006 to 2012. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 17 Suppl 1:267-76. [PMID: 25054269 DOI: 10.1590/1809-4503201400050021] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/09/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the annual evolution of the prevalence of overweight and obesity in the adult population of the 26 Brazilian state capitals and the Federal District from 2006 to 2012. METHODS Annual interviews (around 54,000 per year) from VIGITEL (Surveillance System of Risk and Protective Factors for Chronic Non-Communicable Diseases through Telephone Interviews) were used. Self-reported weight and height were used to estimate body mass index and nutritional status. Prevalence estimates of overweight and obesity are presented according to gender, age and schooling and to each city. Linear regression model was used to evaluate the time trend of prevalence. RESULTS Prevalence of overweight in adults in the 27 cities monitored by VIGITEL increased from 43.2% (2006) to 51.0% (2012), with an annual increase rate of 1.37%. Prevalence of obesity increased from 11.6% to 17.4%, with an annual increase rate of 0.89%. The study showed a statistically significant increase in the prevalence of overweight in all cities, and for both genders, all age groups and all levels of schooling. Similar trends were also verified for obesity. CONCLUSIONS If the trends verified from 2006 to 2012 are maintained, in ten years, around two-thirds of the adults in Brazilian state capitals will be overweight, and a quarter will be obese. This perspective requests urgent response from government and intersectoral actions to combat the obesogenic environment.
Collapse
Affiliation(s)
- Deborah Carvalho Malta
- Department of Non-Communicable Diseases Surveillance and Health Promotion, Ministry of Health, Brasília, DF, Brasil
| | - Silvania Caribé Andrade
- Department of Non-Communicable Diseases Surveillance and Health Promotion, Ministry of Health, Brasília, DF, Brasil
| | - Rafael Moreira Claro
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | | |
Collapse
|
40
|
Yamaguchi MU, Bernuci MP, Pavanelli GC. Scientific research about the National Policy for Health Promotion. CIENCIA & SAUDE COLETIVA 2016; 21:1727-36. [PMID: 27281659 DOI: 10.1590/1413-81232015216.07462016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/05/2016] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivou-se avaliar o nível do conhecimento e sistematização da produção científica vinculada à Política Nacional da Promoção da Saúde (PNPS) após dez anos de sua implementação. Estudo cienciométrico da literatura científica nacional e internacional sobre a PNPS nas bases PubMed e SciELO. A pesquisa foi realizada no mês de dezembro de 2015, utilizando o termo “política nacional de promoção da saúde”, que resultou na identificação de 88 publicações relacionadas à PNPS. Os anos de 2012 e 2013 detiveram o maior número de artigos publicados, identificando a Política Nacional de Alimentação e Nutrição e a temática Saúde Bucal como objetos mais estudados. Os estados de São Paulo, Rio de Janeiro e o Distrito Federal destacaram-se pela quantidade e qualidade da produção científica, os quais foram em sua maioria divulgados em periódicos internacionais classificados nos estratos Qualis A2. As políticas de Atenção às Urgências, Saúde Materno-Infantil e Adolescência figuraram como temas pouco explorados. Embora as produções científicas tenham contribuído para aplicação do conhecimento técnico e científico na promoção da saúde, os setores pouco explorados poderão dificultar o dimensionamento e a reformulação de ações estratégicas para o enfrentamento das iniquidades em saúde nas próximas décadas.
Collapse
Affiliation(s)
- Mirian Ueda Yamaguchi
- Centro Universitário de Maringá, Centro Universitário de Maringá, Maringá PR , Brasil, Programa de Pós-Graduação em Promoção da Saúde, Centro Universitário de Maringá. Av. Guedner 1610, Aclimação. 87050-900 Maringá PR Brasil. mirian.yamaguchi@ unicesumar.edu.br
| | - Marcelo Picinin Bernuci
- Centro Universitário de Maringá, Centro Universitário de Maringá, Maringá PR , Brasil, Programa de Pós-Graduação em Promoção da Saúde, Centro Universitário de Maringá. Av. Guedner 1610, Aclimação. 87050-900 Maringá PR Brasil. mirian.yamaguchi@ unicesumar.edu.br
| | - Gilberto Cezar Pavanelli
- Centro Universitário de Maringá, Centro Universitário de Maringá, Maringá PR , Brasil, Programa de Pós-Graduação em Promoção da Saúde, Centro Universitário de Maringá. Av. Guedner 1610, Aclimação. 87050-900 Maringá PR Brasil. mirian.yamaguchi@ unicesumar.edu.br
| |
Collapse
|
41
|
Abstract
Low- and middle-income countries (LMICs) face a rapid change in the nutrition transition toward increases in noncommunicable diseases. Underlying this transition are shifts in the agricultural system and the subsequent growth of the modern retail and food service sectors across all regions and countries, a change in technology affecting physical activity and inactivity, mass media access, urbanization, and penetration of modern food systems into all societies. The resulting major shifts in diet are toward increased refined carbohydrates, added sweeteners, edible oils, and animal-source foods and reduced legumes, other vegetables, and fruits. Most countries are seeing increases in body mass index (BMI), overweight, and waist circumference (WC), and an increased WC-BMI ratio appears to be emerging in many regions. The implications of these rapidly changing diets and body compositions include the prevalence and severity of diabetes in LMICs.
Collapse
Affiliation(s)
- Barry M Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
| |
Collapse
|
42
|
Studdert DM, Flanders J, Mello MM. Searching for Public Health Law's Sweet Spot: The Regulation of Sugar-Sweetened Beverages. PLoS Med 2015; 12:e1001848. [PMID: 26151360 PMCID: PMC4494810 DOI: 10.1371/journal.pmed.1001848] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
David Studdert and colleagues explore how to balance public health, individual freedom, and good government when it comes to sugar-sweetened drinks.
Collapse
Affiliation(s)
- David M. Studdert
- Stanford Law School, Stanford, California, United States of America
- Center for Health Policy/PCOR, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| | - Jordan Flanders
- Stanford Law School, Stanford, California, United States of America
| | - Michelle M. Mello
- Stanford Law School, Stanford, California, United States of America
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| |
Collapse
|
43
|
Gómez EJ. Understanding the United States and Brazil's response to obesity: institutional conversion, policy reform, and the lessons learned. Global Health 2015; 11:24. [PMID: 26058701 PMCID: PMC4467077 DOI: 10.1186/s12992-015-0107-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 05/04/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In the United States (US) and Brazil, obesity has emerged as a health epidemic. This article is driven by the following research questions: how did the US and Brazil's federal institutions respond to obesity? And how did these responses affect policy implementation? The aim of this article is therefore to conduct a comparative case study analysis of how these nations' institutions responded in order to determine the key lessons learned. METHODS This study uses primary and secondary qualitative data to substantiate causal arguments and factual claims. RESULTS Brazil shows that converting preexisting federal agencies working in primary healthcare to emphasize the provision of obesity prevention services can facilitate policy implementation, especially in rural areas. Brazil also reveals the importance of targeting federal grant support to the highest obesity prevalence areas and imposing grant conditionalities, while illustrating how the incorporation of social health movements into the bureaucracy facilitates the early adoption of nutrition and obesity policies. None of these reforms were pursued in the US. CONCLUSIONS Brazil's government has engaged in innovative institutional conversion processes aiding its ability to sustain its centralized influence when implementing obesity policy. The US government's adoption of Brazil's institutional innovations may help to strengthen its policy response.
Collapse
Affiliation(s)
- Eduardo J Gómez
- International Development Institute, King's College London, Chesham Building, Strand, WC2R 2LS, UK.
| |
Collapse
|
44
|
Friedrich RR, Caetano LC, Schiffner MD, Wagner MB, Schuch I. Design, randomization and methodology of the TriAtiva Program to reduce obesity in school children in Southern Brazil. BMC Public Health 2015; 15:363. [PMID: 25887113 PMCID: PMC4411799 DOI: 10.1186/s12889-015-1727-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/31/2015] [Indexed: 01/09/2023] Open
Abstract
Background The prevalence of child obesity in Brazil has increased rapidly in recent decades. There is, therefore, an urgent need to develop effective strategies to prevent and control child obesity. In light of these considerations, an intervention program with a focus on nutrition education and physical activity was developed for to prevent and control obesity in schools. The intervention was called the TriAtiva Program: Education, Nutrition and Physical Activity. This article describes the design, randomization and method used to evaluate the TriAtiva program. Methods/design This randomized controlled cluster trial was performed in 12 municipal schools in the city of Porto Alegre/RS (six schools in the intervention group and six control schools) which offered first- through fourth grade, during one school year. The TriAtiva Program was implemented through educational activities related to healthy eating and physical activity, creating an environment which promoted student health while involving the school community and student families. The primary outcome of the present study was body mass, while its secondary outcomes were waist circumference, percent body fat, blood pressure and behavioural variables such as eating habits and physical activity levels, as well as the prevalence, incidence and remission rates of obesity. Discussion The intervention was developed based on a comprehensive review of controlled trials of similar design. The TriAtiva Program: Education, Nutrition and Physical Activity was the first study in Southern Brazil to use a randomized controlled design to evaluate an intervention involving both nutrition education and physical activity in schools. Our results will contribute to the development of future interventions aimed at preventing and controlling child obesity in schools, especially in Brazil. Brazilian Clinical Trials Registry (REBEC) number RBR2xx2z4.
Collapse
Affiliation(s)
- Roberta R Friedrich
- Graduate Program in Child and Adolescent Health, School of Medicine, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil.
| | - Lisandrea C Caetano
- Department of Nutrition, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2400, Bairro Santa Cecília, Porto Alegre, 90035003, Rio Grande do Sul, Brazil.
| | - Mariana D Schiffner
- Departament of Nutrition, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2400, Bairro Santa Cecília, Porto Alegre, 90035003, Rio Grande do Sul, Brazil.
| | - Mário B Wagner
- Graduate Program in Child and Adolescent Health, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2400, Bairro Santa Cecília, Porto Alegre, 90035003, Rio Grande do Sul, Brazil.
| | - Ilaine Schuch
- Department of Nutrition, School of Medicine, Federal University of Rio Grande do Sul, Brazil. Centre of Food and Nutrition Studies (CESAN) Clinical Hospital of Porto Alegre, Porto Alegre, 90035003, Rio Grande do Sul, Brazil.
| |
Collapse
|
45
|
Florindo AA, Brownson RC, Mielke GI, Gomes GA, Parra DC, Siqueira FV, Lobelo F, Simoes EJ, Ramos LR, Bracco MM, Hallal PC. Association of knowledge, preventive counseling and personal health behaviors on physical activity and consumption of fruits or vegetables in community health workers. BMC Public Health 2015; 15:344. [PMID: 25885709 PMCID: PMC4410462 DOI: 10.1186/s12889-015-1643-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/16/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is evidence that if a health professional is active and has a healthy diet, he/she is more likely to advise patients about the benefits of physical activity and healthy eating The aims of this study were to: (1) describe the personal physical activity, consumption of fruits and vegetables behaviors and nutritional status of community health workers; (2) evaluate the association between knowledge, delivery of preventive counseling and personal behaviors among community health workers. METHODS This was a cross-sectional study conducted in a nationally sample of health professionals working in primary health care settings in Brazil in 2011. This survey was part of the second phase of the Guide for Useful Interventions for Activity in Brazil and Latin America project, and data were collected through telephone interviews of 269 community health workers from the Unified Health Care system of Brazil. We applied questionnaires about personal reported behaviors, knowledge and preventive counseling in physical activity and consumption of fruits and vegetables. We calculated the prevalence and associations between the variables with logistic regression. RESULTS The proportion of community health workers that practiced 150 minutes per week of physical activity in leisure time or transportation was high (64.9%). Half of community health workers were overweight and only 26.2% reported consuming five portions/day of fruits or vegetables. Most community health workers reported counseling about physical activity for more than six months (59.7%), and most were not knowledgeable of the fruits and vegetables and physical activity recommendations. Meeting the fruits and vegetables recommendations was associated with correct knowledge (OR = 4.5; CI95% 1.03;19.7), with reporting 150 minutes or more of physical activity per week (OR = 2.0; CI95% 1.03;3.7) and with reporting physical activity in leisure time (OR = 2.0; CI95% 1.05;3.6). Regular physical activity counseling was associated with reporting 10-149 minutes per week (OR = 3.8; CI95% 1.1;13.3) and with more than 150 minutes of physical activity per week (OR = 4.9; CI95% 1.5;16.5). CONCLUSION Actions to promote physical activity and healthy eating and to improve knowledge among community health workers within the health care system of Brazil could have a potential positive influence on delivery of preventive counseling to patients on this topic.
Collapse
Affiliation(s)
- Alex A Florindo
- School of Arts, Sciences and Humanities, University of São Paulo, Rua Arlindo Bettio, 1.000, CEP: 03828-000, São Paulo, SP, Brazil.
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Division of Public Health Sciences and Alvin J. Siteman Cancer Center - Washington University in St. Louis, Missouri, USA.
| | - Gregore I Mielke
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil.
| | - Grace Ao Gomes
- Department of Gerontology, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Diana C Parra
- Program in Physical Therapy Surgery (Prevention and Control), School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
| | - Fernando V Siqueira
- School of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil.
| | - Felipe Lobelo
- Hubert Department of Global Health, Emory University - Rollins School of Public Health, Atlanta, USA.
| | - Eduardo J Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Missouri, USA.
| | - Luiz R Ramos
- Department of Preventive Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil.
| | - Mário M Bracco
- Hospital Israelita Albert Einstein; Hospital Municipal Dr. Moysés Deutsch - M'Boi Mirim, São Paulo, SP, Brazil.
| | - Pedro C Hallal
- School of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil.
| |
Collapse
|
46
|
Abstract
This paper provides a comprehensive overview of the recent obesity prevention-related food policies initiated in countries worldwide. We searched and reviewed relevant research papers and government documents, focusing on those related to dietary guidelines, food labeling, regulation of food marketing, and policies affecting food prices. We also commented on the effects and challenges of some of the related policy options. There are large variations regarding what, when, and how policies have been implemented across countries. Clearly, developed countries are leading the effort, and developing countries are starting to develop some related policies. The encouraging message is that many countries have been adopting policies that might help prevent obesity and that the support for more related initiatives is strong and continues to grow. Communicating information about these practices will help researchers, public health professionals, and policy makers around the world to take action to fight the growing epidemic of obesity and other nutrition-related diseases.
Collapse
Affiliation(s)
- Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA
| | - Shiyong Liu
- Department of Epidemology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY 14214-8001, USA; Research Institute of Economics and Management, Southwestern University of Finance and Economics, #55 Guanghuacun Street, Chengdu, Sichuan, China 610074
| | - Ruicui Liu
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA
| | - Hong Xue
- Department of Epidemology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY 14214-8001, USA
| | - Youfa Wang
- Department of Epidemology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY 14214-8001, USA
| |
Collapse
|
47
|
Popkin B, Monteiro C, Swinburn B. Overview: Bellagio Conference on Program and Policy Options for Preventing Obesity in the Low- and Middle-Income Countries. Obes Rev 2013; 14 Suppl 2:1-8. [PMID: 24102826 DOI: 10.1111/obr.12108] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 08/14/2013] [Accepted: 08/15/2013] [Indexed: 01/01/2023]
Abstract
The Bellagio 'Conference on Program and Policy Options for Preventing Obesity in the Low- and Middle-Income Countries' (LMICs) was organized to pull together the current. We need not reiterate the importance of this topic or the speed of change in eating, drinking and moving facing us across the globe. The conference emerges from need to significantly step up the policies and programs to reduce obesity by learning from some current examples of best practice and strengthening the role of the academic and civil society players in translating global evidence and experience into action at the national level. There is also a need to empower the younger generation of scholars and activists in these countries to carry on this effort. The meeting was also timely because a number of funding agencies in the United States, Canada and the UK, at least, are beginning to focus attention on this topic. This set of papers provides not only examples of existing best practice but also a road map ahead for LMICs in the various areas of action needed to reduce obesity across LMICs. The meeting highlighted critical barriers to implementation that have blocked many initiatives.
Collapse
Affiliation(s)
- B Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | |
Collapse
|