Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States

Building Capacity and Advancing Regulatory Measures to Improve Food Environments in the Region of the Americas

Noncommunicable diseases (NCDs) are the main cause of death globally (70%) and in the Region of the Americas (80%), and poor diets are a leading driver of NCDs. In response, the Pan American Health Organization (PAHO)/World Health Organization (WHO) introduced a set of evidence-based regulatory measures to help countries improve diets through the reduced consumption of processed and ultra-processed foods. This paper aims to describe the needs of and propose actions for key actors to advance these measures. A workshop was designed to assess member states' regulatory capacity. A thematic analysis was conducted to analyze regional needs, successes and challenges. Thereafter, the Government Capacity-Building Framework for the prevention and control of NCDs was used to examine findings. The findings were organized in two sets: (i) PAHO/WHO actions to support member states and (ii) key actors' actions to advance regulatory policies. The results show notable regulatory progress across the Region of the Americas. However, progress differs between countries, with opportunities to strengthen measures in most countries, mainly in conflict of interest management. The results identified important actions to strengthen the regulatory capacity of PAHO/WHO member states. To maximize momentum for these actions, timelines must be identified, and political commitment can be boosted by applying human rights-based and food system-wide approaches.

Determinants of overweight and obesity among children between 5 to 11 years in Ecuador: A secondary analysis from the National Health Survey 2018

BACKGROUND

During the 1990s, global eating habits changed, affecting poorer and middle-income nations, as well as richer countries. This shift, known as the "obesity transition," led to more people becoming overweight or obese worldwide. In Ecuador, this change is happening, and now, one in three children is affected by overweight or obesity (OW/OB). This study explores the links between social, economic, and demographic factors and childhood obesity in Ecuador, seeking to provide insights for shaping future health policies in response to this intricate shift.

METHODS

A cross-sectional study using 2018 National Health and Nutrition Survey data from Ecuador. Weighted percentages were computed, and odds ratios for OW/OB unadjusted and adjusted for each category of explanatory variables were estimated using multilevel multivariate logistic regression models.

RESULTS

Among 10,807 Ecuadorian school children aged 5 to 11, the prevalence of OW/OB was 36.0%. Males exhibited 1.26 times higher odds than females (95% CI: 1.20 to 1.33), and each additional year of age increased the odds by 1.10 times (95% CI: 1.09 to 1.10). Economic quintiles indicated increased odds (1.17 to 1.39) from the 2nd to 5th quintile (the richest) compared with the first quintile (the poorest). Larger household size slightly reduced odds of OW/OB (adjusted odds ratio [aOR] = 0.93, 95% CI: 0.91 to 0.95), while regular physical activity decreased odds ([aOR] = 0.79, 95% CI: 0.75 to 0.82). The consumption of school-provided meals showed a non-significant reduction (aOR: 0.93, 95% CI: 0.82 to 1.06). Children from families recognizing and using processed food labels had a higher likelihood of being overweight or obese (aOR = 1.14, 95% CI: 1.02 to 1.26).

CONCLUSION

Age, male gender, and higher economic quintile increase OW/OB in Ecuadorian school children. Larger households and physical activity slightly decrease risks. Ecuador needs policies for healthy schools and homes, focusing on health, protection, and good eating habits.

Monitoring health and nutrition claims on food labels in Brazil

Introduction

The monitoring of nutrition and health claims on food and beverage labels has been proposed by international and national organizations because it can collaborate with the development of public policies to regulate food labeling and marketing strategies. One way of carrying out this monitoring is by using data collected by private companies.

Objective

To compare information on nutrition and health claims available in a commercial database of a private company that monitors the launch of new foods and beverages in Brazilian food retailers with information on those same claims manually coded by trained research assistants.

Methods

This is a cross-sectional observational study using a data sample of newly launched food and beverages available at a commercial database from 2018 to 2021. We compared the information on health and nutrition claims available on the commercial dataset with reliable information on the same nutrition and health claims manually coded by trained research assistants using a tested taxonomy to classify such claims. We used Gwet's Kappa AC1 with 95% CI and percentage agreement to compare both data sources and calculated sensitivity and specificity of the compared data.

Results

A total of 6,722 foods and beverages were analyzed. Mintel-GNPD presented 36.28% (n = 2,439) of nutrition claims, while in the trained researchers' coding, it was 33.73% (n = 2,267). We found a prevalence of 5.4% (n = 362) for health claims in Mintel-GNPD and 10.8% (n = 723) in the researchers' coding. All subcategories of nutrition and health claims showed high agreement (Kappa >0.81). Health claims presented kappa = 0.89 with 33.7% sensitivity and 98.0% specificity while nutrition claims showed kappa = 0.86 with 92.9% sensitivity and 92.5% specificity.

Conclusion

Nutrition and health claims showed high agreement, with great results in nutrition claims, indicating that Mintel-GPND is suitable for monitoring such claims on food and beverage packaging in Brazil. Additionally, our findings show a high prevalence of nutrition and health claims on food packages launched in the Brazilian food retail, highlighting the need to monitor these to develop public policies to regulate food marketing on packaging in Brazil.

Perceptions on Healthy Eating Impact the Home Food Environment: A Qualitative Exploration of Perceptions of Indigenous Food Gatekeepers in Urban Fiji

The home food environment (HFE) can have important direct and indirect impacts on dietary practices. Nutrient transitions in the HFE of Pacific Island countries (PICs) are key contributors of the high rates of adult and childhood overweight and obesity in the region. Pacifica mothers are important sociocultural agents who play critical roles in their HFE through setting eating-appropriateness standards and mitigating the impacts of food availability and accessibility on the HFE. This study used an interpretative phenomenological approach to explore how urban indigenous Fijian mothers perceive healthy eating and how these perceptions impacted the food decisions they made for their families. Mothers in this study held complex, multifaceted perceptions on healthy eating and these perceptions had both positive and negative impacts on the family food choices they made, the strategies they adopted for healthy eating and their perceived motivators for healthy eating. The findings of this study underscore the need for a deeper understanding and analysis of uptake of public health messaging related to healthy and unhealthy eating and the importance of targeted promotion of healthful nutrition in this community. Promoting consumption of traditional and locally grown foods can enhance nutrition and food security and combat nutrition transition in the region.

Awareness, use and understanding of nutrition labels among children and youth from six countries: findings from the 2019 - 2020 International Food Policy Study

BACKGROUND

Nutrition facts tables (NFTs) on pre-packaged foods are widely used but poorly understood by consumers. Several countries have implemented front-of-package labels (FOPLs) that provide simpler, easier to use nutrition information. In October 2020, Mexico revised its FOPL regulations to replace industry-based Guideline Daily Amount (GDA) FOPLs with 'Warning' FOPLs, which display stop signs on foods high in nutrients of concern, such as sugar and sodium. This study examined self-reported awareness, use, and understanding of NFTs and FOPLs among young people in six countries with different FOPLs, with an additional focus on changes before and after implementation of Mexico's FOPL warning policy.

METHODS

A 'natural experiment' was conducted using 'pre-post' national surveys in Mexico and five separate comparison countries: countries with no FOPL policy (Canada and the US), countries with voluntary FOPL policies (Traffic Lights in the UK and Health Star Ratings in Australia), and one country (Chile) with mandatory FOPL 'warnings' (like Mexico). Population-based surveys were conducted with 10 to 17-year-olds in 2019 (n = 10,823) and in 2020 (n = 11,713). Logistic regressions examined within- and between-countries changes in self-reported awareness, use, and understanding of NFTs and FOPLs.

RESULTS

Across countries, half to three quarters of respondents reported seeing NFTs 'often' or 'all the time', approximately one quarter reported using NFTs when deciding what to eat or buy, and one third reported NFTs were 'easy to understand', with few changes between 2019 and 2020. In 2020, awareness, use and self-reported understanding of the Warning FOPLs in Mexico were higher than for NFTs in all countries, and compared with GDA FOPLs in Mexico (p < .001). Mandated Warning FOPLs in Mexico and Chile had substantially higher levels of awareness, use, and understanding than the voluntary Traffic Lights in the UK and Health Star Ratings in Australia (p < .001 for all).

CONCLUSIONS

Mandated easy-to-understand FOPLs are associated with substantially greater levels of self-reported awareness, use and understanding at the population-level compared to NFT and GDA-based labeling systems.

Structural responses to the obesity epidemic in Latin America: what are the next steps for food and physical activity policies?

Obesity is among the most complex public health challenges, particularly in Latin America, where obesity rates have increased faster than in any other region. Many countries have proposed or enacted comprehensive policies to promote adequate diet and physical activity under a structural framework. We summarize articles discussing the scope and impact of recently implemented obesity-related interventions in the light of a structural response framework. Overall, we find that: (1) market-based food interventions, including taxes on junk food, nutrition labelling, and marketing restrictions, decrease the consumption of targeted foods, (2) programs directly providing healthy foods are effective in reducing obesity, and (3) the construction of public areas for recreation increases the average frequency of physical activity. Although obesity-related interventions in the region have somewhat improved health behaviours, obesity prevalence remains on an upward trend. We discuss some opportunities to continue tackling the obesity epidemic in LATAM under a structural framework.

Redrawing Cities with Children and Adolescents: Development of a Framework and Opportunity Index for Wellbeing-The REDibuja Study Protocol

Global changes require urgent integration of health and wellbeing into all urban policies. Complex social and environmental factors define wellbeing outcomes and inequities present in cities. Additionally, political decisions are seldom thought and developed considering the needs and participation of children and adolescents. The REDibuja study aims to develop a multidimensional framework of wellbeing for children and adolescents and to validate an index of opportunities for better wellbeing for children and adolescents in the urban context of Temuco, Chile. This child-centered and cross-sectional study will involve mixed methodologies throughout the implementation of five work packages for two years (2022–2023): (1) development of a conceptual framework for child and adolescent wellbeing, (2) integration of available and public data, (3) studies in the local context, (4) data integration using geographic information systems, and (5) validation of the wellbeing opportunity index for children and adolescents. REDibuja will implement methodologies that until now are little used to facilitate political decisions in our regional context. This process and results could be transferred for assessment and decision-making in Latin America and low- and middle-income countries in other regions.

Why Don’t You [Government] Help Us Make Healthier Foods More Affordable Instead of Bombarding Us with Labels? Maternal Knowledge, Perceptions, and Practices after Full Implementation of the Chilean Food Labelling Law

Experimental and real-life evaluations show that the use of front-of-package warning labels (FoP) in unhealthy foods is well understood and can modify people’s behaviors. However, it is unclear whether these effects remain in the long term because of the risk of message fatigue. The purpose of this study is to explore after four years of implementation of the Chilean Food Labelling law people’s dietary behavior and FoP labels attention. Nine focus groups of mothers (7–10 people each) of children (2–14 yo) were conducted in Santiago, Chile, and macrocodes were developed, combining an iterative process of deductive and inductive thematic analyses. We found that mothers experienced labels’ fatigue but also had greater knowledge about nutrition and appreciation for more natural foods. This greater knowledge about better nutrition interferes with the perception that healthier and less processed foods are financial and physically inaccessible. The key role of schools as an environment for promoting healthier diets in children was strengthened by the mothers. These results suggest that policies based on providing consumer information need reinforcement campaigns to maintain their effectiveness and that we also need to advance policies to improve access and affordability of healthy foods to ensure better diets.

Migration as a determinant of childhood obesity in the United States and Latin America

International migration has economic and health implications. The acculturation process to the host country may be linked to childhood obesity. We use the Community Energy Balance (CEB) framework to analyze the relationship between migration and childhood obesity in Mexican households with international migrants. Using longitudinal data from the Mexican Family Life Survey (MxFLS), we examine how migrant networks affect childhood obesity in origin communities. We also review binational health programs that could be effective at tackling childhood obesity in migrant households from Mexico. Children embedded in migrant networks are at greater risk of developing overweight or obesity, suggesting a significant relationship between childhood obesity and international migration in Mexican households. Based on our search criteria, our analysis of health outreach programs shows that Ventanillas de Salud (VDS)/Health Windows has great promise to prevent childhood obesity in a culturally sensitive and trustful environment. The CEB framework is useful to understand how migration contributes to the risk of childhood overweight and obesity in migrant households. VDS is a feasible and replicable strategy with great potential to address childhood obesity among migrant families accounting for the dynamic and binational determinants of childhood obesity.

Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States

The food environment is a major contributor to unhealthy diets in children and, therefore, to the increasing rates of obesity. Acclaimed by scholars across the world, Latin American countries have been leaders in implementing policies that target different aspects of the food environment. Evidence on the nature and to what extent children are exposed and respond to unhealthy food environments in the region and among Latinos in the United States is, however, deficient. The objective of this review is to use the integrated International Network for Food and Obesity/noncommunicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) framework to create healthy food environment to (i) compare the key elements of childhood obesity-related food environments in Latin America and for Latinos living in the United States; (ii) describe the evidence on solutions to improve childhood obesity-related food environments; and (iii) identify research priorities to inform solutions to fight childhood obesity in these populations. We found that an integrated body of evidence is needed to inform an optimal package of policies to improve food environments to which children in Latin America and Latino children in the United States are exposed and more efficiently translate policy solutions to help curb growing childhood obesity levels across borders.

Measurement challenges for childhood obesity research within and between Latin America and the United States

Childhood obesity is a major public health challenge across Latin America and the United States. Addressing childhood obesity depends on valid, reliable, and culturally sensitive measurements. Such progress within and between countries of the Americas could be enhanced through better measurement across different age groups, different countries, and in sending and receiving communities. Additionally, better and more comparable measurements could accelerate cross-border collaboration and learning. Here, we present (1) frameworks that influenced our perspectives on childhood obesity and measurement needs across the Americas; (2) a summary of resources and guidance available concerning measurement and adaptation of measures for childhood obesity research; and (3) three major areas that present challenges and opportunities for measurement advances related to childhood obesity, including parental behavior, acculturation, and the potential to incorporate ethnographic methods to identify critical factors related to economics and globalization. Progress to reduce childhood obesity across the Americas could be accelerated by further transnational collaboration aimed at improving measurement for better surveillance, intervention development and evaluation, implementation research, and evaluation of natural experiments. Additionally, there is a need to improve training related to measurement and for improving access to valid and reliable measures in Spanish and other languages common in the Americas.