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Phetla MC, Skaal L. Scanning for Obesogenicity of Primary School Environments in Tshwane, Gauteng, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6889. [PMID: 37835158 PMCID: PMC10572655 DOI: 10.3390/ijerph20196889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
The purpose of this study was to scan for the obesogenicity of primary school environments in Tshwane, Gauteng, South Africa. This study was carried out in ten public primary schools in the Tshwane West district of the Gauteng province. An observational design was used to collect the data. Data collection was conducted using an observational checklist guided by the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The findings revealed that although a nutrition policy was available in most schools, few schools were communicating the policy. Despite all the schools having sports fields, children were not exercising. Most schools also had a school nutrition programme. Most primary schoolchildren's lunchboxes contained sweets, sugar-sweetened beverages, and snacks. A few lunchboxes contained fruits and vegetables. Primary schools in Tshwane West did not comply with most aspects of the school mapping environment, indicating that the school environments were obesogenic. It is therefore essential to scan for obesogenicity in all South African schools so that tailor-made interventions can be implemented to rectify and further prevent obesogenic school environments.
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Affiliation(s)
- Morentho Cornelia Phetla
- Department of Human Nutrition & Dietetics, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa
| | - Linda Skaal
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa;
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Wang L, Cohen JF, Maroney M, Cudhea F, Hill A, Schwartz C, Lurie P, Mozaffarian D. Evaluation of health and economic effects of United States school meal standards consistent with the 2020-2025 dietary guidelines for Americans. Am J Clin Nutr 2023; 118:605-613. [PMID: 37527964 PMCID: PMC10550836 DOI: 10.1016/j.ajcnut.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/10/2023] [Accepted: 05/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The current school meal nutrition standards, established in 2010, are not fully aligned with the 2020-2025 Dietary Guideline for Americans (DGA). This study evaluates the potential short-term and long-term health and economic benefits of strengthening the school meal standards on added sugars, sodium, and whole grains to be aligned with current guidelines. METHODS We used comparative risk assessment frameworks based on nationally representative data incorporating current demographics, dietary habits, and risk factors of United States children aged 5-18 y from 3 cycles of the National Health and Nutrition Examination Survey (2013-2018). To estimate short-term impact, the model incorporated estimated dietary changes owing to potential new DGA-aligned school meal nutrition standards and the effect of these changes on childhood body mass index (in kg/m2) and blood pressure. To estimate long-term impact, the model further incorporated data on the sustainability of childhood dietary changes into adulthood, and on demographics and risk factors of United States adults, diet-disease associations, and disease-specific national mortality. RESULTS In a best-case scenario assuming full school compliance, implementing new DGA-aligned nutritional standards would lower elementary children's BMI by an average 0.14 (95% UI: 0.08-0.20) kg/m2 and systolic blood pressure by 0.13 (95% UI: 0.06-0.19) (95% mm Hg. Later in life, the new standards were estimated to prevent 10,600 [95% uncertainty interval (UI): 4820-16,800) annual deaths from cardiovascular disease (CVD), diabetes, and cancer in adulthood; and save 355,000 (95% UI: 175,000-538,000) disability-adjusted life years and $19.3 (95% UI: 9.35-30.3) B in direct and indirect medical costs each year. Accounting for plausible (incomplete) school compliance, implementation would save an estimated 9110 (95% UI: 2740-15,100) deaths, 302,000 (95% UI: 120,000-479,000) disability-adjusted life years, and $15.9 (95% UI: 4.54-27.2) B in healthcare-related costs per year in later adulthood. CONCLUSIONS Stronger school meal nutrition standards on added sugars, sodium, and whole grains aligned with the 2020-2025 DGA recommendations may improve diet, childhood health, and future adult burdens of CVD, diabetes, cancer, and associated economic costs.
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Affiliation(s)
- Lu Wang
- Friedman School of Nutrition Science and Policy, Boston, MA, United States
| | - Juliana Fw Cohen
- Department of Health Sciences, Merrimack College, North Andover, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Meghan Maroney
- Center for Science in the Public Interest, Washington, DC, United States
| | - Fredrick Cudhea
- Friedman School of Nutrition Science and Policy, Boston, MA, United States
| | - Alla Hill
- Center for Science in the Public Interest, Washington, DC, United States
| | - Colin Schwartz
- Center for Science in the Public Interest, Washington, DC, United States
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, DC, United States
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Boston, MA, United States; Division of Cardiology, Tufts Medical Center, Boston, MA, United States.
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O'Hearn M, Lara-Castor L, Cudhea F, Miller V, Reedy J, Shi P, Zhang J, Wong JB, Economos CD, Micha R, Mozaffarian D. Incident type 2 diabetes attributable to suboptimal diet in 184 countries. Nat Med 2023; 29:982-995. [PMID: 37069363 PMCID: PMC10115653 DOI: 10.1038/s41591-023-02278-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/28/2023] [Indexed: 04/19/2023]
Abstract
The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8-14.4 million) incident T2D cases, representing 70.3% (68.8-71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0-27.1%)), excess refined rice and wheat intake (24.6% (22.3-27.2%)) and excess processed meat intake (20.3% (18.3-23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4-87.7%)) and Latin America and the Caribbean (81.8% (80.1-83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1-60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.
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Affiliation(s)
- Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Food Systems for the Future Institute, Chicago, IL, USA.
| | - Laura Lara-Castor
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Victoria Miller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Julia Reedy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jianyi Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - John B Wong
- Tufts University School of Medicine, Boston, MA, USA
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Food Science and Nutrition, University of Thessaly, Volos, Greece
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Tufts University School of Medicine, Boston, MA, USA.
- Department of Medicine, Tufts Medical Center, Boston, MA, USA.
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Smith NR, Grummon AH, Ng SW, Wright ST, Frerichs L. Simulation models of sugary drink policies: A scoping review. PLoS One 2022; 17:e0275270. [PMID: 36191026 PMCID: PMC9529101 DOI: 10.1371/journal.pone.0275270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Simulation modeling methods are an increasingly common tool for projecting the potential health effects of policies to decrease sugar-sweetened beverage (SSB) intake. However, it remains unknown which SSB policies are understudied and how simulation modeling methods could be improved. To inform next steps, we conducted a scoping review to characterize the (1) policies considered and (2) major characteristics of SSB simulation models. METHODS We systematically searched 7 electronic databases in 2020, updated in 2021. Two investigators independently screened articles to identify peer-reviewed research using simulation modeling to project the impact of SSB policies on health outcomes. One investigator extracted information about policies considered and key characteristics of models from the full text of included articles. Data were analyzed in 2021-22. RESULTS Sixty-one articles were included. Of these, 50 simulated at least one tax policy, most often an ad valorem tax (e.g., 20% tax, n = 25) or volumetric tax (e.g., 1 cent-per-fluid-ounce tax, n = 23). Non-tax policies examined included bans on SSB purchases (n = 5), mandatory reformulation (n = 3), warning labels (n = 2), and portion size policies (n = 2). Policies were typically modeled in populations accounting for age and gender or sex attributes. Most studies focused on weight-related outcomes (n = 54), used cohort, lifetable, or microsimulation modeling methods (n = 34), conducted sensitivity or uncertainty analyses (n = 56), and included supplementary materials (n = 54). Few studies included stakeholders at any point in their process (n = 9) or provided replication code/data (n = 8). DISCUSSION Most simulation modeling of SSB policies has focused on tax policies and has been limited in its exploration of heterogenous impacts across population groups. Future research would benefit from refined policy and implementation scenario specifications, thorough assessments of the equity impacts of policies using established methods, and standardized reporting to improve transparency and consistency.
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Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States of America
- Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah Towner Wright
- Health Sciences Library, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
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Livingston AS, Cudhea F, Wang L, Steele EM, Du M, Wang YC, Pomeranz J, Mozaffarian D, Zhang FF. Effect of reducing ultraprocessed food consumption on obesity among US children and adolescents aged 7-18 years: evidence from a simulation model. BMJ Nutr Prev Health 2022; 4:397-404. [PMID: 35028511 PMCID: PMC8718854 DOI: 10.1136/bmjnph-2021-000303] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Children and adolescents in the USA consume large amounts of daily calories from ultraprocessed foods (UPFs). Recent evidence links UPF consumption to increased body fat in youth. We aimed to estimate the potential impact of reducing UPF consumption on childhood obesity rate in the USA. METHODS We developed a microsimulation model to project the effect of reducing UPF consumption in children's diet on reducing the prevalence of overweight or obesity among US youth. The model incorporated nationally representative data on body mass index (BMI) percentile and dietary intake of 5804 children and adolescents aged 7-18 years from the National Health and Nutrition Examination Survey 2011-2016, and the effect of reducing UPF consumption on calorie intake from a recent randomised controlled trial. Uncertainties of model inputs were incorporated using probabilistic sensitivity analysis with 1000 simulations. RESULTS Reducing UPFs in children's diet was estimated to result in a median of -2.09 kg/m2 (95% uncertainty interval -3.21 to -0.80) reduction in BMI among children and adolescents aged 7-18 years. The median prevalence of overweight (BMI percentile ≥85th) and obesity (BMI percentile ≥95th percentile) was reduced from 37.0% (35.9%, 38.1%) to 20.9% (15.1%, 29.9%) and from 20.1% (19.2%, 21.0%) to 11.0% (7.86%, 15.8%), respectively. Larger BMI and weight reductions were seen among boys than girls, adolescents than children, non-Hispanic black and Hispanic youth than non-Hispanic white youth, and those with lower levels of parental education and family income. CONCLUSIONS Reducing UPF consumption in children's diet has the potential to substantially reduce childhood obesity rate among children and adolescents in the USA.
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Affiliation(s)
- Anne Scott Livingston
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Lu Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.,Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Y Claire Wang
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jennifer Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,Tufts Institute for Global Obesity Research, Boston, Massachusetts, USA
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Liu CH, Chang FC, Niu YZ, Liao LL, Chang YJ, Liao Y, Shih SF. Students' perceptions of school sugar-free, food and exercise environments enhance healthy eating and physical activity. Public Health Nutr 2021; 25:1-9. [PMID: 34933694 PMCID: PMC9991674 DOI: 10.1017/s1368980021004961] [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] [Received: 02/25/2021] [Revised: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study was to examine the relationships between students' perceptions of their school policies and environments (i.e. sugar-sweetened beverages (SSB) free policy, plain water drinking, vegetables and fruit eating campaign, outdoor physical activity initiative, and the SH150 programme (exercise 150 min/week at school)) and their dietary behaviours and physical activity. DESIGN Cross-sectional study. SETTING Primary, middle and high schools in Taiwan. PARTICIPANTS A nationally representative sample of 2433 primary school (5th-6th grade) students, 3212 middle school students and 2829 high school students completed the online survey in 2018. RESULTS Multivariate analysis results showed that after controlling for school level, gender and age, the students' perceptions of school sugar-free policies were negatively associated with the consumption of SSB and positively associated with consumption of plain water. Schools' campaigns promoting the eating of vegetables and fruit were positively associated with students' consumption of vegetables. In addition, schools' initiatives promoting outdoor physical activity and the SH150 programme were positively associated with students' engagement in outdoor physical activities and daily moderate-to-vigorous physical activity. CONCLUSIONS Students' perceptions of healthy school policies and environments promote healthy eating and an increase in physical activity for students.
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Affiliation(s)
- Chieh-Hsing Liu
- Department of Health Promotion and Health Education, National Taiwan Normal University, 162, Ho-Ping E. Rd., Sec.1, Taipei10610, Taiwan
| | - Fong-Ching Chang
- Department of Health Promotion and Health Education, National Taiwan Normal University, 162, Ho-Ping E. Rd., Sec.1, Taipei10610, Taiwan
| | - Yu-Zhen Niu
- Office of Student Affairs, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Li-Ling Liao
- Department of Health Management, I-Shou University, Kaohsiung City, Taiwan
| | - Yen-Jung Chang
- Department of Health Promotion and Health Education, National Taiwan Normal University, 162, Ho-Ping E. Rd., Sec.1, Taipei10610, Taiwan
| | - Yung Liao
- Department of Health Promotion and Health Education, National Taiwan Normal University, 162, Ho-Ping E. Rd., Sec.1, Taipei10610, Taiwan
| | - Shu-Fang Shih
- Department of Health Administration, Virginia Commonwealth University, Richmond, USA
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Sanchez-Vaznaugh EV, Matsuzaki M, Braveman P, Acosta ME, Alexovitz K, Sallis JF, Peterson KE, Sánchez BN. School nutrition laws in the US: do they influence obesity among youth in a racially/ethnically diverse state? Int J Obes (Lond) 2021; 45:2358-2368. [PMID: 34285361 PMCID: PMC8528713 DOI: 10.1038/s41366-021-00900-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/05/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Little is known about the separate or combined effects of state and national nutrition policies regulating food and beverages in schools on child overweight/obesity (OV/OB) and related racial/ethnic disparities. We investigated the influence of school nutrition policies enacted in California, independently and in combination with the United States' national policy "Healthy Hunger Free Kids Act" (HHFKA) on childhood OV/OB and racial/ethnic disparities. SUBJECTS/METHODS An interrupted time series design was used with data from 12,363,089 child-level records on 5th- and 7th-graders in California public schools to estimate sex- and racial/ethnic-specific time trends in OV/OB prevalence during three periods: before the California nutrition policies (2002-2004); when only California policies were in effect (2005-2012); and when they were in effect simultaneously with HHFKA (2013-2016). RESULTS Before the state's policies, OV/OB prevalence increased annually among children in most subgroups. Improvements in OV/OB trends were observed for almost all groups after the California policies were in effect, with further improvements after the addition of HFFKA. The total change in annual log-odds of OV/OB, comparing the periods with both state and federal policies versus no policies, ranged from -0.08 to -0.01 and varied by grade, sex, and race/ethnicity. Within each sex and grade, the greatest changes were among African-American (-0.08 to -0.02, all p < 0.05) followed by Latino children (-0.06 to -0.01, all p < 0.05). Although disparities narrowed among these groups versus White children after the dual policy period, disparities remained large. CONCLUSIONS State and national nutrition policies for schools may have contributed to containing the upward trend in childhood OV/OB and racial/ethnic OV/OB disparities within California. However, sizable OV/OB prevalence and disparities persist. To end the epidemic, promote healthy weight and increase health equity, future efforts should strengthen state and national policies to improve food quality in schools, particularly those serving populations with the highest OV/OB prevalence.
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Affiliation(s)
- Emma V Sanchez-Vaznaugh
- Department of Public Health, San Francisco State University, San Francisco, CA, USA.
- Center for Health Equity, University of California, San Francisco, CA, USA.
| | - Mika Matsuzaki
- Department of Public Health, San Francisco State University, San Francisco, CA, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paula Braveman
- Center for Health Equity, University of California, San Francisco, CA, USA
| | - Maria Elena Acosta
- Department of Public Health, San Francisco State University, San Francisco, CA, USA
| | - Kelsey Alexovitz
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - James F Sallis
- Division of Behavioral Medicine, Department of Family and Medicine and Public Health, University of California, San Diego, CA, USA
| | - Karen E Peterson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Time trends of overweight and obesity among schoolchildren in Kuwait over a 13-year period (2007-2019): repeated cross-sectional study. Public Health Nutr 2021; 24:5318-5328. [PMID: 34342262 DOI: 10.1017/s1368980021003177] [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: 12/13/2022]
Abstract
OBJECTIVES This study aimed to examine age-specific trends in the prevalence of overweight and obesity in schoolchildren in Kuwait over a 13-year period (2007 to 2019) using the WHO, the Centers for Disease Control and Prevention (CDC) and the International Obesity Taskforce (IOTF) definitions. DESIGN Using cross-sectional approach, Kuwait Nutrition Surveillance System (KNSS) objectively measured weight and height of schoolchildren over a 13-year period. Log-binomial regression models were used to examine age-specific trends of obesity and overweight over the study period. SETTING Public primary, middle and high schools in all provinces of Kuwait. PARTICIPANTS Schoolchildren aged 5-19 years (n 172 603). RESULTS According to the WHO definition, the prevalence of overweight and obesity in schoolchildren, respectively, increased from 17·73 % and 21·37 % in 2007 to 20·19 % and 28·39 % in 2019 (Pfor trend < 0·001). There is evidence that the obesity in females (but not males) has levelled off in the period 2014-2019 according to the three definitions of obesity, which is corroborated by a similar trend in the mean of BMI-for-age Z-score. CONCLUSION The prevalence of obesity and overweight in schoolchildren in Kuwait has risen over the last 13 years and trends are similar across all definitions. Obesity is no longer increasing at the same pace and there is evidence that the prevalence of obesity in females has plateaued. The current level of childhood overweight and obesity is too high and requires community-based and school-based interventions.
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Soares P, Martinelli SS, Davó-Blanes MC, Fabri RK, Clemente-Gómez V, Cavalli SB. Government Policy for the Procurement of Food from Local Family Farming in Brazilian Public Institutions. Foods 2021; 10:1604. [PMID: 34359474 PMCID: PMC8305705 DOI: 10.3390/foods10071604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/20/2022] Open
Abstract
This study aims to explore and compare Brazilian public institutional food services' characteristics concerning the implementation of the government policy for the procurement of food from family farming (FF) and the opinions of food service managers on the benefits and difficulties of its implementation. We conducted a cross-sectional study employing an online questionnaire. The results were stratified by purchase. The Chi-square and Fisher's Exact tests were applied. Five hundred forty-one food services' managers participated in the study. Most claimed to buy food from FF, and this acquisition was more frequent among those working in institutions of municipalities <50,000 inhabitants, and educational and self-managed institutions. Those buying from FF developed more actions to promote healthy and sustainable food. Most recognized that the purchase could boost local farming and the economy and improve the institution's food. However, the managers believe that the productive capacity of FF, the lack of technical assistance to farmers, production seasonality, and the bureaucratic procurement process hinder this type of purchase. The self-management of food services and the small size of the municipality might be associated with implementing the direct purchase policy from FF, which can contribute to building healthier and more sustainable food systems. However, the lack of public management support and the weak productive fabric may pose an obstacle to its maintenance or dissemination. The strengthening and consolidation of these policies require more significant government investments in productive infrastructure for family farming.
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Affiliation(s)
- Panmela Soares
- Nutrition Post-Graduation Programme, Nutrition Department, Universidade Federal de Santa Catarina, Florianópolis 88040-900, Brazil; (P.S.); (S.B.C.)
| | | | - Mari Carmen Davó-Blanes
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
| | - Rafaela Karen Fabri
- Observatory of Studies on Healthy and Sustainable Food, Florianópolis 88040-900, Brazil;
| | | | - Suzi Barletto Cavalli
- Nutrition Post-Graduation Programme, Nutrition Department, Universidade Federal de Santa Catarina, Florianópolis 88040-900, Brazil; (P.S.); (S.B.C.)
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González MÁSJ, Baviera LCB, Moreno-Villares JM. School lunch menus in Spain. A review on recommendations and policy. An Pediatr (Barc) 2021; 95:55.e1-55.e9. [PMID: 34167902 DOI: 10.1016/j.anpede.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community. MATERIAL AND METHODS National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered. RESULTS There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules. CONCLUSIONS The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations.
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San José González MÁ, Blesa Baviera LC, Moreno-Villares JM. [School lunch menus in Spain. A review on recommendations and policy]. An Pediatr (Barc) 2021. [PMID: 33642175 DOI: 10.1016/j.anpedi.2021.01.010] [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: 10/22/2022] Open
Abstract
INTRODUCTION An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community. MATERIAL AND METHODS National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered. RESULTS There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules. CONCLUSIONS The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations.
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Woolf HR, Fair M, King SB, Dunn CG, Kaczynski AT. Exploring Dietary Behavior Differences among Children by Race/Ethnicity and Socioeconomic Status. THE JOURNAL OF SCHOOL HEALTH 2020; 90:658-664. [PMID: 32557667 DOI: 10.1111/josh.12915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 11/19/2019] [Accepted: 03/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In Spartanburg County, SC, nearly 33.7% of children are overweight or obese. The purpose of this study was to investigate differences in eating behavior of youth by race/ethnicity and socioeconomic status. METHODS Students (N = 997) in 4th to 5th grades completed the School Nutrition and Physical Activity Survey. School databases categorized students as either White or racial/ethnic minority and free/reduced or full paid lunch status. Dietary behaviors included 13 composite measures: unhealthy proteins, healthy proteins, dairy, refined grains, whole grains, vegetables, fruit, fried snacks, sugar-sweetened beverages, sweets, and consumption of a breakfast, evening, and/or restaurant meal. Logistic regression, controlling for sex, was used to analyze differences in consumption for each nutrition variable. RESULTS Minority youth were less likely to consume healthy proteins (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.55-0.92) and more likely to eat at a restaurant (OR = 1.32, 95% CI = 1.02-1.70) compared to white youth. Lower socioeconomic status youth were less likely to eat an evening meal compared to higher socioeconomic status youth (OR = 0.59, 95% CI = 0.39-0.89). CONCLUSIONS Differences in dietary behaviors may result from food accessibility and insecurity in minority and/or low-income neighborhoods. Future research should explore policy strategies that can help ensure all youth maintain healthy eating habits and weight status.
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Affiliation(s)
- Hope R Woolf
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29201
| | - Melissa Fair
- Institute for the Advancement of Community Health, Furman University, 3300 Poinsett Hwy, Greenville, SC, 29613
| | - Sarah B King
- Clemson University's Youth Learning Institute, 82 Camp Long Rd., Aiken, SC, 29805
| | - Caroline Glagola Dunn
- Harvard Chan School of Public Health, 677 Huntington Avenue, Kresge 414, Boston, MA, 02115
| | - Andrew T Kaczynski
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 529, Columbia, SC, 29201
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Askelson N, Ryan G, Brady P, Meier CL, Delger P, Scheidel C. Middle School Students' Perceptions of the Lunchroom: Implications for Future Interventions. J Sch Nurs 2020; 38:233-240. [PMID: 32458718 DOI: 10.1177/1059840520928504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The National School Lunch Program provides nutritious and inexpensive lunches, but low participation and food waste are challenges in many schools. Interventions aim to improve participation in the program, but little is known about how students' perceptions affect their participation. This study explored how middle school students in a rural state perceive school food service staff, food served, and lunchroom atmosphere. An online survey was administered to middle school students at six schools participating in a larger lunchroom intervention. Mean perception scores were calculated for all measures. Multilevel logistic regression was used to examine the relationship between perceptions and consumption. Overall perceptions of staff, food, and atmosphere were positive, and students classified as school lunch eaters had more positive perceptions in all three areas than noneaters. Interventions to increase participation in school lunch programs and promote consumption of healthy food items should address multiple factors that contribute to school lunch participation.
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Affiliation(s)
- Natoshia Askelson
- Public Policy Center, College of Public Health, University of Iowa, IA, USA
| | - Grace Ryan
- Public Policy Center, College of Public Health, University of Iowa, IA, USA
| | - Patrick Brady
- Public Policy Center, College of Public Health, University of Iowa, IA, USA
| | | | - Patti Delger
- Iowa Department of Education, Des Moines, IA, USA
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Park E, Lee HY. [Environment Factors Affecting Childhood Obesity: Voices from Students, Parents, and Teachers with Photograph]. J Korean Acad Nurs 2019; 49:254-262. [PMID: 31266922 DOI: 10.4040/jkan.2019.49.3.254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to explore the environmental factors affecting childhood obesity using photovoice from the perspectives of students, parents, and teachers in the community. METHODS Six school students, seven parents, and seven school teachers completed an assignment requiring them to take 24 pictures and participate in group discussions. After training session, the participants were asked to take pictures associated with food and physical activity environments related to childhood obesity at home, school, and within their communities for two weeks and to submit the pictures with records. Each group had four sessions for discussion. RESULTS School cafeteria, convenience stores near schools, instant food and fast food joints, food delivery, and high-calorie snacks comprised the food environmental factors. Lack of physical activity classes at school, commuting by car, barriers to physical activity, and use of smart-phone were environmental factors that inhibited physical activity. CONCLUSION To reduce childhood obesity, the creation of a supportive environment for encouraging the consumption of healthy foods and enhancing physical activity should be considered. Modifications of and improvement to the obesogenic environment might be a good strategy to prevent and reduce childhood obesity.
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Affiliation(s)
- Eunok Park
- College of Nursing, Jeju National University, Jeju, Korea
| | - Hyo Young Lee
- Departmemt of Health Administration, Dongseo University, Busan, Korea.
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Anderson CA, Thorndike AN, Lichtenstein AH, Van Horn L, Kris-Etherton PM, Foraker R, Spees C. Innovation to Create a Healthy and Sustainable Food System: A Science Advisory From the American Heart Association. Circulation 2019; 139:e1025-e1032. [DOI: 10.1161/cir.0000000000000686] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current dietary intakes of North Americans are inconsistent with the
Dietary Guidelines for Americans
. This occurs in the context of a food system that precludes healthy foods as the default choices. To develop a food system that is both healthy and sustainable requires innovation. This science advisory from the American Heart Association describes both innovative approaches to developing a healthy and sustainable food system and the current evidence base for the associations between these approaches and positive changes in dietary behaviors, dietary intakes, and when available, health outcomes. Innovation can occur through policy, private sector, public health, medical, community, or individual-level approaches and could ignite and further public-private partnerships. New product innovations, reformulations, taxes, incentives, product placement/choice architecture, innovative marketing practices, menu and product labeling, worksite wellness initiatives, community campaigns, nutrition prescriptions, mobile health technologies, and gaming offer potential benefits. Some innovations have been observed to increase the purchasing of healthy foods or have increased diversity in food choices, but there remains limited evidence linking these innovations with health outcomes. The demonstration of evidence-based improvements in health outcomes is challenging for any preventive interventions, especially those related to diet, because of competing lifestyle and environmental risk factors that are difficult to quantify. A key next step in creating a healthier and more sustainable food system is to build innovative system-level approaches that improve individual behaviors, strengthen industry and community efforts, and align policies with evidence-based recommendations. To enable healthier food choices and favorably impact cardiovascular health, immediate action is needed to promote favorable innovation at all levels of the food system.
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Franco-Arellano B, Kim MA, Vandevijvere S, Bernstein JT, Labonté MÈ, Mulligan C, L'Abbé MR. Assessment of Packaged Foods and Beverages Carrying Nutrition Marketing against Canada's Food Guide Recommendations. Nutrients 2019; 11:E411. [PMID: 30781351 PMCID: PMC6412409 DOI: 10.3390/nu11020411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 02/07/2023] Open
Abstract
Canadians' food purchases consist largely of packaged processed and ultra-processed products, which typically fall outside the "core" foods recommended by Canada's Food Guide (CFG). Almost half of packaged products in Canada carry nutrition marketing (i.e., nutrient content and health claims). This study assessed whether packaged foods carrying nutrition marketing align with recommendations outlined in the 2007 CFG. Label data (n = 9376) were extracted from the 2013 Food Label Information Program (FLIP). Label components (including nutrition marketing) were classified using the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) labelling taxonomy. The Health Canada Surveillance Tool (HCST) was used to assess the alignment of products to CFG. Each food or beverage was classified into one of five groups (i.e., Tier 1, Tier 2, Tier 3, Tier 4, "Others"). Products in Tier 1, 2 or water were considered "in line with CFG". Most products in the analyzed sample were classified as Tier 2 (35%) and Tier 3 (27%). Although foods with nutrition marketing were significantly more likely to align to CFG recommendations (p < 0.001), many products not "in line with CFG" still carried nutrition marketing. This study provides important baseline data that could be used upon the implementation of the new CFG.
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Affiliation(s)
- Beatriz Franco-Arellano
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Min Ah Kim
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada.
| | - Stefanie Vandevijvere
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland 1010, New Zealand.
| | - Jodi T Bernstein
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Marie-Ève Labonté
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- School of Nutrition & Institute of Nutrition and Functional Foods, Laval University, Québec, QC G1V 0A6, Canada.
| | - Christine Mulligan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Mary R L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
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Fernandez-Jimenez R, Al-Kazaz M, Jaslow R, Carvajal I, Fuster V. Children Present a Window of Opportunity for Promoting Health: JACC Review Topic of the Week. J Am Coll Cardiol 2018; 72:3310-3319. [PMID: 30527619 DOI: 10.1016/j.jacc.2018.10.031] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 01/04/2023]
Abstract
Cardiovascular disease is the leading cause of death and disability in the world, largely because of risk factors modifiable by changes in behavior. There is evolving evidence that our behavior as adults has its roots in the environment that we live in from early childhood. Early sustained multicomponent educational programs focused on health promotion in children may represent a window of opportunity to potentially prevent disease in adulthood. The integration of school-based, family-based, and community-based strategies, along with the support of public policies, are likely necessary for the success of these programs. In this review, the authors describe the future of promoting health. Specifically: 1) reasons why children should be a focus for health promotion (alarming trends of risk factors, association between unhealthy factors and subclinical disease, and cost-effectiveness); 2) strategies for health promotion in children (school-based, family-based, and community-based approaches) along with legislative efforts; and 3) research gaps are discussed.
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Affiliation(s)
- Rodrigo Fernandez-Jimenez
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Mohamed Al-Kazaz
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Risa Jaslow
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Isabel Carvajal
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
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