A large number of case studies covering a variety of food policy issues in many different countries are available on the following web site: http://cip.cornell.edu/gfs. Each of the case studies focuses on an important policy issue in a particular country or region. In addition to a description of the policy problem, each case identifies the key policy issues, stakeholder groups and suggests a set of potential policy solutions. The cases are developed for use in teaching and for general information for interested individuals. Each week this blog will feature one of the cases.
Overweight, obesity and related chronic diseases are a very serious and increasingly important health problem in developing countries. The executive summaries of case studies for China and Chile are shown below.
The Nutrition Transition and Obesity in China (Case 3-9) by Fuzhi Cheng
Executive Summary: Before China’s economic reforms of the late 1970s, the typical Chinese diet consisted primarily of grain products and starchy roots, with few animal source foods, caloric sweeteners, or fruits and vegetables. Since the 1980s, Chinese people have experienced drastic changes in their food consumption behavior and nutritional status as a result of rapid economic development, expansion of agricultural production, globalization, urbanization, and technological improvement. These social and economic changes have helped shift the Chinese dietary structure toward increased consumption of energy-dense foods that are high in fat, particularly saturated fat, and low in carbohydrates. Dietary changes have been accompanied by a decline in energy expenditure associated with sedentary lifestyles, motorized transportation, labor-saving devices at home and at work, and physically undemanding leisure activities.
Along with the nutritional transition in China has come a rising epidemic of overweight and obesity among adults and adolescents, as well as widespread diet-related, noncommunicable diseases (DR-NCDs) including cardiovascular diseases, diabetes, and certain forms of cancer. The DR-NCDs are currently the leading causes of death, and mortality rates are projected to increase in the future. Obesity and related chronic diseases create large adverse impacts on individuals, families, communities, and the country as a whole and are China’s primary public health concerns.
Recognizing that obesity and associated diseases are both individual and social problems, China has pursued a set of integrated, multisectoral, and population-based policies. The National Plan of Action for Nutrition in China serves as an overarching framework for setting food-based policies related to the country’s nutrition and health issues. Specific polices range from promoting healthy diets and lifestyles to providing incentives to healthy food growers. In addition to food-based policies, China is implementing intensive disease prevention and control programs to address clinical aspects of obesity-related diseases.
Despite these efforts, the country still faces complex food and nutrition issues that are at the core of its economic and social development. Broad-based nutrition programs are still missing owing to the lack of funding for nutritional activities and a lack of institutions to coordinate and manage nutrition interventions. Food policies, including those designed to affect the relative prices of unhealthy foods, remain questionable because it is often difficult to identify certain foods as “unhealthy”. The coexistence of underweight, micronutrient-deficient, and overweight populations further complicates the situation. Given that large pockets of poverty exist, special care must be taken to avoid increasing the likelihood of underweight and micronutrient deficiency among the population as a result of policy changes to cope with overweight and obesity. It is increasingly important that policies focusing on healthy diets and physical activities will lead to optimal health outcomes.
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The Nutrition Transition in Chile (Case 3-10) by Fernando Vio del Rio
Executive Summary: The nutrition transition in Chile has occurred very rapidly. In particular, obesity rates in all age groups have increased instead of decreasing, despite the goals established by the Ministry of Health (MOH) for the period 2000–2010.
Data on the nutritional status of the Chilean population from different sources, such as the National Board for Day Care Centers (JUNJI), the National Board for School Assistance and Scholarships (JUNAEB), and the MOH, show that obesity increased significantly during the 1980s and presently constitutes the main nutritional problem of the population. In preschool children who attend day care centers belonging to JUNJI, the prevalence of obesity is 10.6 percent; this figure varies according to age: in 2- to 3-year-olds it is 6 percent; in 3- to 4-year-olds, 11 percent; and in 4- to 5-year-olds, 14 percent. Among first-grade schoolchildren, for which JUNAEB has collected yearly data since 1987, obesity prevalence is currently 18.5 percent. In pregnant women obesity has also increased markedly, from 12 percent in 1987 to 32.6 percent in 2004. For adults, the 2003 National Health Survey of the MOH showed that there is a 22 percent prevalence of obesity (body mass index [BMI] > 30) and a 1.3 percent prevalence of morbid obesity (BMI > 40). Obesity varies according to gender and educational level; it is higher among women (25 percent compared with 19 percent in men) and among adults from low socioeconomic levels.
In the year 2000 the MOH established sanitary goals for the decade 2000–2010, aiming to reduce obesity prevalence in preschool children attending JUNJI centers from 10 to 7 percent and in first-grade schoolchildren from 16 to 12 percent. For pregnant women, the goal was to reduce the prevalence from 32 to 28 percent.
Epidemiological and nutrition changes in Chile were so rapid that maternal and child policies were not changed successfully to address these changes until 1998, when the National Board for Health Promotion was created. This commission introduced a strong health promotion policy to cope with the increasing obesity in the country. Nonetheless, although the policy was well designed—it followed a decentralized model for regions and counties, it focused on the main risk factors for chronic diseases, it had well-trained human resources, and it changed food programs to cope with obesity instead of undernutrition—obesity has continued increasing. The main reason for this failure appears to be a lack of political commitment to making obesity prevention a high priority for funding and regulation.
A clear, high-priority strategy to prevent obesity is necessary at the national level. It will require the participation of schools and preschools at the county level. It will also require involvement by both the government and the private sector. The government must enact laws and regulations against the marketing of unhealthy food practices by the food industry and promote physical activity at all levels of society. The private sector will need to compromise on issues related to agricultural production that affect cost of high-calorie foods. Without such a strategy, Chile will not accomplish its goals for the year 2010.