Co-creating obesity prevention policies with youth: Policy ideas generated through the CO-CREATE project.

Despite growing recognition of the importance of applying a systems lens to action on obesity, there has only been limited analysis of the extent to which this lens has actually been applied. The CO-CREATE project used a youth-led participatory action research approach to generate policy ideas towards the reduction of adolescent overweight and obesity across Europe. In order to assess the extent to which these youth-generated policy ideas take a systems approach, we analyzed them using the Intervention Level Framework (ILF). The ILF ascribes actions to one of five system levels, from Structural Elements, the least engaged with system change, up to Paradigm, which is the system's deepest held beliefs and thus the most difficult level at which to intervene. Of the 106 policy ideas generated by young people during the CO-CREATE project, 91 (86%) were categorized at the level of Structural Elements. This emphasis on operational rather than systems level responses echoes findings from a previous study on obesity strategies. Analyzing the distribution of systems level responses using the ILF has the potential to support more effective action on obesity by allowing identification of opportunities to strengthen systems level responses overall.

Overweight and obesity prevention for and with adolescents: The "Confronting obesity: Co-creating policy with youth" (CO-CREATE) project.

The CO-CREATE project focuses on the need for research on obesity prevention in adolescents to move away from studies of single interventions, toward the investigation of systems-based research incorporating youth involvement. This paper provides an overview of the project, presenting the objectives, design, and novel methodologies applied, as well as findings to date and anticipated outcomes. Adolescents (16-18 years old) in five European countries participated. Methods applied in the project include monitoring and benchmarking of policies, systematic literature reviews, epidemiological surveillance, linking observed overweight and obesity trends to observed policy landscapes, group model building to identify perceived drivers of obesity, alliance building with adolescents, dialog with stakeholders, and system dynamics modelling to explore the potential impact of policy options. Outcomes include tools for developing policy ideas and investigation of prevention strategies with adolescents, including policy databases, system maps of drivers of obesity, protocols for organizing youth alliances, an intergenerational policy dialog tool, and system dynamic models exploring the impacts of cocreated policy ideas. These outcomes make an important contribution to building a pan-European infrastructure for designing and evaluating policies and for providing youth with the opportunity to make their voices heard in the development and implementation of obesity prevention measures.

Pilot test of the NOURISHING policy index-Assessing governmental nutrition policies in five European countries.

The NOURISHING database is a repository of more than 1000 verified nutrition and diet-related governmental policy actions currently in effect globally. The database is a unique and rich data source on governmental policy actions with a potential for developing tools that capture the overall policy efforts in a country, identify policy gaps, and enable cross-national comparisons. Policy actions from a sample of five European countries have been benchmarked against aspirational standards using the NOURISHING benchmarking tool. This paper presents the results of the pilot testing from the benchmarking process for the construction of the NOURISHING policy index. The development of the index was guided by existing tools for developing composite indicators. The findings from the pilot test indicate that the NOURISHING policy index can identify both policy gaps and cross-national policy differences. These results demonstrate that the policy index merits testing on a larger sample to identify potential refinements.

Youth engagement in research and policy: The CO-CREATE framework to optimize power balance and mitigate risks of conflicts of interest.

Including youth in the co-creation of policies that affect them has proven to be particularly impactful in public health. Using youth participatory action research methods, the CO-CREATE project engages European youth 16-18 years old in the co-creation of obesity prevention policies. To discuss the feasibility and implications of the policy, youth are invited to engage in an intergenerational dialogue. Given the youth-adult dynamic and policy discussion, conflicts of interests (COIs) can arise and impact the quality of the dialogue. COI frameworks are a tool that can help identify, mitigate, and address COIs. This paper presents a novel framework to mitigate COIs in intergenerational policy dialogues, with a focus on power imbalance. Following a series of youth consultations, interviews, and examination of existing frameworks, our findings suggest that safe, participatory, and empowering dialogues can take place if appropriate measures are integrated into all phases of a dialogue. The selection of stakeholders, use of accessible language, and youth moderation are all factors that can impact COI risks. Measures that promote mutual empowerment, such as equal representation of youth and adults, were deemed important. This framework provides a roadmap to ensure that youth participation in the formulation of policies is safe and empowering.

A collective call to strengthen monitoring and evaluation efforts to support healthy and sustainable food systems: 'The Accountability Pact'.

There is widespread agreement among experts that a fundamental reorientation of global, regional, national and local food systems is needed to achieve the UN Sustainable Development Goals Agenda and address the linked challenges of undernutrition, obesity and climate change described as the Global Syndemic. Recognising the urgency of this imperative, a wide range of global stakeholders - governments, civil society, academia, agri-food industry, business leaders and donors - convened at the September 2021 UN Food Systems Summit to coordinate numerous statements, commitments and declarations for action to transform food systems. As the dust settles, how will they be pieced together, how will governments and food corporations be held to account and by whom? New data, analytical methods and global coalitions have created an opportunity and a need for those working in food systems monitoring to scale up and connect their efforts in order to inform and strengthen accountability actions for food systems. To this end, we present - and encourage stakeholders to join or support - an Accountability Pact to catalyse an evidence-informed transformation of current food systems to promote human and ecological health and wellbeing, social equity and economic prosperity.

Progress achieved in restricting the marketing of high-fat, sugary and salty food and beverage products to children.

In May 2010, 192 Member States endorsed Resolution WHA63.14 to restrict the marketing of food and non-alcoholic beverage products high in saturated fats, trans fatty acids, free sugars and/or salt to children and adolescents globally. We examined the actions taken between 2010 and early 2016 - by civil society groups, the World Health Organization (WHO) and its regional offices, other United Nations (UN) organizations, philanthropic institutions and transnational industries - to help decrease the prevalence of obesity and diet-related noncommunicable diseases among young people. By providing relevant technical and policy guidance and tools to Member States, WHO and other UN organizations have helped protect young people from the marketing of branded food and beverage products that are high in fat, sugar and/or salt. The progress achieved by the other actors we investigated appears variable and generally less robust. We suggest that the progress being made towards the full implementation of Resolution WHA63.14 would be accelerated by further restrictions on the marketing of unhealthy food and beverage products and by investing in the promotion of nutrient-dense products. This should help young people meet government-recommended dietary targets. Any effective strategies and actions should align with the goal of WHO to reduce premature mortality from noncommunicable diseases by 25% by 2025 and the aim of the UN to ensure healthy lives for all by 2030.

En mai 2010, 192 États membres ont ratifié la Résolution WHA63.14 pour restreindre, à l'échelle internationale, la commercialisation des produits alimentaires et boissons non alcoolisées riches en graisses saturées, en acides gras trans, en sucres libres et/ou en sel, destinés aux enfants et aux adolescents. Nous avons étudié des initiatives d'organisations de la société civile, de l'Organisation mondiale de la Santé (OMS) et de ses bureaux régionaux, d'autres agences de l'Organisation des Nations unies (ONU), d'institutions philanthropiques et de groupes industriels internationaux, menées entre 2010 et début 2016 en vue d'aider à réduire la prévalence de l'obésité et des maladies non transmissibles liées à l'alimentation chez les jeunes. En fournissant aux États membres des outils et des conseils utiles en matière technique et pour l'adoption de mesures politiques, l'OMS et d'autres agences de l'ONU ont contribué à protéger les jeunes face à la commercialisation d'aliments et de boissons de marques, riches en graisses, en sucre et/ou en sel. Les résultats obtenus grâce aux initiatives des autres acteurs étudiés semblent variables et généralement moins solides. Nous suggérons d'accélérer les progrès accomplis vers la mise en œuvre complète de la Résolution WHA63.14, en restreignant davantage la commercialisation des aliments et boissons mauvais pour la santé et en investissant dans la promotion de produits denses sur le plan nutritionnel. Cela permettrait d'aider les jeunes à atteindre les objectifs nutritionnels recommandés par les gouvernements. Pour être efficaces, les stratégies et mesures adoptées doivent être cohérentes avec l'objectif de l'OMS visant à réduire la mortalité prématurée due aux maladies non transmissibles de 25% d'ici 2025 et avec l'objectif de l'ONU visant à permettre à tous de vivre en bonne santé d'ici 2030.

En mayo de 2010, 192 Estados Miembros aprobaron la Resolución WHA63.14 para limitar la promoción de alimentos y bebidas no alcohólicas con elevadas cantidades de grasas saturadas, ácidos grasos trans, azúcares libres y/o sal dirigida a los niños y adolescentes de todo el mundo. Se examinaron las medidas tomadas entre 2010 y principios de 2016 por parte de grupos de la sociedad civil, la Organización Mundial de la Salud (OMS) y sus sedes regionales, otras organizaciones de las Naciones Unidas, instituciones filantrópicas e industrias transnacionales para contribuir a la reducción de la prevalencia de la obesidad y enfermedades no contagiosas relacionadas con la alimentación entre los jóvenes. Mediante las directrices y herramientas políticas y técnicas correspondientes ofrecidas a los Estados Miembros, la OMS y otras organizaciones de las Naciones Unidas han ayudado a proteger a los jóvenes de la promoción de productos alimentarios y bebidas de marca con elevadas cantidades de grasa, azúcar y/o sal. Los progresos realizados por los otros participantes investigados parecen ser desiguales y, en general, menos sólidos. Nuestra sugerencia es que el progreso hacia la implementación completa de la Resolución WHA63.14 se acelere limitando aún más la promoción de productos alimentarios y bebidas insanos y se invierta en la promoción de productos altamente nutritivos. Esto debería ayudar a los jóvenes a alcanzar los objetivos nutricionales recomendados por los gobiernos. Todas las estrategias y medidas eficaces deberían ajustarse a la meta de la OMS de reducir la mortalidad prematura provocada por enfermedades no contagiosas en un 25% en 2015 y el objetivo de las Naciones Unidas de garantizar una vida sana para todos en 2030.

Reflecting on ICN2: was it a game changer?

At the Second International Conference on Nutrition (ICN2), November 2014, 170 member states endorsed the Rome Declaration on Nutrition and a Framework for Action. The Rome Declaration committed to ending malnutrition in all its forms while the Framework for Action offered 60 voluntary actions to help achieve this. These documents and ICN2 itself had the potential to be a major step forward for public health nutrition, addressing issues associated with today's complex food system. This article reviews ICN2, its process, outputs and some of the gaps and weaknesses of the documents. ICN2's legacy can be interpreted in two ways-a missed opportunity or one of broad aspirations which have yet to translate into meaningful action. The paper considers whether ICN2 could have adopted a more ecological approach to diet and nutrition, linking health and sustainability. While this fits the evidence, it would require a strong commitment to coherence and food system change, almost certainly a firm stance on some food corporate power, and resolve to champion health at the heart of economic policy. This ambitious agenda would require specific multi-actor and multi-level action, together with metrics and mechanisms for accountability. Coherent government policies and actions to tackle all manifestations of inappropriate diet, and to reframe the economic forces which shape such diets are urgently required. To achieve this, the public health movement needs to work closely with civil society, yet ICN2 showed that there is some reluctance to energise that combination. As a result, ICN2 must be judged a missed opportunity, despite having useful aspirations.

Symposium report: the prevention of obesity and NCDs: challenges and opportunities for governments.

This paper is written as a briefing document with the aim of providing support to policy-makers and government officials tackling obesity and related non-communicable diseases. It is based on a symposium Obesity and non-communicable diseases: Learning from international experiences convened by the International Association for the Study of Obesity (now the World Obesity Federation) and its policy section, the International Obesity TaskForce (now World Obesity - Policy and Prevention). The symposium discussed a wide range of proposals to tackle the consumption of unhealthy food products, including interventions in the market through fiscal policies and marketing restrictions, measures to strengthen public health legislation and measures to limit agri-food company lobbying activities. It recognized the need for government leadership and action in order to reduce preventable deaths while improving economic performance and identified a need for governments to take a systems wide approach to tackling obesity and to work with civil society, especially to monitor the drivers of disease and to hold all stakeholders accountable for progress.

Surveys of the salt content in UK bread: progress made and further reductions possible.

OBJECTIVES: To explore the salt reductions made over time in packaged bread sold in the UK, the biggest contributor of salt to the UK diet. STUDY DESIGN: Cross-sectional surveys were carried out on the salt content of breads available in UK supermarkets in 2001(40 products), 2006 (138) and 2011 (203). MAIN OUTCOME MEASURES: The primary outcome measure was the change in salt content per 100 g over time. Further measures included the proportion of products meeting salt targets and differences between brands and bread types. RESULTS: The average salt level of bread was 1.23±0.19 g/100 g in 2001, 1.05±0.16 in 2006 and 0.98±0.13 in 2011. This shows a reduction in salt/100 g of ≈20% between 2001 and 2011. In the 18 products which were surveyed in all 3 years, there was a significant reduction of 17% (p<0.05). Supermarket own brand bread was found to be lower in salt compared with branded bread (0.95 g/100 g compared with 1.04 g/100 g in 2011). The number of products meeting the 2012 targets increased from 28% in 2001 to 71% in 2011 (p<0.001). CONCLUSIONS: This study shows that the salt content of bread has been progressively reduced over time, contributing to the evidence base that a target-based approach to salt reduction can lead to reductions being made. A wide variation in salt levels was found with many products already meeting the 2012 targets, indicating that further reductions can be made. This requires further progressive lower targets to be set, so that the UK can continue to lead the world in salt reduction and save the maximum number of lives.