Consensus-building around the conceptualisation and implementation of sustainable healthy diets: a foundation for policymakers.

BACKGROUND: Healthy and sustainable diets need to be adopted to reduce the negative impact of food consumption on human and planetary health. Food systems account for a third of greenhouse gas emissions. "Dietary Patterns for Health and Sustainability" is a World Health Organization (WHO) project that aims to build consensus among international food, health, and sustainability experts and policymakers on how to conceptualise healthy and sustainable diets and on the actions and policies that could be implemented in the WHO European Region to promote these diets. METHODS: A qualitative study among European food, health, and sustainability experts and policymakers to elicit their views on multiple dimensions of food sustainability and health was carried out using a three-phase process, including semi-structured interviews, a Nominal Group Technique, and focus groups during a participatory WHO workshop held in Copenhagen. Thematic analysis was used to analyse the three data sources. RESULTS: The workshop resulted in a shared understanding of the interconnected components of sustainable healthy eating habits. As a result of this understanding, a variety of potential solutions were identified, including actions across different policy domains, tools, strategic guidelines, needs, and pathways for sustainable healthy diets. The pathways included the need for a multi-stakeholder approach, as well as the simultaneous execution of an aligned and coherent mix of policies at the local and national levels. CONCLUSIONS: The prioritised actions should be aimed at helping government policymakers promote sustainable healthy diets and make decisions on improving dietary patterns for citizens' health and wellbeing in line with the United Nations Sustainable Development Goals in the European Region.

Physical Activity, Screen Time, and Sleep Duration of Children Aged 6-9 Years in 25 Countries: An Analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015-2017.

BACKGROUND: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. OBJECTIVES: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). METHOD: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration. RESULTS: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night. CONCLUSIONS: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children.

The Relationship between Written District Policies and School Practices among High-Need Districts in New York State.

BACKGROUND: This study tested the hypothesis that written district wellness policies are associated with higher rates of implementation of nutrition and physical activity practices. METHODS: Written wellness policies and building level practices were assessed for schools (N = 295) within high-need districts (N = 70) in New York State. The relationship between policies and practices was measured using multi-level mixed-effects logistic regressions. RESULTS: Overall, stronger written district policies significantly increase the likelihood of practice implementation in schools. This relationship is strongest for physical education and physical activity items, followed by nutrition standards for competitive foods in middle and high schools. Most elementary schools implemented nutrition practices with or without a policy and there were differences in implementation rates between elementary and middle/high schools. When examined separately, policies were for the most part not significantly associated with implementation of corresponding practices. CONCLUSIONS: Strong and comprehensive written policies are associated with higher rates of practice implementation overall, but the consistency of this relationship varies by policy-practice domain. The newer policy topics areas of school wellness promotion and marketing were less frequently included in written policies. Future research should examine whether districts that strengthen their written policies achieve greater implementation over time.

Improving the Food Environment in Hospitals and Senior Meal Programs.

Most Americans consume more than the recommended daily level of sodium, and tools are needed to assess and improve food practices related to sodium. We describe how the Sodium Practices Assessment Tool (SPAT) was developed and used in 19 hospitals and senior meal facilities in upstate New York. Initial results identified opportunities for improvement in food preparation, presentation, and purchasing practices to reduce sodium consumption. Pre-post comparison results showed significant increases in the use of herbs, spices, unsalted butter, fruits and vegetables, and in the availability of lower-sodium foods. Food service sites can use SPAT to assess sodium practices, inform development of action plans, and measure change over time.