The INFORMAS healthy food environment policy index in Brazil: Benchmarking, current policies, and determining priorities for the future.

INTRODUCTION: Obesity and non-communicable diseases are the most important cause of death and inability in Brazil and worldwide. Public policies are an important strategy to prevent obesity. This study analysed the scope of Brazilian public policies for preventing and controlling obesity using the INFORMAS/Food-EPI protocol. METHODS: The public policies evaluation was conducted based on the INFORMAS/Food-EPI protocol. Experts from academia, civil society, and government assessed the level of implementation of food policies compared with international best practices and proposed new actions to be developed nationally. The protocol consisted of five phases: (1) A comprehensive review of the implementation of food environment-related public policies; (2) validation with experts; (3) comparison of the national actions with the international best practice and due to the level of implementation; (4) list a set of actions to improve the current policies; and (5) evaluation of the actions due to their importance and achievability. RESULTS: Brazilian actions were focused on monitoring, leadership, governance, and resources and financing domains. CONCLUSION: The results will provide elements to support and improve the national policies that aim at the promotion of a healthy food environment and obesity prevention.

Do Brazilian regulatory measures promote sustainable and healthy eating in the school food environment?

BACKGROUND: Regulatory measures regarding food in the school environment aim to promote a healthier food environment in public and private schools. In Brazil, implementing regulations in the school food environment does not occur the same way across states and cities, and no national regulation covers public and private schools. The present study aims to analyze regulatory measures for school food environments in Brazilian states and cities and develop a score to evaluate them. METHODS: A systematic search of the regulatory measures in force and implemented until 2021 was conducted. The score was developed based on the Model Law Project prepared by the Brazilian Institute for Consumer Protection. It considered food and nutrition education actions, restrictions on the sale and distribution of food, a ban or restriction on food advertising and marketing, and points of excellence. These points included regulations that addressed the importance of supervision and social control, laws regulated by decree, the mention of a ban on ultra-processed foods, and whether the regulatory measures covered public and private schools. RESULTS: Sixty-five cities and states regulatory measures in force were found to be evaluated jointly by a federal entity (n = 43). Among the federal entities evaluated, only 13.95% fulfilled the function of promoting sustainable and healthy eating (8-12 points). CONCLUSIONS: Brazilian children and adolescents are exposed to a school food environment with regulations that partially fulfill the function of promoting an adequate, healthy, and sustainable diet. In this sense, it is necessary to improve regulatory measures or to encourage states and cities to develop effective legal provisions that are in line with the food guide for the Brazilian population and with the perspective of a healthy school food environment for the effective promotion of adequate, healthy and sustainable and healthy food in schools.

[Intersectoral approach to obesity prevention and control: the Brazilian experience from 2014 to 2018Enfoque intersectorial para la prevención y el control de la obesidad: la experiencia de Brasil en el período 2014-2018]. / Abordagem intersetorial para prevenção e controle da obesidade: a experiência brasileira de 2014 a 2018.

The present article aims to describe and discuss the actions implemented from 2014 to 2018 at the federal level in the context of the Intersectoral Strategy to Prevent and Control Obesity issued by the Brazilian federal government. The goal of the Intersectoral Strategy is to prevent and control obesity based on six action plans: 1) availability and access to adequate and healthy foods; 2) education, communication, and information; 3) promotion of healthy lifestyles in specific environments/territories; 4) food and nutrition surveillance; 5) comprehensive care for individuals presenting obesity in the health care network; and 6) regulation and control of the quality and harmlessness of food. To gather information, semi-structured questionnaires were submitted to representatives from the ministries of Education, Health, Planning, Citizenship, and Agrarian Development. The actions implemented in the period were described in terms of the six action plans. Positive results were achieved through the shared management model adopted, even though many challenges still remain. The agenda for action proposed in the Intersectoral Strategy is attuned to the Brazilian context, and intersectoral management was still in place until the writing of the present article.

El objetivo del presente artículo es describir las actividades realizadas a nivel federal en el período 2014-2018 dentro del marco de la estrategia intersectorial de prevención y control de la Obesidad, publicada por el Gobierno Federal de Brasil, y hacer algunos comentarios pertinentes. La estrategia tiene por objetivo prevenir y controlar la obesidad y se ha organizado en seis grandes ejes de acción: 1) disponibilidad de alimentos adecuados y saludables y acceso a los mismos; 2) educación, comunicación e información; 3) promoción de estilos de vida saludables en entornos y territorios específicos; 4) vigilancia alimentaria y nutricional; 5) atención integral a la salud de las personas con sobrepeso y obesidad en la red asistencial, y 6) regulación y control de la calidad y la inocuidad de los alimentos. Para recopilar información se enviaron cuestionarios semiestructurados a representantes de los Ministerios de Educación, Salud, Planificación, Ciudadanía y Desarrollo Agrario. Las actividades realizadas se presentan según los ejes de acción de la estrategia. Se lograron resultados positivos a partir del modelo de coordinación adoptado, con gestión compartida, aunque fue preciso superar varios desafíos. El programa de trabajo sobre los ejes de acción propuestos en la estrategia está en consonancia con el contexto brasileño y el modelo intersectorial de gestión permaneció vigente hasta el momento de preparación de este artículo.

A década da nutrição, a política de segurança alimentar e nutricional e as compras públicas da agricultura familiar no Brasil

[RESUMO]. A aprovação da Década da Nutrição (2016 a 2025) pelas Nações Unidas partiu da constatação de que as causas que levam à má nutrição são complexas e multidimensionais – a exemplo da situação de pobreza e extrema pobreza e da falta de acesso a uma dieta diversificada e de qualidade, que respeite os hábitos e as culturas alimentares dos diversos povos e países. No Brasil, a agenda da segurança alimentar e nutricional sempre foi conduzida por uma visão integrada do sistema alimentar, expressa no conceito de “segurança alimentar e nutricional”. O objetivo do presente artigo é descrever como a experiência brasileira na estruturação de uma agenda pública nacional de segurança alimentar e nutricional nas duas últimas décadas dialoga e converge com a concepção de nutrição e sistemas alimentares abordada nos documentos que instituem a Década. Para tanto, são abordados aspectos relativos à governança da segurança alimentar e nutricional no Brasil e o papel dos programas de compras públicas da agricultura familiar, com objetivo de incentivar a produção, a comercialização e o acesso a uma alimentação saudável em nível local e propiciar um sistema alimentar mais saudável.

[ABSTRACT]. The proclamation of the Decade of Action on Nutrition (2016-2025) by the United Nations was prompted by the realization that the causes of malnutrition are complex and multidimensional – as exemplified by situations of poverty and extreme poverty and by the lack of access to a quality, diversified diet that respects the dietary habits and cultures of different peoples and countries. In Brazil, the food and nutrition security agenda has always been guided by an integrated vision of the dietary system, expressed in the concept of “food and nutrition security.” The aim of the present article is to describe how the Brazilian experience structuring a national public agenda on food and nutrition security in the past two decades relates to and converges upon the notion of nutrition and food systems covered in the Decade of Action on Nutrition framework. For that, we discuss aspects relating to the governance of food and nutrition security in Brazil and the role of public purchases from family farming, which are aimed at encouraging production, sales, and access to a healthy diet locally and promoting a healthier food system.

[RESUMEN]. El Decenio de las Naciones Unidas de Acción sobre la Nutrición (2016-2025) se aprobó a raíz de que se comprobó que las causas de la malnutrición son complejas y multidimensionales, lo que ejemplifica lo que sucede con la situación de pobreza y extrema pobreza y la falta de acceso a una alimentación diversificada y de calidad, en la cual se respeten los hábitos y las culturas de las diversas sociedades y países. En Brasil, la agenda de seguridad alimentaria y nutricional siempre ha sido impulsada por una visión integrada del sistema alimentario, expresada en el concepto de “seguridad alimentaria y nutricional”. El objetivo del presente artículo es describir cómo se relaciona y converge la experiencia brasileña en la estructuración de una agenda pública nacional de seguridad alimentaria y nutricional en los dos últimos decenios con el concepto de la nutrición y de los sistemas de alimentación abordado en los documentos de creación del Decenio. Para ello, se abordan los aspectos relativos a la gobernanza de la seguridad alimentaria y nutricional en Brasil y el papel de los programas de compras públicas de la agricultura familiar, con el objetivo de incentivar la producción, la comercialización y el acceso a una alimentación saludable a nivel local y de propiciar un sistema de alimentación más saludable.

Abordagem intersetorial para prevenção e controle da obesidade: a experiência brasileira de 2014 a 2018

[RESUMO]. O objetivo do artigo é descrever e comentar as ações implementadas em nível federal, no período de 2014 a 2018, no escopo da Estratégia Intersetorial de Prevenção e Controle da Obesidade, publicada pelo governo federal no Brasil. A Estratégia tem por objetivo prevenir e controlar a obesidade e foi organizada em seis grandes eixos de ação: 1) disponibilidade e acesso a alimentos adequados e saudáveis; 2) educação, comunicação e informação; 3) promoção de modos de vida saudáveis em ambientes específicos/territórios; 4) vigilância alimentar e nutricional, 5) atenção integral à saúde do indivíduo com sobrepeso/obesidade na rede de saúde e 6) regulação e controle da qualidade e inocuidade de alimentos. Para levantamento das informações, questionários semiestruturados foram enviados a representantes dos Ministérios da Educação, Saúde, Planejamento, Cidadania e Desenvolvimento Agrário. As ações implementadas são apresentadas segundo os eixos da Estratégia. Resultados positivos foram alcançados a partir do modelo de coordenação adotado, com gestão compartilhada, ainda que desafios necessitem ser superados. A agenda de ações propostas na Estratégia está alinhada ao contexto brasileiro e o modelo intersetorial de gestão permanece vigente até o período de elaboração do artigo.

[ABSTRACT]. The present article aims to describe and discuss the actions implemented from 2014 to 2018 at the federal level in the context of the Intersectoral Strategy to Prevent and Control Obesity issued by the Brazilian federal government. The goal of the Intersectoral Strategy is to prevent and control obesity based on six action plans: 1) availability and access to adequate and healthy foods; 2) education, communication, and information; 3) promotion of healthy lifestyles in specific environments/territories; 4) food and nutrition surveillance; 5) comprehensive care for individuals presenting obesity in the health care network; and 6) regulation and control of the quality and harmlessness of food. To gather information, semi-structured questionnaires were submitted to representatives from the ministries of Education, Health, Planning, Citizenship, and Agrarian Development. The actions implemented in the period were described in terms of the six action plans. Positive results were achieved through the shared management model adopted, even though many challenges still remain. The agenda for action proposed in the Intersectoral Strategy is attuned to the Brazilian context, and intersectoral management was still in place until the writing of the present article.

[RESUMEN]. El objetivo del presente artículo es describir las actividades realizadas a nivel federal en el período 2014-2018 dentro del marco de la estrategia intersectorial de prevención y control de la Obesidad, publicada por el Gobierno Federal de Brasil, y hacer algunos comentarios pertinentes. La estrategia tiene por objetivo prevenir y controlar la obesidad y se ha organizado en seis grandes ejes de acción: 1) disponibilidad de alimentos adecuados y saludables y acceso a los mismos; 2) educación, comunicación e información; 3) promoción de estilos de vida saludables en entornos y territorios específicos; 4) vigilancia alimentaria y nutricional; 5) atención integral a la salud de las personas con sobrepeso y obesidad en la red asistencial, y 6) regulación y control de la calidad y la inocuidad de los alimentos. Para recopilar información se enviaron cuestionarios semiestructurados a representantes de los Ministerios de Educación, Salud, Planificación, Ciudadanía y Desarrollo Agrario. Las actividades realizadas se presentan según los ejes de acción de la estrategia. Se lograron resultados positivos a partir del modelo de coordinación adoptado, con gestión compartida, aunque fue preciso superar varios desafíos. El programa de trabajo sobre los ejes de acción propuestos en la estrategia está en consonancia con el contexto brasileño y el modelo intersectorial de gestión permaneció vigente hasta el momento de preparación de este artículo.

[The nutrition decade, the public policy for food security, and public purchases from family farming in BrazilEl Decenio de las Naciones Unidas de Acción sobre la Nutrición, la política de seguridad alimentaria y nutricional, y las compras públicas de la agricultura familiar en Brasil]. / A década da nutrição, a política de segurança alimentar e nutricional e as compras públicas da agricultura familiar no Brasil.

The proclamation of the Decade of Action on Nutrition (2016-2025) by the United Nations was prompted by the realization that the causes of malnutrition are complex and multidimensional - as exemplified by situations of poverty and extreme poverty and by the lack of access to a quality, diversified diet that respects the dietary habits and cultures of different peoples and countries. In Brazil, the food and nutrition security agenda has always been guided by an integrated vision of the dietary system, expressed in the concept of "food and nutrition security." The aim of the present article is to describe how the Brazilian experience structuring a national public agenda on food and nutrition security in the past two decades relates to and converges upon the notion of nutrition and food systems covered in the Decade of Action on Nutrition framework. For that, we discuss aspects relating to the governance of food and nutrition security in Brazil and the role of public purchases from family farming, which are aimed at encouraging production, sales, and access to a healthy diet locally and promoting a healthier food system.

El Decenio de las Naciones Unidas de Acción sobre la Nutrición (2016-2025) se aprobó a raíz de que se comprobó que las causas de la malnutrición son complejas y multidimensionales, lo que ejemplifica lo que sucede con la situación de pobreza y extrema pobreza y la falta de acceso a una alimentación diversificada y de calidad, en la cual se respeten los hábitos y las culturas de las diversas sociedades y países. En Brasil, la agenda de seguridad alimentaria y nutricional siempre ha sido impulsada por una visión integrada del sistema alimentario, expresada en el concepto de "seguridad alimentaria y nutricional". El objetivo del presente artículo es describir cómo se relaciona y converge la experiencia brasileña en la estructuración de una agenda pública nacional de seguridad alimentaria y nutricional en los dos últimos decenios con el concepto de la nutrición y de los sistemas de alimentación abordado en los documentos de creación del Decenio. Para ello, se abordan los aspectos relativos a la gobernanza de la seguridad alimentaria y nutricional en Brasil y el papel de los programas de compras públicas de la agricultura familiar, con el objetivo de incentivar la producción, la comercialización y el acceso a una alimentación saludable a nivel local y de propiciar un sistema de alimentación más saludable.

[Malnutrition and obesity in Brazil: dealing with the problem through a unified nutritional agenda]. / A desnutrição e obesidade no Brasil: o enfrentamento com base na agenda única da nutrição.

Brazil, like other developing countries, is currently experiencing a nutritional transition that is often determined by poor eating. Population-based surveys have shown a continuing downward trend in undernutrition in this country, together with increases in excess weight at different stages of life. Monitoring the nutritional profile helps generate an attitude of surveillance and orientation of health promotion activities. The Family Health Strategy, together with various situational aspects in Brazil, has shown tangible results in the reduction of undernutrition; still, poor eating has played a major role in the increased prevalence of obesity and other chronic non-communicable diseases, besides having a heavy impact on individual quality of life and placing a significant burden on the Unified National Health System. Intervening in this contemporary public health dilemma requires prioritizing a unified nutritional agenda focused on the entire course of life, breaking the vicious circle that begins during the intrauterine period and lasts throughout life.

A desnutrição e obesidade no Brasil: o enfrentamento com base na agenda única da nutrição / Malnutrition and obesity in Brazil: dealing with the problem through a unified nutritional agenda

O Brasil, assim como outros países em desenvolvimento, convive atualmente com a transição nutricional, determinada freqüentemente pela má-alimentação. Os inquéritos populacionais mostraram a tendência contínua de redução da desnutrição no país, associada ao aumento do excesso de peso em diferentes fases da vida. O monitoramento do perfil nutricional permite a geração de uma atitude de vigilância e o direcionamento das ações de promoção de saúde. A Estratégia Saúde da Família, em conjunto com diversos aspectos conjunturais do país, mostrou resultados concretos para a redução da desnutrição; contudo, a má-alimentação contribuiu de forma expressiva para o aumento da prevalência de obesidade e de outras doenças crônicas não transmissíveis, que, além de ter grande impacto na qualidade de vida do indivíduo, oneram significativamente o Sistema Único de Saúde. Para atuar nesse dilema da saúde pública contemporânea, é necessário priorizar uma agenda única de nutrição, no enfoque do curso da vida, quebrando um ciclo vicioso que se inicia ainda no período intra-uterino e se perpetua ao longo da vida.

Brazil, like other developing countries, is currently experiencing a nutritional transition that is often determined by poor eating. Population-based surveys have shown a continuing downward trend in undernutrition in this country, together with increases in excess weight at different stages of life. Monitoring the nutritional profile helps generate an attitude of surveillance and orientation of health promotion activities. The Family Health Strategy, together with various situational aspects in Brazil, has shown tangible results in the reduction of undernutrition; still, poor eating has played a major role in the increased prevalence of obesity and other chronic non-communicable diseases, besides having a heavy impact on individual quality of life and placing a significant burden on the Unified National Health System. Intervening in this contemporary public health dilemma requires prioritizing a unified nutritional agenda focused on the entire course of life, breaking the vicious circle that begins during the intrauterine period and lasts throughout life.