Technical package on

obesity prevention and

management
Fabio da Silva Gomes
Audrey Morris
Leo Nederveen
Francesca Celletti
Claire Chaumont
Technical Area and description of interventions
Areas of intervention Specific Actions
Implement Code of marketing of breast milk substitutes
Early Food environment
Protect, promote and support breastfeeding.
Physical activity in education Mandate physical education in primary, lower, and upper high school and public education campaign
Reformulate food for older infants and young children.
Reformulation
Mandate limits on sodium and TFA, mandate sugar reformulation policies to bring sugar intake to recommended levels
Implement policies to protect children from the harmful impact of food marketing (including through digital media, and
Food marketing in settings where children gather)
Implementation of the Code
Fiscal policies Tax sugar-sweetened beverages, including all types of beverages containing free sugars
Implement standards and regulations for food served or sold in and around schools
Public food procurement and service Implement standards for food served or sold in food outlets
Implement standards for food served or sold in other public settings (e.g. government offices, workplaces, etc.).
Implement mandatory nutrient declaration in line with CODEX guidelines.
Food labelling Implement front of pack labelling

Public education and awareness
Integrated service delivery
Conduct national public education communication campaigns on physical activity every two years.
Conduct behavior change communication and mass media campaign for healthy diets
Train health professional in essential nutrition action and prevention and management of obesity.
Include obesity management interventions in UHC and primary care benefit plan.
Integration of obesity management health services in all service delivery points as appropriate across the health system
and community
2
Include physical activity education, counselling, and support as intervention of all service delivery packages.

2
Plan Mundial Plan Regional
Medidas de apoyo a las condiciones de alimentación temprana;
1. Atención primaria de salud y promoción de la
integración de los servicios de prevención y gestión de la
obesidad en el nivel de atención primaria de salud con
lactancia materna y la alimentación saludable;
orientación pertinente para los servicios de atención secundaria y
terciaria
2. Mejoramiento del entorno con respecto a la
Políticas escolares sobre alimentación y nutrición (incluidas nutrición y la ac:vidad <sica en los
iniciativas para reglamentar la venta de productos ricos en grasas, establecimientos escolares;
azúcares y sal cerca de las escuelas); normas y reglamentos sobre
medios de transporte activos y actividad física en las escuelas;
Reglamentación que proteja a los niños contra la mercadotecnia 3. Polí:cas fiscales y reglamentación de la
de alimentos y bebidas malsanos; políticas de tributación y publicidad, promoción y e:quetado de
precios orientadas a promover dietas saludables; políticas sobre alimentos;
etiquetado nutricional;
Campañas de educación y concienciación del público;
4. Otras medidas mul:sectoriales;
5. Vigilancia, inves:gación y evaluación.
 PAHO/WHO Technical Package
Content for each area
• Evidence for action
• Considerations for design and
monitoring of the interventions
• Country examples
• Resources: policy briefs and
technical support tools
• What success could look like
Integration and synergies
• Identifying synergies &
commonalities across the
policy cycle among different
areas of intervention
• Alignment and policy
coherence among areas of
interventions
• Development and health
sector plans including fiscal
plans, national dietary
guidelines, incl. FBDG…
4
Early food environment
• AREA : EARLY FOOD ENVIRONMENT

KEY INTERVENTIONS
• Support breastfeeding women
• Restrict marketing of breast-milk substitutes and foods for infants and young children
• Mandate sugar reformulation for complementary foods

Why breastfeeding?
• Horta et al. meta-analysis of 113 studies found 26% reduction in odds of overweight/obesity later in life
• Strongest in 10-19 year olds
• Similar effects by HIC/LMIC, controls for confounding, age of study
• Biological pathways
• Human milk factors affecting growth – choline, insulin, GnRH
• Hormonal responses – ghrelin & leptin
• High protein content of formula
• Child recognition of satiety (passive vs. active suckling, mixing of foremilk & hindmilk, finishing the
bottle)

6
• AREA: EARLY FOOD ENVIRONMENT
• Protection, promotion and support for breastfeeding

BMS
marke5ng

Maternity
Funding protection

Leadership
& advocacy Ten Steps to
Monitoring Successful
Breastfeeding

Community Counselling
networks in health
facilities

7
 • AREA : EARLY FOOD ENVIRONMENT
• Ten Steps to Successful Breastfeeding

GUIDELINE: Protecting, promoting and supporting breastfeeding in

facilities providing maternity and newborn services

IMPLEMENTATION GUIDANCE: Protecting, promoting and supporting

breastfeeding in facilities providing maternity and newborn services

Key messages:
• Ten Steps must be integrated as standard of care for all
newborns
• Facility designation has not been a sustainable strategy
• National responsibility to scale up to universal coverage

BFHI Networks established in 2018 for Latin American Countries and

Caribbean countries

8
• AREA : EARLY FOOD ENVIRONMENT
• Ten Steps to Successful Breastfeeding - TECHNICAL SUPPORT TOOLS

9
• AREA : EARLY FOOD ENVIRONMENT
• Skilled breastfeeding counselling

GUIDELINE: Counselling of women to improve

breastfeeding practices

IMPLEMENTATION GUIDANCE: Counselling women to

improve breastfeeding practices

Key messages:
• All pregnant and lactating women need breastfeeding
counselling
• Minimum of six contact points recommended
(antenatal, perinatal, up to 2 years)

10
• AREA : EARLY FOOD ENVIRONMENT
• Skilled breastfeeding counselling – Technical Support Tools

11
 • AREA : EARLY FOOD ENVIRONMENT
• Marketing of breast-milk substitutes
Resources
Guidelines WHA Resolutions: Code of marketing of breast-
milk substitutes and subsequent relevant WHA
resolutions

Key messages:
• Need to invest in enactment, monitoring,
and enforcement of national laws
• Barriers include political will,
interdepartmental and bureaucratic
constraints, industry interference, and
complexity of marketing
• Marketing affects societal support for
breastfeeding support policies

12
• AREA : EARLY FOOD ENVIRONMENT
• Marketing of breast-milk substitutes

Resources
Frequently Overall FAQs
asked
questions FAQs on The roles and responsibilities of health workers

Technical Model legislation

support tools
Online Code training course
Code NETCODE TOOLKIT: Monitoring the marketing of breast-milk substitutes—
monitoring protocol for ongoing monitoring systems

NETCODE TOOLKIT: Monitoring the marketing of breast-milk substitutes—

protocol for periodic assessment
Recent reports How the marketing of formula milk influences our decisions on infant feeding
Scope and impact of digital marketing strategies for promoting breastmilk
substitutes
Code Status Report 2022

13
 !"#$%&'()*+,-.$*#/0123$412$561786$91:;/12;:<$8:=$ PAHO/WHO

>?@@12/$412$+A@6#A#:/8/;1:$14$/"#$+:/#2:8/;1:86$,1=#$
B*#/,1=#C
• Chile
• Colombia
• Ecuador
• Mexico
• Panama
• Suriname
• Uruguay
https://www.who.int/publications/i/item/978924
https://www.who.int/publications/i/item/97892415 1513494
13180
• AREA : EARLY FOOD ENVIRONMENT
• Foods for infants and young children

Resources
Guidelines GUIDELINE: Guidance on ending inappropriate promotion of foods
for infants and young children

IMPLEMENTATION GUIDANCE: Guidance on ending the

inappropriate promotion of foods for infants and young children

Key messages:
• Nutrient-rich, home-prepared, locally available foods should be
emphasized
• Promotion of commercial complementary foods must be limited by
nutrient profile models and other safety and quality standards
• Conflicts of interest between industry and health system must be
curtailed
Technical Nutrient profile model for commercially available complementary
support foods
tools

15
• AREA : EARLY FOOD ENVIRONMENT
• Where do we stand? Exclusive breastfeeding for the first 6 months: 32.3%
Alignment of national law with Code of Percent of babies born in facilities designated
Marketing of Breast-milk Substitutes, 2022 as “Baby-friendly”

Code Report, 2022 Global Breastfeeding Scorecard, 2022 16

School food, nutrition and physical activity
Plan of Action for the Prevention of Obesity in Children and
Adolescents (2014-2019)
Goal:
To halt the rise of the rapidly growing
obesity epidemic in children and adolescents

Five Strategic Lines of Action:

1. Primary health care and promotion of breastfeeding
and healthy eating.
2. Improvement of school nutrition and
physical activity environments.
3. Fiscal policies and regulation of food marketing
and labelling
4. Other multisectoral actions
5. Surveillance, research, and evaluation

https://www.paho.org/hq/dmdocuments/2015/Obesity-Plan-Of-Action-Child-Eng-2015.pd f
 Schools are a unique platform to improve the health and
nutrition of children

Lifecourse approach
Allow sustainable and
Opportunity to reach institutionalised
out to families and interventions reaching a
communities large number of
children

School feeding Development of

knowledge, attitudes,
programes
life skills and habits at
a critical age

School does not cause hunger, but it can cause

School policy framework

Coordination team

Situation analysis

Work plan and monitor system

Goals and objectives

Dissemination
 Policy options in schools

• School curriculum
• Food services
environment
• Physical environment
• Health promotion for
school staff
• School health services
• Family and community
involvement

Source: http://www.who.int/dietphysicalactivity/SPF-en-2008.pdf?ua=1
 Food services environment

• Nutritional standards for school food

• School food programmes
• Regulations:
• Food service area
• Vending machines and school snack
bars
• Food availability near schools
• Elimination of food and non-alcoholic
beverage marketing
 PAHO/WHO
Components of the policy, programme or school nutrition standard (physical environment)

Facilidades de

Alimentación

Agua potable
alimentación

saneamiento
Prohibición

Facilidades
Estándares

Estándares
para llevar

publicidad
Alimentos
alimentos

alimentos
Programa

Programa
máquinas

cocinar y

verduras

Huertas
frutas y
escolar

agua y
comer

leche
Antigua y Barbuda (19) X X X X X X
Argentina (20) X X X X X X X
Bahamas (21, 22) X X X X
Barbados (19) X X X X X X X X
Belice (19) X X X X X X X
Bolivia (Estado Plurinacional de)
(19, 51)
X X X X X X

Brasil (19) add source X X X X

Canadá (23) X X X
Chile (19) X X X X X X X X X X X
Colombia (19) X X X X X X X
Costa Rica (19, 28) X X X X X
Cuba (26) X
Dominica
Ecuador (19, 52) X X X X X X
El Salvador (19) X X X X X X
Estados Unidos de América (19)
X X X X X X X
Granada (34) X X X X X X
Guatemala (35) X X X X X
Guyana
Haití (19, 36) X X X X X
Honduras (38) X X
Jamaica (19) X X X X X X
México (19, 53) X X X X X X
Nicaragua (19) X X X X X
Panamá (16, 40, 49) X X X
Paraguay (39) X X X X
Perú (19, 54) X X X X X
República Dominicana (42)
X X X X X
San Cristóbal y Nieves
Santa Lucía
San Vicente y las Granadinas

Suriname (19) X X X
Trinidad y Tobago X X X X X
Uruguay (45, 46) X X X X X
Venezuela (República
Bolivariana) (19) X X
25 3 19 29 6 6 3 12 19 18 15
TOTAL
71% 9% 54% 83% 17% 17% 9% 35% 54% 51% 43%
 BRAZIL: National School Feeding Program

At least:
• 70% fresh food products
• 30% from small family farmers

42 million students
160,000 schools
 JAMAICA: School interventions

Intervention
program:
Regulation of the JAMAICA Moves
school food in Schools
environment
 Benefits of physical activity in school children

• Improves health and physical condition;

• Stimulates cognitive performance;
• Has a possitive influence on psychological
wellbeing of children and can counter risky
behaviour;
• Reduces risk factors of noncommunicable
diseases.
 Promoting Physical Activity Through Schools:
Policy Brief
This policy brief describes the importance of integrating physical
activity into primary and secondary schools so that all children and
young people can be physically active on a regular basis, which will
contribute to preventing the increasing public health problem of
childhood obesity.
It outlines six evidence-based domains for promoting physical activity
in schools:
1. Quality physical education
2. Active travel to and from school
3. Active before- and after-school programmes
4. Opportunities during recess to encourage physical activity
5. Active classrooms
6. Inclusive approaches to physical activity

https://apps.who.int/iris/bitstream/handle/10665/354605/9789240049567-eng.pdf?sequence=1&isAllowed=y
 PAHO/WHO
Action areas
Inter-American Program on healthy food and physical activity policies in the school environment
2022-2025
Healthy school food Promotion of physical activity Action framework for development
environments in schools and implementation the public food
procurement and service policies for a
healthy diet
Physical activity
 Physical inactivity by Region
Increase from
50
33% to 39%
(2001 vs. 2016)
% not meeting recommendations

45

40

35

30
GLOBAL
AVERAGE
25

20

15

10

0
Latin America and High-income High-income Asia South Asia Central Asia, Middle Central and Eastern Sub-Saharan Africa East and South East Oceania
Caribbean Western countries Pacific East, North Africa Europe Asia
Guthold, Stevens, Riley, Bull. Lancet Global Health
Females Males Online September 4, 2018
 Global Action Plan on Physical Activity 2018-2030

Available at: www.who.int/health-topics/physical-activity

WHO Guidelines on physical activity and sedentary behaviour
 Tools and guidance on key practical actions

https://www.who.int/teams/health-promotion/physical-activity
To access these documents and for more about our work on physical activity - Visit: www.who.int/health-topics/physical-activity
 GenMove

https://www.getgenmove.com
Public education and
awareness
 Social Marketing for Public Health Program

2022

This Program is a collaboration between the Pan American Health Organization and the School of Public Health at the
University of South Florida College of Public Health. The program is funded by the American Heart Association.

36
 Social Marketing for Public Health
Program
• PAHO completed development of the five courses of the Social Marketing Program
in Public Health.
• We have reached out to more than 16,500 participants in the LAC Region
and worldwide since the Program was launched in July 2020.
• This interactive multi-course curriculum prepares professionals in public health to
use social marketing as a program development approach to achieve
behavior change. Second cohort of tutorized modality will start in July 2022, targeting
participants from MoHs and civil society.
• In 2023, the Program will be distributed in two courses, one will have the introductory
course with interactives modules related to the basics of Social Marketing, key ideas,
strategy elaboration of a social marketing campaign and case studies that included:
Promotion of breastfeeding, Promotion of physical activity, Promotion of healthy eating,
Prevention of Heart Disease and Social Marketing and the COVID-19 Pandemic. Link:
https://www.campusvirtualsp.org/en/course/introduction-social-marketing-public-health-
course-1-self-learning
• The second course will have the integration of module 2 to 5 which is related to the
Planning and Development of the Social Marketing Program for Public Health. Link:
https://www.campusvirtualsp.org/en/course/planning-and-development-social-
marketing-program-public-health-2022-edition
#UniversalHealth
Public food procurement and
service policy
Benefits of healthy public food procurement
and service policies
1. Public health benefits
2. Economic benefits
3. Increased productivity and educational attainment
4. Boosting availability of healthy, affordable, culturally
acceptable food that is sustainably produced through local
agriculture
5. Equity benefits
6. Large reach
 WHO Action framework for developing and implementing
public food procurement and service policies for a healthy diet
Ø Tool for countries aiming to make public food
procurement and service healthier

Ø Policy cycle
1. Policy preparation
2. Policy development
3. Policy implementation
4. Monitoring, enforcement
and evaluation

https://www.who.int/publications/i/item/9789240018341
Launch event available (in 6 UN languages) at the WHO website
 • With government • Any foods, beverages, • Entire process of purchase,
funds, served/sold ingredients, meals or snacks subsidy, provision, distribution,
in any public setting covered by the policy service and sale

Healthy public food procurement and service policy

• Limit the intake of free sugars • Policies, strategies,

• Shift fat consumption away from saturated fats to directives, legislation, rules,
unsaturated fats and eliminate industrially produced standards or guidelines;
trans fats mandatory as well as
voluntary
• Limit sodium consumption and ensure salt is iodized
• Increase consumption of whole grains, vegetables,
fruits, nuts and pulses
• Ensure the availability of free, safe drinking water
 Nutrition criteria
are established to define food to be encouraged, limited or prohibited in
public food procurement and service in order to promote healthy diets

Nutrient-based criteria Examples

National or regional dietary recommendations Ø Snacks served in all city agencies may not contain
WHO Regional Nutrient Profile Models more than 230 mg sodium per serving
WHO Healthy Diet factsheet (Philadelphia, USA)

Food-based criteria Ø School canteens may not sell pickled items

National or regional FBDGs
WHO 5 keys to a healthy diet
Other nutrition-related criteria
Targeting the preparation or service of food
Cooking methods, portion sizes, placement of
food or menu labelling
(Malaysia)
Ø Caterers must include whole grains in all staple
options for all government-organized functions
and events (Singapore)
Ø Salt containers that are visible to students and
whose purpose is to add it to prepared foods shall
not be allowed inside schools (Uruguay)
Food labelling
Mexico

la
zue
ne
Ve
Ecuador

Peru

Chile
Brazil

Urugu
ay

Argentina
 Canada

Mexico

la
zue
ne
Ve
Colombia

Ecuador

Peru

Bolivia

Chile
Brazil

Urugu
ay

Argentina
 SISTEMA DE
ADVERTENCIA

+Sencillo
+Rápido
+Relevante
+Útil
+Cambia decisión
https://iris.paho.org/handle/10665.2/53013
 OBJETIVOS

FACILITAR LA CORRECTA Y FÁCIL IDENTIFICACIÓN DE

PRODUCTOS QUE SON EXCESIVOS EN NUTRIENTES CRÍTICOS Y
OTROS INGREDIENTES DE PREOCUPACIÓN DE SALUD PÚBLICA

AZÚCARES
GRASAS (total, sat, trans)
SAL/SODIO
ADITIVOS
 OBJETIVOS

REDUCIR LA DEMANDA POR

PRODUCTOS EXCESIVOS EN NUTRIENTES CRÍTICOS Y OTROS
INGREDIENTES DE PREOCUPACIÓN DE SALUD PÚBLICA

AZÚCARES
GRASAS (total, sat, trans)
SAL/SODIO
ADITIVOS
 Panel C. Criterios del modelo de perfil de nutrientes de la OPS para
DE
indicar los productos procesados y ultraprocesados que contienen FIN
ICI
una cantidad excesiva de sodio, azúcares libres, otros edulcorantes, ON
grasas saturadas, total de grasas y grasas trans ES
Sodio Azúcares Otros Total de Grasas Grasas trans
libres edulcorantes grasas saturadas
1 mg de 10% del Cualquier 30% del 10% del 1% del
sodio por total de cantidad total de total de total de
1 kcal energía de otros energía energía energía
prove- edulcorantes prove- prove- prove-
niente de niente del niente niente
azúcares total de de grasas de grasas
libres grasas saturadas trans

Si los azúcares libres no se declaran en las etiquetas alimentarias,

DE
FIN
ICI
ON
ES
2.7% de kcal de grasas trans

Casi el
Triple del límite (i.e. 1%)
500mg de grasas trans
500mg de grasas trans

1.18% kcal
de grasas trans
500mg de grasas trans

1.18% kcal
de grasas trans
 PAHO/WHO

UBICACIÓN
Margen superior del panel principal de exhibición

Crosbie E, Gomes FS, Olvera J, et al.

The Lancet Regional Health - Americas
2022
https://www.thelancet.com/journals/lanam
 PAHO/WHO

UBICACIÓN
Margen superior del panel principal de exhibición

Crosbie E, Gomes FS, Olvera J, et al.

The Lancet Regional Health - Americas
2022
https://www.thelancet.com/journals/lanam
 PAHO/WHO

UBICACIÓN
Margen superior del panel principal de exhibición
En envases cilíndricos o cónicos: margen superior central

Crosbie E, Gomes FS, Olvera J, et al.

The Lancet Regional Health - Americas
2022
https://www.thelancet.com/journals/lanam
 PAHO/WHO

FORMATO
Octógono negro con letras blancas y borde blanco
aplicado sobre caja de aislamiento de fondo blanco

Crosbie E, Gomes FS, Olvera J, et al.

The Lancet Regional Health - Americas 2022
https://www.thelancet.com/journals/lanam
/article/PIIS2667-193X(22)00217-
 PAHO/WHO

FORMATO
Octógono negro con letras blancas y borde blanco
aplicado sobre caja de aislamiento de fondo blanco

Caja de aislamento de fondo

Borde blanco

Crosbie E, Gomes FS, Olvera J, et al.

The Lancet Regional Health - Americas 2022
https://www.thelancet.com/journals/lanam
/article/PIIS2667-193X(22)00217-
 PAHO/WHO

TEXTO
EXCESO

Crosbie E, Gomes FS, Olvera J, et al.

The Lancet Regional Health - Americas 2022
https://www.thelancet.com/journals/lanam
/article/PIIS2667-193X(22)00217-
 PAHO/WHO

TAMAÑO

Ocupar al menos 30% de la superficie

Crosbie E, Gomes FS, Olvera J, et al.

The Lancet Regional Health - Americas 2022
https://www.thelancet.com/journals/lanam
/article/PIIS2667-193X(22)00217-
 PAHO/WHO

TAMAÑO

Ocupar al menos 30% de la superficie

Crosbie E, Gomes FS, Olvera J, et al.

The Lancet Regional Health - Americas 2022
https://www.thelancet.com/journals/lanam
/article/PIIS2667-193X(22)00217-
 Niños y niñas (n=80, 5-6 años). Nota de 1 a 5 para el sabor.

Personajes influencian la sensación

Lapierre, M. A. et al. Arch Pediatr Adolesc Med 2011;165:229-234.

 770 779 cereals
Mrs. Meier wants to buy breakfast forFruchtzucker”)
“enthält 100% her children. on the front
780 condition “fruit sugar & claim” of Experim
771 781

AN
772 782

M
Arch Pediatr Adolesc Med 2011,165:229-34
Pediatrics 2010, 126:88e93
Appetite 2015, 95:252-61
773
Public Health Nutr 2017, 17:1-11
Los alimentos
preenvasados no deberán
describirse ni presentarse
con una etiqueta o
etiquetado en una
forma que sea falsa,
equívoca o engañosa, o
susceptible de crear en
modo alguno una
impresión errónea
respecto de su naturaleza
en ningún aspecto.
MONITOREO

FISCALIZACIÓN

SANCIONES

DEFENSA

MEJORAS
Marketing of foods and
non-alcoholic beverages
Evidence for action
Evidence that food marketing
remains prevalent globally

Food marketing associated with

significant increases in the following:
Intake
Choice
Preference

Narrative review (2022) Systematic: review (2022)

Supplement other Evidence of impact on eating
reviews behaviours and health
 OBJETIVOS
Reducir la demanda por productos ultraprocesados y productos
procesados con exceso de nutrientes de preocupación para la
salud pública

Reducir exposición y poder de persuasión

Mejorar la alimentación

Asegurar derecho a la protección de niñas y niños y de

consumidores, el derecho a la salud y otros derechos humanos
 OBJETIVOS
DEFINICIONES
MONITOREO
FISCALIZACIÓN
SANCIONES
DEFENSA
MEJORAS
Evidence for action: how?
The WHO set of recommendations on marketing food and non-alcoholic beverages to
children (2010): Considerations for policy development, implementation, monitoring and
evaluation
12 Recommendations in 5 Sections:
• Rationale – Recommendations 1 – 2
• Policy development – Recommendations 3 – 6
• Policy implementation – Recommendations 7 – 9
• Monitoring and evaluation – Recommendations 10 – 11
• Research – Recommendation 12
Canada
Peru
Chile
https://iris.paho.org/handle/10665.2/56423
 Use of existing laws and regulations
Colombia Brazil
Doña Gallina (Mrs. Hen in English), Quala S.A. McDonald’s and the clown
Fine of 451,045,000 Colombian pesos (700 Fine of 6,000,000 reals (approximately 6,000
minimum wages). minimum wages)
Violation of Law 1480 Using a theater play for supposedly educational
The advertising generated a false, mistaken purposes to enter schools and encourage children to
perception regarding the product’s attributes for consume its products
consumers. The ad said that “Doña Gallina soups The Department of Consumer Protection determined
are 100% creole hen,” which was not the case. that the practice was illegal and considered it to be
abusive advertising
Peru
Ambrosía (gomitas), Molitalia S.A.
Fine three tax units and was ordered, as
a corrective measure, to definitively and
immediately terminate the advertising on the
product’s packaging
Violated Decree No. 1044.
Used images of fruits in a candy that did not
contain natural fruits
Fiscal policies: SSB taxation
Evidence on the effectiveness of SSB taxes
• Robust evidence that SSB
taxes increase price and
reduce demand for SSBs

• Considering the pathway of

effect this will lead to reduced
consumption and improved
health outcomes in the longer
term
 OBJETIVOS

Reducir la demanda por bebidas azucaradas/endulzadas

Reducir la asequibilidad de las bebidas endulzadas

Mejorar la alimentación
 OBJETIVOS
DEFINICIONES
MONITOREO
FISCALIZACIÓN
SANCIONES
DEFENSA
MEJORAS
 OPS/OMS

Summary price elasticity −1.36

Price increase Purchase reduction

+10% −13.6%
+20% −27.2%
+25% −34.0%

+YY% (?) −XX.X% (?)

−XX.X% = YY% / price-elasticity

https://iris.paho.org/bitstream/handle/10665.2/53562/9789275323007_eng.pdf
 Excise taxes on SSBs
in Latin America
and the Caribbean
Total: 21/33 PAHO/WHO Member States

- Latin America: 15/19

- Caribbean: 6/14 (data missing for Haiti)

These are all countries in which an excise

tax applies on SSBs.
Most are not optimized from a public
health perspective…
Source: PAHO (2020). Sugar-sweetened beverage taxes in the Region of the
Americas.
 Tax share

Notes:
1. Brazil: Retail price and tax
data and tax information
represent only the State of Rio
de Janeiro. However, all
indirect taxes applied on sugar-
sweetened beverages in Brazil
are applied at federal level,
except the value added tax,
which rate varies by state.
Data, estimates, and
information published could
not be approved by federal (or
Median = 17.5% national) authorities.
2. Dominica: Data, estimates,
and information published
could not be approved by
national authorities.
3. Venezuela (Bolivarian
Republic of): Tax data and
information were approved by
national authorities. However,
retail price data could not be
approved by national
authorities.
Source: Roche M, Alvarado M, Sandoval RC, et al. Comparing taxes as a percentage of sugar-sweetened beverage prices in Latin America
and the Caribbean. The Lancet Regional Health-Americas. 2022 Jul 1;11:100257.
 OPS/OMS
Impuestos selectivos sobre las bebidas azucaradas en la Región de las Américas, en vigor a marzo del 2019

21 Estados Al menos 4 incluyen

bebidas lácteas
Miembros
azucaradas.
de la OPS/OMS
con impuestos 10 usan ad valorem con
selectivos alguna de las bases
sobre las BBAA imponibles definidas en
+7 los primeros tramos de
jurisdicciones la cadena de valor
de EEUU
7 de monto específico

4 estructura combinada
o mixta

https://iris.paho.org/bi
tstream/handle/10665. https://iris.paho.org/bitstream/ha
2/53562/97892753230 ndle/10665.2/54745/v45e1242021
07_eng.pdf .pdf
tax base
A Food and Nutrition
Systems Approach to All
Forms of Malnutrition
Enfoque de sistemas alimentarios
y de nutrición en los procesos de trabajo
de la Organización Panamericana de la
Salud
ENLACE Data Portal
Data and information on a comprehensive set
of indicators on noncommunicable diseases,
risk factors, nutrition and physical activity,
mental health, substance use prevention, and
disability and rehabilitation.
Building capacity in the
health system to deliver
obesity management
services
 How success would look like...

• Obesity is a NCD and should be treated as such

• Obesity management services integrated across the
life course and throughout the continuum of care in the
existing service delivery platform
• Health care providers trained to deliver quality health
services
• Innovative technology can support and increase access
to services
• Health and community systems functions in place to
scale and sustain quality obesity management health
services

• The Economic Impact of Overweight & Obesity in 2020 and

2060, RTI International, 2022
 • Obesity service delivery framework
• Obesity management services in the
WHO tools to UHC Compendium
build capacity • WHO Academy Course – Obesity
Module for foundation training of
in the health primary care workers
system to • Advanced Training for Obesity
deliver obesity Management for primary care
management physicians and other clinical
providers
services • Operational manual to strengthen
health system capacity and functions
to deliver obesity management
health services
Redesign of the care model through:

eHealth- and mHealth-focused service delivery innoations to increase access to more

people at a lower cost and facilitate their journey through the health system at different
touch points.

101
Organization of obesity prevention and management services

• Preconception and pregnancy • Children 5-9 y

• Adolescents 10-19 y • Adults

102
 For initial/first health encounter:
Routinely assess for body weight, height and compute for body mass index (body weight [kg]/ height2 [m])

HEALTHY WEIGHT STATUS

OVERWEIGHT OBESITY
For adults, if BMI is 18.5-24.9 kg/m2
For adults, if BMI is ≥25 kg/m2 (pre-obesity) For adults, If BMI is ≥30 kg/m2
For 10-19 years old adolescents, if BMI is
For 10-19 years old adolescents, if BMI SD is >+1 For 10-19 years old adolescents, if BMI SD is >+2
between -1 and + 1 standard deviation (SD)

ASK PERMISSION TO DISCUSS WEIGHT STATUS AND AVOID STIGMATIZATION

ü Promote healthy behaviors
ü Prevent weight gain

ASSESS ROOT CAUSES OF WEIGHT GAIN AND MEDICAL CONDITIONS ASSOCIATED

WITH OVERWEIGHT AND OBESITY

ADVISE ON OBESITY PREVENTION

IN PATIENTS WITH OVERWEIGHT
ü If the patient is overweight, attain a healthy ADVISE ON OBESITY MANAGEMENT (link)
weight status or prevent weight gain
ü Prevent or manage related medical conditions

Assessment Algorithm for ADVISE ON MANAGEMENT OF ASSOCIATED MEDICAL CONDITIONS (links with other NCDs)
ü Conduct further diagnostic tests as relevant
Overweight and Obesity in ü Manage according to existing guidelines and consider medical therapy when behavioral intervention
Adults and Adolescents are not working
ü Refer for specialist care as needed
IRAN: Integration of obesity prevention and management services in PHC

Intervention Policy Duration Specific goals or Impact (if measured) Enablers and
objectives challenges
Delivery of 2015-presen -Increasing access to The number of people Budget
nutrition community nutrition referred to the nutritionist in limitations to
services in the services 2021: 1.5M individuals with recruit
PHC System to -Prevention and control overweight/obesity sufficient
people with of nutritional risk number of
National- overweight and factors of target non- nutritionists,
PHC system obesity communicable diseases not equitable
-Prevention and control distribution –
Recruitment of of various types of rural areas
>1450 malnutrition undersrved
nutritionists in
PHC system

104
 KUWAIT:
KUWAIT Integration of obesity prevention and management services in PHC

Ministry of Health

Intervention Policy Duration Specific goals or Impact Enablers and

objectives Challenges

2. Healthcare 2.1 PHC Plan is to establish 2-3 For early screening of Expanded Integration of
services Establishing nutrition clinics: new clinics/year until all NCDs and to improve coverage obesity mgt and
Currently, 44 nutrition clinics operate PHC in all governorates health care services nutrition in
in most primary health care centers are covered. provided to the National PHC
with a dietitian present public Strategy
2.2 Hospital 2003 Dietitian as a part of
All government hospitals in Kuwait multidisciplinary care
have nutrition clinics and qualified team
dietitians
2.3 Building capacity Ongoing To promote optimal
• Training courses on breast- breastfeeding
feeding and growth chart for practices
qualification as breast-feeding
counselor.

105
 Return on High cost and
high risk

investment Lower cost

and lower risk
Acceleration roadmap and execution- technical support

Virtual Session Execution

At the ICD
In-person sessions during the dialogue and virtual sessions after that are designed to develop
sections of the Acceleration plan

Session on ‘WHO Technical Package’ Sessions – 1 hour/week

• Evidence and policy guidelines Finalization of the priority interventions
• Policy briefs and technical support tools • Follow-up on Acceleration plan
• Country Examples THEORY Of change implementation, problem-solving,
• Resources for technical support to countries
Indicators, targets and acceleration technical support on:
• Design
scenarios • Endorsement
Indicators, targets and acc. Scenarios (2) • Integration
Innovations • Compliance
• Re-programming
Assessing the delivery chain • Reporting mechanisms at country,
Action plan regional and global level
Optimizing progress-tracking routines
• Regional Thematic Community of
Resources for the plan: fundraising Practices
Plan your first stock take
Plan Execution
 From the priority area onwards

Selection and Adoption and

Priority area: new Course correcting
or reprogrammed
design of Endorsement integration
interventions

Stock taking
and
reprogramming
of the
Mid-term and long-term intervention if
needed
Modelling tool
 Tool design and use

The tool
ü is simple, easy-to-use
ü assesses the short- and mid- term impact of interventions –
upto year 2030
ü can be used by policy makers with minimum training over a
short period of time
ü uses quantitative evidence from literature
ü represents results as graph and table
ü can be applied to understand individual as well as combined
impact of policies by target year
ü summarizes changes in outcomes (obesity prevalence and
intermediate outcomes) under different scenarios against
business-as-usual scenario** between baseline and target year

** Business-as-usual: no additional intervention is implemented

110
 WHO estimates of Intervention-specific
DATA FLOW UN Population
height, weight, obesity data (e.g. Average energy
estimates
prevalence trends intake (per person day))

Country specific datasets

WHO staff
Effect of interventions (HQ/Region/Country), Target year, policy
from scientific literature country reps, obesity action plans
control experts

Obesity Interventions Impact Modelling Tool (OIIMT)

Main Output of OIIMT

Secondary Output of OIIMT
Estimated obesity prevalence reduction at country-level
Estimated changes in intermediate outcomes at country-level
under a combination of actionable policies*

*Current tool design allows combination of up to 3 policies

 Workstream 1
• ACCELERATION SCENARIO: Implementing an additional 20% tax
on sugar-sweetened beverages can immediately start to reverse
rising trends in obesity
Historic data SSB Tax Implementation in 2010
BAU Projections SSB Tax Implementation in 2018
Global NCD Framework Target SSB Tax Implementation in 2022
• In a country with high obesity and SSB consumption
40 rates, a 20% tax on sugar-sweetened beverages could
Obesity Prevalence in total country population (%)

38,4
36,6 immediately reduce obesity by 1.1%, with continued
34,3
35
35,6 34,1
reduction up to 3.9% by 2025
33,3
29,6
30 30,4
• If SSB tax had been implemented in 2010, we would
29,6
28,7 have prevented continued increases in obesity rate, thus
25
meeting the halt the rise target
24,0

20
• Delaying implementation of more substantial taxation
on SSB, is stalling progress to halt the rise in obesity
15

10

Acceleration scenario modelling is aligned with assumptions from

5 WHO’s NCD Best Buys analysis;

0 It is a part of a broader tool covering more interventions

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Note: 1) This economic analysis was undertaken for evidence generation for the update of Appendix 3 of the Global Action Plan for Non-Communicable Diseases 2) Assumes BMI >= 30 as obesity for all age groups. 3) Assumes that
112
the country currently has no tax on SSBs. 4) Obesity Prevalence in total country population has been calculated as population-weighted mean of the three Healthier Populations Billion indicators of obesity prevalence in 5-19 age
group, 18+ age-group, and overweight prevalence in 0-4 age-group.