Ramos, Eugenia

International Development Research Centre: IDRC Digital Library

 FINAL TECHNICAL REPORT INTERAMERICAN HEART FOUNDATION INC  Eugenia Ramos   Eugenia Ramos   ©2022,  EUGENIA RAMOS   This work is licensed under the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/legalcode), which permits unrestricted use, distribution, and reproduction, provided the original work is properly credited. Cette œuvre est mise à disposition selon les termes de la licence Creative Commons Attribution (https://creativecommons.org/licenses/by/4.0/legalcode), qui permet l’utilisation, la distribution et la reproduction sans restriction, pourvu que le mérite de la création originale soit adéquatement reconnu.    IDRC GRANT / SUBVENTION DU CRDI : - BUILDING A COMMUNITY OF PRACTICE FOR HEALTHY FOOD SYSTEMS IN LATIN AMERICA AND THE CARIBBEAN Overweight and obesity trends are worsening in Latin America and the Caribbean What can be done? Overweight and obese children are at higher risk of suffering chronic diseases later in life.  *Source: Global Nutrition Report • The South American region relatively worsened the indicator for overweight in young children of less than 5 years of age since 2000 from 7.5% to 8.2% in 2020, and this is even pre-pandemic years.   • All the countries surveyed are outside the range of the overweight target in the Sustainable Development Goals (SDGs) for 2030 in the under 5 years of age group goal (a reduction of more than one and a half percentage points compared to the base year).   • Some countries in the region such as Argentina and Uruguay, have made progress combating hunger and have relatively good indicators for stunting and wasting in children, but at the same time are among the worst in levels of overweight for this age group.  In these countries there is a serious malnutrition problem, with overweight levels high and well above the region's average. Others continue to have difficulty with stunting and wasting indicators but also in overweight like Ecuador and Bolivia.    Argentina Brasil Ecuador Peru Colombia Uruguay Chile Costa Rica Jamaica Bolivia Barbados Mexicoperception of importance of overweight in children less than 5yMost country teams questioned in the survey stated that this continued to be a major problem in their countries.   Red circle: high, Yellow circle: medium, Green circle: Low               6.3% 6.4% 6.8%7.3% 7.5%8.1%9.8% 10.1%11.4% 11.7%13.6%Overweight in children less than 5Y (%)What are the challenges for a healthy nutrition? What suggestions are recommended by civil society?  Challenges                                                                      Suggestions   Lack of sufficient understanding of healthy vs healthy foods. Mandated FOPL. Promote at different levels of government nutritional re-education (also necessary for the adult population).    Overweight in children less than 5 years of age is concentrating in lower socio-economic groups.  Focus mainly on the groups most at risk by income quintile. Increase access and availability to healthy foods. It is necessary not only to increase access to food, but also to guarantee children a healthier diet by Implementing a comprehensive policy that promotes healthy environments where children meet.   Unhealthy environments, lack of surveillance and controls, lack of adequate policies Comprehensive and intersectoral policies are needed to address this complex problem.   Over the years the sugary, fatty foods in particular have been increasingly available due to low relative price in terms of healthier alternatives. Consider fiscal policy as a useful tool, and subsidize certain key healthy foods.  Improve access to a variety of healthy foods in locations where markets are not providing enough at reasonable prices.  Breast feeding of infants up to at least 6 months not universal.  Strengthen monitoring and compliance of the International Code of Marketing of Breast-milk Substitutes Support breastfeeding, feeding in day care centers, nurseries.  Industry advertising of unhealthy foods. Regulate the advertising and marketing of food and beverages particularly to children.                                • Young boys and girls have increasing overweight levels in the region. Countries in Latin America and the Caribbean have levels well above the global average, which is already too high (21.9% boys and 19% girls).  • In Argentina 43.2% of boys and young men are overweight, with lowest Colombia with 24.1%. while in girls the maximum of 36.8% is found in Mexico and a minimum of 25.8% in Colombia.    • Based on the year 2000, almost all countries in the sample have doubled or more than doubled the percentage of overweight in the population within this age group.  Even in Colombia, which has the lowest levels, the indicator has worsened by 50% since 2000.     Red circle: high, Yellow circle: medium, Green circle: Low        Argentina Brasil Ecuador Peru Colombia Uruguay Chile Costa Rica Jamaica Bolivia Barbados Mexicoperception of importance of overweight in children less than 5yCountry teams questioned in the survey stated that this a particularly urgent problem in their countries and mentioned that there are insufficient attention and adequate policies to deal with it24.1% 28.1% 28.5%29.7% 32.3% 32.5% 33.2%37.6% 37.8% 39.7%43.1%27.8%29.3% 31.7% 31.0%33.2% 28.1%35.6%36.8% 32.1%35.0% 33.0%Overweight in children and adolescents 5-18YOverweight in children and adolescents 5-18Y (%) .  Boys .  GirlsWhat are the challenges in nutrition for children and young people? What can we do?  Challenges      Suggestions  Policy implementation problems.  Legislation and regulations are present, but there is not enough impact.   Comprehensive programs including healthy school policies are required in most countries, but there are some good experiences in the region such as the School Food Policy in Brazil.     Lack of sufficient surveillance, inspections, and enforcement in general in school environments. Regulation of the sale of ultra-processed foods and foods of low nutritional value in school environments. Penalties for violators.  Lack of regulation and of a “whole of government” approach. Need for greater articulation between health and educational authorities.  Excessive centralization of implementation.   Greater participation of local governments (i.e. municipalities).   Lack of public awareness. It is necessary to carry out education and awareness campaigns to improve the fight against obesity.        • Overweight in adults is a widespread problem in the region, in all cases well above the global international averages of 40.8% in men and 40.4% in women.   • Except in Brazil and Colombia in women and Brazil, Colombia, Peru and Jamaica in men, no country shows less than 60% overweight in the region, which is 50% higher than the global level.  • The data on the evolution of overweight and obesity based on the year 2000 shows an increase in the indicator between 50% and 100% in the countries surveyed in the region (100% in Jamaican women, Colombian men; in most countries surveyed, the increase in men and women is 50% higher than 20 years ago.  How can we face the challenges for the adult overweight challenge?  Challenges      Suggestions  The problem is multifactorial. Requires a comprehensive approach to address it, isolated measures would have no effect. Strategy should be based in adequate resources, it should be comprehensive and involve the “whole of government”, involve the sub-national governments and be an intersectoral effort (include academia and civil society organizations). Strategy should include mandatory front of package nutritional warnings for food and drinks with an excess in critical nutrients like sugar, salt, fats, saturated fats, trans fats and calories.  There is no full comprehensive strategy that stands out in the region to confront the obesity epidemic.  Most governments have a clear understanding of the nature of the problem but come short of developing a winning strategy. Lack of coordination of government agencies for the supply of fresh produce and other healthy foods. Intersectoral work to strengthen agricultural policies to achieve sustainable food systems and public procurement from small landowners and family farmers.  Lack of cost-effective policies and better resource allocation. Resources devoted to design food policy have to increase, and be focused on tackling malnutrition including obesity across all the ages   Food policy design should adapt to a rapid transition of the overweight and obesity epidemic and improve resource allocation.  Include not only focus on breastfeeding and early childhood development but also in later ages.    50.0% 54.4% 54.6% 56.0% 58.6% 59.8%62.7% 65.5% 66.5% 66.9% 68.0%64.9% 61.4% 60.7% 61.5% 52.6%57.0%65.4% 67.4% 62.6% 62.0% 60.5%Overweight population 18y and olderOverweight in adults over 18y   .  Men   . WomenFiscal policy has not been adequate, even in countries that have excise taxes on sugary-sweetened beverages.  No taxation on junk food.  There is a need for effective fiscal policies, such as subsidies that encourage increased consumption of fruits and vegetables and taxes that discourage the consumption of sugary-sweetened beverages and other products high in salt, sugars, saturated fats, trans fats and calories.  Relatively more expensive retail prices of healthy foods, fresh foods in particular. Availability of fresh foods is key. Analyze tax increases and subsidies to modify this situation.  Discuss some subsidies for healthy fresh foods.  Lack of availability and proper supply of healthy foods. It is necessary to increase the supply and availability of healthy food in schools, public and/or private,  at workplaces, and educational institutions of all levels but including high schools, universities, technical education institutions, etc.  Populations are misguided by advertising and promotion of unhealthy products in the media. Carry out consumer education campaigns on the importance of healthy eating, overcome the low consumption of critical nutrients.   Include front of package warnings for food products with excess of critical nutrients and include in the policy bans of marketing and promotion in products which contain at least one warning.    How can we effectively leverage fiscal policy to improve the food environment? Fiscal policy can be a very effective tool for governments to reduce consumption of unhealthy food and beverages steering consumption of healthier choices.    • Retail prices for 1 liter of a popular brand of soda ranges between USD 0.65 in Colombia, and 0.73 in Bolivia at the lower end; and USD 1.72 in Uruguay and USD 1.96 in Barbados at the higher end.     • Multinationals marketing policies seem to take into account the per capita income in Latin America and the Caribbean (the higher the per capita income, the higher the retail price).               • All countries surveyed have excise taxes on sugary-sweetened beverages, except Jamaica and Colombia.  • Nominal tax rates on sugary-sweetened beverages are all less than the 20% rate recommended by PAHO, except for Peru which has a 25% rate.   • All the countries surveyed tax these beverages with a Value Added Tax (VAT).  • Tax burdens in countries that have a health-focused tax strategy for sugary-sweetened beverages do not differ from those countries that have traditionally had high tax burden only for fiscal revenue purposes 0.0% 0.0%5.90%9.1% 9.1% 9.4%4.0%9.1%15.3%7.4%10.9%20.0%16% 17%13.80%11% 12% 12%18%15%9%17%18%15%Excise and value added tax Coca-ColaExcise tax share  Coca-Cola Value added tax share0.65 0.73 0.79 0.81 0.84 0.920.9751.07 1.09 1.26 1.72 1.96 COLOMBIABOLIVIAJAMAICAARGENTINABRASILECUADORCHILEMEXICOPERUCOSTA RICAURUGUAYBARBADOSRetail price in USD of one liter Coca-Cola(i.e. Argentina and Uruguay have higher excise tax burden than Mexico, with no specific fiscal policy for taxing sugary-sweetened beverages).   • Countries that have in place health a tax policy strategy for sugary-sweetened beverages also have wide differences in tax burden (i.e. Chile and Peru).   • There is also a disparity between the retail price of sugary-sweetened beverages and bottled water: in Costa Rica the soda and water cost about the same, the soda costs than double in Chile and Brazil and close to double in Argentina and Uruguay as compared to the cost of bottled water.  • The highest prices for bottled water are in Costa Rica and Barbados followed by Uruguay, Mexico and Ecuador, and the cheapest in Brazil.  Between the cheapest and the most expensive water there is a difference of 400%.   • Some countries surveyed do not impose an excise tax or VAT on bottled water (Colombia, Ecuador, Mexico and Peru). In these countries, bottled water seems to be considered a merit good and governments have proceeded fiscally accordingly excepting them from taxes.  However, in the rest of the countries analyzed there does not seem to be such a fiscal tax strategy in place to favor water as a healthier alternative.  •  The country that has the most affordable Coca-Cola is Chile; even considering its fiscal-sanitary policy on sugary-sweetened beverages, Chile has a lot of room to increase the excise tax to make these beverages less affordable.    • At the opposite end are Ecuador and Peru, which also have a fiscal policy on sugary-sweetened beverages that has succeeded in making these beverages less affordable compared to other countries in the region.     • Mexico has a greater affordability index, compared to Peru, Coca-Cola is 50% more affordable, which would indicate a relative delay in the adequacy of tax rates after its pioneering role in the region.   1.01 1.38 1.38 1.62 1.74 1.82 1.84 1.95 2.32 2.38 2.39 R EL AT IV E  R ET AIL  P R ICE  O F  CO CA - CO L A T O  B O T T L ED  WAT ER0.74%0.95% 1.04%1.11% 1.23%1.23% 1.27% 1.28%1.64% 1.68%1.77%2.33%Affordability index of Coca-Cola (retail price of 100l/GDP per capita)Food policy good practices Intersectoral approach in the development and implementation of food safety systems. Mexico is the country that would be comprehensively addressing the problem of obesity.  The intersectoral program GISAMAC (Intersectoral Group of Health, Food, Environment and Competitiveness) seeks the articulation, harmonization and progressive evolution of public policies and which includes the program development and operational capacity of the Federal Executive.  Taxes on sugary-sweetened beverages and fiscal strategy according to sugar content. Differential fiscal treatment according to sugar content in sugary-sweetened beverages (SSB) in Chile: incremental excise tax rates for higher sugar content.   A rate of 10% on natural or artificial carbonated beverages, energizing or hypertonic, syrups, and mineral or thermal waters to which dyes, flavorings or sweeteners have been added. If their nutritional composition includes high sugar content (more than 15 grams per 240 ml) the rate is 18% (a 5% increase). A study conducted four years after the SSB tax implementation showed a highly significant decrease of 21.6% in the monthly purchased volume of the higher-taxed, sugary soft drinks.    Peru follows the same policies since legislation was passed in September of 2021.  Front of package nutritional labelling (FOPL) of warnings. Compliance. Chile was the first to implement FOPL, also Peru and Uruguay have introduced black octagonal FOPL warnings, and Mexico and Argentina are in the process of implementation with specific legislation in place.  In Chile in June 2016 the new law "On nutritional composition of food and its advertising” became a model for the region, introducing black octagons with warnings about excess sugar, salt, saturated fats, trans fats.  Follow-up reports showed high compliance with the regulation (use of black octagons, and advertising and sales regulation in schools). Average compliance reached of 75% by 2017 and 80% in 2018.   Regulation of advertising and marketing standards. Chile has a ban on advertising to children under 14, for products containing FOPL warnings, and restricts marketing in schools of foods with excess sugar.  Argentina bans the advertising, promotion, and sponsorship of products with at least one octagon warning label aimed at children under the age of 18. The law regulates health claims (no claims are allowed on products that have warning labels).  Mexico also has a restriction on the advertising of products that have at least one octagon or precautionary message.    Government food procurement. The national government in Argentina will prioritize products without warning labels when comparing similar procurement offers.   National food guidelines. In Brazil guidelines are based on the scope and nature of industrial food processing and privileging fresh and minimally processed foods; the respondents considered that they are an excellent opportunity for civil society to use them to promote public policies aligned with the health recommendations.   Regulation and elimination of trans fats. Limits for industrially produced trans fats: Argentina, Uruguay, Chile, Mexico, Peru. Colombia has limits but also a national trans-fat reduction plan.     Reduction of dietary sodium. In Argentina, the sodium reduction strategy began with a voluntary initiative to reformulate sodium in baked goods and other processed foods more than a decade ago. In 2013 sodium legal limits were approved and regulations were included in 2017 in the Argentinian Food Code.    School food policies.   Brazil has the National School Feeding Program (2020), which provides meals for all children in public schools. Other countries also have similar programs, but Brazil stands out for its ability reduce the consumption of ultra-processed and processed foods, privileging fresh and minimally processed foods.   Food policies in times of COVID-19.  Threats. Chile since 2020 has implemented some regulations to mitigate the effects of the pandemic on the national food system. Its National Food Security Plan includes the constant monitoring of food supply chains, financial and technical support to agriculture; targeted measures to favor short food supply chains and the direct delivery of food boxes. Problems are exacerbated by COVID-19, such as the diversion of resources; corporate social responsibility (CSR) actions of the food and beverage industries; industry lobby to reduce its tax burden; delays in implementation of policies and the control and surveillance; as well as delays in the parliamentary treatment of FOPL policy.    

Overweight and obesity trends are worsening in Latin America and the Caribbean

https://idl-bnc-idrc.dspacedirect.org/bitstream/10625/61572/1/2022-10-07_Factsheets%20final.pdf

Overweight and obesity trends are worsening in Latin America and the Caribbean

Abstract

Similar works

Full text

Available Versions

International Development Research Centre: IDRC Digital Library