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Healthy food environments and obesity in childhood and adolescence: understanding and overcoming the challenges for implementing the most effective public policies

Abstract

The worsening situation of the grow thing trends of obesity is associated with negative changes in food environments, such as the increase in the availability of ultra-processed foods. As a result, there is an increase in non-communicable chronic diseases associated with unhealthy dietary patterns, particularly in children and adolescents. Recommendations to build health-promoting environments are identified as priorities, including those from the World Health Organization for the promotion of food environments that favor healthier choices. Considering the challenges for the implementation of such measures, the INFORMAS international network proposes to monitor food environments and support the generation of evidence for the implementation of policies for the prevention of chronic non-communicable diseases. In Brazil, measures related to the food environment have been proposed to tackle obesity, including municipal initiatives to restrict access to ultra-processed foods by children and adolescents and the approval of federal regulations, such as the new nutrition labeling rules including front-of-package labels for foods high in sugar, salt and fat and the National Strategy for Prevention and Attention to Childhood Obesity (PROTEJA), of the Ministry of Health. Children and adolescents are among the most vulnerable groups who suffer the consequences of obesity for a longer period of time. Consumer food environments, such as supermarkets, still present numerous barriers to the promotion of healthy eating and need to be the target of public policies. In view of the evidence and international recommendations of the need to promote healthier food environments for the prevention of risk factors associated with non-communicable chronic diseases in children and adolescents, this project aims to develop a multicomponent study to increase the effectiveness, acceptance and scalability of evidence-based interventions, including PROTEJA, for the promotion of healthier food environments for the prevention obesity and other non-communicable chronic diseases risk factors in children and adolescents. The specific objectives are: 1- to conduct a literature review on effective policies to promote healthy food environments for children and adolescents; 2- to analyze the actions agreed by the municipalities in PROTEJA related to the food environment; 3- to develop a mapping of actors to identify barriers and facilitators for the implementation of actions related to food environments; 4- to develop a diagnosis of the food environment in municipalities that have adhered to PROTEJA, using INFORMAS tools; 5- to test evidence-based interventions in food settings to inform how PROTEJA can be strengthened to reduce risk factors for noncommunicable chronic diseases; 6- to develop a strategy for adherence, scalability and implementation of actions on food environments in the long term, and contribute to a review of the package of interventions offered in PROTEJA; 7- to disseminate and develop training activities. The project components are: Stage 1: literature review; Stage 2: critical analysis of the actions agreed in PROTEJA on the food environment; Step 3: stakeholder mapping and analysis; Stage 4: diagnosis of retail food environments in São Paulo and identification of easy wins to improve the nutritional quality of these spaces; Step 5: development and implementation of a package of interventions; Step 6: Dissemination of results to strategic actors and potential expansion of the implementation of the package of interventions. (AU)

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