Regarding the recent launch, prepared during the outgoing administration, of the National Plan for the Prevention and Management of Childhood Obesity by 2030 that highlights the serious public health problems linked to diet that occur in our country (obesity, diabetes, cardiovascular diseases and cancer), the evident discrepancy between the identified causes and the proposals raised is powerfully striking. While there is consensus in attributing the alarming figures to structural causes, linked to the social determinants of health and obesogenic environments, the proposals proposed are mostly focused on guidelines, norms and measures of individual intervention, which do not have evidence of obtaining positive results so far, an issue that is explicit in the same theoretical framework of the Plan and in its references.
Of the 35 measures proposed in the Childhood Obesity Plan, only 2 are of a structural nature, that is, they are aimed at modifying obesogenic environments. We value and congratulate both measures that seek to modify the immediate environments of the population. The first aims to improve school environments, expanding the Law (20,606) – which today restricts the sale of “high in” food within schools – to immediate school environments. The second is aimed at forming community support groups to increase breastfeeding. However, these measures are insufficient to impact on the social determinants of health and modify obesogenic environments, as proposed by their diagnosis. On the contrary, most of the measures incorporated in this Plan are aimed at the development of numerous guides, technical guidelines and standards to be applied in primary health care, which then involve training of the professionals who will apply them and that will result in countless recommendations to the families of children regarding what is good to eat or not and the practice of adequate physical activity, reducing the problem to educational actions, which do not consider the physical and economic barriers that these families will have to comply with these indications.
The authors that the Obesity Plan uses as a theoretical reference, as well as the multiple international organizations (FAO, WHO, UNICEF and others) referenced, have insisted on the need to add to the traditional educational and informative actions in health, structural measures that point to the causal heart of these problems. This involves acting on two fronts: on the one hand, increasing the availability and physical and economic access to healthy food; and on the other, take strong action to restrict the availability and access, as well as marketing, to unhealthy foods. The same authors agree (which is reflected in the theoretical part of Plan) that it is essential that these measures be intersectoral, and yet, most of the proposed measures are restricted exclusively to the health sector. In this sense, a “National Plan” lacks transversal measures that aim to modify social determinants and obesogenic environments, such as the subsidy to healthy foods (production, transport and marketing), the increase in the minimum wage to ensure economic access to it, actions that promote the increase of free fairs throughout the country and short marketing circuits for small agricultural and fishing producers, among others. Likewise, powerful measures that limit the availability and access to unhealthy foods are absent from the National Plan, such as specific taxes on foods with “High in” seals or the increase in restrictions on the marketing of unhealthy foods (today only the one aimed at children under 14 years of age is limited). Probably, if we want to have real effects on the child population, it is time that we start considering unhealthy foods as tobacco was treated at the time, policies whose results are evident in the latest National Health Survey.
We hope that the incoming Ministry of Health authorities will reconsider the measures of the Plan, complementing it with structural and intersectoral measures, more direct and stronger to face childhood obesity. The increase in obesity has epidemic magnitudes and, as several authors have described, participates in a global syndemic in which it shares common drivers with climate change and other forms.Malnutrition, which has been enhanced by the COVID-19 pandemic. We cannot continue to observe how our population, and especially our children, develop malnutrition in front of our eyes without us being able to take effective and evidence-based measures.
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