1 2015 NM Objectives Manage the obesogenic environment
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2015 NM Objectives Manage the obesogenic environment Encourage action to attain normal weight Increase awareness on proper nutrition and physical activity to prevent obesity
Outline • What is overweight and obesity? Ø Ø Ø • • Assessment Status Causes and consequences Current efforts Recommendations
Overweight and Obesity Abnormal or excessive fat accumulation When energy “in” is greater than energy out = weight gain 4
Measures of overweight and obesity • • Weight-for-age Body Mass Index Waist circumference Waist-hip ratio 5
Weight-for-age For children 0 -5 years old 6
Body Mass Index (BMI) For older children (61 months and above) and adults BMI = weight in kilograms height in meters 2 7
BMI Classification BMI <18. 5 -24. 9 25. 0 -29. 9 30. 0 -34. 9 35. 0 -39. 9 ≥ 40. 0 Source: WHO Classification Chronically Energy Deficient Normal Overweight Obese Grade III Disease risk Normal Increased High Very high 8
Waist Circumference (WC) • Measurement of abdomen around top of iliac crest (middle point of last rib and pelvic bone) • Excess fat in abdomen is out of proportion to total body fat 9
Waist Circumference (WC) You have higher risk of developing noncommunicable diseases if your waist circumference is: Equal or more than 88 cm for women Equal or more than 102 cm for men 10
Waist-Hip Ratio (WHR) • Measures waist at narrowest point and hip at widest point • Divide waist circumference by hip circumference • Ex: woman with 35” waist and 46” hip 35/46 = 0. 76 11
Waist-Hip Ratio (WHR) You have higher risk of developing noncommunicable diseases if your waist-hip ratio is: Equal or more than 0. 85 for women Equal or more than 1. 0 for men 12
Trend of overweight and obesity in the Philippines 13
Prevelance of overweight and obese among children and adolescents by region, 2013 Region O-5 years Source: 8 th National Nutrition Survey, DOST-FNRI. 5. 08 -10 years 10. 08 -19 years
Prevalence of overweight and obese adults by place of residence and wealth index, 2013 Source: 8 th National Nutrition Survey, DOST-FNRI. 15
Trend in high waist circumference among adults, 20 years and older, 1998 -2013 Source: 8 th National Nutrition Survey, DOST-FNRI. 16
Trend in high waist hip ratio among adults, 20 years and older, 1998 -2013 Source: 8 th National Nutrition Survey, DOST-FNRI. 17
Physical inactivity Unhealthy diet Child undernutrition Poor breastfeeding practices Overweight & Obesity E N V I R O N M E N T 18
Distribution of adults 20 years and older, by physical activity level, 2008 Source: Philippine Nutrition Facts and Figures 2008, FNRI-DOST. 20
Comparison in low physical activity among adults 20 years and older, by domain, 2003 -2008 Source: Philippine Nutrition Facts and Figures 2008, FNRI-DOST. 21
Physical activity among adolescents • Only 13. 9% students were physically active for a total of 60 mins per day • Only 22% of students went to physical education class for 3 or more days each week during school year • 32. 3% spent 3 or more hours/day sitting Source: WHO Global School-based Student Health Survey – Philippines 22
Changing dietary patterns • • • Filipinos have been eating more meat, fish and eggs which are good sources of protein High consumption of sugars and syrups, fats and oils Low consumption of vegetables, fruits and complex carbohydrates 23
Per capita food consumption pattern of Filipinos, 1978 -2013 Food group Consumption (gram), raw as purchased 1978 1982 1987 1993 2008 2013 Cereals and products 367 356 345 340 364 361 387 Starchy roots & tubers 37 42 22 17 19 17 31 Sugars and syrups 19 22 24 19 14 17 16 Fats and oils 13 14 14 12 18 15 16 Milk and products 42 44 43 44 49 42 7 Fish and products 102 113 111 99 104 110 101 Meat and products 23 32 37 34 61 58 58 Egg 8 9 10 12 13 14 17 Dried beans, nuts, seeds 8 10 10 9 9 Vegetables 145 130 111 106 111 110 120 Fruits 104 102 107 77 54 54 44 Source: National Nutrition Surveys, FNRI-DOST 24
Changing dietary patterns • • • increasing urbanization – diets that are high in fat, simple sugars, processed foods, refined carbohydrates globalization – increased trade liberalization making available wide variety of processed and fast food establishments increased frequency of eating away from home ICT – rampant use of computers, online games influence of mass media Source: Pedro, et. al. 25
Child undernutrition • Particularly during first 1, 000 days of life • Infants who experienced growth failure early in life and had rapid weight gain are at risk to adult obesity and NCDs 26
Poor breastfeeding practices • • • Breastmilk has protective factor against obesity and NCDs in adulthood Breastfeeding improves feeding method, affects infant’s appetite Physiological differences between breastmilk and infant formula 27
Consequences of obesity http: //www. hkjpaed. org/details. asp? id=43&show=1234
Current efforts to address overweight and obesity
Philippine Plan of Action for Nutrition (PPAN), 2011 -2016 • • Target is “no increase in 2008 prevalence” Promote healthy lifestyle Increased consumption of vegetables and fruits Increase physical activity 30
National Policy on NCDs DOH Administrative Order 2011 -003 “National Policy on Strengthening the Prevention and Control of Chronic Lifestylerelated NCDs” • Addresses the four shared risk factors of NCDs – smoking, unhealthy diet, physical inactivity, consumption of alcohol 31
DOH-Healthy lifestyle promotion a. Pilipinas Go 4 Health b. Recognition system through “Outstanding Healthy Lifestyle Advocacy Awards” c. Belly Gud for Health 32
Promote Good Nutrition Program - NNC • • • Nutrition counseling and education Exclusive breastfeeding and appropriate complementary feeding Nutritional Guidelines for Filipinos 33
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Pinggang Pinoy – Healthy Food Plate • easy-to-understand • uses a familiar food plate model to convey right food group proportions • per-meal basis to meet energy and nutrient needs of Filipino adults 35
Nutrition labelling DOH AO 20140030 requires mandatory labelling of all processed food products 36
Nutrition labelling FDA Circular 2012015 – voluntary front-of-pack panel labelling of caloric content of processed foods 37
Promotion of desirable infant and young child feeding (IYCF) practices • • EO 51 or The Milk Code RA 10028 – Expanded Breastfeeding Promotion Act of 2009 Mother-Baby Friendly Hospital Initiative IYCF National Plan of Action 2011 -2016 38
School-based interventions to prevent obesity • • • Dep. ED AO No. 08 S 2007 on sale of healthy foods in school canteens Integration of health, nutrition and PE in school curriculum Bi-annual nutritional assessment 39
Obesity prevention interventions for individuals • Achieve energy balance between intake and use of calories • Limit intake of total fats, unsaturated fats vs. saturated fats and sugars • Eat more veggies, fruits, legumes, whole grains, nuts • 30 minutes of regular, moderate-intensity physical activity on most days of the week 40
Obesity prevention interventions among children • Practice exclusive breastfeeding for the first six months of life and give appropriate complementary feeding starting at six months while continuing breastfeeding • Instruct mothers to accept child’s ability to regulate energy intake rather than feeding until plate is empty 41
Obesity prevention interventions among older children and adolescents • Promoting an active lifestyle • Promoting intake of vegetables and fruits • Limiting intake of energy-dense, micronutrient-poor foods • Targeting mass media campaign to parents and care providers, school children and adolescents 42
Obesity prevention interventions among older children and adolescents • Enacting legislation to support healthier composition of food choices • Developing policies to encourage consumption of healthier food products and increase access to recreational physical activity • Providing an enabling environment to increase physical activity 43
Recommended actions to prevent overweight and obesity Individual/Family 1. Eat a variety of foods everyday - more of vegetables and fruits, legumes and other fiber-rich foods 2. Prepare food at home more often 3. Exclusively breastfeed newborns up to six (6) months, then give appropriate complementary foods while continuing breastfeeding 44
Recommended actions to prevent overweight and obesity Individual/Family 4. Monitor and manage weight of family members. 5. Have regular exercise with the family. Encourage children to play games. 6. Limit exposure of children to television, computers, other electronic gadgets to no more than 2 hours a day. 45
Recommended actions to prevent overweight and obesity Community leaders 1. Grow vegetables and fruit-bearing trees within the community. 2. Organize regular exercise activities that encourage participation of community members. 3. Provide access and support to community members to be able to measure and monitor their weight. 46
Recommended actions to prevent overweight and obesity Community leaders 4. Encourage mothers to exclusively breastfeed infants and practice appropriate complementary feeding practices. 5. Provide safe play area for children and other supportive infrastructure to encourage physical activity. 6. Mobilize youth groups for sports activities and to have healthy diets. 47
Recommended actions to prevent overweight and obesity School administrators 1. Serve healthy food choices in school canteens and cafeterias. 2. Grow fruit-bearing trees and vegetables in schools. 3. Include enjoyable physical activities and sports events in schools. 48
Recommended actions to prevent overweight and obesity Local policy makers and program managers 1. Formulate local policies to support consumption of healthy diet and increase access to recreational physical activity. 2. Implement wellness programs or conduct regular exercises for community members. 3. Recreate physical environments to support active commuting like walking or biking. 49
Recommended actions to prevent overweight and obesity Employers 1. Serve healthier food choices during meetings, seminars, conferences, and other events 2. Conduct seminars/lectures on the importance of healthy diet and active lifestyle 3. Implement wellness programs for employees such as the “Belly Gud for Health” 50
Recommended actions to prevent overweight and obesity Food industry 1. Self-regulate marketing of foods and nonalcoholic beverages to children. 2. Reformulate food products to reduce saturated fats, sodium and sugars. 3. Comply with nutrition labelling guidelines issued by FDA. 51
Recommended actions to prevent overweight and obesity National government agencies 1. Develop and implement food and agriculture policies to have adequate supply of food particularly vegetables and fruits at affordable prices 2. Disseminate information on good nutrition and healthy lifestyle 52
Recommended actions to prevent overweight and obesity National government agencies 3. Strictly enforce the Milk Code, RA 10028 and implement policies that promote, protect and support appropriate infant and young child feeding practices. 53
Recommended actions to prevent overweight and obesity National government agencies 4. Use sin taxes to finance health promotion activities, nutrition education and promotion of physical activity. 5. Regulate advertisements on consumption of high-fat, high-sodium and high-sugar products. 54
Recommended actions to prevent overweight and obesity Legislators 1. Enact legislation to regulate the marketing of foods and non-alcoholic beverages to children. 2. Enact legislation to increase taxes on sugarsweetened beverages. 3. Develop policies on rural and urban planning and transport to create facilities that support physical activity. 55
Celebrating Nutrition Month • • • Hang Nutrition Month streamers Conduct seminars and other fora Promote physical activity Implement wellness programs Conduct nutrition assessment and nutrition counselling sessions
Nutrition Month activities • National Launch on 1 July • Tie-up with Mandaluyong City on 19 July for biggest Zumba dance to beat Guinness Record • Mass media promotion • Seminars and lectures
For more details: National Nutrition Council 2332 Chino Roces Ave Extension, Taguig City http: //www. nnc. gov. ph www. facebook. com/nncofficial www. twitter. com/NNC_Official www. youtube. com/user/NNC 1974 info@nnc. gov. ph Tel. (02) 843 -0142 Fax. 816 -4239 58
Regional NM plans Region Activities Nutrition Forum; Biggest Loser Challenge; Nutri 1 outreach 2 CAR 3 Launching, 10 Kumainments and Pinggang Pinoy school caravan, Nutrikalesa painting contest, simultaneous vegetable planting and hataw activity, various contests, media exposure Launcing/Kapihan, Walk for Nutrition, media exposure Seminar on “State of the Art of Obesity Research in the Philippines; various contests 59
Regional NM plans Activities Region NCR “BNS Hataw na” Dancercise event; Advocacy 4 B 5 6 Forum on Child Obesity; Photo-essay and poster making contests Launching; Stakeholders’ Forum and Regional NAOs Conference; Regional Nutrition Awarding Ceremony Launching; nutri-parade; nutrition and diet counselling; media exposures; seminars and fora; press conference Dance exercise with school faculty, children, and LGUs; Recognition of 40 longest serving 60
Regional NM plans Region Activities Weight Management Counselling in schools and 7 8 9 10 Healthy Lifestyle Promotion and Health Management Booths in malls, media exposures Launching, walkathon, BMI assessment, NGO forum, BNS Day Promotion of local healthy food recipes; “Thirst Quencher Master Chef" contest focusing on the benefits of healthy drinks Launching, forum on prevention of overweight and obesity, joint Hi 5 & NM Nutrifair in Camiguin, school/university activities, media 61 exposures, culmination activity
Regional NM plans Region Activities Zumba contest, nutrition counseling, 10 11 Kumainments and Pinggang Pinoy exhibits, press conference; media exposures Launching, Fat Run and Zumba, health and 12 nutrition assessment, obesity forum, tri-media CARAGA Launching, nutrition forum, nutrition assessment and counseling, BNS conference, NM campaign in correctional facilities, media exposures ARMM Nutri-parade and Nutri-hataw; Nutrition Month Forum; school and community-based info drive 62
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