We developed the NOURISHING framework to highlight where governments need to take action to promote healthy diets and reduce overweight and obesity.
The framework is accompanied by a regularly updated database (last updated 24 October 2018), providing an extensive overview of implemented government policy actions from around the world.
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We know from the evidence that making fruit and vegetables available in schools increases consumption. There is also evidence that food standards to restrict availability have the effect of reducing consumption of the restricted food.
For these actions to be effective for all children, they need to be sustained over time and accompanied by complementary behaviour change communication techniques, such as "modelling", school gardens, and communication to all stakeholders involved in the provision and consumption of school food. Worksites and healthcare also present strong potential for improved eating among adults.
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In March 2015, Health Directive No 063 Promotion of Healthy Kiosks and School Canteens was adopted in Peru. The Health Directive establishes recommendations for food provided in school kiosks and canteens, including the amount of energy to be supplied in lunches. School kiosks and canteens are evaluated twice a year at the regional level using a scorecard provided within the Health Directive. School kiosks and canteens that meet the indicators of the evaluation are graded as healthy and given a green pennant.
Empirical estimates show that food prices influence, to a varying degree, how much food people buy. Targeted subsidies have been shown to help overcome affordability barriers to healthy food for people on low incomes. Incentives, like financial rewards or price discounts, have also been shown to encourage people to switch to healthier options.
Emerging evidence from implemented taxes, as well as modelling studies, indicate the potential for effectiveness to reduce consumption. Given food choices are influenced by a whole host of factors, especially in modern, complex food markets, taxes must be designed very carefully to maximise effectiveness.
Please note, $ refers to USD.
On 10 May 2018, the Peruvian Government implemented Supreme Decree No. 091-2018-EF which imposes a 25% tax on beverages with a sugar content of 6g or more per 100mL. This is an 8% increase from the 17% tax which was already in place. Taxed beverages include non-alcoholic beverages, sweetened waters and 0% alcohol beer. Beverages with less than 6g of sugar per 100mL are not taxed.
There is clear evidence that the advertisements children see influence their food preferences and habits. There is also a lot of evidence that children and adolescents around the world are exposed to a whole host of other promotional techniques, whether on a billboard or through a phone or computer.
Emerging evidence shows that restrictions work to reduce children’s exposure to marketing, but this depends on the criteria used in the restrictions. Given the role played by parents and caregivers in what children eat, consideration is needed of how they are also influenced by promotional activities.
In 2013, the law Promoting Healthy Eating for Children and Adolescents (Ley No 30021) was passed in Peru. The technical parameters for food and drinks considered high in sugar, salt and saturated fat (required for the law to be applied) were approved in April 2015 (Supreme Decree No 007-2015-SA): sugar: ≥2.5g/100ml of drink, ≥5g/100g of food, salt: ≥300mg/100ml of drink or 100g of food, saturated fat: ≥0.75g/100ml of drink, ≥1.5g/100g of food.
The law includes a range of provisions designed to discourage unhealthy diets, including restrictions for advertising aimed at children and adolescents under the age of 16 years through any medium, including not using age inappropriate portion sizes, not using gifts, prizes or any other benefit to encourage purchase or consumption of food or drinks, not using real or fictional characters known to children. The law also includes warnings on advertising for food high in saturated fats, sugars and salt, and containing trans fats: “High in sodium/sugar/saturated fat: avoid excessive consumption”, “Contains trans fat: avoid consuming”.
It is reported that industry compliance is poor and that industry is waiting for the publication of the full implementing regulations (in addition to the technical parameters).
Awareness is one precursor to eating well. The evidence suggests that public campaigns can boost awareness. To influence consumption, they need to be sustained and use multiple channels.
The Peruvian Ministry of Production launched the Dame Anchoveta (Give me Peruvian Anchovy) campaign in December 2013 (ongoing) to increase awareness of the nutritional benefits of fish (specifically anchovies) compared with other meat (red meat, pork, chicken). The campaign uses advertising on TV, radio and on the street, recipe books, and an interactive website with information about the nutrition, sustainability and biology of the Peruvian anchovy. This campaign aims to reconnect Peruvians with healthy traditional food.
In October 2011, the Ministry of Health, supported by the private sector, launched the campaign Come rico, come sano, come peruano (Eat delicious, eat healthy, eat Peruvian food). It aims to improve eating patterns by promoting the high nutritional quality of Peruvian food through recipe books, TV and radio spots, conferences and Mistura – Peru’s biggest food festival. The campaign is ongoing.
The reason for nutrition education is to improve knowledge and the ability to put that knowledge into practice. Studies have demonstrated that nutrition knowledge and healthy dietary behaviour are positively correlated. Higher levels of general education have been found to increase the ability of individuals to obtain and understand the health-related information needed to develop health-promoting behaviours.
The evidence shows that interventions to provide education can be effective, but this depends on the pre-existing attitude, knowledge and habit strength of the targeted group. Education should thus be accompanied by changes in the food environments to effect longer-lasting change.
Community Kitchens (Comedores Populares) are an important channel for the provision of food to families living in poverty in Peru. They are community-focused and involve cooking programmes to develop food skills and basic nutrition education. A project is currently underway to increase the use and consumption of fruits in the kitchens, and reduce the use of saturated fat and salt.