Recommended Priority Interventions
An overall objective is to develop comprehensive national and local plans that take advantage of every opportunity to encourage and promote healthy eating and active living. These plans would involve health care providers; worksites; schools; media; urban planners; all levels of food production, processing, and preparation; and governments. The goal is cultural change in the direction of healthy living. An important element in cultural change is national leadership by individuals and by professional organizations. Specific interventions will depend on local physical and cultural conditions and should be based on careful analysis of existing dietary and activity patterns and their determinants; however, the following interventions can be considered (specific interventions for control of smoking are discussed elsewhere):
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Physical activity:
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Develop transportation policies and a physical environment to promote walking and riding bicycles. This intervention includes constructing sidewalks and protected bicycle paths and lanes that are attractive, safe, well-lighted, and functional with regard to destinations.
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Adopt policies that promote livable, walker-friendly communities that include parks and are centered around access to public transportation.
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Encourage the use of public transportation and discourage overdependence on private automobiles.
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Promote the use of stairs. Building codes can require the inclusion of accessible and attractive stairways.
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Healthy diets:
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Develop comprehensive school programs that integrate nutrition into core curricula and healthy nutrition into school food services. Regional or national standards to promote healthy eating should be developed for school food services. Programs should also aim at limiting television watching, in part by promoting attractive alternatives.
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Work with the agriculture sector and food industries to replace unhealthy fats with healthy fats, including adequate amounts of omega-3 fatty acids. This goal can be achieved through a combination of education, regulation, and incentives. Specific actions will depend on local sources of fat and on regional production and distribution. For example, in areas where palm oil is dominant, research could focus on developing strains that are lower in saturated fat and higher in unsaturated fat through selective breeding or genetic alteration. Labeling requirements or regulation can be used to discourage or eliminate the use of partially hydrogenated vegetable oils and to promote the use of nonhydrogenated unsaturated oils instead.
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Require clear labeling of energy content for all packaged foods, including fast food.
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Use tax policies to encourage the consumption of healthier foods. For example, high-sugar sodas could be fully taxed and not subsidized in the same way as healthier foods.
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Emphasize the production and consumption of healthy food products in agriculture support and extension programs.
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Implement folic acid fortification if folic acid intake is low.
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Ensure that health providers regularly weigh both children and adult patients, track their weights over time, and provide counseling regarding diet and activity if they are already overweight or if unhealthy weight gain is occurring during adulthood. Those activities should be integrated with programs that address undernutrition. Health care providers should be encouraged to set a good example by not smoking, by exercising regularly, and by eating healthy diets.
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Promote healthy foods at worksite food services. Worksites can also promote physical activity by providing financial incentives for using public transportation or riding bicycles (and by not subsidizing automobiles by providing free parking). Providing areas for exercise during work breaks and showers may be useful.
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Set standards that restrict the promotion of foods high in sugar, refined starch, and saturated and trans fats to children on television and elsewhere.
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Set national standards for the amount of sodium in processed foods.
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National campaigns:
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Invest in developing locally appropriate health messages related to diet, physical activity, and weight control. This effort is best done in cooperation with government agencies, nongovernmental organizations, and professional organizations so that consistent messages can be used on television and radio; at health care settings, schools, and worksites; and elsewhere. This effort should use the best social-marketing techniques available, with messages continuously evaluated for effectiveness.
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Develop a sustainable surveillance system that monitors weight and height, physical activity, and key dietary variables.
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Implementation of the recommended policies to promote health and well-being is often not straightforward because of opposition by powerful and well-funded political and economic forces, such as those involved in the tobacco, automobile, food, and oil industries (Nestle 2002). The solutions will depend on a country's specific political landscape. However, experiences in many countries indicate that alliances of public interest groups, professional organizations, and motivated individuals can overcome such powerful interests. Strategies should start with sound science and can use a mix of mass media, lobbying efforts, and lawsuits. Also, the food industry is far from monolithic, and elements can often be identified whose interests coincide with health promotion, which can create valuable partnerships. As an example, the willingness of some margarine manufacturers to invest in developing products free of trans fatty acids greatly helped the effort to reduce these fats, because these producers then became proponents for labeling the trans fat content of foods. Protection of children can be a powerful lever because of almost universal concern about their welfare and the recognition that they cannot be responsible for the long-term consequences of their diet and lifestyle choices.
