RESULTS OF THE IMPLEMENTATION OF THE
GENERAL GUIDELINES ON SCHOOL NUTRITION
STANDARDS FOR FOOD AND BEVERAGES SOLD
AND DISTRIBUTED IN ELEMENTARY AND
SECONDARY SCHOOLS
Workshop on prevention childhood obesity and
school environment
Aruba, June 2013
Content
1. Overweight and obesity in children and adolescents
Current situation in Mexico
2. Strategies and actions for the prevention and care of
overweight and obesity in Mexico
3. General Guidelines for Food and Beverage offered in
basic education schools
a. First stage qualitative evaluation
b. Second stage quantitative evaluation
4. Conclusions
Overweight and obesity in children and
adolescents (2011)
In Mexico 29.3% of the total population (33 millions) are children (0 to
14 years old) (INEGI 2010)
The National Survey on Health and Nutrition (ENSANUT 2012)
shows that:
• 34.4% of children from 5 to 11 years old have excessive weight
• 19.8% overweight and 14.6% obesity
• Between 2006 and 2012 these numbers have not increased
• 35% of teenagers from 12 to 19 years old, present overweight or
obesity.
•The obesity rate is higher in women (23.7%) that in men (19.6%)
• Between 2006 and 2012 the overweight and obesity increase in
5%
-Instituto Nacional de Estadística y Geografía. Censo de población y vivienda 2010. INEGI, México 2010.
-Gutiérrez JP, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, Cuevas-Nasu L, Romero-Martinez M, HernándezAvila M. Encuesta Nacional de Salud y Nutrición 2012. Cuernavaca, México: Instituto Nacional de Salud Publica, (MX) 2012.
Overweight and obesity in children and
adolescents
Prevalence on overweight and obesity in children. ENSANUT 2012
Male
Female
National
Male
ENN 1999
Female
National
Male
ENSANUT 2006
Female
National
ENSANUT 2012
Overweight
Obesity
Prevalence on overweight and obesity in teenagers. ENSANUT 2012
Male
Female
National
Male
ENSANUT 2006
Female
ENSANUT 2012
Overweight
Obesity
National
Causes
Physical activity. ENSANUT 2012
• More than half of children between 10 and 14 years old have not carried out any
formal physical activity, in the last 12 months previous to the survey.
• Only 33% of surveyed children stay less than two hours (maximum recommended
time) in front of the screens.
School diet
• Several studies have indicated that the Mexican students consume an average of
433 calories in the school snack, with a change in the consumption pattern:
• Children 1 to 4 years old increased calories intake from 165 to 297 kcal.
• Students 5 to 11 years old increased calories intake from 190 to 343 kcal.
• Energy average allowance of lunch must be of 17.5% of total energy:
• Pre-school 227 kcal +/-5%
• Primary school 276 kcal +/-5%
Rivera-Dommarco J, et al. El estado nutricional de la población de México:
• Secondary school 382 kcal +/-5%
cambios en magnitud, distribución y tendencias de la mala nutrición de 1988 a
2006. Salud Pública Mex; 2008; 49, 267-269.
Strategies and actions for overweight and obesity
prevention in Mexico
• As an answer of Mexico’s government, the
Ministry of Health, started the National
Agreement for Nutritional Health: Strategy
against overweight and obesity (ANSA), January
2010.
•Both government and society must act to
combat the epidemic of obesity
•National policies should encourage and provide
opportunities for increased physical activity and
improve the availability and accessibility of
healthy foods
•The severity of the problem calls for the
participation and responsibility of different
government sectors, civil society, private sector
as well as individuals and families.
Strategies and actions in school setting
School as important
setting to promote
healthy nutrition and
physical activity habits
Action Plan for Schools
• Health Promotion and
Education
• Regular physical activity
Availability and access to
healthy food and
beverages in schools
Guidelines on Nutrition
Standards for Foods and
Beverages
offered in Schools
Implementation of guidelines
• Gradually, (by school years) to allow a sustained and continuous
change, enabling acceptance and adjustment of all actors
Energy per portion <=
140 kcal
Total fats <=
≤ 40%
Stage I (School year
2010-2011).
Energy per portion < = 130 kcal
Total fats <= ≤ 40%
Reduction of sugar, saturated
and trans fats, sodium and
fiber
Stage II (School year 20112012)
Energy per portion <= 130
kcal
Total fats <= ≤ 35%
More reduction of sugar,
saturated and trans fats and
sodium
Stage III (Starting from
school year 2012)
Closure of stage II
2500
2000
1920
1500
Total of products that
fulfill the nutritional
criteria
1000
545
500
413
336
0
Stage I
Beginning Closure of Beginning
of stage II Stage II Stage III
Guidelines criteria
General Criteria
Average energy requirement for pre, elementary and secondary school
Maximum amount of calories and macronutriments recommended for school snack
Combination of food for correct diet, according to NOM-043-SSA2-2012, Promotion and Education for
nutritional health .
Daily consumption: 1) Vegetables and fruits, 2) Plain water, 3) Prepared food
Recommendations for school snack
Food category
Energy Value 15% to 20% (17.5% average)
Prepared food
25-30% fats, 55-60% carbohidrates, 10-15% protein
Beverages
Saturated fats <10%, trans fat <1%,
Added sugars <10%, salt < 5g
Liquid foods
To include daily:
• One or more portions of vegetables and fruits
• One portion of prepared food according to nutritional
criteria
• Plain water
Twice a week: one portion ok semi or skimmed milk or yogurt,
fermented dairy products, juices non caloric sweeteners free
Once a week: salty snacks, cookies, candies and desserts that
fulfill the nutritional criteria
• Milk
• Yogurt and fermented liquid food
• Fruit and vegetable juices
• Soybean liquid food
Snacks
• Included cheeses for lunch
Cookies, candies and desserts
Oleaginous and legumes as snack
First qualitative evaluation
Objective
To identified the main factors that facilitate or obstruct the application of
the nutritional guidelines
Methodology
Semi-structured face-to-face interviews
1. School principals
2. Parents
3. Members of Social Participation School Councils
4. Persons-in-charge of the school store
5. Primary and secondary school students
Main results
• Most of the members of the educational community (teachers,
parents and students) knew about the general guidelines (77.14%).
• 75.46% of school vendors fulfilled the general guidelines.
• The same beverages were offered in pre, primary and secondary
schools.
• There was some resistance from parents used to sending a school
snack with a high energy content and sugared beverages.
Second stage evaluation
Objective
To have the information concerning the application of the general guidelines in the
second stage and to identify the factors which support or hinder its fulfillment
Methodology
• National representative sample of 172 schools (122 elementary and 50 secondary)
• From June 11th to 29th, 2012
• The surveys included school principals and teachers, members of the School Store
Committee, parents, students and school vendors.
• Information was obtained concerning:
• Knowledge about guidelines
• Perception of change at schools according to several actors
• Food and beverages sold at school
• School snack
• Consumption of plain water
• Physical activation
• Educational materials
• Perception of obstacles and facilitators for the application of the guidelines
Second stage of the guidelines
RESULTS
Knowledge about guidelines
•90% of teachers and principals and 85% of the members of the committee knew them
•60% of parents identified the guidelines as a measure against overweight and obesity
Healthy school snack
• The actors recognized the sale of vegetables and fruit and a healthy lunch as the main
criteria which define the guidelines
• 40% in elementary and 60% in secondary schools also identify drinking plain water as part
of a healthy snack
Perception of changes in the schools according to different actors
• 85% of all actors observed a favorable change in the sale of food in both levels and 45%
and 55% in the sale of beverages
•65% of school vendors in elementary schools and 75% in secondary schools mentioned
that they have made changes in the preparation and in the foods they offer
Reasons which help to the creation of guidelines for
distribution of food and beverages at schools
(elementary)
Overweight / Obesity
Diabetes
Wide availability of highcalorie foods
Principals
CECE
CIAF
Teachers
Parents
Reasons which help to the creation of guidelines for
distribution of food and beverages at schools
(secondary)
Overweight / Obesity
Diabetes
Wide availability of highcalorie foods
Principals
CECE
CIAF
Teachers
Parents
Second stage evaluation
RESULTS
Food and beverages sold in the school
Food
elementary
Secondary
Cookies and candies
26.1%
34.1%
Non fried preparations
19.2%
20.9%
Sugared beverages
7.4%
7.8%
Fruits and vegetables
11%
6.1%
Fried preparations
10.2%
5%
Foods that the students refered they buy at
school (stage II) RESULTS
Cereal bars
Salty Snacks
Sweet Snacks
Fried food or fast food
Not fried food
Milk/Yogurt
Sugary beverages or
soda
Plain water
Fruit or vegetable
Secundary
Elementary School
Content of school lunch referred by parents and
observed in the student’s lunchbox (elementary)
RESULTS
Fruit or
Vegetable
Not fried
food
Plain
water
Parents
Milk /
Yogurt
Sugary
beverages
or soda
Fried food Sweet snack
or fast food
Student's lunchbox
Cereal Bars
Content of school lunch referred by parents and
observed in the students’ lunchbox (secondary)
RESULTS
Fruit or
Vegetable
Not fried
foods
Drinking
water
Parents
Milk /
Yogurt
Sugary
drink or
soda
Fried food
or fast food
Student's lunchbox
Cereal Bars
Sweet snack
Second stage of the guidelines
RESULTS
Access and availability of plain water
• 72.9% in elementary schools and 62% in secondaries have any
source of drinking plein water.
• There are 1.4 drinking fountain in function for each 100 children.
Water supply
elementary
Secondary
Water sprue
42.8%
37.1%
Carrafs in common areas
21.8
15%
Carrafs in classrooms
32%
8.7%
Second stage of the guidelines
RESULTS
Physical activation
• In 38% of elementary schools and 19% of the secondaries was observed physical activity
the day of the visit with a duration of 14 minutes
Elementary School
Secondary
With at least one period of
physical activity
Average duration
of AF (min)
14.4±7.8
At the start of the school day
14.2±8.6
12.0±4.0
15.6±8.6
Another time
Second stage of the guidelines
RESULTS
• Educative Material for the application of the guidelines
• About 70% of the vendors and 65% of the CECE have them.
• 20% of the parents and 7% of the teachers have this material
90.0
80.0
70.0
Primaria
Elementary
Secondary
Secundaria
School
76.7
70.6
67.4
59.4
60.0
49.9
50.0
%
40.0
30.0
24.3
20.3
20.0
14.8
11
10.0
3
0.0
Vendedores
Vendors
CECE
Food
Committee
CIAF
Physical
activity
committee
Docentes
Teachers
Padres
Parents
Educational materials
Second stage of the guidelines
RESULTS
Obstacles and facilitators percieved for the application of the
guidelines
• 70% of the school members and 65% of parents agree that the
guidelines have been fulfilled.
• Main obstacles:
• Family habits which are not very healthy
• The lack of interest of parents
• The preferences of students for food with a high content of
sugar, fat and sodium
• The lack of information about the guidelines
• Main facilitators:
• Principal’s leadership
• Teachers’participation
• Parents’support
Benefits of general guidelines in health and
nutrition
The guidelines benefit about 18 million students
 11 954 867 from 65 739 elementary school
 5 138 075 from 28 316 secondaries
 TOTAL CHILDREN: 17 092 942
With the participation of :
 64 092 principals
 764 949 teachers
 TOTAL SCHOOL COMMUNITY : 828 041
Source: Census of the Ministry of Education. Academic year 2001/12OF
Conclusions
During these evaluations we can observe the following:
• In the first stage there was resistance from the vendors
because they didn’t have the educational materials and there
is also a lack of cooperation from the parents.
• In the second stage there is more participation of all actors,
the vendors had the educational material, they agreed to
follow the guidelines because they knew them and parents
take into consideration the guidelines to prepare the lunch of
their chidren.
Challenges of the guidelines
• To put emphazis in students and teachers about the
importance of physical activity, by means of educative
campaigns which underline their benefits.
• To increase the participation of parents for motivating physical
activity.
• To intensify the supervision of sale of food and beverages by
the committees and principals
• http://www.insp.mx/alimentosescolares/
LNCA. Zaira Valderrama Álvarez
Nutrition Coordinator
Mexico Ministry of Health
zaira.valderrama@salud.gob.mx