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Rev Med Chile 2021; 149: 1485-1494
A description of Chilean food and 1
Escuela de Salud Pública,
Universidad de Chile.
nutrition health policies 2
Escuela de Nutrición y Dietética,
Facultad de Medicina-Clínica
Alemana, Universidad del
1 Desarrollo.
LORENA RODRÍGUEZ-OSIAC, 3
2 Instituto de Nutrición y
ANNA CHRISTINA PINHEIRO FERNANDES, Tecnología de los Alimentos,
3 4
MARIA-F. MUJICA-COOPMAN, PATRICIA CARO-MOYA, Universidad de Chile. Santiago,
5
DEBORAH NAVARRO-ROSENBLATT Chile.
4
Escuela de Salud Pública,
Universidad Mayor.
5
ABSTRACT Programa Doctorado, Escuela
de Salud Pública, Universidad
de Chile.
Background: Chile has implemented numerous successful food and nu-
th Author List for Indexing:
trition initiatives since the early 20 century, aiming to address malnutrition
in all its forms. Aim: To summarize the major nutrition and food-related Rodríguez-Osiac, Pinheiro
policies, strategies, and programs implemented in Chile, using the NOURI- Fernandes, Mujica-Coopman,
SHING Framework. Material and Methods: The NOURISHING framework Caro-Moya, Navarro-Rosenblatt
Author disclosures: Rodríguez-
proposes a methodology for reporting, monitoring, and categorizing actions Osiac, Pinheiro Fernandes,
to promote healthier eating in three main domains: food environment, food Mujica-Coopman, Caro-Moya,
system and behavior change communication. The data collection was carried Navarro-Rosenblatt have no
out reviewing the databases of the Chilean Ministries of Health, Education and conflicts of interest.
Social Development, and the Parliament. Information about nutrition related Recibido el 25 de septiembre
public health policies, strategies or programs was obtained from peer reviewed de 2020, aceptado el 17 de
articles, official reports, official State websites, as well as interviews with former noviembre de 2021.
and current stakeholders. Results: Chile has mandatory nutritional labeling
that was updated to front-of-package warning labels about critical nutrients. Correspondence:
In addition, the advertising of unhealthy foods and breast milk substitutes is Deborah Navarro-Rosenblatt
restricted, among other food and nutrition policies. Nevertheless, strategies related Escuela de Salud Pública,
to mass and social media communication campaigns, or periodic education and Universidad de Chile.
information interventions still need to be implemented. Conclusions: Using dnavarro.rosenblatt@gmail.com
the NOURISHING framework, a comprehensive summary and description of
nutrition and food public health policies implemented in Chile is described. An
overview of the policy changes required according to the nutritional needs of the
population and the nutritional transition in Chile is provided.
(Rev Med Chile 2021; 149: 1485-1494)
Key words: Chile; Health Policy; Malnutrition; Nutrition Policy; Obesity.
Una descripción de las políticas de nutrición y
alimentación en Chile
Antecedentes: Chile ha implementado numerosas iniciativas sobre nutrición
y alimentación desde el comienzo del siglo 20, para combatir la malnutrición
en todas sus formas. Objetivo: Recopilar las principales políticas y programas
sobre nutrición y alimentación implementados en Chile utilizando la estructura
NOURISHING. Material y Métodos: La estructura NOURISHING propone un
método para informar, monitorear y categorizar las acciones destinadas hacia
una alimentación más saludable en tres dominios: ambiente nutricional, sistemas
1485
SALUD PúBLICA
The NOURISHING framework in the Chilean context - L. Rodríguez-Osiac et al
de alimentación y comunicación para lograr cambios de comportamiento. Se
recolectó información desde bases de datos de los Ministerios de Salud, Educación
y Desarrollo Social y del Congreso. La información acerca de políticas, programas
o estrategias de salud pública se obtuvo de artículos revisados por pares, informes
oficiales, sitios de internet del Estado y de entrevistas con quienes están o estu-
vieron involucrados en estos programas. Resultados: Dentro de las políticas de
nutrición y alimentos en Chile, se destaca el sistema obligatorio de etiquetado
nutricional que ha evolucionado hacia la incorporación de advertencias en
envases de alimentos señalando la presencia de nutrientes críticos. En Chile
también se ha restringido la publicidad de alimentos no saludables y sustitutos
de leche materna, entre otras políticas. Sin embargo, aún falta implementar
campañas de comunicación y educación masiva sobre nutrición y alimentación
saludable. Conclusiones: Utilizando la estructura NOURISHING entregamos
un resumen y descripción de los programas de nutrición y alimentación imple-
mentados en Chile en las últimas décadas. Se entrega una visión general de los
cambios requeridos de acuerdo con las necesidades de la población y la transición
nutricional que se ha experimentado.
Palabras clave: Chile; Desnutrición; Obesidad; Política de Salud; Política
Nutricional.
ince the beginning of the 20th century, Objectives, Chile has launched various structural
Chile has implemented multiple public and individual-level public health policies focu-
health policies and programs focused on sed on improving lifestyles and community food
S
9
preventing and controlling undernutrition and environments .
1
micronutrient deficiencies . However, since the As several countries now face high rates of
1990s, Chile has undergone a rapid epidemiologic obesity and related diseases, the World Cancer
transition. After reducing the high rates of infec- Research Fund International (WCRF) has propo-
10
tious diseases and chronic and acute childhood sed the NOURISHING Framework as a template
undernutrition, which were critical health pro- for guiding and monitoring national food and
blems in the 1970s, a new challenge emerged as nutrition policies, focusing on three key policy
excess weight and related chronic diseases became domains: food environment, food systems, and be-
2,3
widespread throughout the country . According haviour change communication. NOURISHING
4 allows comparison policies and programs between
to the 2016-2017 National Health Survey , over
70% of the adult population has excess weight, countries and provides the opportunity to learn
and over 10% of children under 6 years of age from the experiences of other countries. The aim
are obese. In addition, the National School Food of this report is to describe the major food and
Program revealed in 2019 that 24,8% of first-year nutrition policies, strategies, and programs im-
elementary school children are obese5 plemented in Chile over the last 70 years, based
. In Chile, as
is likely the case globally, a high rate of processed on the NOURISHING framework.
food consumption is a major contributing factor
to weight gain, with half of the energy intake in Methods
the Chilean diet coming from processed and ul-
tra-processed foods6 This article describes food and nutrition public
.
In response to rising rates of overweight and policies, strategies, and programs implemented in
obesity, and aligned with international pleas from Chile since the 1950s, using the previously publi-
7 10
the United Nations (UN) and the Pan-American shed NOURISHING Framework .
8
Health Organization (PAHO) , to tackle these The NOURISHING framework was develo-
health problems as multi-sectorial and compre- ped in 2015 by a high-level policy advisory group
hensive efforts and the National Health Strategy convened by the WCRF to provide guidance to
1486 Rev Med Chile 2021; 149: 1485-1494
SALUD PúBLICA
The NOURISHING framework in the Chilean context - L. Rodríguez-Osiac et al
stakeholders and policymakers in developing schemes mentioned above; if they were fully imple-
and implementing policies to prevent cancer and mented by the time of data collection and if they
nutrition-related chronic diseases through diet, were implemented at national or regional level.
nutrition, weight control, and physical activity. On the other hand, health policies, strategies
The framework proposes a methodology for re- or programs were excluded if they were imple-
porting, monitoring, and categorizing actions to mented for less than six months; if no official or
promote healthier eating by three main domains: peer-reviewed documentation was available to
food environment, food system and behavior cite them, and if they were implemented as part
change communication, which are reflected in of pilot interventions or pilot studies. Each health
the following ten policy areas: nutrition label policy, strategy or program included after the
standards and regulations on the use of claims search, was carefully analyzed, and placed in the
and implied claims on foods (N); offering healthy corresponding letter.
foods and setting standards in public institutions
and other specific settings (O); use of economic Results
tools to address food affordability and purchase
incentives (U); restriction of food advertising A comprehensive summary of the main nu-
and other forms of commercial promotion (R); trition public health policies and programs was
improvement of the quality of the food supply gathered after obtaining information from several
(I); setting incentives and rules to create a healthy articles, reports, websites and from stakeholders
retail environment (S); harness supply chain and and expert. To have a better representation of
actions across sectors to ensure coherence with the different policies implemented to tackle nu-
health (H); informing people about food and trition related public health problems, this article
nutrition through public awareness (I); nutrition summarizes these policies in a widespread table
advice and counselling in health care settings (N); that includes the items contained in the NOURI-
and providing nutrition education (G). The pre- SHING framework.
sent article will report the recollected information Table 1 shows that Chile implemented
using the NOURISHING Framework in Chile, and promptly obligatory nutritional labelling, which
will organize it chronologically. also included regulation of nutritional and healthy
claims. The early forcemeat of this obligatory la-
Data collection belling allowed the implementation of innovative
The authors identified laws, public policies, and novel strategies such as the Front-of-Package
programs, and strategies over the last 50 years nutritional (FOP) warning labels, food advertising
in Chile that promote a healthy diet and address restrictions of unhealthy foods and infant milk
obesity prevention in Chile by exhaustively sear- formulas, prohibiting the sale of these foods in
ching the databases of the Chilean Ministry of schools, and the implementation of sugar swee-
Health, Ministry of Education, Ministry of Social tened beverages (SSB) taxes.
Development, and the Parliament. In addition, However, Chile still does not have fiscal measu-
information was also obtained from peer reviewed res, such as incentives for healthy and sustainable
articles, official reports, official State websites, as food production, and taxes on solid or other un-
well as interviews with former and current stake- healthy foods to strengthen the implementation
holders. Furthermore, we included data provided of healthy environments. Moreover, Chile lacks
by institutions such as World Health Organization from having a continuous public health commu-
(WHO), PAHO, United Nations International nication, education, and informative campaigns
Children’s Emergency Fund (UNICEF) and Food in mass and social media.
and Agriculture Organization (FAO), as well as The results of this summary showed that
through the support from recognized Chilean during the 1950s and 1960s, the programs and
experts and politicians from different fields. The policies (e.g., complementary food programs and
search and subsequent data collection were com- fortification programs) were focused on preven-
pleted by December 2018. ting nutritional deficiencies, while programs and
Interventions were included if they fulfilled the policies to tackle obesity and overweight have been
NOURISHING framework, belonging to any of the implemented only recently.
Rev Med Chile 2021; 149: 1485-1494
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SALUD PúBLICA
The NOURISHING framework in the Chilean context - L. Rodríguez-Osiac et al
- -
n
and e
in”), and womand has absen with a with a
for calories,
“low size gnant
” or 13 pre that its impact has . This regulation is
all 13 on beverages
for
“free of ts 10%
and portion
11,12 produc. PNAC is well-accepted have shown 18% on sugary beverages
14 of this program is to reduce 20
production, commercialization, dairy the limits established by the MoH for
d from 13% to
nutrient claims (e.g.ation per 100 g,fortifie objective
The Recent studies decreased
inform 15-17
rules on provides were
increasing from 13% to
including of all foods that exceed
established norms for the program
11 his lunch, and snacks. and beverages in all private and public schoolsin 2014, while taxes
T ,
21
ml
ented in 2006, 1954. changed
in g/100 22
plem d were
mandatory nutritional content definitions, which were voluntary until this point. im14,18
starte 6.25
was hat
t
into force in 2016 with Law N° 20.606, which requires labels to highlight food and beverage , sugars, saturated fat, or sodium content using a black octagon (Figure 2) with the sentence beverages
ood and Health Regulations11 and distributes breakfast,
,
implementing labelling ood Program was created in 1964 for vulnerable pre-school and school-aged children who attend19
, program
Chilean F . The cut-off points for the aforesaid nutrients were per 100 g or 100 ml of product. This regulation only -sweetened above or equal to
of foods universal
13,14 a
warning labels came is , sodium, sugars, and saturated fatson sugar
applies to foods and beverages with added sodium, sugars, or saturated fats. In addition, this regulation prohibits marketing of “high in” foods and beverages directed at children and the sales of these products in schoolsPNAC and children under 6 years old, who have up-to-date vaccinations and health visitseffectively increased vaccine and routine health visit adherence among children and pregnant women. It has achieved asignificant decrease in acute and chronic undernutrition and anemiaACAM was implemented in 2000. This program is for people over 70 years who are enrolled in the Chilean Public Healthbeen partialA 2016 regulation banned sales of “high in” foods axes content of sugar less than 6.25 g/100 ml
DescriptionIn 1996, the marketing These regulations also included definitions for nutrient content, specific health messagesMandatory nutrition protein, carbohydrates, sugars (since 2014), fats (saturated, monounsaturated, polyunsaturated), and sodium. It also includes information of allergens and the list of ingredients in quantity decreasing orderFOP products with high energy“high in”PSystem and have up-to-date vaccinations and health visits, supplying a powdered dairy beverage and cream soup, bothfortified with vitamins and mineralsThe National School Fpublic establishmentsteeism and school desertion and secondarily to provide heathy foods. part of Law 20.606 that prohibits sales and marketing energyTsugar content
ood -
able 1. Description of Chilean food and nutrition policies and programs
T
ood Program
-sweetened
-package nutritional
ront-of ood Program for the Elderly ACAM, for its acronym in ood and beverage sale axes on sugar
Policy/programMandatory nutrition labellingF(FOP) warning labelsNational Complementary FProgram (PNAC, for its acronym in Spanish)National Complementary F(PSpanish)National School FFrestrictions in all private and public schoolsTbeverages
N O U
Nourishing
1488 Rev Med Chile 2021; 149: 1485-1494
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