Progressive self-established goals the “step-by-step” approach

1. Progressive self-established goals the “step-by-step” approach  10 quantitative steps to healthy eating and healthy weight are suggested and recommended. Families and individuals within families are invited to analyze own behavior on the light of such steps and set up their goals.  Self-applicable questionnaire with 20 simple questions and overall index will be made available through all channels as a support tool.

2. Step 1.Increase the consumption of a variety of fruits and vegetables up to 5 serving sizes per day; Step 2. Eat beans, at least 4 times a week; Step 3. Reduce foods high in fat, such as fat meat, processed meat, fried foods, chips and crisps and bakery products high in fat to 2 serving sizes per day.

3. Step 4. Reduce vegetable oil consumption to less than one can (900 ml) of oil per 4 family members a month. Step 5. Have 3 meals and no more than one snack daily. Don’t skip meals. As a snack, eat a fruit. Step 6. Reduce to consumption of “empty” calories from pop-drinks, refined sugar and other refined sugar rich foods to a minimum of 1 serving size a day;

4. Step 7. Reduce the consumption of alcohol to a minimum and avoid the daily consumption of any alcohol; Step 8. Make, as much as possible, your meals a family occasion; don’t eat in the street or when watching TV. Step 9. Maintain your weight within the healthy range - your BMI should be from 18.5 to 24.9

5. Step 10. Be active. Accumulate 30 minutes of physical activity daily. Climb stairs instead of using the lift, walk whenever possible, don’t spend long periods watching TV. Dance with others - or with yourself!

6. Some selected on-going projects and programs

7. Food labeling • Mandatory nutrition labeling on processed foods (ANVISA - Resolution 94, November 1 2000) • All packed foods to list energy, protein, carbohydrates, total fats, saturated fats, cholesterol, calcium, iron, sodium, dietary fiber • Brazilian serving sizes were established to provide easier information for consumers: high fat, high fiber, medium fiber, low fiber • Design of a communication strategy for consumers, on how to interpret and use nutrition labeling • Information on the nutritional content of raw and unpacked foods at point of sale

8. Food labeling • Information on food labels can be derived from Brazilian food composition tables or direct analysis. • New table will include 250 foods analyzed for micro and micronutrients. Emphasis on indigenous tropical fruits and vegetables. (With University of Campinas). • A full databank will be build with all labeling information.

9. For informed consumer choice ‘Shop smart - the best buy’ software - Software to help consumers to make good value and healthier choices. To be available at the points of sale. Special prices and bargains are part of the retailers’ stock policies and the software takes all of those into account to suggest the best value nutritionally sound purchase. (With University of Campinas) Educational material produced to consumers, industry and food retail shops.

10. Guidelines, manuals and information to the public • Production of technical guidelines and manuals for more than 150.000 community health workers already covering 70% of the Brazilian population. - Food guidelines for children under two; - Good eating at low cost; - Brazilian regional plant foods;

11. National Screening of Hypertension will be carried out in November 2001 - booklet with self-applicable questionnaire and “step-by-step” approach to health eating and physical activity will be delivered to more than 40 million Brazilian adults.

12. Surgery for morbid obesity • Regulation of gastroplasty for morbid obese patients in state owned healthcare institutions. (IMC >40 or IMC>35 with associated diseases) - In 1999 63 bariatric operations were carried out financed by the public health services. - From January to December 2000, more than 200 operations have been carried out with public funds.

13. Children and schools • Regulation of the school meals program, to increase raw and semi-processed foods to 70% of total purchases, and increase the amount of fruits and vegetables given to children. One portion of fruit and vegetable a day of each school children is the aim. (With the Ministry of Education) • Studies being undertaken in the following fields - Regulation of the advertising and marketing of foods during children’s TV programs and children’s magazines - Regulation of foods sold in school canteens

14. Children and Schools • TV channel - Special TV channel to train elementary school teachers. Four videos (10 minutes each) broadcast every two months since April 1999, potentially reaching 37 million elementary school children. Themes: Obesity, malnutrition; physical activity and health; food and culture; food safety. (With Ministry of Education) - Programs can be recorded and shown to students. Support material is also produced and distributed so teachers can create new classwork topics.

15. Television • 3 videos (1.5 minutes each) produced and broadcast on state owned educational TV channels as part of the series “What do I do, doc?”, from July 23 1999 for 15 consecutive days. Repeated every 4 months. Themes, healthy diets, healthy weight (the 10 steps), obesity, nutrition and aging. • 2 videos (3 minutes each) produced and broadcast by the cable TV channel TV Futura, several times. Themes, healthy food habits and obesity

16. Print media • Magazines - Ciência Hoje das Crianças. Childrens’ science magazine. Folder with games in the August 1999 issue. 230.000 copies - Nova-Escola’ Magazine for school teachers. Poster and information in the November 1999 issue. 600,000 copies. Hundreds of phone calls received for complementary information.

17. Website www.saude.gov.br programas e projetos - alimentação e nutrição Helpline • Disk Saúde - toll-free number - 0800.611997 - comprehensive databank with information on all aspects of food and nutrition.