Prevention of Obesity
The health system
1. Monitor BMI on an annual basis, and in the future, measure waist circumference in primary care clinic.
2. Provide incentives for maintenance of a healthy lifestyle such as engaging in physical activity and adhering to healthy nutrition (via discrete funding through the Health Basket).
Industry and government
Encourage the provision of healthful food through legislation or through negotiation with the food industry to reduce the price of healthful food products and improving their content, along with reducing portion sizes, encouraging the low energy density foods, and providing information regarding the nutritional composition of ready to eat or prepared foods sold in supermarket chains, fast food chains or served in restaurants.
1. Limit advertising of food with low nutritional value during children’s peak television viewing hours.
2. The media should be encouraged to use positive role models to further the consumption of healthful food.
1. Limit the sale of low nutritional value food and drink and increase the availability of healthful foods in cafeterias and vending machines.
2. Adopt innovative approaches in the teaching of nutrition, physical activity and wellness, as well as select and train appropriate teaching staff.
3. Monitor students’ BMI from the age of six and above.
4. Include education for a healthy lifestyle in the school curriculum.
1. Reduce children’s “screen time” (television, computer, video games) by one of the following behavioral methods:
• Skill building, goal setting and reinforcement techniques.
• Parent or family support through provision of information on successful environmental strategies for reducing access to television, video games, and computers.
• Encourage a “TV turnoff challenge” in which participants are encouraged not to watch television for a specified number of days.
2. Encourage family meals, including provision of support for healthy decision-making with regard to the type and quantity of food, as well as the frequency of meals.
Treatment of Obesity
The health system
1. Monitor weight in the clinics by means of BMI screening and lifestyle counseling, including an assessment of barriers and readiness to make behavioral changes. This will generally be performed by the primary care team. The US Preventive Services Task Force (USPSTF) recommends BMI screening in children aged six and above.
2. Offer behavioral therapy or cognitive behavioral therapy for people suffering from obesity, through monthly or more frequent sessions. Obese children should be offered at least 25 hours of therapy over 6 months by skilled professionals such as dieticians.
3. Individual or group counseling with the aim of maintaining desired weight, through personal counseling or with written materials, as well as with technology such as the Internet, e-mail, computer programs, computerized telephone systems focused on health-promoting nutrition and physical exercise, and using pedometers with written or computerized tracking of the number of steps taken daily.
4. Offer incentives for participation in weight loss classes or workshops.
5. In cases where behavioral change has not been sufficiently successful, weight loss medication should be considered.
6. If all the above do not succeed and the person involved has a body mass index of ≥ 40 or ≥ 35 with obesity-related morbidity (e.g., diabetes), bariatric surgery should be considered.
1. Increase employees’ knowledge of health-promoting nutrition and physical exercise by means of lectures, written information, or designated computer software.
2. Change employee behavior by means of behavioral and social strategies such as individual or group behavioral counseling, skill-building activities such as cue control, providing encouragement or rewards, and inclusion of co-workers or family members to build support systems.
3. Enact changes in policy or in the work environment, such as improving access to healthful foods by changing cafeteria offerings and vending machine content, along with provision of on-site and on-the-job time for physical activity.
Schools and families
1. Develop and field multi-year school curricula on topics such as reducing “screen time”, increasing physical activity, increasing consumption of fruits and vegetables, and reducing consumption of unhealthful foods. Involve parents in the development and family-relevant implementation of programs.
2. Cast parents as agents of change promoting a healthy lifestyle for the entire family. Efforts should be focused on families that are motivated to succeed and willing to devote effort in changing the lifestyle of the entire family.
1. Mandatory fortification of basic foods with the vitamins and minerals listed below :
a. All flour imported and/or produced in Israel should be fortified with iron (44mg/kg) and the full vitamin B complex.
b. All salt, imported and domestic, should be fortified with iodine (20 mg/kg). Future reductions of recommended salt intake and salt concentration in processed foods should be taken into account.
c. All dairy products (including milks, yoghurts, soft cheese, and milk substitutes) should be fortified with vitamin D (400 IU/liter).
d. Continued fluoridation of all community water supplies.
2. Healthful food and drink should be assured through reguation, establishment of labeling standards for macro- and micronutrients, and provision of healthful menus in cafeterias of large organizations. Particular attention should be paid to the following:
a. Banning of importing, production, and sale of trans fats-rich foods by the year 2013. These should not be replaced with saturated fats. Clearly label high trans or saturated fat foods.
b. Reduce the sodium content of manufactured foods by 25% by the year 2015, and 35% by 2020, while clearly labeling the salt content of processed foods.
c. Reduce the sugar content in processed foods by 15% by 2020. Clearly label sugars of all kinds on all products.
3. Healthcare providers should counseling people with nutritionally-sensitive chronic diseases and/or risk factors for disease, in keeping with international best practice. This includes the prescription of the following supplements (which should be funded through the Health Basket):
a. Vitamin D: Daily vitamin D supplements (400 IU/d for children and 1000 IU for those 71+) and/or measured daily exposure to the midday sun, considering individual dermal solar sensitivity.
b. Folic acid: Women of childbearing age should be encouraged by all health and social agency providers to consume 400 mg/d.
c. Iron: Infants aged 4 to 12 months should receive 15 mg of iron per day. Assess iron-deficiency status at 9 -12 months, 18 months in all infants. Assess at 24 months in high risk toddlers (Arab/Bedouin, ultraorthodox, low SES, low birth weight, and premature birth) to determine need for continued supplementation.
d. Parenteral supplementation with Vitamin K at birth to all newborns.