A.  ESTABLISHMENT OF HEALTHY NUTRITION AND ACTIVE LIFE PROGRAM OF TURKEY MANAGEMENT AND DEVELOPMENT OF POLICY

A.1. Supplying political will and determination at national and local level and putting into application.

Strategies and activities:

1. To establish "Healthy Nutrition and Active Life Program Committees"

- Preparation of the general principles for the ''Healthy Nutrition and Active Life Program Committees'' 

- To provide periodical attendance of City governors and superiors of the Health Directorates of the evaluation meetings of the Committees

2. To provide the establishment of the ‘Adequate and Balanced Nutrition and Active Life Board'  in 81 provinces

- Monitoring and evaluation of the provincial activity reports presented with systematical periods by ‘Adequate and Balanced Nutrition and Active Life Board' which are established or planned to be established within the body of Provincial Hygiene Boards.

- Periodical Presentation of activity reports and working priorities

- To forward the activity reports planned and approved by "Adequate and Balanced Nutrition and Active Life Board" to the General Directorate of Primary Health Care

 

A.2. Financial arrangements in the management of obesity prevention.

Strategies and activities:

1. To provide obesity fight strategies to be taken place among national health strategies and policies.

- Meetings will be organized about the importance of obesity prevention initiatives being taken place in the plans and policies of the related institutions and organizations

- Assessing the obesity prevention studies of all the stakeholders within the framework of best practices by 'General Directorate and Program Committees' and sharing of the results within the public.

2. To determine economical precautions within the budget possibilities by giving priority to the regions not developed socio-economically to improve the attainability of finding safe food which forms the basis for adequate and balanced diet in the country as a whole.

- To supply the necessary coordination to do the legislative arrangements for reaching qualified foods and menus that supply adequate and balanced diet for the risk groups.

3. To allocate resources within the budget possibilities in order to support the prevention from obesity program in the annual budget of the all stakeholders at national and local level.

-To allocate funds and to make initiatives to improve physical activity opportunities at the workplace and in schools and to create sports centers and recreation areas especially for risk groups.

- To allocate funds and to make initiatives to create better city arrangements and transportation possibilities that will provide opportunity to do exercise.

- To develop actions for prevention, diagnosis and treatment of obesity in health organizations.

 

A.3. To determine the current situation at the national and local level and to support the researches that are going to be done.

Strategies and activities:

1. To provide evidence based, updated data concerning obesity from researches.

- To develop a standard form/guidance document directed to the headings that will take place in the researches for having the obtained results to be comparable

2. To provide "Turkey Nutrition and Health Survey"

-  To provide coordination of the related institutions and organizations and to form a background

3. To do Researches at Provincial level by the "Adequate and Balanced Nutrition and Active Life Board".

- To provide coordination of the related institutions and organizations and to form background. 

- To do 'Provincial Nutrition, Physical Activity and Health Survey' in every province, every 5 years and present the results to the Program Committees

4. To do researches on nutrition directed to special groups (pregnant, babies and children, school children, the elders, health workers etc.)

- Determination of risks groups and completion of the background studies concerning the planning and application of the researches

5. To update “Dietary Guidelines of Turkey” according to research results and to prepare “National Physical Activity Guidelines” according to age groups.

- Updating the “Dietary Guidelines for Turkey” according to research results

- Preparation of the “National Physical Activity Guide” according to age groups

 

B.  ACTIONS FOR OBESITY PREVENTION

B.1. To Inform and Make The Society Conscious About Obesity, Adequate and Balanced Diet   and Physical Activity

Strategies and activities:

1. To arrange in-service training programs to improve the knowledge level of health personnel about prevention from obesity.

- To create education team a consisting of doctor, dietitian, psychologist, physiotherapist, food engineer and nurse in 81 provinces at Health Directorates.

- Formation of education modules and guidance document and development of education materials (book, poster, brochure, film etc.)

- Application of the training of the trainers programs directed to the provincial training teams.

2. To supply information to the individuals who applied to the health organizations about prevention from obesity.

- Preparation and updating of information documents

- Doing trainings for giving information

3. To make the prevention from obesity applications widespread especially to risk groups (babies, children, pregnant and breastfeeding women, elderly, disabled people, people who quit smoking etc.) within the scope of preventive health care and family doctor services.

- Doing informative studies for encouraging the exclusive breastfeeding for the first 6 months, complementary feeding starting after 6 months and continuation for two years.

- Doing informative studies for pregnant and lactating women to benefit from the consultancy service related to body weight

- Doing informative studies for the elder people living in nursing homes, rescue homes, etc.

- doing Informative studies for improving and making widespread of the consultancy service and physical activity possibilities within the budget possibilities for disabled people.

4. Besides routine services developing campaigns, events and programs and applying with regular intervals and making widespread directed to the special groups. 

- To provide the taking part in 'Obesity prevention information line' within the ALO 184 in the body of Ministry of Health to reach every time and get correct information

- Organizing training events in places such as public training centers etc.

- To supply information to the soldiers in the institutions and organizations within the body of Turkish armed forces especially in the recruit drill centers about the prevention of obesity.

- To make religion chaplain mention obesity prevention subjects in their speeches.

- To make the higher education institutions educating teachers to put the courses in obesity, nutrition and physical activity subjects into their course program.

- To make the governmental institutions and privet sector to put the prevention from obesity subjects into their in- service training programs.

- To plan various activities directed to the housewives (healthy menus for guests, in house exercise program etc.)

- To give information to the public in the sport centers and recreational areas and to provide the exercise to be done under the control of experts.

- To encourage and appreciate the local administrations, privet sectors, NGOs implementing various activities concerning the importance of physical activities. 

5. To cooperate with media to transport right messages to society about obesity prevention and within this scope to increase knowledge and awareness level.

- Organization of training programs of the media members (health reporters, producers, film directors etc.)

- To provide role model people in the public (artists, sportsman, politicians etc.) to join educational activities.

- To do initiatives for right message about adequate and balanced diet, obesity and physical activity to be given in the subtitles, spot films, informative advertisements, web-sites, health programs etc.

 

B.2. To Gain The Habit of Adequate and Balanced Diet and Regular Physical Activity for Obesity Prevention in Schools

Strategies and activities:

1. To inform preschool and school children, teachers and parents on obesity prevention.

- To develop educational modules and materials (book, brochure, book separator, coloring books, video films etc.)

- To apply training programs for informing the pre-school secondary education students about prevention from obesity with the use of interactive teaching techniques, computer games, drama, theater, lays etc.

- Organization of activities (seminar, conference, panel, competition etc.) for secondary education and university students related with the prevention from obesity subject)

- Celebration of the special days and weeks about adequate and balances diet and physical activity effectively

- Organization of various events in schools by sport federations and sport clubs in order to form the love of sport in the children and young people.

- To provide organization of free breakfast/ meal programs at schools in low socioeconomic regions within the budget possibilities

- To provide information about the importance of basic nutrition and physical activity to the students in summer schools and camps etc.

2. To ensure improvement of the education program related with the adequate and balanced nutrition and physical activity in preschools, primary education, secondary education and universities.

- Determination of current situation  of the subject related to the adequate and balanced nutrition and physical activity in the education program of the preschool, primary education and secondary education and doing an increase at least for to two hours.

3. To improve the physical activity possibilities (gymnasium, arrangement of school gardens, supply of tools and equipment etc.) in preschools, primary education, secondary education and universities within the budget possibilities.

- To provide the use of sport-facilities in and out of school hours and at the weekend

- To improve condition of school sport halls and yards which are not appropriate for physical activity or not used, and to increase the number of proper ones within the budget possibilities.

- To give more emphasis on the construction of the sport halls in the new schools, organization of the campaigns for the construction and improvement of sport halls in schools

- To encourage university students to attend physical and sport activities, making the conditions of the sport areas in the body of the universities sufficient and supporting the youth clubs activities.

 - To preform certification programs by giving training for ‘exercise trainers’. 

4. To determine students at risks (underweight, overweight, obese) in preschools, primary education, secondary education and in universities

- To measure weight and height of all of the students in pre-schools, primary education, secondary education and universities twice a year

- To direct students who are determined as problematic in the BMI assessment (underweight, overweight, obese) to the health organizations by school management/guidance services

5. To implement nutrition program to encourage consuming food from basic food groups to provide adequate and balanced nutrition in children and adolescents and to provide the periodical control of food services

- To implement various campaigns and activities in order to encourage healthy applications in the food services of the school canteens and cafeterias. (White flag project, Nutrition friendly schools etc.) 

- To select the foodstuffs that will be placed in the food and drink machines in schools and in privet establishments preparing students for various exams, according to the essential food groups

- To develop training programs for encouraging the students to do physical activity in privet establishments preparing students for various exams

- To provide arrangements of the free breakfast/ meal programs at schools in low socio-economic regions within the minimum budget possibilities

- To arrange the delivery of the free fresh fruit, vegetables, milk at schools especially in low socioeconomically areas.

- To launch 'School Milk Program' in primary education schools

- Control of menus being adequate and balanced nutrition following the guide of Ministry of Health in preschools, primary education, secondary education and universities

- To provide inspection of food services in the school canteens and cafeterias according to the adequate and balanced diet and food safety criteria

- To make summer schools and camps widespread and provide inspection of food services in these places in terms of adequate and balanced food and safety criteria

 - To do periodical inspection for the capability of the foodstuffs, food safety and food services in terms of adequate and balanced diet principles in the workplaces selling foodstuffs and/or giving food services around the schools

 

B.3. Actions for Workplaces

Strategies and activities:

1. to increase the knowledge level of the workers on adequate and balanced diet and physical activity.

- To create in-service training documents and to organize programs that this documents are used

2. To ensure doing of obesity prevention studies concerning the workers within the frame of workplace medical services.

- To organize training programs in order to improve knowledge level of workplace doctors working in governmental and privet sector related with the prevention from obesity subject

- To do research for the determination of obesity among workplace staffs within the frame of workplace medical services

3. To complete the background studies given in the workplaces.

- To generalize the menus supporting the improvement of positive nutrition habits which are prepared by dieticians in food services of workplaces (cafeteria, canteen etc.)

- Inspection of the general food services given in the workplaces in terms of food safety

- To bring obligation to build sport center/facilities having best fit capacity to the number of workers in workplaces heaving more than 500 workers and implementation of exercise programs in this facilities by specialist.

- To prepare training set for the employees to do physical activity before and after working hours and during the lunch break.

- To make sport events and competitions widespread among workers

 - To encourage employees to benefit from privet sport facilities at reduced price

 

B.4. Providing Cooperation with Food Industry for Obesity Prevention

Strategies and activities:

1. To ensure cooperation with the food industry in the national policies.

- To do social responsibility projects and training programs related to the subject

- To increase production of food heaving the properties of providing opportunity for adequate and balanced diet and giving positive nutrition habits in the prevention from obesity (fat reduction, sugar and salt ratio etc.)

2. To inform the superior managers of food industry about obesity prevention.

- Organization of trainings meeting

3. To inform and to make consumers conscious of adequate and balanced diet by the food industry.

- Organization of trainings and campaigns for consumers by food industry about balanced nutrition and physical activity

- Taking place of the information about adequate and balanced diet and physical activity subjects on the promotions done for public in the food service places, especially in fast-food restaurants and presentation of best fit foods to the adequate and balanced diet in the menu content

4. To develop advertisement and marketing activities in such a way that will provide the consumers to do the right choices by taking the international applications into account and to take the precautions to let them not to be misleader.

- It is provides in the labels of food products; information to the consumers by taking the international approaches into consideration, easy understandable and easily read nutrient table (energy, total fat, saturated fat, trans-fat, salt and sugar)

- To do additional arrangements for the nutrition and health claims

- To do advertisement and campaign studies by the fruit and vegetable producers in order to increase vegetable and fruit consumption in the public

- To implement activities for presentation of the foods oriented to the supply of adequate and balanced diet and development of positive nutrition habits in the general usage areas such as around schools and work places, cinemas etc. 

- To do 'consumers perception of label' research, to determine the conscious level and perception of consumers

 

B.5. Supporting Adequate and Balanced Nutrition and Active Life in Media News and Advertisements

Strategies and activities:

1. To make the necessary arrangements by reassessing the legal arrangements related with the food advertisements and introductory activities, to put these arrangements into force and to control their applications.

- To revise properly the current legal arrangements related with food and advertisements and presentation activities which take place in the media for children in the direction of needs developed and international agreements that we are a party of them

- To establish self-control center and privet media monitoring groups to control food advertisements

2. To provide right information to be given to the public by written and visual media on adequate and balanced diet, active life and obesity.

- To create websites related with the adequate and balanced diet and physical activity subjects and having application source property in the internet

- To do programs in the national and local TV's and radio channels related with adequate and balanced diet, prevention of obesity and increasing physical activity and having scientific validity and supported by the specialists of the subject. 

- To give information about the development of adequate and balanced diet habits in the woman programs especially in the meal preparation parts with the accompany of dietician, scientific and best fit with the principals of the adequate and balanced diet and having economical options

- To generalize scientific, interactive exercise programs in the national and local TV's and radio channels where information about the positive effects of physical activity on health and its role in the prevention of obesity are given with the accompany of specialists

 

B.6. Encouragement of Physical Activity and Improvement of Environmental Factors

Strategies and activities:

1. To form sport facilities and recreational areas within the budget possibilities in the leadership of local administrations for making the physical activity in the public widespread. (Healthy cities)

- To increase the green areas in the city centers by the local administrations and to do events arrangements such as nature walks at the places away from city center.

- To create exercise areas, basketball and football fields etc. in the parks

- To do the required arrangements in order to make individuals benefit from the sport facilities during the day time

- To form inner city spaces designed by the giving priority to the pedestrians, disables, bicycle users etc. not according to the cars.

- To create exercise areas in the collectively used areas like shopping malls.

- To do activities encouraging walking instead of using car for short distance

- To do activities to encourage individuals for the use of steps instead of lifts if they have no health problems

21. To develop physical activity applications that can be easily applied inside the house

 

- To prepare exercise programs especially for the housewives and to broadcast in the TV Channels 

 

 C. PRECAUTIONS FOR DIAGNOSIS AND TREATMENT OF OBESITY IN HEALTH INSTITUTIONS

Strategies and activities:

1. To contribute to the increase of knowledge of health personnel on diagnosis and treatment of obesity and also to contribute to the generalization of the applications directed to the public.

- To organize training programs for the personnel (team consisting of medical doctor, dietician, psychologist, physical therapist, nurse/health officer, food engineer etc.) in the first step institutions/ public health centers who are concerned with the subject and assigned

- To develop programs for the decrees of obesity prevalence in the region with the use of trained personnel

- Clinical guidance document will be published for the diagnosis and treatment of obesity

2. To ensure diagnosis and treatment of the individuals who applied to the health institutions in terms of overweight and obesity

- To establish obesity units in the first step healthcare institutions/in the family doctor system and obesity schools/centers in the government, special and university hospitals

- To direct the patients who apply to the hospital for any reason and diagnosed with overweight or obesity to obesity unit/center/school

 - To form surveillance system to follow the patients who apply to an obesity unit/center/school.

- To establish mechanism for monitoring the data in the health information system of MoH, AHBS, TSIM and hospital information system databases

3. To make the necessary official arrangements for the application conditions of the bariatric surgery (gastric balloon, bypass etc.) and for the payment of the costs of these methods.

 - the required legal arrangements for the sale conditions and inspection of the pharmacies and the seller of herbs related with the products such as weight loss patches, herbal products which are out of scope for the legislations of MoH and MARA

 

 D. MONITORING AND ASSESMENT

Strategies and activities:

1. To form the monitoring and assessment system.

- To ensure the regular flow of the obtained data, related information and the activities implemented under the responsibility of the different institutions to the MoH General Directorate of Primary Health Care

- To present regularly the data reached to the MoH General Directorate of Primary Health Care to the 'Program Committees' for the purpose of monitoring and assessment of the Action Plan

- To form a subcommittee within the scope of the consulting committee in order to monitor and assess the activities and studies done. To prepare progress report twice a year in order to be presented to the executive committee

- To update and improve monitoring system in order to determine and solve the problems faced in the applications

- To organize annual evaluation meetings by 'Program Committees'

2. To prepare 3 years progress reports as it was mentioned in the WHO European Charter on Counteracting Obesity and to publish the first progress report in 2010.

- Preparation of the progress report in order to present it to WHO

3. To do the assessment of the "Healthy Nutrition and Active Life Program of Turkey" in 2015 and to publish the assessment report.

 - To publish assessment report