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BackgroundNutritional warnings are used as a public health strategy to prevent increases in obesity prevalence. Peru approved in 2013 and implemented in 2019 a Law requiring nutritional warnings on the marketing and packaging of processed foods high in sugar, sodium, saturated fat, and containing transfat. The complexity behind the implementation of this set of policies over six years provide unique learnings, essential to inform the obesity prevention context, especially when facing strong opposition from powerful stakeholders such as the food industry.AimsDescribe milestones and key stakeholders’ roles and stances during the nutritional warnings policy design in Peru; and identify and analyze the main drivers of policy change that explain its approval.MethodologyIn 2021, interviews were conducted with 25 key informants, advocates and opponents of the policy, closely involved in its design. Interviews were analyzed using the Kaleidoscope Model as a theoretical framework. Relevant policy documents and news were also analyzed.ResultsMilestones for this policy were the approval of the Law, Regulation, and Manual. Policy supporters were mainly from the Congress, civil society organizations, and Health Ministers; whereas opponents came from other parties in the Congress, ministries linked to the economic sector, the food industry, and media. Across the years, warning’s evolved from a single text, to traffic lights, to the approved black octagons. Main challenges included the strong opposition of powerful stakeholders; the lack of agreement for defining the appropriate evidence for nutritional warning parameters and design; and the political instability of the country. Based on the Kaleidoscope Model, the policy successfully targeted a relevant problem (unhealthy eating decisions) and had powerful advocates who effectively used focusing events to reposition the warnings in the policy agenda across the years. Negotiations weakened the policy but led to its approval. Importantly, government veto players were mostly in favor of the policy, which enabled its final approval despite the strong opposition.ConclusionsDespite the strong opposition faced and technical and political difficulties to define the best parameters and warnings’ design, Peru’s nutritional warnings policy was approved. Lessons learned are essential to inform similar and related prevention policies in Peru and elsewhere.

Background Sugar-sweetened beverage consumption is associated with obesity and chronic disease. In 2018, Peru increased the tax on high-sugar beverages (≥6 g of sugar per 100 mL) from 17 to 25%, yet little is known about pre-existing beverage trends or demographic characteristics associated with purchases in the country. The aim of this study was to explore beverage purchasing trends from 2016 to 2017 and examine variation in purchase volume by sociodemographic characteristics among urban households in Peru. Methods This study used monthly household purchase data from a panel of 5145 households from January 2016–December 2017 from Kantar WorldPanel Peru. Beverage purchases were categorized by type and tax status under the 2018 regulation (untaxed, lower-sugar taxed, high-sugar taxed). To assess beverage purchasing trends, per-capita volume purchases were regressed on a linear time trend, with month dummies for seasonality and clustered standard errors. Mean volume purchases by beverage tax status (total liters purchased per month), overall and by key demographic characteristics (education, socioeconomic status, and geographic region), were calculated. Mean volume by beverage type was assessed to identify the largest contributors to total beverage volume. Results The trends analysis showed a decline in total beverage volume of − 52 mL/capita/month (95% CI: − 72, − 32) during the 24-month study period. Over 99% of households purchased untaxed beverages in a month, while > 92% purchased high-sugar taxed beverages. Less than half of all households purchased low-sugar taxed beverages in a month and purchase volume was low (0.3 L/capita/month). Untaxed beverage purchases averaged 9.4 L/capita/month, while households purchased 2.8 L/capita/month of high-sugar taxed beverages in 2017. Across tax categories, volume purchases were largest in the high education and high socioeconomic (SES) groups, with substantial variation by geographic region. The highest volume taxed beverage was soda (2.3 L/capita/month), while the highest volume untaxed beverages were milk and bottled water (1.9 and 1.7 L/capita/month, respectively). Conclusions Nearly all households purchased high-sugar taxed beverages, although volume purchases of taxed and untaxed beverages declined slightly from 2016 to 2017. Households with high SES and high education purchased the highest volume of taxed beverages, highlighting the need to consider possible differential impacts of the tax policy change by sub-population groups.

Introducción: El aumento de sobrepeso y obesidad se debe, entre múltiples causas, al creciente consumo de alimentos procesados y ultraprocesados. Diversos estudios han demostrado que algunos de estos productos contienen declaraciones de salud y nutricionales y, a la vez, cantidades elevadas de nutrientes críticos (grasas saturadas, sodio y azúcar). Por ello, el objetivo principal de este estudio fue identificar el uso de declaraciones nutricionales y de salud en productos procesados y ultraprocesados ofertados en una cadena de supermercados de Lima, Perú, además de evaluar la relación entre el nivel de nutrientes críticos y la presencia de declaraciones nutricionales de clasificación “light”. Metodología: Se realizó un estudio analítico de corte transversal a partir de productos fotografiados en 3 supermercados de Lima, Perú. Se observaron las etiquetas y se identificaron las declaraciones de salud y nutricionales. La información de nutrientes críticos se obtuvo de la información nutricional declarada en el etiquetado. Finalmente se realizó la prueba de chi-cuadrado para evaluar la relación del nivel de nutrientes críticos con las declaraciones nutricionales de clasificación “light”, además se determinó la razón de prevalencia. Resultados: Se incluyeron 1247 productos, de los cuales 422 presentaban alguna declaración nutricional, y de estos, 122 demostraron alguna declaración nutricional de clasificación “light” (145 declaraciones). Además, se identificaron 35 declaraciones de salud. Se encontró una relación significativa entre las declaraciones nutricionales de clasificación “light” y los niveles “no altos” de grasas saturadas (RP= 3,32; IC95%: 1,64-6,73) y azúcar (RP= 8,71; IC95%: 3,73-20,33). La fuerza de asociación respecto al sodio no fue significativa (RP= 0,93; IC95%: 0,46-1,88). Conclusiones: Se encontró que ante la presencia de las declaraciones “light” hay una mayor probabilidad de contener cantidades no altas de grasas saturadas y azúcar en los productos analizados.

In June 2019, mandatory front-of-package warning labels (FOPL) were implemented in Peru. The aim of the study was to describe changes in marketing strategies on packaging: marketing techniques (MT), health claims (HC), and nutritional claims (NC) on the packaging of products frequently consumed by children before and after the FOPL implementation. Product photos were taken pre- (March 2019) and post-implementation (March-October 2020) in three supermarkets in Lima, Peru. Following INFORMAS protocols and Peruvian Technical Norms, the presence of MT, HC, and NC was assessed on all package sides. Products were classified as “high-in” and “not high-in” based on the regulation threshold for critical nutrients. Differences in the proportion of products with each strategy in both periods were evaluated. Also, a subsample of products was matched according to the barcode and exact McNemar test was used to compare proportions of strategies pre/post-implementation. We included 883 and 1,035 products in pre- and post-implementation, respectively. In both periods, MT appeared on almost 70% of all products. The presence of HC increased significantly only for beverages (24.5–38.1%, p < 0.001). In both phases, NC were commonly used on beverages (>80%). Overall, the prevalence of “high-in” products using MT increased (73.6–82.1%, p = 0.007), while use of HC increased among “not high-in” products (32.9–41.6%, p < 0.001). There is a high frequency of MT on all products and NC on beverages. The increase in MT in “high-in” products may be an industry response to minimize the impact of the FOPL on food choices and sales. New regulatory aspects regarding labeling should be implemented to strengthen the current policy.

To examine factors associated with abdominal obesity among normal-weight individuals from the Demographic and Health Survey of Peru (2018–2021). Cross-sectional analytical study. The outcome variable was abdominal obesity defined according to JIS criteria. Crude (cPR) and adjusted prevalence ratios (aPR) were estimated for the association between sociodemographic and health-related variables and abdominal obesity using the GLM Poisson distribution with robust variance estimates. A total of 32,109 subjects were included. The prevalence of abdominal obesity was 26.7%. The multivariate analysis showed a statistically significant association between abdominal obesity and female sex (aPR: 11.16; 95% CI 10.43–11.94); categorized age 35 to 59 (aPR: 1.71; 95% CI 1.65–1.78); 60 to 69 (aPR: 1.91; 95% CI 1.81–2.02); and 70 or older(aPR: 1.99; 95% CI 1.87–2.10); survey year 2019 (aPR: 1.22; 95% CI 1.15–1.28); 2020 (aPR: 1.17; 95% CI 1.11–1.24); and 2021 (aPR: 1.12; 95% CI 1.06–1.18); living in Andean region (aPR: 0.91; 95% CI 0.86–0.95); wealth index poor (aPR: 1.26; 95% CI 1.18–1.35); middle (aPR: 1.17; 95% CI 1.08–1.26); rich (aPR: 1.26; 95% CI 1.17–1.36); and richest (aPR: 1.25; 95% CI 1.16–1.36); depressive symptoms (aPR: 0.95; 95% CI 0.92–0.98); history of hypertension (aPR: 1.08; 95% CI 1.03–1.13), type 2 diabetes (aPR: 1.13; 95% CI 1.07–1.20); and fruit intake 3 or more servings/day (aPR: 0.92; 95% CI 0.89–0.96). Female sex, older ages, and low and high income levels increased the prevalence ratio for abdominal obesity, while depressive symptoms, living in the Andean region, and fruit intake of 3 or more servings/day decreased it.

In 2015, the Pan American Health Organization (PAHO) published sodium targets for packaged foods, which included two distinct levels: one “regional” and one “lower” target. Changes to the sodium content of the food supply in Latin American Countries (LAC) has not been evaluated. A repeated cross-sectional study used food label data from 2015 (n = 3859) and 2018 (n = 5312) to determine changes in the proportion of packaged foods meeting the PAHO sodium targets and the distribution in the sodium content of foods in four LAC (Argentina, Costa Rica, Paraguay, Peru). Foods were classified into the 18 food categories in the PAHO targets. The proportion of foods meeting the regional targets increased from 82.9% to 89.3% between 2015 and 2018 (p &lt, 0.001). Overall, 44.4% of categories had significant decreases in mean sodium content. Categories with a higher proportion of foods meeting the regional and lower targets in 2018 compared to 2015 (p &lt, 0.05) were breaded meat and poultry, wet and dry soups, snacks, cakes, bread products, flavored cookies and crackers, and dry pasta and noodles. While positive progress has been made in reducing the sodium content of foods in LAC, sodium intakes in the region remain high. More stringent targets are required to support sodium reduction in LAC.

This study aimed to describe the supply and advertising of foods and beverages both inside educational institutions and in their respective local areas in 15 public and private schools in Lima during 2019. Unbiased observations were recorded regarding the types of food available, the presence of octagons, and advertisements used in kiosks and cafeterias. Mobile food vendors were observed at the end of the school day. All schools offered processed products, 73.3% sold food with octagons, and 60% displayed advertising for processed and ultraprocessed foods. Mobile food vendors were observed in 86.7% of schools, several of which were found to sell ultraprocessed products. The results suggest an unhealthy food environment both inside and outside schools, and a noncompliance with current regulations. It is therefore necessary to improve the dissemination and supervision of the food policy, and develop strategies with schools to promote healthy eating.El objetivo del estudio fue describir la oferta y la publicidad de alimentos y bebidas en instituciones educativas y entornos escolares de 15 colegios públicos y privados de Lima en 2019. Se realizaron observaciones inopinadas y se registraron los alimentos ofrecidos, la presencia de advertencias publicitarias, octógonos y la publicidad en quioscos y cafeterías. A la hora de salida se observó la venta ambulatoria de alimentos. Todas las escuelas ofrecían productos ultraprocesados, el 73,3% vendía alimentos con octógonos y el 60% tenía publicidad de alimentos procesados y ultraprocesados. En el 86,7% de los colegios había vendedores ambulantes de alimentos, varios de los alimentos eran productos ultraprocesados. Los resultados sugieren un ambiente alimentario no saludable dentro y alrededor de las escuelas, y el incumplimiento de la regulación actual. Resulta necesario mejorar la difusión y supervisión de la política alimentaria, y construir con las escuelas estrategias para promover una alimentación saludable.

The purpose of this paper was to determine the foods and beverages offered in the city of Lima, Peru, that would be subject to front-of-package warning labels (octagons) according to the thresholds for the two phases (6 and 39 months after the approval) for nutrients of concern (sugar, sodium, saturated fat, and trans-fat) included in the Peruvian Law of Healthy Eating. An observational, descriptive cross-sectional study was conducted that evaluated the nutritional composition of processed and ultra-processed foods that are sold in a supermarket chain in Lima. Of all the processed and ultra-processed foods captured, foods that report nutritional information and do not require reconstitution to be consumed were included. A descriptive analysis was carried out by food categories to report the nutrient content and the percentage of foods that would be subject to front-of-package warning labels. Results: A total of 1234 foods were evaluated, according to the initial thresholds that became effective 6 months after the law was implemented, 35.9% of foods had two octagons, 34.8% had one octagon, 15.8% had no octagons, 12% had three octagons, and no products had four octagons. At 39 months, when the final and more restrictive thresholds become effective, 4.8% did not have octagons. The majority of processed and ultra-processed foods that are sold in a Peruvian supermarket chain carry at least one octagon, and more than 10% of them carry octagons for three of the four nutrients of concern.

Consumption of ultra-processed foods has increased alarmingly, representing a risk to children&rsquo, s health. Different techniques in marketing to kids (M2K) used on food labels are influencing the purchasing decisions of these products. This study aims to provide useful information about M2K found in labeling of food products sold in a supermarket chain in Lima, Peru and to determine its relationship with critical nutrient content. This was an observational, correlational, descriptive study. Data were collected by photographing the front-of-pack (FoP) of 2747 product labels sold in three supermarkets in Lima, but only those that met all the inclusion criteria were evaluated (n = 1092). A relationship was found between the use of techniques in marketing to kids and the level of critical nutrient regarding saturated fat (PR = 0.56, CI95%: 0.52&ndash, 0.63), total sugar (PR = 1.70, CI95%: 1.64&ndash, 1.77), and sodium (PR = 1.05, CI95%: 1.03&ndash, 1.07). Particularly with sugar, the presence of M2K is a risk factor. New regulatory policies for the use of these food labeling techniques should be implemented to improve children&rsquo, s health at the population level.

Despite the negative effects of high sodium and low potassium consumption on cardiovascular health, their consumption has not been quantified in sites undergoing urbanization. We aimed to determine the sodium and potassium consumption in a semi-urban area in Peru with a cross-sectional study. 24-h urine samples were collected. The outcomes were mean consumption of sodium and potassium, as well as adherence to their consumption recommendation

En las últimas décadas, el sobrepeso y la obesidad han aumentado de forma acelerada en los países de ingresos medios y bajos, una situación que consolida a las enfermedades crónicas no transmisibles (ENT) como una de las más importantes causas de mortalidad y discapacidad a nivel global. Actualmente, uno de cada dos peruanos mayores de 15 años tiene exceso de peso y uno de cada cinco sufre de obesidad, una situación que está en continuo crecimiento y afecta cada vez más intensamente a los que viven en condiciones de pobreza, quienes, con frecuencia, son beneficiarios de programas de complementación alimentaria, dirigidos a enfrentar la inseguridad alimentaria y la desnutrición. Existe globalmente una urgente necesidad de encontrar políticas y programas que permitan enfrentar el problema de la obesidad a nivel poblacional, una tarea todavía pendiente. En este artículo revisamos la situación actual de la epidemia de sobrepeso y obesidad en el Perú y el mundo, sus consecuencias y determinantes más importantes, con énfasis en el acceso y disponibilidad de alimentos; describimos los programas de complementación alimentaria más importantes y sintetizamos información de algunas investigaciones e intervenciones para reflexionar sobre cómo sus hallazgos podrían servir para que los programas sociales sean una como plataforma para reducir la obesidad y prevenir las ENT en el Perú. In recent decades, overweight or obesity have increased dramatically in middle- and low-income countries; a situation which consolidates chronic non-communicable diseases (NCD) as one of the leading causes of mortality and disability worldwide. Currently, half the people in Peru over the age of 15 years are overweight, and one fifth suffer from obesity. The situation is worsening and increasingly affects people in poverty, who frequently benefit from food supplement programs designed to combat food insecurity and malnutrition. There is an urgent worldwide need to find policies and programs that help fight the problem of obesity at the population level, a task that is still pending. In this article, we review the current epidemic of overweight and obesity in Peru and the world and its most significant consequences and causes, with an emphasis on access to and availability of foods. We describe the largest food supplement programs and synthesize the research on interventions in order to reflect on how their findings might help social programs work as a platform to reduce obesity and prevent NCD in Peru.