Diapositiva 1

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Ministry of Public Health of Chile Department of
Nutrition
University of Chile Faculty of Medicine Department
of Nutrition
Evaluation of an intervention in women aimed to
reduce obesity through counseling in healthy
behaviors. Erazo M, Pinheiro A, Gaete P, Silva
J, Pizarro T, Ayala JM.
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Chile
Democracy In habitants 16.284.741 Economic
growth 7 per year
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In last years

• Health problems in the population have changed.

DEFICIT EXCESS
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Prevalence rates undernourished and obese
pregnant women 1987-2002
159

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Fuente MINSAL
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Temporal trend of nutritional status at birth, by
sex.
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Nutritional status children lt 6 y.o.
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Stunting rate (lt - 2 SD H/A) in children lt 6 y.o.
Fuente MINSAL
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Nutritional status in school-children 1993-2002
Fuente JUNAEB
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Prevalence rate of over weighted and obese adults
in Santiago
Fuente Fagalde, Atalah, 2003
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Exclusively breast-feeding 6 months
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NUTRITIONAL INTERVENTION THROUGH VITAL CYCLE
Counseling in healthy lifestyle. More controls
Strict surveillance Nutritional status during
pregnancy Stimulating exclusive breast-feeding
(6 mo) Create more support nets
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Counseling in healthy life
Promote healthy conducts and change
habits. Stimulate self-care.
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Evaluation of the intervention
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• Aims
• To verify an increase in 10 of healthy behaviors
  in intervened population.
• To identify the role of counseling.
• To make a cost-effectiveness evaluation.

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Methods
Pregnancy
Delivery 6th month

Cohort I year 2004 n 272
Cohort II years 2006-2008 n 276

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Multi-level design
New programmatic intervention Implementation A
cquisition of healthy lifestyles Weight
recovery Reduction of incidence and prevalence
of overweight and obesity (nationwide)
Ministry of Health
Health Services
Health centers
Level 2
Level 1
Women
Women Anthropometry Dietary intake Physical
activity Socio-economic level Pathologies
Health centers N Professionals Hours for
counseling Counseling
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Multilevel analysis
Healthy lifestyles
Level 1 (women)
Counseling
Level 2 (health centers)
Residuals
General equation
Mean for all groups
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PRELIMINARY RESULTS
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Table 1. General characteristic of population
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Figure 1. Nutritional status at the beginning
and end of the pregnancy.
p value0,24.
p value 0,28.
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Table 2. Weight gain during pregnancy and weight
retention at month 6.
Average difference intervened vs. Not
intervened
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Table 3. Average consumption of calories and
macro nutrients.
p value lt 0,001
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Table 4. Hours of activities (in a day).
p value lt0,05
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Table 5. Risk factors for not recovering
pre-gestational weight at month 6.
-2 Log likelihood432,112.
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What happened with counseling?
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NOTHING!!!!
Not prepared Health centers Have neither time
nor human resources for counseling Women They
want the professionals to tell them what is
wrong and what is right!!
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Conclusions

• Counseling was not implemented. Professionals
  focused over obese women.
• Centers did not have the necessary number of
  professionals and they were not properly trained
  in counseling .
• Women wanted to be lead by the professionals,
  they do not want to make their own decisions.

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Challenges

• Professionals well qualified in counseling.
• To evaluate the proposed actions.
• What do we want to do?, To diminish prevalence or
  incidence?

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• We ourselves feel that what we are doing is
  just a drop in the ocean, but the ocean would be
  less because of that missing drop.
• Mother Teresa of Calcutta