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Introduction
In Colombia, overweight, obesity and nutrition-related noncommunicable diseases (NCDs) are a public health priority.1 At the national level, according to the National Nutrition Situation Survey 2015 (ENSIN 2015),2 one in four schoolchildren (7-12 years) (24.4%) and more than half of the adult population (18-64 years) (56.5%) are overweight or obese. Furthermore, according to the World Health Organization (WHO), in 2016, cardiovascular diseases, cancer and diabetes accounted for 30%, 20% and 3% of NCD deaths in the country, respectively.3
The overweight and obesity epidemic in Latin American countries is being driven by the transition to a diet high in saturated fats, sugars and sodium, based on a high consumption of foods of animal origin, refined cereals, and processed and ultra-processed products.4,5 A diet with these characteristics impacts not only human health, but also the health of the planet, as the production of these foods affects local ecosystems and fuels environmental degradation.6
The transition to an unhealthy diet depends on several factors such as income growth in a country or region, economic and trade policy liberalization, urbanization, and investment for improving the country's or region's infrastructure.4 Consequently, to combat obesity and nutrition-related NCDs, Colombia requires state intervention based on intersectoral policies that guarantee access for the Colombian population to a healthy, sustainable, and environmentally friendly diet.5,6
In this regard, through the NOURISHING framework, the World Cancer Research Fund proposes 10 policy areas to promote healthy diets and reduce obesity and nutrition-related NCDs. This institution also established a methodology for updating the framework that allows for the categorization, monitoring, and reporting of policy actions and their assessments in each policy area.7
According to the NOURISHING framework, a policy action is any form of government action that includes, but is not limited to, legislation, regulations, decrees, rules, policies, programs, fiscal policies, actions, and voluntary agreements sponsored or endorsed by the government. Interestingly, with regard to policy action evaluation, the framework only addresses evaluations of their process or impact but does not specify the definition of policy action evaluation.7
In this article, any government action aimed at solving a public problem was considered a public policy action.8 In turn, implemented and non-implemented policy actions were taken into account, and both types of actions were defined under the same term: "Policy Action Initiatives" (PAI).
Public policy evaluation is defined as the collection, verification and interpretation of information on the implementation and effectiveness of public policies and programs.9 For the purposes of this work, the term "policy action evaluations" (PAE) groups together formal evaluations of public policies and programs and other documents (e.g., monitoring or implementation reports, surveys, and policy recommendations) that provide information on the follow-up of PAIs.
Therefore, the objective of this study is to identify, using the NOURISHING framework methodology, the PAIs and PAEs against obesity formulated in Colombia since 2005, as it will allow recognizing the areas of the NOURISHING framework that have been addressed in the country, as well as those that require better implementation strategies and further evaluation to adequately tackle the overweight and obesity epidemic in the country.
Materials and methods
Following the NOURISHING framework methodology,7 a literature review was conducted in two phases. During the first phase, PAI data were identified, selected and extracted; these processes were carried out by two reviewers trained to understand the policy areas defined in this methodology and who met periodically to standardize the criteria for the classification of the PAIs in those policy areas. In the second phase, the principal investigator was in charge of identifying, selecting, and extracting data from the PAEs. Each phase is detailed below.
Identification and selection of PAIs
The sources of information were established based on the reference methodology,7 namely, reports and websites of international agencies, government websites, academic publications, updates from civil society organizations (e.g., news, opinion articles, briefing papers, interviews, reviews, etc.), news and communications with public policymakers, policy experts, and stakeholders interested in their implementation.
Data were collected between March and April 2019 from the websites of government agencies or entities attached to the Colombian government (e.g., Ministry of Health and Social Protection, Senate of the Republic), civil society organizations (e.g., Educar Consumidores, Dejusticia), and the newspaper El Tiempo, which was included because it offers the possibility of searching for opinion articles and news using keywords.
First, a search was performed using the term "obesity" and then the equations described in Table 1; this process was carried out on all the websites consulted. The search was also conducted in the Educar Consumidores, the Administrative Department of Science, Technology and Innovation (Colciencias), the Bank of the Republic and the Senate of the Republic websites using each term. No filters by date or language of publication were used in any of the websites, with the exception of the website of the Senate of the Republic, where we searched for bills filed since the 2005-2006 legislative period.
Table 1 Search equations for each of the sources of information consulted.
* Civil society organizations: Educar Consumidores, Red PaPaz (https://www.nocomasmasmentiras.org/), and Dejusticia.
† Government or government agencies, and national entities: Ministry of Health, Ministry of National Education, Senate of the Republic, Bank of the Republic, Colciencias, and repository of the National System of Evaluation of Management and Results (Sinergia).
Source: Own elaboration.
Once the searches were completed, the evidence screening and selection process was carried out. First, by reading the titles, duplicate records were removed and texts that did not address the topic of interest of the present review were excluded. Then, based on the reading of the abstract, the informative or opinion texts and those that addressed the issues of interest at the local level (i.e., no national scope) or in foreign countries were excluded. Finally, the remaining texts were read in their entirety to ensure that they met the inclusion criteria.
Inclusion criteria: 1) texts on the reduction or prevention of obesity and/or nutrition-related NCDs; 2) texts addressing one of the 10 policy areas of the NOURISHING framework; 3) texts on a law, decree, resolution, government policy, national plan, national strategy or bill, or texts classified as such; 4) documents published since 2005.
Exclusion criteria: 1) informative or opinion texts; 2) texts dealing with issues of interest, but at the local level (i.e., no national scope) or in foreign countries.
The searches were updated on August 18, 2020, on all websites, except for Educar Consumidores, Colciencias, and El Tiempo since the former did not allow searching by keywords and the other two did not refer to any PAI or discussed PAIs already addressed in other sources until the end of 2019.
PAIs formulated since 2005 were included because that was the year in which the first ENSIN was conducted in the country (ENSIN 2005)10 and the National Food and Nutrition Plan 1996-2005 was finalized.11
Identification and selection of PAEs
The search for PAE was performed in May 2019 in the Medline (via PubMed) and SciELO databases using the search equations described in Table 1. Moreover, there were no filters by period or language of publication. This search was updated on August 16, 2020.
The screening and selection process of the studies retrieved in the literature searches was similar to that performed in the case of the PAIs: once duplicate records were removed, the titles of the documents were read and those that were not related to the subject matter of interest of the present study were excluded. Then, based on the reading of the abstract, the following types of studies were discarded: editorials, letters to the editor, reflection articles, as well as those articles that, even though addressed PAEs, did so locally (i.e., no national scope) or in other countries. Finally, the resulting studies were read in their entirety to verify whether they met the established inclusion criteria.
Inclusion criteria: 1) studies with a national scope (Colombia); 2) papers with authors considered as academics (whether independent or belonging to universities, civil society organizations, and government agencies or entities contracted by the latter); 3) studies published since 2005.
Exclusion criteria: 1) editorials, letters to the editor, reflection articles; 2) studies on PAEs with a local (i.e., no national scope) or foreign scope. In addition, a complementary search was conducted on August 16, 2019, in the Sinergia repository, which was updated on August 16, 2020. This search was carried out using the equations described in Table 1, but no results were obtained. Therefore, the filter "SECTOR" was used, which allowed to identify the PAEs made by the government organizations that formulated the most PAIs, namely, Ministry of Health and Social Protection, Ministry of Agriculture and Rural Development, Ministry of National Education, and Presidency of the Republic. After eliminating duplicates and excluding documents that, based on the reading of their title, were not related to the topic of interest of the present review, the full text of the remaining documents was read to identify the PAEs of the PAIs included in phase one of evidence search.
Data extraction
The lines of action for each PAI were identified and classified according to the 10 policy areas of the NOURISHING framework,7,12 as follows: N: nutrition label standards and regulations on the use of claims and implied claims on foods ; O: offer healthy food and set standards in public institutions and other specific settings ; U: use economic tools to address food affordability and purchase incentives; R:restrict food advertising and other forms of commercial promotion ; I: improve nutritional quality of the whole food supply; S: set incentives and rules to create a healthy retail and food service environment; H: harness supply chain and actions across sectors to ensure coherence with health; I: inform people about food and nutrition through public awareness; N: nutrition advice and counselling in healthcare settings; and G: give nutrition education and skills .
The data collected were discussed with scholars and researchers with expertise in food and nutrition public policies, who provided analytical elements for their study and recommended the inclusion of additional documents in the review. According to the NOURISHING methodology, "implementation" is defined as the moment when the policy action takes effect.7 In Colombia, standards are in force from the date of publication or, failing that, six months after publication.13
Results
Identification and selection of PAIs
After removing duplicates, 2 291 texts on PAIs were retrieved from the searches carried out on the websites of civil society organizations and government agencies. Subsequently, 2 256 texts were excluded in the title review and summary stages (2 119 and 137, respectively); in addition, 6 documents on PAEs were identified at this stage and included in the PAE selection process (described in the corresponding section). Therefore, in the full-text reading stage, 29 PAIs were reviewed, as well as 18 additional PAIs identified manually in the reference list of the 29 PAIs initially selected; of these 47 PAIs, 31 were selected for full analysis.
These 31 PAIs included documents such as the Food-Based Dietary Guidelines for the Colombian population over 2 years of age14 and the Clinical Practice Guidelines for the Prevention, Diagnosis and Treatment of Overweight and Obesity in Adults,15 which, although they are not a law, decree or government policy, are a PAI according to the NOURISHING framework.7 Resolution 5166 of January 21, 2005, was also included; it adopts the operating regulations of the "Food Security Network" Program - RESA, a program that, according to said document, was created by the High Council for Social Action (Social Solidarity Network) of the Presidency of the Republic through Resolution 3300 of 2003.16
PAI: policy action initiative; PAE: policy action evaluation. * PAI and PAE found in the reference list or mentioned in the documents selected for full-text reading. t PAEs retrieved using the PAI search strategy. The results of the Colciencias and El Tiempo searches were excluded due to the reasons mentioned in the Materials and Methods section. Source: Own elaboration.
Figure 1 Flowchart of the searching and selection process of policy action initiatives and policy action evaluations.
Characteristics of the PAIs
The 42 PAIs included were classified as follows: 16 normative documents (laws, decrees, resolutions, etc.),1,16-30 2 government plans,31,32 5 national strategies,33-37 2 guidelines,14,15 5 bills,38-51 1 draft resolution,52 and 1 government initiative.53 It should be noted that, given that bills can be modified during their review by the Congress of the Republic, the versions identified in the search were analyzed or, in case of not having a specific reference, the first version published in the Congressional Gazette was taken into account.
The 16 PAIs classified as normative documents1,16-30 were considered as implemented because they entered into force prior to their inclusion in the review. On the other hand, data collected were insufficient to determine the implementation of 9 PAIS.14,15,31-37 Finally, the bills,38-52 the government initiative,53 and the draft resolution54 were deemed as unimplemented PAIs. The PAIs included in the review are presented in Table 2.
Table 2 Policy action initiatives against obesity formulated in Colombia since 2005.
PAI: policy action initiative. Source: Own elaboration.
Classification of PAIs according to the NOURISHING framework
The 42 PAIs established 82 lines of action covering all policy areas of the NOURISHING framework, as shown in Table 3.
Table 3 Lines of action of policy action initiatives against obesity formulated in Colombia since 2005 grouped according to the policy areas of the NOURISHING framework7.
| Policy area (number of action lines) | Lines of action | PAI (reference) | ||
|---|---|---|---|---|
| Implemented | Not implemented | No evidence of implementation | ||
| N (9) | Mandatory nutrient lists on packaged food | |||
| Trans fats included in mandatory nutrient labels | ||||
| Clearly visible "interpretative" labels and warning labels | 38- 41, 53 | |||
| Rules on health claims | ||||
| O (8) | Healthy food supply in schools | |||
| Fruit and vegetable initiatives in schools and other specific locations | 33 | |||
| Fruit and vegetable initiatives in the workplace | 34 | |||
| Mandatory standards regulating the food offered in the school feeding program | 20 | |||
| Mandatory standards for foods available in schools, including restrictions on unhealthy food | 42 | |||
| Initiatives for the implementation of healthy tuck shops | 39-41 | |||
| U (2) | Health-related food taxes | 43,44 | ||
| R (14) | Regulation of broadcast food advertising to children | |||
| Mandatory regulation of broadcast food advertising to children | 45 | |||
| Mandatory regulation of food advertising through any medium | 39-41 | |||
| Mandatory regulation of marketing of specific food items and beverages | 46,47 | |||
| Mandatory regulation of specific marketing techniques | 40,44 | |||
| Mandatory regulation of food marketing in schools | 40,42 | |||
| I (5) | Voluntary reformulation of food products | |||
| Mandatory limits of trans fats in food products | ||||
| Mandatory limits on level of salt in food products | 48,54 | |||
| S (2) | Initiatives to increase the availability of healthier food in stores and food service outlets | 34 | ||
| Incentives and rules to reduce salt in food service outlets | 48 | |||
| H (17) | Public procurement through 'short' chains | 20,24-27 | 39,49 | 31 |
| Community food production | 16,26 | 31,34,36 | 50 | |
| Governance structures for multi-sectoral/stakeholder engagement | 51,52 | |||
| I (9) | Development and communication of food-based dietary guidelines | 14 | ||
| Public awareness, mass media and informational and social marketing on healthy eating | 1 | 39-41,44 | 31,37 | |
| Public awareness campaigns concerning salt | 35 | |||
| N (7) | Guidelines and programs to provide support in primary care to people who are overweight and obese | 29 | 15 | |
| Nutritional counseling in primary health care | 32,34 | |||
| Training for health professionals | 34 | |||
| G (9) | Nutrition education programs in schools | 42 | 31,36 | |
| Nutrition education on curricula | 34 | |||
| Initiatives to train schoolchildren on growing food | 34,36 | |||
| Workplace or community health schemes | 44 | |||
| Educational interventions on healthy foods in higher education institutions | 44 | |||
PAI: policy action initiative.
Source: Own elaboration.
In the PAIs implemented (n=16), 24 lines of action were identified, and the highest number of lines of action was found in the "H" policy area (n=8). In turn, there were 21 lines of action in the PAIs without sufficient evidence to determine their implementation, and area "G" was the policy area with the most lines of action (n=5). Finally, 37 lines were identified in non-implemented PAIs (n=15), with "R" being the policy area with the most lines of action (n=10). The distribution of the lines of action established by the PAIs according to the policy areas of the NOURISHING framework, their implementation status, and year of publication are presented in Figure 2.
Identification and selection of PAEs
After removing duplicates, 277 documents on PAEs were retrieved from Medline, SciELO, and Sinergia. Subsequently, 265 studies were excluded in the title and abstract reading stages (251 and 14, respectively), so 12 PAEs were reviewed in the full-text reading stage, as well as 6 PAEs retrieved using the PAI search strategy and 2 PAIs manually identified in the reference list of the 29 PAIs selected for full-text reading; of these 20 PAEs, 10 were included in the review for full analysis.
It should be noted that among these 10 PAEs, local purchasing records from all regions of the country were included by the Colombian Institute of Family Welfare under its Local Purchasing Strategy,55 which seeks, on the one hand, to support small farmers by purchasing their products, and, on the other hand, to contribute to the food and nutritional security of the country's children and adolescents.
Finally, after consultation meetings with food and nutrition public policy experts, two PAEs recommended by them were added, as well as the ENSIN 2015,2 which contains information collected after the implementation of the obesity law.1 Therefore, 13 PAEs were finally included in the review, which are presented in Table 4.
I: implemented; PAI: policy action initiative; Ni: Not implemented; In: insufficient evidence to determine implementation. • Line of action established in an implemented PAI. x Line of action established in a non-implemented PAI. † Line of action established in PAI without sufficient evidence to determine its implementation. Source: Own elaboration.
Figure 2 Distribution of the action lines established by the policy action initiatives in the NOURISHING framework's policy areas based on their implementation status and year of publication.
Table 4 Policy action evaluations on overweight and obesity in Colombia.
| Policy action evaluation | Year of publication |
|---|---|
| Evaluation of results from the ReSA food safety network56 * | 2007 |
| Executive evaluation: Food Security Network Program - ReSA57 * | 2009 |
| Strengthening of the Healthy Environments Strategy and its implementation, within the framework of the National Development Plan and commitments58 † | 2012 |
| Operations and performance evaluation to determine the degree of effectiveness of the School Feeding Program (PAE)59 * | 2013 |
| Nutritional content of foods and beverages advertised in Colombia during children's viewing slots60 ‡ | 2014 |
| Institutional and performance evaluation of the National Food and Nutrition Security Policy (PSAN)61 * | 2015 |
| First follow-up report on the National Food and Nutrition Security Plan 2012-201962 † | 2016 |
| Process evaluation of the Ten-Year Breastfeeding Plan 2010-202063 † | 2016 |
| Knowledge, perceptions, understanding and use of three nutrition labeling formats to make food decisions among consumers in Colombian households64 † | 2017 |
| Obesity Prevention Study - Labeling Report 201765 ** | 2017 |
| Institutional and performance evaluation of the Comprehensive Early Childhood Care Policy from Zero to Forever66 * | 2018 |
| ENSIN: National Health and Nutrition Situation Survey 20152 † | 2019 |
| Local purchasing strategy: Local purchasing in regions55 † | 2019 |
* PAE conducted by advisors hired by the national government.
† PAE conducted by governmental or national government agencies.
‡ PAE conducted by academics.
** PAE conducted by civil society organizations.
Source: Own elaboration.
Characteristics of PAEs
In terms of authorship, 6 PAEs were carried out by government and/or national government entities:2,55,58,62-64 5 by advisors hired by the national govemment,56,57,59,61,66 1 by academics,60 and 1 by civil society organizations.65
In terms of the issues evaluated, 4 PAEs addressed food security policies and programs56,57,61,62 and 2 discussed perceptions and use of nutrition labels.64,65 The remaining PAEs assessed different issues, namely, the Healthy Environments Strategy,58 the School Feeding Program (PAE),59 television advertising of food and drink products,60 the Ten-Year Breastfeeding Plan,63 the Local Purchasing Strategy,55 and the Comprehensive Early Childhood Care Policy from Zero to Forever.66
It should be noted that the PAE of the School Feeding Program59 was carried out before the corresponding PAI20 became effective, so this PAE could reflect the evaluation of previous program guidelines.
Discussion
According to the evidence found in this review, 42 PAIs were formulated in Colombia between 2005 and 2020 and they, in turn, established 82 lines of action that address all policy areas of the NOURISHING framework.7 In addition, "R" (restrict food advertising and other forms of commercial promotion), "H" (harness food supply chain and actions across sectors to ensure coherence with health), and "G" (give nutrition education and skills) were the policy areas with the highest number of lines of action that were not implemented (n=10), implemented (n=8), or with insufficient evidence of their implementation (n=5), respectively. Moreover, only 13 PAEs were found, with food safety being the most commonly evaluated topic.
According to Perez-Tamayo et at.,67 between 2000 and 2015, the development of public food and nutrition policies in Colombia was based on the axes of food and nutrition security (food availability, access to food, food consumption, and biological use of food).24,67 Perhaps for this reason, implemented PAIs focus on the "H" policy area, particularly on food supply, while food security (specifically the lines of action in food supply) is the most frequently evaluated issue by the PAES.56,57,61,62
Conversely, the scarce evaluation of the other PAIs could be attributed to the influence of particular interests of the competent authorities,68 as well as to their lack of experience in these initiatives, since the inclusion of obesity in the country's public agenda is rather recent.69 Consequently, food and nutrition policies in Colombia continue to focus on the prevention of food insecurity and malnutrition.69
A high degree of heterogeneity among the PAEs identified (reports and follow-up records of political actions, surveys and executive, institutional, operational, performance, and evaluation related to the implementation process of political actions) was also observed, which made it impossible to carry out detailed analyzes consistent with the objectives of the present study. In this sense, further work is needed to consider the additional processes necessary to analyze these PAEs in depth. Nevertheless, the efforts of the individuals and organizations involved in performing the PAEs are noteworthy, as they help to guarantee the right of citizens to be informed about the government actions that affect them.70
With regard to unimplemented PAIs, 7 bills38-41,43-45 on measures for overweight and obesity prevention were identified,71 namely, warnings on front-of-package labeling,38-41 healthy taxes,43,44 and regulation of advertising of unhealthy food and drink products for children and adolescents.39-41,45 Of these, at the time of preparation of this study, 2 were still in the process of review and discussion in the Congress of the Republic to define whether or not they were passed as laws,41,44 4 had been filed (although this does not mean that the bill was rejected, but that the bill was "shelved", but not forgotten),38-40,45 and 1 passed as law, but without the inclusion of the health tax.43
The lack of implementation of regulatory measures for the prevention of overweight and obesity in the country could be driven by corporate political activity (CPA), defined as corporate attempts to shape government policies in favor of corporate interests.72 In this regard, it has been reported that in Latin America and the Caribbean, the ultra-processed food products industry employs CPA strategies during the development of national public health policies in the region.73
In this regard, it has been described that the food industry uses 6 CPA strategies to influence the development of public health policies and their outcomes, including:
i) information and messaging (e.g., lobbying with policy makers, stressing the importance of industry in the economy, promoting deregulation, framing the debate on food and other public health issues in favor of industry);
(ii) financial incentives (funding and providing financial incentives to political parties and policymakers);
(iii) building constituency (establishing relationships with opinion leaders, health organizations, policy makers and the media, and seeking to engage with communities);
(iv) legal (taking or threatening to take legal action against public policies contrary to the interests of industry and influencing the development of trade and investment agreements);
v) policy substitution (designing and promoting more lax alternatives compared to mandatory public health policies, such as voluntary self-regulatory initiatives or non-regulatory initiatives); and
(vi) opposition fragmentation and destabilization (e.g., criticizing public health advocates, or infiltrating, monitoring and distracting public health advocates, groups or organizations).73
Recent studies suggest that the food industry in Colombia negatively exerted an influence to prevent the approval of laws on the tax on sugary drinks74 and on warnings on front-of-package labeling.75 Despite this, in February 2020, the Presidency of the Republic made public the initiative to implement front-of-package labeling,53 but at the time of writing this article, such an initiative had not become an official law.
It should be noted that, according to the NOURISHING methodology, voluntary agreements and actions of companies can be considered as policy actions, as long as they are endorsed or sponsored by the government.7 However, in Latin America, voluntary and self-regulatory initiatives in the ultra-processed food industry have been defined as CPA strategies.73 Therefore, the conflict between both definitions requires further discussion by food and nutrition public policy experts in the region.
On the other hand, the increasing prevalence of overweight, obesity2 and nutrition-related NCDs3 in the country, coupled with the paucity of information on the implementation and effectiveness of PAIs regarding food and nutrition, suggest that current PAIs are deficient. Thus, it is imperative to approve cost-effective regulatory initiatives that generate a timely and significant impact on the Colombian population's nutritional health and that can be subject to an adequate evaluation and follow-up system.71
Regulatory policy actions that have so far proven to be effective in reducing overweight and obesity rates in the region are front-end labeling and restriction of advertising of high-calorie foods, saturated fats, sugars and sodium in Chile,76 as well as the tax on sugary drinks and non-staple foods with high energy density in Mexico.77 Based on the Chilean experience, in order to implement these measures, stakeholders must join forces and generate a strong sense of awareness among the competent authorities and parliamentarians regarding the pressing need to find a solution to the public health problems related to overweight and obesity.78
In Colombia, social mobilization with respect to regulatory measures against overweight and obesity is led by civil society through the Alianza por la Salud Alimentaria (Alliance for Food Health), a coalition of social organizations, non-governmental organizations, academics and researchers working on the rights to food health, a healthy food environment, adequate food and food security, sovereignty and autonomy in the country.79 However, the academy's involvement in these initiatives is recent and not yet consolidated.
Members of the academic and scientific community play an important role in defining the public health problem of overweight and obesity, as well as in the development of solutions and decision-making regarding the implementation of public policies aimed at solving this problem. In each of these processes, scientific reason is a source of legitimacy for public policy actions.80 For this reason, greater participation of these actors in the development of public policies in food and nutrition will enhance the efforts of civil society in favor of the approval of regulatory measures aimed at reducing the prevalence of overweight and obesity in the country, such as the front-of-package labeling law, the regulation of advertising for ultra-processed foods high in saturated fat, salt and sugars, healthy taxes, and other measures designed to promote healthy food environments in the country. In addition, such participation should be free from conflicts of interest, so that these policy actions are not adjusted or adapted to meet interests other than those related to public health.81
One of the main strengths of this review is that it is the first study to identify PAIs and PAEs aimed at preventing overweight and obesity in Colombia. Furthermore, the use of the NOURISHING framework, an internationally standardized methodology, allowed for a comprehensive and systematic mapping of these documents. In this sense, the results reported here are a starting point for encouraging the monitoring and evaluation of the PAIs identified herein.
At the same time, it should be noted that this review has some limitations related to the fulfillment of some aspects of the NOURISHING methodology: (i) besides the PAIs and PAEs identified in systematic searches of electronic databases and other sources of information that met the inclusion criteria, documents suggested by academic experts on the subject were included; (ii) due to the lack of information available in the search sources, it was not verified which PAIs were still in force, nor what their degree of implementation was, and, finally, (iii) the methodological quality of PAEs was not assessed.
Conclusions
Colombia has PAIs against obesity with lines of action covering all policy areas established in the NOURISHING framework. However, implemented PAIs focus on food supply and unimplemented PAIs on regulatory measures. Further government engagement is required to implement PAIs on regulatory measures such as restricting the advertising of unhealthy foods and drinks, along with adequate evaluation and monitoring of these PAIs. In the medium and long term, this will contribute to improving the eating habits of the population and, therefore, to reducing the rates of overweight and obesity and nutrition-related NCDs in the country.
