Implementation Of Nutrition Policies Research Articles

Gaps in Nutrition Policy Implementation in Childcare Centres in The Edmonton Metropolitan Region: A Cross-Sectional Survey

Purpose: To describe (i) nutrition policies in childcare centres, (ii) the resources and processes used to enable policy implementation, and (iii) the association between policy implementation and childcare centres' or administrators' characteristics.Methods: Between October 2018 and June 2019 a web-based survey that addressed nutrition policy, policy implementation, and sociodemographic characteristics was sent to eligible childcare programs (centre-based and provided meals) in the Edmonton (Alberta) metropolitan region. The survey was pretested and pilot tested. Statistical tests examined the relationship between policy implementation with centres' and administrators' characteristics.Results: Of 312 childcare centres that received the survey invitation, 43 completed it. The majority of centres had a nutrition policy in place (94%). On average, centres had about 9 of the 17 implementation resources and processes assessed. Most often administrators reported actively encouraging the implementation of the nutrition policy (n = 35; 87%) and least often writing evaluation reports of the implementation of the nutrition policy (n = 9; 22%). Administrator's education level was associated with implementation total score (p = 0.009; Kruskal-Wallis).Conclusion: Most childcare centres had a nutrition policy in place, but many lacked resources and processes to enable policy implementation. Additional support is required to improve nutrition policy development and implementation.

The barriers and enablers to implementing the New South Wales Healthy School Canteen Strategy in secondary schools in the Illawarra and Shoalhaven regions – A qualitative study

In 2017, the New South Wales Healthy School Canteen Strategy (Strategy) was introduced into primary and secondary schools. Studies have reported that secondary schools have a lower level of compliance with healthy canteen policies compared with primary schools. This study aims to identify and describe the barriers and enablers to implementing the Strategy in Department of Education (DoE) secondary schools in the Illawarra and Shoalhaven regions. The framework underpinning the study was the systems theory. Canteen managers (CM) and principals from the 21 DoE secondary schools in the Illawarra and Shoalhaven regions were invited to participate in semi-structured interviews. The interviews were structured around the five focus areas of the Strategy, including questions on school nutrition policies and the role of the canteen. Data were collated using the interview guides as a framework and qualitative content analysis, using manual coding, was undertaken. Eight (38%) schools participated with seven CMs and six principals interviewed. Barriers to implementing the Strategy included the changing role of the canteen, the increased demands placed on CMs and inconsistencies between the school food environment and the Strategy. Enablers included monitoring implementation, and internal and external support. This study also recognised that previously identified barriers to healthy canteen strategy implementation are ongoing. The school canteen is an integral part of the school environment and therefore needs whole-of-school support if successful implementation of the Strategy is to occur. Addressing the barriers and promoting the enablers identified in this study will support better nutrition policy implementation in secondary schools.

Understanding the need for a whole-of-society approach in school nutrition policy implementation: a qualitative analysis

BackgroundOnly three of twenty Caribbean Community (CARCICOM) countries have mandatory school nutrition policies despite one third of the region’s children being overweight or obese. In Barbados, there are nutrition guidelines which lack the legal mandate of a formal policy. We aim to assess the comprehensiveness of current national nutrition guidelines and to understand the factors operating in the inner and outer school setting that may influence the implementation of a mandatory school nutrition policy from the perspectives of school administrators.MethodsA documentary analysis of existing nutritional guidelines was conducted along with qualitative semi-structured interviews in primary (elementary) and secondary (high) schools in Barbados. We purposively sampled six primary and four secondary school administrators (principals, deputy principals or senior teachers) to explore their knowledge and views on the National School Nutrition Guidelines. The deterministic implementation paradigm, Consolidated Framework for Implementation (CFIR), was used to explore the complexities within the inner and outer settings of schools. Documentary analysis used a theory-based framework informed by the Wellness School Assessment Tool—school policy analysis questionnaire. Interview transcripts were team coded using thematic analysis with constant comparison facilitated by NVIVO software version12.ResultsSchool administrators were unaware of the existing National School Nutrition Guidelines which documentary analysis found to be restrictive and weak for implementation. Administrators envisioned a government-led (outer setting), whole of society approach as the most effective strategy for the development and implementation of a proposed mandatory school nutrition policy. School administrators identified lack of financial and human resources as barriers to nutrition policy implementation. Formal and informal food vendors are institutionalized in schools and are influential determinants of the school food environment. Schools have individually reached into the outer setting to work with civil society organizations and private individuals to provide financial support and nutrition expertise to their institutions. Mass media campaigns in the outer setting may influence child and parental food choices.ConclusionSchool administrators describe that government-led, CSO supported policy development using a whole-of-society approach has implications for improving nutrition policy implementation. Our findings demonstrate the use of a deterministic implementation framework in the pre-implementation phase of school nutrition policy development.

Stakeholder Perspectives on Barriers and Facilitators on the Implementation of the 1000 Days Plus Nutrition Policy Activities in Ghana.

Optimizing nutrition in the preconception and 1000 days periods have long-term benefits such as higher economic productivity, reduced risk of related non-communicable diseases and increased health and well-being. Despite Ghana’s recent progress in reducing malnutrition, the situation is far from optimal. This qualitative study analyzed the maternal and child health nutrition policy framework in Ghana to identify the current barriers and facilitators to the implementation of nutrition policies and programs relating to the first 1000 days plus. Data analyzed included in-depth interviews and focus group discussions conducted in Ghana between March and April 2019. Participants were composed of experts from government agencies, civil society organizations, community-based organizations and international partners at national and subnational levels. Seven critical areas were identified: planning policy implementation, resources, leadership and stakeholders’ engagement, implementation guidance and ongoing communication, organizational culture, accountability and governance and coverage. The study showed that, to eradicate malnutrition in Ghana, priorities of individual stakeholders have to be merged and aligned into a single 1000 days plus nutrition policy framework. Furthermore, this study may support stakeholders in implementing successfully the 1000 days plus nutrition policy activities in Ghana.

The Gift of Data: Industry-Led Food Reformulation and the Obesity Crisis in Europe

Ultraprocessed-food manufacturers have proposed product reformulation as a key strategy to tackle obesity. In determining the impact of reformulation on population dietary behaviors, policy makers often depend on data provided by these manufacturers. Where such data are “gifted” to regulators, there may be an implicit expectation of reciprocity that adversely influences nutrition policies. The authors aimed to assess Europe’s industry-led reformulation strategy in five countries deploying critical policy studies as an approach. They found that interim results on industry-led food reformulation did not meet the countries’ targets. Information asymmetries exist between food industry and policy makers: the latter are not privy to marketing intelligence and must instead rely on data that are voluntarily donated by food industry actors, which represent a distorted snippet of the marketing intelligence system from whence they came. Because these data indeed bear all the hallmarks of a gift, regulatory and public health authorities operate within a gift economy. The implications of this “data-gift economy” are strategic delay and the need to set goals when the field is not visible. Ultimately, this could diminish the implementation of public health nutrition policies that run counter to the commercial interests of ultraprocessed-food producers.

Defining Nutritional and Functional Niches of Legumes: A Call for Clarity to Distinguish a Future Role for Pulses in the Dietary Guidelines for Americans.

Legume food crops can contribute to the solution of diet-related public health challenges. The rich diversity of the botanical family Fabaceae (Leguminosae) allows legumes to fill numerous nutritional niches. Pulses (i.e., a subgroup of legumes including chickpeas, cowpeas, dry beans, dry peas, and lentils) are a nutrient-dense food that could play a key role in eliminating the dramatic underconsumption of dietary fiber and potassium, two dietary components of public health concern, all while maintaining a caloric intake that promotes a healthy weight status. However, incorrect use of terminology—in the commercial and scientific literature as well as in publications and materials prepared for the consuming public—creates confusion and represents a barrier to dissemination of clear dietary guideline messaging. The use of accurate terminology and a simple classification scheme can promote public health through differentiation among types of legumes, better informing the development and implementation of nutritional policies and allowing health care professionals and the public to capitalize on the health benefits associated with different legumes. Although inconsistent grouping of legumes exists across countries, the recently released 2020–2025 Dietary Guidelines for Americans (DGA) were chosen to illustrate potential challenges faced and areas for clarification. In the 2020–2025 DGA, pulses are included in two food groups: the protein food group and ‘beans, peas, lentils’ vegetable subgroup. To evaluate the potential of pulses to contribute to intake of key dietary components within calorie recommendations, we compared 100 kilocalorie edible portions of pulses versus other foods. These comparisons demonstrate the unique nutritional profile of pulses and the opportunity afforded by this type of legume to address public health concerns, which can be greatly advanced by reducing confusion through global harmonization of terminology.

Development of the Hellenic Food Thesaurus (HelTH), a branded food composition database: Aims, design and preliminary findings

The Hellenic Food Thesaurus (HelTH) is the first systematic attempt to create a Greek Branded Food Composition Database. Data on the nutritional composition of foods for up to 45 nutrients, on-pack claims (health, nutrition, social, environmental), quality indicators, and prices were recorded for more than 4,000 foods as they appear on the photographs of their packages available on retailers’ websites. A group of trained researchers carried out data collection and classification using LanguaL. HelTH highlights the variability in nutritional compositions of packaged foods in Greece and the need for better labelling of key nutrients such as trans fatty acids. According to a preliminary analysis of on-pack communications (n = 2008 products), health claims are used rarely (4.1% of products analyzed) with greater prevalence of nutrition (~32%) and natural claims (~24%). HelTH is a key infrastructure for the implementation of food and nutrition policies, new product development, and nutrition and consumer research.

Enhancing nutrition specific interventions through public health policies and public-private partnerships in the Eastern Mediterranean Region: a desk review

Background: Public private partnerships (PPPs) in public health have been widely promoted as an effective tool for accelerating progress toward achieving the United Nation’s Sustainable Development Goals (SDGs), including SDG2 “to eliminate hunger”. Partnership with the private sector was found to be very instrumental in improving the nutritional status of poor and food-insecure people and promoting healthy lifestyles. In countries of the Eastern Mediterranean Region (EMR), PPPs for nutrition actions have been mainly driven by the United Nations (UN) and international development agencies to support low and middle-income countries in achieving better health outcomes. Despite the increased prominence of engaging the private sector in public health actions in the EMR, evidence on the role of the private sector in the design/implementation of these actions is still not documented. The objective of this study is to assess the role and contribution of the private sector in the design/implementation of nutrition-specific interventions addressing the double burden of malnutrition in countries from the EMR and identify the key factors for successful PPP implementation. Methods: The study design was descriptive using secondary data obtained from digital internet sources, including World Health Organization (WHO) databases, grey literature, and websites of the UN and international development agencies. Results: The desk review revealed that the private sector has played a sizable role in the implementation of food fortification initiatives and in the implementation of nutritional policies promoting healthy diets. The experience of the EMR shows the significant impact of government commitment, and the availability of national policies and systems for monitoring and enforcement on the sustainability and effectiveness of PPP-specific nutrition interventions. Conclusion: The study emphasizes the key actions recommended for governments to enhance the application of PPPs as a tool to accelerate the EMR’s progress toward achieving nutrition targets under SDG2 by 2030.

Iodine nutrition: Disorders, monitoring and policies.

Iodine is an essential mineral nutrient and an integral component of thyroid hormones. Iodine deficiency is typically associated with goiter, but can have more serious health implications. Adequate iodine status is important for normal brain development. Iodine deficiency in utero or in early life can cause severe neurological and cognitive impairment. Over the last three decades, global efforts have reduced the prevalence of iodine deficiency disorders (IDD) in many areas of the world with implementation of nutrition policies and programs such as "salt" iodization. However, in a number of areas iodine deficiency is still widespread. Iodine deficiency in remote regions with high poverty will be more difficult to eradicate. Efforts to eliminate IDD in affected areas and sustaining successful iodine programs will be a priority given the substantial public health and economic benefits. A key component will be periodic monitoring of population iodine status to ensure sufficient intakes and the absence of excessive intakes. Median urinary iodine concentration (UIC), a validated biomarker for assessing population iodine status, will facilitate monitoring. Research validating "usual" UIC for use in combination with the Estimated Average Requirement cut-point method will expand its utility and allow accurate determination of the prevalence of inadequate intakes in populations. Further research on the development of biomarkers for assessment of individual iodine status for routine patient care will be important.

Multi-Year Examination of School-Based Programs in Preventing Childhood Obesity: A Case of a State Policy in the U.S.

This study examined the association between the obesogenic factors and the risk of suffering from weight excess in school-based state programs regarding physical activity, physical education, nutrition standards, and nutrition education in preventing childhood obesity. Data were drawn from the 1999–2011 Youth Risk Behavior Survey in the State of Mississippi (N = 8862; grades 9–12). Logistic regression with year-fixed effects was performed to capture the influence of the legislation on teenage obesity, controlling for demographics and nutrition- and physical activity-related behaviors. The age-, sex-, and ethnicity-adjusted mean of the body mass index had reduced since 2007 (year 1999: 23.52; year 2001: 23.53; year 2003: 23.76; year 2007: 24.26; year 2009: 24.29; and year 2011: 23.91). The legislation was significantly associated with a decreased likelihood of being overweight (year 2007, odds ratio (OR) = 0.686; year 2009, OR = 0.739; and year 2011, OR = 0.760; all p < 0.01). Children who were more sedentary, more frequently fasted to lose weight, and were less physically active and likelier to be overweight (OR = 1.05, 1.37, and 0.97, respectively; all p < 0.05), as were African-American children (OR = 0.64; p < 0.05) and female students (OR = 1.59; p < 0.05). In conclusion, schools are among the most easily modifiable settings for preventing childhood obesity and reducing its prevalence, with the implementation of physical activity and nutritional policies.

Menuju Literasi Gizi: Komponen Pengetahuan Gizi pada Program Edukasi Gizi Siswa Sekolah Dasar

Pengetahuan tentang zat gizi merupakan dasar untuk menentukan sikap dan praktik dalam pemilihan makanan. Studi ini bertujuan untuk menge-tahui besaran pengetahuan gizi pada siswa sekolah dasar. Analisis dilakukan berdasarkan data pre test dan post test siswa sekolah dasar ter-pilih yang telah diberikan intervensi edukasi gizi oleh tim Gerakan Nusantara. Program intervensi edukasi gizi diselenggarakan tahun 2014 sampai 2018 pada 7113 siswa sekolah dasar terpilih di Indonesia. Analisis menggunakan uji t dependen pada perangkat lunak SPSS. Standarisasi dilakukan untuk mengetahui besaran perubahan setiap komponen penge-tahuan zat gizi sebelum dan sesudah diberikan intervensi edukasi gizi. Hasil studi menunjukkan terdapat perubahan yang bermakna pada penge-tahuan siswa setelah diberikan intervensi edukasi gizi dengan nilai p&lt;0,05 setiap tahunnya dari tahun 2014 sampai 2018. Besaran perubahan pengetahuan terendah terjadi pada tahun 2014 (skor rata-rata=6,0±18,2). Perubahan komponen pengetahuan terendah adalah tumpeng pedoman gizi seimbang dan piring makanku (skor rata-rata=2,3±1,4). Studi ini menunjukkan bahwa terdapat peningkatan pengetahuan siswa terkait zat gizi dengan dukungan faktor lingkungan sekitar sedangkan komponen pengetahuan yang mengalami besaran perubahan terendah adalah tum-peng pedoman gizi seimbang dan piring makanku. Penerapan kebijakan gizi di sekolah yang diikuti dukungan media dan metode yang efektif perlu dilakukan untuk meningkatkan pengetahuan gizi siswa yang akan berpe-ngaruh pada sikap dan perilaku.

A Thematic Analysis on the Implementation of Nutrition Policies at Food Pantries Using the RE-AIM Framework.

Food pantries are responsible for the direct distribution of food to low-income households. While food pantries may be concerned about the nutritional quality of the food they are serving, they may have limited resources to adopt and implement nutrition policies to support efforts to promote high nutritional quality of the food served. Guided by the RE-AIM (Reach, Effectiveness or Efficacy, Adoption, Implementation, Maintenance) framework, this qualitative study explored the degree of implementation of nutrition policies at food pantries, as well as the barriers to implementation in those pantries that had not adopted a nutrition policy. Semistructured interviews were conducted with 10 food pantry directors: seven pantries with a formal nutrition policy and three with an informal nutrition policy. Using a thematic analysis method, results demonstrated themes from the interviews with policy-adopting pantries to be barriers, enforcement, delivery of the policy, unexpected consequences, and fidelity to the policy. A targeted intervention that builds on this research and focuses on building the capacity of food pantries to develop, adopt, and implement nutrition policies as well as helping to increase fidelity to the policy would be beneficial to continue to improve the food donated and distributed at food pantries. By supporting food pantries in the development, adoption, and implementation of nutrition policies, researchers can play an important role in improving the quality of food in the emergency food network.

P116 Serving Their Needs: Nutrition Policy Implementation in the Early Care and Education Setting

Background Childhood obesity is a growing problem in the United States and results in increased risk for chronic diseases such as diabetes, heart disease, and hypertension. Thirteen percent of youth in Georgia are obese. Identifying strategies to assist children in establishing healthy habits is essential to reduce the risk of childhood obesity. The Early Care and Education (ECE) setting is ideal for the implementation of obesity prevention practices. However, there are barriers present for implementing nutrition policies in this setting. Objective The aim of this qualitative study was to explore the implementation of food and beverage best practices in the ECE setting and highlight barriers and facilitators to adopting these policies. Study Design, Setting, Participants The study sample included ECE teachers in Georgia serving children ages 0-5. A randomized, stratified sample of facilities was selected. Researchers conducted 24 interviews and 6 focus groups with ECE program directors and teachers in 6 regions in Georgia. A trained qualitative researcher facilitated focus groups and interviews. Measurable Outcome/Analysis Data were audio-recorded and transcribed verbatim. Qualitative data analysis software, NVivo 10, was used to code data and identify emergent themes. Results Several key themes related to barriers against food and beverage policy implementation emerged, including the need for enhanced parent communication, resources to limit juice consumption, and support to decrease food costs. Facilitators of nutrition policy implementation included ease of access to water, children's preferences for fruits and vegetables, and availability of existing nutrition resources. Findings will inform the development of resources to support nutrition policy implementation as well as policy training for ECE teachers in Georgia. Conclusions Study findings may provide insight about how to improve current resources and develop new strategies to promote adoption and implementation of nutrition policies in the ECE setting. Funding Robert Wood Johnson Foundation.

Eating during the Hemodialysis Session: A Practice Improving Nutritional Status or a Risk Factor for Intradialytic Hypotension and Reduced Dialysis Adequacy?

Historically, eating during the hemodialysis treatment has been associated with increased risk for adverse intradialytic symptoms and events, risks that have resulted in the implementation of restrictive in-center nutrition policies. Recent studies, however, have recorded a shift in clinical practice with a higher proportion of physicians following the view that administration of intradialytic meals and supplements represents a simple and effective approach to enhance caloric intake and improve nutritional status among patients on hemodialysis. This shift towards less restrictive in-center nutrition practices is mainly supported by evidence from observational studies associating intradialytic nutritional supplementation with improvements in protein-energy wasting, inflammatory state, and health-related quality of life. In sharp contrast, earlier and recent interventional studies have documented that feeding during the hemodialysis treatment provokes a rapid postprandial decline in blood pressure and raises the incidence of symptomatic intradialytic hypotension. Furthermore, other studies have shown that postprandial redistribution in intravascular volume and enhanced blood supply to the gastrointestinal circulation may interfere with the adequacy of the delivered hemodialysis. Those who defend the position that intradialytic nutritional support is beneficial do not dispute the physiology of postprandial hemodynamic response, but they argue against its clinical significance. In this article, we provide an overview of studies that explored the effect of eating during the hemodialysis treatment on intradialytic hemodynamic stability and adequacy of the delivered hemodialysis. We reason that these risks have important clinical implications that are not counteracted by anticipated benefits of this strategy on caloric intake and nutritional status.

Prevalence of current school-level nutrition policies and practices of secondary schools in NSW, Australia.

Lowering the rates of adolescent overweight and obesity is a public health priority. The implementation of nutrition policies and practices in schools is recommended by various health organisations, but there is little information on the extent of their implementation. The aim of this study is to describe the prevalence of the implementation of recommended school-level nutrition policies and practices in secondary schools in New South Wales (NSW), Australia, and reported barriers and facilitators to the adoption of such policies and practices in school plans. A cross-sectional study was undertaken with school principals and canteen managers. All eligible secondary schools in NSW were approached to participate in a telephone survey (n=440). Descriptive statistics were used to describe prevalence, and associations between school characteristics and implementation were examined using univariate statistics. A total of 137 school principals and 80 canteen managers completed the survey. The implementation of practices on drinking water during class, healthy food and beverage marketing and learning opportunities regarding healthy eating was high (>90% of participating schools). The implementation of practices regarding the restriction of unhealthy drinks in school canteens, healthy school fundraisers and staff training related to healthy eating was reported in under 25% of participating schools. There were no significant differences in implementation by school sector, socio-economic status and geographic location. The main barrier to inclusion of nutrition policies and practices in the school plan was having other priorities and commitments (28.5%), and the main facilitator was support from stakeholders, the staff, students and their parents (37.2%). There is opportunity to improve the implementation of nutrition policies and practices in NSW secondary schools. SO WHAT?: Strategies are needed for targeting barriers. These include: gaining support from school staff, students and parents, provision of resources and funding and staff training.

Nutricia Code: nutrition and conflict of interest in academia

To combat malnutrition in all its forms, actions must be integrated from society as a whole. The main interest of the actors involved in these actions should be health. However, there are actors with conflict of interest that interfere in the design, planning, implementation and monitoring of public health nutrition policies. In order to mitigate the adverse effect that result from these conflicts, from evidence generation to the design and implementation of policies, this Code is proposed. It invites the nutrition and health community to adopt it, promote it and subscribe it, and to favor the advancement of actions and policies without industry interference to address the problem of malnutrition.

School nutrition: Support for providing healthy food and beverage choices in schools.

The implementation of nutrition policies and guidelines in Canadian schools has increased the availability and consumption of nutrient-rich foods while reducing access to and consumption of foods and beverages that are high in sugars, sodium, and saturated fats. Positive changes in health outcomes for children and youth, such as improved body mass indices, have been observed. However, observed impacts of school nutrition policies on academic performance have been mixed. This statement reviews key elements of school nutrition policies, with specific focus on nutrition standards. School nutrition policies should align with recommendations in Canada's Food Guide and promote nutrient-rich foods and beverages that are lower in saturated fat, sugar, and sodium.

Analysis of implementation of global nutrition policies to tackle the double burden of malnutrition in Nigeria, Zambia and Indonesia

AbstractThe double burden of malnutrition (DBM) is described as the co-existence of undernutrition and overweight or diet-related non-communicable diseases within a country, community or an individual (WHO). It is a major global issue, affecting approximately half of the worlds’ population. International organizations have published policy reports to function as guidelines for national implementation to tackle the double burden of malnutrition. The goal of this study is to analyze the advancement of the implementation of these recommendations in a number of middle-income countries.Reports and recommendations on policies against DBM from 10 leading international organizations are analyzed and compared on several aspects, such as proposed measures, stakeholder involvement and target population. These organizations are UN, FAO, WHO, EAT forum, GAIN, World Food Program, World Bank, UNICEF, IFPRI and Global Panel on Agriculture and food systems for Nutrition. The level of implementation of the described policies is studied for Nigeria, Zambia and Indonesia by means of desk research and stakeholder interviews. These (semi-structured) interviews are based on the encountered information gaps within the desk research. Stakeholders were selected from a variety of organizations, such as government, NGO's, consumer organizations, science and industry in order to be able to examine the subject from different angles.The study is still ongoing at the time of abstract submission. The (preliminary) results and conclusions will be presented and they are expected to describe per country which nutrition policies against DBM are initiated or implemented. Major learnings and best practices of these implementations will be reported and major differences and similarities between implementations in Nigeria, Zambia and Indonesia will be described and compared with the policy guidelines from the leading health organizations. These results may be used as learning when policies against DBM are newly implemented in other middle-income countries or to improve existing policies.

Serving Their Needs: A Qualitative Examination of Nutrition Policy Implementation in the Early Care and Education Setting

Background: Childhood obesity is a growing problem in the United States and results in increased risk for chronic diseases such as diabetes, heart disease, and hypertension. Thirteen percent of youth in Georgia are obese. Identifying strategies to assist children in establishing healthy habits is essential to reduce the risk of childhood obesity. The Early Care and Education (ECE) setting is ideal for the implementation of obesity prevention practices. However, there are barriers present for implementing nutrition policies in this setting. This report explores the implementation of food and beverage best practices in the ECE setting and highlights barriers to and facilitators for adopting these policies.

Stratification of BMI categories among older adults within and across countries.

Within- and across-country nutritional disparities were examined among older adults in six different countries at varying levels of development. Cross-sectional study. Older adults (aged 50 years or over) in China, Ghana, India, Mexico, Russia and South Africa using the Study on global AGEing and adult health (SAGE). While the distribution of BMI categories varied by country, development-related characteristics were generally related to BMI category in a similar way: urban-living, educated and wealthier individuals were typically more likely to be in a higher BMI category. However, there were some exceptions that corroborate findings in more developed countries. Indeed, a pooled partial proportional odds model which included gross domestic product per capita interactions made the case for intertwining processes of development and the nutrition transition. Population segments to be targeted by nutrition policy and programme implementation might need to change over the course of development.