Table 4 Identification and ranking of strategies for the prevention and control of overweight and obesity in Kenya

1. Promotion of indigenous foods in Kenya Agricultural & Livestock Research Organisation (KALRO) [18]

Stakeholders proposed to have KALRO promote and coordinate research to identify the nutritional value of indigenous foods. The research-based evidence would then be used to promote indigenous foods found to have high nutritional value.

This was considered a potential policy strategy as the research findings would guide policy in the agriculture and food industry. They considered that it would also potentially influence behavior patterns through the resulting health promotion and social marketing programs.

4 gold, 2 green

16

2. Health promotion and education to extend to all levels (beyond behaviors to environments)

Remarked that health promotion and education should not just tell people to eat healthy diets but should also create a healthy environment.

3 gold, 3 green, 1 blue

16

3. Gym, jogging, walking, running

In this, we grouped all behavior that would impact physical activity at the individual level as identified by the stakeholders. Some of the proposed strategies included formulation of regulation that required all new apartments to put up gym facilities in the building, provision of gym at workplaces

3 greens, 2 blues

8

4. School curricula on nutrition and health promotion

This was an existing strategy within the Kenya Comprehensive School Health Policy [19]. It was remarked that the curriculum was comprehensive, but the question was raised as to whether the curricula were being implemented as prescribed. This was identified as a potential question for research.

2 gold, 1 blue

7

5. Integration of Physical Education (PE) into the new Competency-Based Education policy in Kenya [19].

This was identified as a policy-based strategy.

It was acknowledged that the PE was incorporated in the former school curriculum as per the Kenya Comprehensive School Health Policy [19]. However, the participants considered this as not having been very effective citing a lack of adequate, safe, and suitable PE facilities particularly for schools in the urban center who have limited space. They also queried whether adequate time was allocated for physical activity in the schools.

1 gold, 1 green, 2 blues

7

6. ‘Control’ of public transportation

The stakeholders discussed this as a policy-based strategy towards the provision of accessible, adequate, and safe infrastructure that would increase the use of public transport in Kenya.

2 gold

6

7. Trail messages: use technology to enhance health promotion messages

This was identified as a strategy that would help modify behavior patterns encouraging increased levels of physical activity and intake of healthy foods. Stakeholders envisioned that an app or text messages via mobile phone would act as reminders or prompts for one to do their daily PA or to check their energy intake. An example of reminders sent through trail messages received from M-PESA [20] mobile money app was given. This was considered futuristic, but it was mentioned that there was already an app being used in the country for the management of hypertension and diabetes [21]. Within this app, there is a function that sends alerts to technicians and patients. If one’s appointment was due, or if one missed their appointment, one receives a reminder. A similar system was proposed for the prevention and control of overweight and obesity in Kenya. Stakeholders identified that such a strategy would act at the behavior modification level.

1 blue, 2 green

5

8. Emphasis on health education in media channels

Stakeholders identified this as a health promotion strategy that would address both the environment and behavior determinants of overweight and obesity.

‘iNooro’ TV and Radio stations [22], the largest vernacular stations in Kenya were given as good examples of local media channels that were already involved in health education.

1 green

2

9. Health promotion in health centres through health talks and display of messages on posters and advertising screens.

The morning health talks given in the health centers were described in detail. These sessions were considered very meaningful and “said a lot”. They also highlighted that this was an intervention at the grass-root level in the counties.

1 green

2

10. Fads, games, and competitions

Stakeholders identified that a number of these are seen to take place as part of nutrition-focused interventions. They noted that some are very popular but without specific medical grounding. Some scientists had raised complaints about such programs.

These were considered to impact individual behavior patterns.

1 green

2

11. Social support networks

These networks were seen to spring from some of the fads or other interventions. The example given was the aggressive social media support groups for quail consumption witnessed in Kenya between the years 2013 and 2014 [23, 24]. These support networks were considered effective if the health-promoting product or behavior being supported by the group was scientifically sound. These would impact on sociocultural environments and behavior patterns.

2 blue

2

12. Launching a healthy foods guideline as a national strategy; for example, through the Institute of Food and Agricultural Sciences

This was identified as a policy-based strategy.

2 blues

2

13. Media-based health promotion program

An example given for this was the Slim Possible media program [25] that was featured in Kenya a few years back by the CITIZEN TV media house [22].

0

14. Health promotion strategies that increase the uptake of physical activity

0

15. Introduction of fat tax

It was noted that this discussion was well underway but still at the discussion stage in Kenya [26]. This was considered a policy-based intervention.

0

16. Creation and use of patriotic songs in health promotion

A famous patriotic song that was considered to have encouraged citizens to engage in farming activities was given as an example. Stakeholders present jointly sang along the famous Swahili line ‘wakulima ongezeni kilimo’.

0

17. The establishment of a health promotion department at the Ministry of Health and health promotion chapters within their Country health departments

0

18. School feeding programs [19]

Stakeholders remarked that these programs had been in operation for a while now. They commented that the programs were considered fairly effective.

0

19. Health promotion within the antenatal care settings

Commented that antenatal care centers offered a lot of teachings and monitoring to the perinatal and up to five years of baby’s life. Stakeholders discussed that very many interventions are offered in these clinics. A special mention here was the ANC booklets offered to mothers.

0

20. Promotion of agriculture and production of high fibre foods

Stakeholders discussed that Kenya is an agricultural nation. The country produced a lot of good crops, but this has not been looked at as a strategy for health promotion. Stakeholders said that this can be enhanced to inform or positively impact the food environment in the country.

0

21. Have charges for air travel computed per body weight

This strategy raised a lot of debate on human rights and ethics. Discussion around who would receive the income from these charges took place with stakeholders debating whether the proceeds would go to the airline companies or the government as taxes. This way, people would be motivated to lose weight to pay less for travel. This strategy was not deleted from the list but after discussion, the stakeholders considered it not feasible and somewhat unethical.

0

22. Promotion of healthy cooking methods

The use of air fryer was given as an example. On behalf of one of the sub-groups, a stakeholder explained that an air fryer works by circulating hot air around the food and that it was considered a healthy alternative to deep-fried groups.

0

23. Promotion of specifically identified diets such as the Mediterranean diet [27]

A remark was made that the scientific data on the composition of these diets and their effect on health would need to be sourced for the consideration of such a strategy.

0

24. Strategies that address diet and nutrition at the family level not only individual level

It was observed that most of what people eat is influenced by the home setting. An example given was that what children ate was influenced by their parents or households where they lived. So, to fully determine the children’s diet, one would need to know what is being consumed in the homes. This also brought about the issue of food affordability.

0