Estadísticas

 array:24 [
  "pii" => "S021391111000261X"
  "issn" => "02139111"
  "doi" => "10.1016/j.gaceta.2010.09.014"
  "estado" => "S300"
  "fechaPublicacion" => "2010-12-01"
  "aid" => "358"
  "copyright" => "SESPAS"
  "copyrightAnyo" => "2010"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "ssu"
  "cita" => "Gac Sanit. 2010;24 Supl 1:49-55"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 13712
    "formatos" => array:3 [
      "EPUB" => 244
      "HTML" => 12045
      "PDF" => 1423
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0213911110002608"
    "issn" => "02139111"
    "doi" => "10.1016/j.gaceta.2010.09.013"
    "estado" => "S300"
    "fechaPublicacion" => "2010-12-01"
    "aid" => "357"
    "copyright" => "SESPAS"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "ssu"
    "cita" => "Gac Sanit. 2010;24 Supl 1:56-61"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 7300
      "formatos" => array:3 [
        "EPUB" => 221
        "HTML" => 6013
        "PDF" => 1066
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Welfare state, labour market inequalities and health. In a global context: An integrated framework. SESPAS report 2010"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "56"
          "paginaFinal" => "61"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "El reto de la globalización para la salud pública: el estado de bienestar, y las desigualdades en salud. Informe SESPAS 2010"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "f0010"
          "etiqueta" => "Fig. 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1634
              "Ancho" => 2917
              "Tamanyo" => 316857
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Micro-level framework and policy entry points&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Carles Muntaner, Joan Benach, Haejoo Chung, NG Edwin, Ted Schrecker"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Carles"
              "apellidos" => "Muntaner"
            ]
            1 => array:2 [
              "nombre" => "Joan"
              "apellidos" => "Benach"
            ]
            2 => array:2 [
              "nombre" => "Haejoo"
              "apellidos" => "Chung"
            ]
            3 => array:2 [
              "nombre" => "NG"
              "apellidos" => "Edwin"
            ]
            4 => array:2 [
              "nombre" => "Ted"
              "apellidos" => "Schrecker"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911110002608?idApp=WGSE"
    "url" => "/02139111/00000024000000S1/v1_201301221241/S0213911110002608/v1_201301221241/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0213911110002591"
    "issn" => "02139111"
    "doi" => "10.1016/j.gaceta.2010.09.012"
    "estado" => "S300"
    "fechaPublicacion" => "2010-12-01"
    "aid" => "356"
    "copyright" => "SESPAS"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "ssu"
    "cita" => "Gac Sanit. 2010;24 Supl 1:42-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 9533
      "formatos" => array:3 [
        "EPUB" => 236
        "HTML" => 8101
        "PDF" => 1196
      ]
    ]
    "es" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Desigualdades sociales en la salud infantil&#46; Informe SESPAS 2010"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "42"
          "paginaFinal" => "48"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Social inequalities in child health&#46; SESPAS report 2010"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "f0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1090
              "Ancho" => 1617
              "Tamanyo" => 130981
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Tasas de mortalidad infantil&#46; Distrito de Ciutat Vella y resto de Barcelona 1983&#8211;2007&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Luis Rajmil, Elia D&#237;ez, Rosanna Peir&#243;"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Rajmil"
            ]
            1 => array:2 [
              "nombre" => "Elia"
              "apellidos" => "D&#237;ez"
            ]
            2 => array:2 [
              "nombre" => "Rosanna"
              "apellidos" => "Peir&#243;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911110002591?idApp=WGSE"
    "url" => "/02139111/00000024000000S1/v1_201301221241/S0213911110002591/v1_201301221241/es/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "titulo" => "Prevention of childhood obesity in Spain&#58; a focus on policies outside the health sector&#46; SESPAS report 2010"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "49"
        "paginaFinal" => "55"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Manuel Franco, Bel&#233;n Sanz, Laura Otero, Adri&#225;n Dom&#237;nguez-Vila, Benjam&#237;n Caballero"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Manuel"
            "apellidos" => "Franco"
            "email" => array:1 [
              0 => "mfranco&#64;cnic&#46;es"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff1"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff2"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor1"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Bel&#233;n"
            "apellidos" => "Sanz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff3"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Laura"
            "apellidos" => "Otero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff3"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Adri&#225;n"
            "apellidos" => "Dom&#237;nguez-Vila"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff3"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Benjam&#237;n"
            "apellidos" => "Caballero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff4"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Departamento de Epidemiolog&#237;a&#44; Centro Nacional de Investigaci&#243;n Cardiovascular &#40;CNIC&#41;&#44; Madrid&#44; Espa&#241;a"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff1"
          ]
          1 => array:3 [
            "entidad" => "Department of Epidemiology&#44; Johns Hopkins Bloomberg School of Public Health&#44; Baltimore&#44; MD&#44; USA"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff2"
          ]
          2 => array:3 [
            "entidad" => "Escuela Nacional de Sanidad&#44; Instituto de Salud Carlos III&#44; Madrid&#44; Espa&#241;a"
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "aff3"
          ]
          3 => array:3 [
            "entidad" => "Center for Human Nutrition&#44; Johns Hopkins Bloomberg School of Public Health&#44; Baltimore&#44; MD&#44; USA"
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "aff4"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding autor&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Prevenci&#243;n de la obesidad infantil en Espa&#241;a&#58; un enfoque en pol&#237;ticas ajenas al sector de la salud&#46; Informe SESPAS 2010"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "f0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1326
            "Ancho" => 2333
            "Tamanyo" => 115405
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Prevalence of obesity and overweight and obesity in Spain &#40;enKid 6&#8211;9 years old&#44; SNHS 5&#8211;9 years old&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Obesity has been recognized as a global public health problem<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Childhood obesity increases the risk of long-term energy imbalance and adult obesity and its comorbidities&#44; type 2 diabetes&#44; cardiovascular disease and other non communicable chronic diseases<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">The evidence from developmental psychology indicates that infancy and childhood are critical periods for the adoption of food preferences and other key behaviors associated with energy intake and physical activity&#46; Thus&#44; it is recognized that effective prevention strategies must intervene at these early periods&#44; in order to promote healthy habits and reduce risk behaviors&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">In the field of public health&#44; it is important to acknowledge that childhood obesity is determined by social and economic factors situated in sectors other than the health system&#46; Research in the field of obesity has shown that in the past three decades&#44; population-wide changes are the main driving forces of the worldwide increase of childhood obesity&#46; There is a consensus among obesity experts that changing the &#8216;&#8216;obesogenic&#8217;&#8217; environment is a critical step to advance in the prevention and control of obesity<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a>&#46; Reversing the current policies that lead to increased caloric consumption and reduced physical activity will require major changes in different sectors such as advertising&#44; transportation&#44; urban planning&#44; education and the food environment<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>&#46;<elsevierMultimedia ident="b005"></elsevierMultimedia></p><p id="p0020" class="elsevierStylePara elsevierViewall">The increasing number of children affected&#44; coupled with the difficulty&#44; cost&#44; and low yield of therapeutic approaches available&#44; suggests that prevention should be the primary focus of our efforts to reduce and eliminate childhood obesity&#46; Furthermore&#44; once obesity is established&#44; it is a protracted and difficult-to-treat condition&#59; therefore&#44; it makes sense to focus prevention efforts on the younger generations<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="p0025" class="elsevierStylePara elsevierViewall">The Health in All Policies &#40;HiAP&#41; European Initiative reinforces the idea of the potential impact in health outcomes of policy actions that lay in sectors other than health<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a>&#46; While the health sector&#180;s curative activities are mainly planned and implemented through health outcomes&#44; health promotion and prevention need to be planned from the social and economic determinant points of view&#46; This approach showed to be very useful for decreasing the burden of cardiovascular disease in Finland&#44; and is particularly relevant for the case of obesity<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a>&#46; This approach acknowledges the role of regulations and laws that may influence the different policies in relation to childhood obesity&#46; We will follow the example of HiAP framework to identify the current policies affecting childhood obesity and are therefore amenable of change for the prevention of childhood obesity in Spain&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">In this article we will first briefly review the current situation of childhood obesity in Spain within the context of other European countries&#46; Next&#44; we will identify and analyze a series of policies directly related to the sectors mentioned above&#46; These policies affect different environments where children spend most of their time&#58; physical environment<a class="elsevierStyleCrossRef" href="#bib8"><span class="elsevierStyleSup">8</span></a>&#44; school environment<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a> and home&#47;family environment<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#46; We also paid special attention to social factors such as gender differences&#44; work-life balance and socio-economic status&#44; that act as risk regulators<a class="elsevierStyleCrossRef" href="#bib11"><span class="elsevierStyleSup">11</span></a> for the different policies in relation to childhood obesity&#46; We will subsequently describe several policy changes aimed at preventing and controlling the current childhood obesity epidemic in Spain&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Current situation of childhood obesity in Spain and other European countries</span><p id="p0035" class="elsevierStylePara elsevierViewall">The prevalence of childhood obesity in Spain is among the highest of European countries&#44; as shown by data gathered by the expert group on childhood obesity of the International Obesity Taskforce &#40;IOTF&#41; &#40;<a class="elsevierStyleCrossRef" href="#f0005">fig&#46; 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a>&#46; The criteria used to define &#39;childhood obesity&#39; and &#39;overweight&#39; has been debated extensively<a class="elsevierStyleCrossRef" href="#bib13"><span class="elsevierStyleSup">13</span></a>&#46; To facilitate comparison across different studies&#44; all the data presented in the review use the definitions corresponding to the IOTF criteria<a class="elsevierStyleCrossRef" href="#bib14"><span class="elsevierStyleSup">14</span></a>&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0040" class="elsevierStylePara elsevierViewall">It is noteworthy that the southern European countries in the Mediterranean region&#44; along with the UK&#44; are those showing the highest figures of childhood obesity and overweight<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">Greece presents childhood obesity statistics as high as Spain<a class="elsevierStyleCrossRefs" href="#bib15"><span class="elsevierStyleSup">15&#44;16</span></a>&#46; Greek studies have also shown that the principal factor underlying instance of being overweight among 10&#8211;12 years old in Athens was extended physical inactivity<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a>&#46; Furthermore&#44; a study conducted in rural Greece confirmed the association between high blood pressure and increased BMI in children aged 4 to 10<a class="elsevierStyleCrossRef" href="#bib16"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="p0050" class="elsevierStylePara elsevierViewall">On the other hand&#44; not only Mediterranean countries present high levels of childhood excess weight in Europe as exemplified by the UK<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a>&#46; Studies conducted in Scotland<a class="elsevierStyleCrossRef" href="#bib17"><span class="elsevierStyleSup">17</span></a> and England<a class="elsevierStyleCrossRef" href="#bib18"><span class="elsevierStyleSup">18</span></a> showed a clear socioeconomic gradient with higher prevalence of being overweight and obese in low socioeconomic strata&#46;</p><p id="p0055" class="elsevierStylePara elsevierViewall">To date&#44; the only nationally-representative survey on childhood obesity in Spain with direct measurements of height and weight is the enKid study&#44; conducted in 1998&#8211;2000 in a random sample of 2&#8211;24 year-old children and young adults<a class="elsevierStyleCrossRefs" href="#bib19"><span class="elsevierStyleSup">19&#44;20</span></a>&#46; In 6&#8211;9 year-old children&#44; the study reported prevalence of being overweight and obese of 25&#46;8&#37; and 12&#46;1&#37; in boys&#44; and of 26&#46;2&#37; and 8&#46;6&#37; in girls&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#f0010">fig&#46; 2</a>&#41;&#46; In the 10&#8211;13 year-old age group&#44; obesity and overweight prevalence were reported as 6&#46;6&#37; and 23&#46;8&#37; in boys and 2&#46;6&#37; and 18&#46;4&#37; in girls&#44; respectively&#46; The Spanish National Health Survey &#40;SNHS&#41; included parental self-reported height and weight of 5&#8211;9 year-old children&#46; Both boys and girls from 5&#8211;9 years have increased their prevalence of obesity&#44; whereas instance of being overweight has stayed unchanged or slightly declined&#46; The total combined prevalence of obesity and being overweight is&#44; according to the last SNHS in 2006&#44; 39&#37; for girls and 35&#37; for boys &#40;<a class="elsevierStyleCrossRef" href="#f0010">fig&#46; 2</a>&#41;<a class="elsevierStyleCrossRef" href="#bib21"><span class="elsevierStyleSup">21</span></a>&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia><p id="p0060" class="elsevierStylePara elsevierViewall">A number of local studies have also been carried out in Spain in the last 3 decades&#46; Among these&#44; the Cuenca study was able to directly measure height in 9&#8211;10 year-old children from that city in 1992&#44; 1996&#44; 1998 and 2004&#46; The prevalence of obesity increased from 4&#46;4&#37; in 1992 to 10&#46;1&#37; in 2004 among boys and from 2&#46;9&#37; to 7&#46;8&#37; among girls<a class="elsevierStyleCrossRef" href="#bib22"><span class="elsevierStyleSup">22</span></a>&#46; Together with the data from the enKid study and the Spanish National Survey&#44; these are highly concerning statistics&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">Several determinants of childhood obesity in Spain have been reported in existing scientific literature&#46; The enKid study found that sex&#44; age group&#44; place of residence&#44; mother&#8217;s level of education and family income were significant predictors for obesity in children under 14 years<a class="elsevierStyleCrossRef" href="#bib19"><span class="elsevierStyleSup">19</span></a>&#46; A case-control study conducted in children from Navarra found that low levels of physical activity&#44; an existing family history of obesity&#44; long hours of watching television&#44; and sugar-sweetened beverage consumption were important predictive variables for childhood obesity<a class="elsevierStyleCrossRef" href="#bib23"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="p0070" class="elsevierStylePara elsevierViewall">All these factors were individual characteristics of the children and their parents&#46; It is important to underline the lack of studies aiming to understand the possible relation of contextual characteristics and policies associated with childhood obesity in Spain&#46; Nevertheless&#44; important geographical differences were found in the enKid study pointing out possible group level determinants of childhood obesity<a class="elsevierStyleCrossRef" href="#bib20"><span class="elsevierStyleSup">20</span></a>&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Policy determinants of childhood obesity</span><p id="p0075" class="elsevierStylePara elsevierViewall">Next&#44; we will review the literature pointing out policies outside the health sector related with childhood obesity&#46; After reviewing the current international literature&#44; we identified several different sectors that relate to obesity&#46; For their relevance for preventive actions&#44; we decided to focus on advertising&#44; transportation&#44; the built environment&#44; education and the food environment&#46; Thus&#44; we propose the following framework &#40;<a class="elsevierStyleCrossRef" href="#f0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="f0015"></elsevierMultimedia><p id="p0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Advertising&#58;</span> Advertising is currently an extremely important sector of market economies&#46; Television and tie-in ad campaigns have been shown to be very effective in modifying food preferences in children and adolescents&#46; Unfortunately&#44; most of these campaigns promote low-nutrient density&#44; high-energy foods and beverages<a class="elsevierStyleCrossRef" href="#bib24"><span class="elsevierStyleSup">24</span></a>&#46; The fierce competition among food manufacturers results in extensive ad campaigns that use children&#8217;s educational programs&#44; iconic characters such as movie stars&#44; cartoons and sports celebrities to promote their products&#46; This is a widespread phenomenon described not just in the US<a class="elsevierStyleCrossRef" href="#bib25"><span class="elsevierStyleSup">25</span></a> but also in Spain<a class="elsevierStyleCrossRef" href="#bib26"><span class="elsevierStyleSup">26</span></a>&#46; The relevance of advertising runs parallel to the fact that 90&#37; of Spanish children watch TV every day and 20&#37; persist for at least 2<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#bib27"><span class="elsevierStyleSup">27</span></a>&#46; TV advertising of foods of low nutritional value adds to the well-known burden of sedentarism associated with TV watching<a class="elsevierStyleCrossRef" href="#bib28"><span class="elsevierStyleSup">28</span></a>&#44; which has already been associated with obesity in Spanish children<a class="elsevierStyleCrossRefs" href="#bib20"><span class="elsevierStyleSup">20&#44;29</span></a>&#46;</p><p id="p0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Transportation&#58;</span> This topic has acquired relevance due to the difficulty of modern societies to expend sufficient daily calories to match energy intake&#46; Certain forms of transportation provide a useful outlet to increase daily energy expenditure&#58; walking&#44; bicycling&#44; even use of public transportation instead of personal car&#46; The association of the type of transportation with physical activity levels has been explored in Spain<a class="elsevierStyleCrossRef" href="#bib30"><span class="elsevierStyleSup">30</span></a> and other countries&#44; including China<a class="elsevierStyleCrossRef" href="#bib31"><span class="elsevierStyleSup">31</span></a>&#46; A secondary burden associated with sedentary transportation &#40;personal car&#41; is the ever expanding need for highways and parking lots&#44; usually at the expense of open spaces&#44; which could be used for physical activity&#46; The car-centred culture also promotes the creation of large shopping complexes&#44; reducing further the need for walking to fulfil daily purchasing needs&#46;</p><p id="p0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Built environment&#58;</span> A large number of studies have looked at the specific features of the built environment in relation to obesity&#46; Papas et al&#46; conducted a systematic review and found a consistent positive association between some aspect of the built environment and obesity<a class="elsevierStyleCrossRef" href="#bib32"><span class="elsevierStyleSup">32</span></a>&#46; In the specific case of Spain&#44; it is important to acknowledge that more than 90&#37; of the population lives in residential urban areas &#40;an urban area is defined as more than 2000 inhabitants&#41;<a class="elsevierStyleCrossRef" href="#bib33"><span class="elsevierStyleSup">33</span></a>&#46; Therefore it is important to acknowledge that open spaces &#40;parks and recreational facilities&#41;&#44; specifically designed for children and facilitating physical activity&#44; are far from being the norm in the Spanish urban environment&#46;</p><p id="p0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Education and the school environment&#58;</span> Through the different levels and components of the childhood education process it is important to include the concepts of healthy habits in relation to diet and physical activity&#46; These concepts go beyond the school and include parents and other stakeholders such as local and national government&#46; Regarding the school environment and its association with childhood obesity&#44; we find several relevant aspects&#58;<ul class="elsevierStyleList" id="li0005"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">1&#46;</span><p id="p0100" class="elsevierStylePara elsevierViewall">Lack of clear and national regulation over school menus in terms of quantitative and qualitative nutritional adequacy&#46; This is a very complex topic&#46; Currently in Spain there is a national effort to come to a nation-wide agreement on school lunch menus&#46;</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">2&#46;</span><p id="p0105" class="elsevierStylePara elsevierViewall">The amount of physical activity that children perform in their schools as part of their curriculum and in their free time at schools has been decreasing in the last 3 decades<a class="elsevierStyleCrossRef" href="#bib29"><span class="elsevierStyleSup">29</span></a>&#46; Relevant to this topic&#44; is the physical environment available within schools that include green spaces&#44; safe parks and most importantly sport and recreational facilities&#44; which provide opportunities for children to be physically active&#46; It is important to distinguish between the hours and possibilities of physical education offered to all the children in a given school in comparison to sports offered only to some children enrolled in &#171;varsity teams&#187;&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">3&#46;</span><p id="p0110" class="elsevierStylePara elsevierViewall">The availability of vending machines offering low nutritional value products to children is also a topic of great discussion&#46; In the case of Spain&#44; vending machines are by law only available in High Schools&#46;</p></li></ul></p><p id="p0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Food environment&#58;</span> Research based in the US suggests that neighbourhood residents who have lower availability of healthy food options have a lower quality diet<a class="elsevierStyleCrossRef" href="#bib34"><span class="elsevierStyleSup">34</span></a>&#46; This might not be a problem in Spain but research is definitely needed in this area&#46; The price of healthy options is an important feature of the food environment&#46; In Spain two different studies so far have proved that healthier and recommended diets are more expensive than low quality diets<a class="elsevierStyleCrossRefs" href="#bib35"><span class="elsevierStyleSup">35&#44;36</span></a>&#46; This fact will most probably affect the acquisition of healthy foods for parents and schools with low budgets&#46; The food environment in the areas surrounding schools&#44; parks and other areas dedicated to children is important since they tend to offer low nutritional value foods&#46; The food environment is currently changing in all countries and the consumption of foods away from home is becoming more prevalent&#46; As societies urbanize&#44; the fraction of daily caloric intake &#40;&#62;50&#37; in the US&#41; increases&#46; The quality and quantity of food consumed inside or outside the home is strikingly different even within individual families&#46; Shopping malls&#44; which have become popular recreational places for some children in Spain&#44; are relevant participants in the influence of food quality in children and adolescents&#46; This raises interesting questions given the large availability of low nutritional value food in these malls&#46;</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Social factors as mediators of policies related to childhood obesity</span><p id="p0120" class="elsevierStylePara elsevierViewall">Social factors such as socioeconomic status&#44; work-life balance and gender differences act as risk regulators<a class="elsevierStyleCrossRef" href="#bib11"><span class="elsevierStyleSup">11</span></a> regarding childhood obesity&#46; Next&#44; we describe these factors and use some examples for clarification&#46;</p><p id="p0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Socio-economic status &#40;SES&#41;&#58;</span> Currently several studies have described a gradient in which children of low SES or living in poor neighbourhoods present higher risk of becoming overweight and obese<a class="elsevierStyleCrossRef" href="#bib37"><span class="elsevierStyleSup">37</span></a>&#46; In Spain&#44; the prevalence of childhood obesity is higher among low socio-economic status &#40;SES&#41; families<a class="elsevierStyleCrossRef" href="#bib20"><span class="elsevierStyleSup">20</span></a>&#44; where the mechanisms involved in this association are several and of different kinds&#46; Family level SES have been related to the type of food the families buy and consume<a class="elsevierStyleCrossRef" href="#bib38"><span class="elsevierStyleSup">38</span></a>&#44; and may also relate to the amount of free time for parents to cook and the amount of leisure time to spend with their children&#46; Additionally&#44; low SES families have a lower educational level&#44; and may be less concerned about the relevance of healthy diets and physical activity<a class="elsevierStyleCrossRef" href="#bib17"><span class="elsevierStyleSup">17</span></a>&#46; Low SES families usually live in neighbourhoods characterized by poor access to safe open-air areas to practice physical activity and a food environment characterized by cheap&#44; low nutritional value options<a class="elsevierStyleCrossRef" href="#bib39"><span class="elsevierStyleSup">39</span></a>&#46; SES also determines another relevant social factor&#44; i&#46;e&#46; the work-life balance&#46;</p><p id="p0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Work-life balance&#58;</span> In most of developed countries&#44; maternal employment has increased during the last 3 decades&#46; These changes in labor patterns have translated into lifestyle changes of the family members&#46; Some studies suggest that the probability of a child becoming overweight is related to the number of hours worked by the mother and not necessarily by the father<a class="elsevierStyleCrossRefs" href="#bib40"><span class="elsevierStyleSup">40&#8211;42</span></a>&#46; Reasons for this association could be that working women may have less time to acquire and prepare fresh foods&#59; a larger portion of prepared foods may be consumed in the households of working mothers&#59; children of working mothers may eat more low nutritional value foods&#44; spend less time being physically active and instead spend more time watching TV<a class="elsevierStyleCrossRef" href="#bib43"><span class="elsevierStyleSup">43</span></a>&#46; Social policies aimed to achieve a work-life balance could help promote healthy lifestyle habits for the family members&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Gender differences&#58;</span> Gender is a social factor affecting several aspects relating to eating habits&#44; physical activity and body weight&#46; Large gender differences are observed in different countries in terms of childhood obesity&#44; where in the case of Spain&#44; boys present higher prevalence of obesity than girls<a class="elsevierStyleCrossRefs" href="#bib20"><span class="elsevierStyleSup">20&#44;22</span></a>&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">First&#44; we find that there are different perceptions between what is considered excess weight for boys compared to girls&#46; Excess weight is perceived earlier in girls&#44; while families maybe more tolerant with excess weight in boys for longer periods of time<a class="elsevierStyleCrossRef" href="#bib44"><span class="elsevierStyleSup">44</span></a>&#46;</p><p id="p0150" class="elsevierStylePara elsevierViewall">In relation to advertising&#44; stereotypes linked to gender greatly influence the marketing campaigns of toys&#46; Female toys are more static&#44; supportive of a &#39;thinner&#39; body form and less &#171;physical&#187; than toys directed at males&#46; This fact is also directly related to gender differences in the choice of sports and therefore the level of physical activity&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Proposed policy changes in Spain towards the prevention of childhood obesity</span><p id="p0155" class="elsevierStylePara elsevierViewall">In 2004&#44; the World Health Assembly approved the Global Strategy on Diet&#44; Physical Activity and Health with the aim of reducing the risk factors of non communicable chronic diseases related to unhealthy diets and physical inactivity<a class="elsevierStyleCrossRefs" href="#bib45"><span class="elsevierStyleSup">45&#44;46</span></a>&#46; It is noteworthy that in Spain&#44; subsequently to the WHO initiative&#44; the Ministry of Health began implementing the Strategy for Nutrition&#44; Physical Activity and the Prevention of Obesity &#40;NAOS Strategy&#41; in 2005<a class="elsevierStyleCrossRef" href="#bib47"><span class="elsevierStyleSup">47</span></a>&#46; The Reference Pilot School-based Program against Obesity &#40;PERSEO&#41; is included in the NAOS Strategy and is aimed to promote healthy habits in the children of 67 schools around the country&#46; To reach its target&#44; The PERSEO program promotes fruit consumption and physical activity in and outside the schools with a special interest in the family&#47;home environment&#46;</p><p id="p0160" class="elsevierStylePara elsevierViewall">In this review&#44; we critically analyzed the five social and economic sectors explained above and propose a number of policy changes that may help to prevent excessive energy intake and increase energy expenditure in Spanish children &#40;<a class="elsevierStyleCrossRef" href="#f0020">fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="f0020"></elsevierMultimedia><p id="p0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Advertising&#58;</span> For the time being&#44; the launch of the PAOS regulatory code has not reached the expected impact in terms of quantity and quality of food advertising targeting children<a class="elsevierStyleCrossRef" href="#bib26"><span class="elsevierStyleSup">26</span></a>&#46; Thus&#44; larger efforts are warranted in this area&#46; As a possible first step&#44; advertising regulation policies should be established&#44; both in television and other mass media and public events &#40;sports&#44; cultural&#44; etc&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib48"><span class="elsevierStyleSup">48</span></a>&#46;</p><p id="p0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Transportation&#58;</span> Within the framework of public health practice&#44; current means of transportation must be evaluated and modified to continuously encourage more healthy options&#44; such as walking and bicycling<a class="elsevierStyleCrossRef" href="#bib49"><span class="elsevierStyleSup">49</span></a>&#46; Tools such as the PEP project &#40;Transport Health and Environment Pan-European Programme&#41;<a class="elsevierStyleCrossRef" href="#bib50"><span class="elsevierStyleSup">50</span></a>&#44; studying the effects of transportation in children&#44; identifies the following interventions&#58; creation of adequate infrastructure for safer bicycling&#44; creation of connected slow-traffic areas that encourage walking&#44; and traffic control through appropriate regulations&#46; Several local initiatives in Spain currently aim to organize a network of schools and parents to increase the number of children that walk to school&#46; These initiatives have not translated yet into research articles&#46;</p><p id="p0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Built environment&#58;</span> A process of urban planning where health &#40;and childhood obesity in our case&#41; is considered&#44; is another point in which authorities should take action and join efforts towards a healthy built environment<a class="elsevierStyleCrossRef" href="#bib51"><span class="elsevierStyleSup">51</span></a>&#46; This is especially important for children&#44; since they usually depend on their parents to participate in physical activity and play sports&#46; Recreational areas are specifically needed in order to give children the opportunity to play sports and be physically active&#46; Although the authors did not find published evidence in Spain&#44; the positive relationship between recreational areas and physical activity has been well established<a class="elsevierStyleCrossRefs" href="#bib52"><span class="elsevierStyleSup">52&#8211;54</span></a>&#46;</p><p id="p0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Education and the school environment&#58;</span> Since children spend a significant amount of time within the school environment&#44; policy changes to education will have a great impact on child behaviour and encourage a healthier lifestyle&#46; Necessary changes in the educational sector are&#58;<ul class="elsevierStyleList" id="li0010"><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">1&#46;</span><p id="p0185" class="elsevierStylePara elsevierViewall">Modify the school curriculum to take into account aspects relating nutrition and health<a class="elsevierStyleCrossRef" href="#bib55"><span class="elsevierStyleSup">55</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">2&#46;</span><p id="p0190" class="elsevierStylePara elsevierViewall">Adapt the school cafeteria menus to offer a healthier and high quality diet to children&#46; In addition&#44; we should not only pay attention to maintaining an energetic balance&#44; but comply with other nutritional requirements determined by the Recommended Dietary Allowance &#40;RDA&#41; of each nutrient and food category<a class="elsevierStyleCrossRefs" href="#bib56"><span class="elsevierStyleSup">56&#8211;58</span></a>&#46; In regards to this&#44; the Spanish Ministry of Health &#40;MSPS&#41; has just launched an important set of recommendations for school lunch menus and the school food environment&#46; These recommendations follow two main objectives&#58; firstly&#44; to promote the consumption of healthy foods and beverages within school menus&#44; which will establish an adequate consumption of a variety of healthy food groups&#59; and secondly&#44; to limit the availability of low nutritional value food items in schools&#46;<a class="elsevierStyleCrossRef" href="#bib59"><span class="elsevierStyleSup">59</span></a></p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">3&#46;</span><p id="p0195" class="elsevierStylePara elsevierViewall">Dedicate more teaching and free time to physical activity and psychomotricity&#46; Doing exercise on a regular basis at school may promote a more active attitude back at home&#46;</p></li></ul></p><p id="p0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Food environment&#58;</span> Residents of communities with poor access to healthy foods present a higher risk of following poor quality diets<a class="elsevierStyleCrossRef" href="#bib34"><span class="elsevierStyleSup">34</span></a>&#46; Food environment&#44; policy&#44; multilevel strategies for improving diet and obesity control are recommended based on a rapidly growing body of research&#46;<a class="elsevierStyleCrossRef" href="#bib8"><span class="elsevierStyleSup">8</span></a> Developing policies related to the food environment in order to improve the availability of healthy options in food stores at reasonable prices<a class="elsevierStyleCrossRef" href="#bib60"><span class="elsevierStyleSup">60</span></a> is a field of necessary research and evaluation&#46; Currently in the US&#44; the idea of taxing sugar-sweetened beverages is being considered<a class="elsevierStyleCrossRef" href="#bib61"><span class="elsevierStyleSup">61</span></a>&#46; This is also now being considered in countries including Mexico and Colombia&#44; in an attempt to influence children not to buy this unhealthy beverage&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="p0205" class="elsevierStylePara elsevierViewall">Childhood obesity is of growing concern given the associated risk of a decreasing level of health in the future adult population&#46; Childhood obesity in Spain is among the highest in Europe&#46; From a prevention perspective&#44; childhood offers the greatest opportunity to learn and establish healthy habits within nutrition and physical activity&#46; Childhood obesity is a multi-factorial disease where social and environmental factors play a crucial role&#46; These factors are located in different sectors of our societies and are amenable to be intervened through policies that take into account their possible impact on childhood obesity&#46; The HiAP framework offers a valid perspective towards the case of childhood obesity<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a>&#46; We identified several sectors &#40;advertising&#44; transportation&#44; the built environment&#44; education and the food environment&#41; that are directly related to childhood obesity&#44; where policy changes may help preventing and controlling the current situation in Spain&#46; It is important to acknowledge that these policies will only be fully efficient if they take into account social determinants of childhood obesity as SES&#44; gender differences and work-life balance&#46;</p><p id="p0210" class="elsevierStylePara elsevierViewall">In Spain&#44; the Ministry of Health developed a national strategy for the prevention and control of obesity that included the PERSEO program&#46; Both&#44; the PERSEO and the NAOS Strategy extend far beyond the health sector&#44; by combining actions in different sectors&#46; Importantly&#44; the NAOS strategy includes informative campaigns&#44; agreements with public and private institutions&#44; voluntary working agreements&#44; educational programs and supporting health promotion initiatives<a class="elsevierStyleCrossRef" href="#bib47"><span class="elsevierStyleSup">47</span></a>&#46; The comprehensive evaluation of the NAOS and PERSEO programs strategy will offer a great opportunity in facilitating the prevention and control of childhood obesity&#46; Since the PERSEO program is a school based initiative&#44; the sectors including the built environment&#44; transportation and the food environment have received less attention and regulation&#46;</p><p id="p0215" class="elsevierStylePara elsevierViewall">A key success will be the ability to set a policy with the explicit and primary goal of achieving advances in the prevention and control of childhood obesity despite the possible resistance from different sectors and stakeholders&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:2 [
          "identificador" => "xres11712"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec13169"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres11711"
          "titulo" => "Resumen"
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec13170"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "s0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "s0010"
          "titulo" => "Current situation of childhood obesity in Spain and other European countries"
        ]
        6 => array:2 [
          "identificador" => "s0015"
          "titulo" => "Policy determinants of childhood obesity"
        ]
        7 => array:2 [
          "identificador" => "s0020"
          "titulo" => "Social factors as mediators of policies related to childhood obesity"
        ]
        8 => array:2 [
          "identificador" => "s0025"
          "titulo" => "Proposed policy changes in Spain towards the prevention of childhood obesity"
        ]
        9 => array:2 [
          "identificador" => "s0030"
          "titulo" => "Conclusions"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2010-03-17"
    "fechaAceptado" => "2010-09-06"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec13169"
          "palabras" => array:6 [
            0 => "Childhood obesity"
            1 => "Health policy"
            2 => "Public policy"
            3 => "Prevention"
            4 => "Epidemiology"
            5 => "Spain"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec13170"
          "palabras" => array:6 [
            0 => "Obesidad infantil"
            1 => "Pol&#237;tica sanitaria"
            2 => "Pol&#237;tica p&#250;blica"
            3 => "Prevenci&#243;n"
            4 => "Epidemiolog&#237;a"
            5 => "Espa&#241;a"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Obesity is currently a global public health problem&#46; Obesity in early life increases the risk of long-term energy imbalance and adult obesity and its comorbidities&#44; type 2 diabetes&#44; and cardiovascular disease&#46; Since infancy and childhood are critical periods for the adoption of food preferences and physical activity&#44; prevention strategies must intervene in these early periods to promote healthy habits and reduce risk behaviors&#46; Trends in the prevalence of childhood obesity and overweight in Spain have continuously increased in the last three decades&#46; Obesity and overweight currently affect 15 and 20&#37; of Spanish children&#44; respectively&#44; and these percentages are among the highest in Europe&#46; Childhood obesity is determined by social and economic factors pertaining to sectors other than the health system&#44; such as advertising&#44; the built environment&#44; education and the school environment&#44; transportation and the food environment&#46; Following the Health in All Policies &#40;HiAP&#41; approach&#44; the authors identified a series of multisector policy changes that may help to prevent and control the current rising trend of childhood obesity in Spain&#46; The HiAP approach acknowledges that social factors including socioeconomic status&#44; gender differences and the work-life balance are important to develop effective policy changes in the prevention of childhood obesity&#46; A key to success in the prevention of childhood obesity in Spain through policy changes will depend on the ability to establish a policy with the explicit and primary goal of improving health outcomes&#44; despite the anticipated resistance from various sectors and stakeholders&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Actualmente&#44; la obesidad es un problema de salud p&#250;blica en todo el mundo&#46; La obesidad temprana aumenta el riesgo de sufrir desequilibrio energ&#233;tico a largo plazo&#44; as&#237; como de presentar obesidad en edad adulta o sus comorbilidades&#58; diabetes tipo 2 y enfermedades cardiovasculares&#46; Puesto que la infancia y la ni&#241;ez son per&#237;odos cruciales para establecer las preferencias alimenticias y de actividad f&#237;sica&#44; las estrategias de prevenci&#243;n deben iniciarse durante esta etapa para fomentar h&#225;bitos saludables y reducir los comportamientos de riesgo&#46; La tendencia en la prevalencia de la obesidad y el sobrepeso infantil en Espa&#241;a ha aumentado de forma continua en las tres &#250;ltimas d&#233;cadas&#46; En la actualidad&#44; la obesidad y el sobrepeso afectan a un 15 y a un 20&#37; de los ni&#241;os espa&#241;oles&#44; respectivamente&#44; y estos porcentajes se encuentran entre los m&#225;s elevados de Europa&#46; La obesidad infantil viene determinada por factores sociales y econ&#243;micos que son independientes del sistema sanitario&#44; tales como la publicidad&#44; el entorno&#44; la educaci&#243;n y el ambiente escolar&#44; el transporte y el entorno alimentario&#46; Mediante el enfoque de la Uni&#243;n Europea&#44; <span class="elsevierStyleItalic">Salud en Todas las Pol&#237;ticas</span>&#44; los autores identificaron una serie de cambios de pol&#237;tica dirigidos a varios sectores y que podr&#237;an ayudar a prevenir y controlar la creciente tendencia actual de la obesidad infantil en Espa&#241;a&#46; Este enfoque reconoce que factores sociales como el nivel socioecon&#243;mico&#44; las diferencias de g&#233;nero y el equilibrio entre la vida laboral y personal son importantes para la prevenci&#243;n de la obesidad infantil&#46; El &#233;xito de la prevenci&#243;n de la obesidad infantil en Espa&#241;a depender&#225; en gran medida de la capacidad que tengamos para desarrollar pol&#237;ticas fuera del sector sanitario que tengan el objetivo expl&#237;cito y primario de mejorar resultados en salud pese a la resistencia esperada de diferentes sectores econ&#243;micos y partes interesadas&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "f0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1237
            "Ancho" => 1630
            "Tamanyo" => 92215
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Prevalence of obesity and overweight in schoolchildren aged 7-11 from Spain&#44; Portugal&#44; Italy&#44; UK&#44; Greece&#44; France and Germany&#46; Source&#58; EU Platform on Diet&#44; Physical Activity and Health&#44; 2005<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a>&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "f0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1326
            "Ancho" => 2333
            "Tamanyo" => 115405
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Prevalence of obesity and overweight and obesity in Spain &#40;enKid 6&#8211;9 years old&#44; SNHS 5&#8211;9 years old&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "f0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1072
            "Ancho" => 1500
            "Tamanyo" => 145631
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Policy determinants of childhood overweight&#47;obesity in Spain&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "f0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1787
            "Ancho" => 2500
            "Tamanyo" => 281255
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Policy changes for preventing childhood overweight&#47;obesity in Spain&#46;</p>"
        ]
      ]
      4 => array:5 [
        "identificador" => "b005"
        "tipo" => "MULTIMEDIATEXTO"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0250" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Key points</span><ul class="elsevierStyleList" id="li0015"><li class="elsevierStyleListItem" id="u0035"><span class="elsevierStyleLabel">&#8226;</span><p id="p0225" class="elsevierStylePara elsevierViewall">Childhood obesity is an increasing public health problem&#44; since around one third of our children already have excessive bodyweight&#46; The number of overweight and obese children in Spain is among the highest observed in Europe&#46;</p></li><li class="elsevierStyleListItem" id="u0040"><span class="elsevierStyleLabel">&#8226;</span><p id="p0230" class="elsevierStylePara elsevierViewall">The current health of children relates directly to the health of our future population&#46; Specifically cardiovascular health and primordial prevention focuses directly on the healthy habits that children might learn and carry on through their adult life&#46;</p></li><li class="elsevierStyleListItem" id="u0045"><span class="elsevierStyleLabel">&#8226;</span><p id="p0235" class="elsevierStylePara elsevierViewall">Childhood obesity is a multi-factorial disease where different social and economic sectors play a crucial role&#46; Sectors other than the health system&#44; closely related to childhood obesity include advertising&#44; transportation&#44; the built environment&#44; education and the food environment&#46; These sectors are amenable to be intervened through policies that take into account their possible impact on childhood obesity&#44; such as the Health in All Policies framework&#46;</p></li><li class="elsevierStyleListItem" id="u0050"><span class="elsevierStyleLabel">&#8226;</span><p id="p0240" class="elsevierStylePara elsevierViewall">Social determinants such as socioeconomic status&#44; work-life balance and gender differences act as risk regulators of the proposed policies in relation to childhood obesity and therefore should be taken into account in the development of preventive interventions&#46;</p></li><li class="elsevierStyleListItem" id="u0055"><span class="elsevierStyleLabel">&#8226;</span><p id="p0245" class="elsevierStylePara elsevierViewall">Policy changes&#44; recommendations and regulations in each of the analyzed sectors&#44; with its subsequent evaluations&#44; may help to prevent this important public health problem&#46; The NAOS strategy and the PERSEO program have been important steps in this direction&#46;</p></li></ul></p></span>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bb0005"
          "bibliografiaReferencia" => array:61 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The global epidemic of obesity&#58; an overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; Caballero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/epirev/mxm012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiol Rev"
                        "fecha" => "2007"
                        "volumen" => "29"
                        "paginaInicial" => "1"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17569676"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Worldwide trends in childhood overweight and obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Y Wang"
                            1 => "T&#46; Lobstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Pediatr Obes"
                        "fecha" => "2006"
                        "volumen" => "1"
                        "paginaInicial" => "11"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17902211"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adolescent overweight and future adult coronary heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K Bibbins-Domingo"
                            1 => "P Coxson"
                            2 => "MJ Pletcher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMsa073166"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2007"
                        "volumen" => "357"
                        "paginaInicial" => "2371"
                        "paginaFinal" => "2379"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18057339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and the environment&#58; where do we go from here&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "JO Hill"
                            1 => "HR Wyatt"
                            2 => "GW Reed"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1126/science.1079857"
                      "Revista" => array:6 [
                        "tituloSerie" => "Science"
                        "fecha" => "2003"
                        "volumen" => "299"
                        "paginaInicial" => "853"
                        "paginaFinal" => "855"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12574618"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity prevention in children&#58; opportunities and challenges"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; Caballero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ijo.0802797"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Obes Relat Metab Disord"
                        "fecha" => "2004"
                        "volumen" => "28"
                        "numero" => "Suppl 3"
                        "paginaInicial" => "S90"
                        "paginaFinal" => "S95"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15543227"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The North Karelia project&#58; 15 years of community-based prevention of coronary heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P Puska"
                            1 => "J Tuomilehto"
                            2 => "A Nissinen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Med"
                        "fecha" => "1989"
                        "volumen" => "21"
                        "paginaInicial" => "169"
                        "paginaFinal" => "173"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2765257"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Puska P&#44; Stahl T&#46; Health in All Policies-the finnish initiative&#58; background&#44; principles&#44; and current issues&#46; Annu Rev Public Health&#46; 2010"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical activity and food environments&#58; solutions to the obesity epidemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "JF Sallis"
                            1 => "K&#46; Glanz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-0009.2009.00550.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Milbank Q"
                        "fecha" => "2009"
                        "volumen" => "87"
                        "paginaInicial" => "123"
                        "paginaFinal" => "154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19298418"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The school food environment and student body mass index and food consumption&#58; 2004 to 2007 national data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "YM Terry-McElrath"
                            1 => "PM O&#39;Malley"
                            2 => "J Delva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jadohealth.2009.04.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Adolesc Health"
                        "fecha" => "2009"
                        "volumen" => "45"
                        "paginaInicial" => "S45"
                        "paginaFinal" => "S56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19699436"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fruits and vegetables at home&#58; child and parent perceptions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R Robinson-O&#39;Brien"
                            1 => "D Neumark-Sztainer"
                            2 => "PJ Hannan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jneb.2008.08.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nutr Educ Behav"
                        "fecha" => "2009"
                        "volumen" => "41"
                        "paginaInicial" => "360"
                        "paginaFinal" => "364"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19717120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Behavioral science at the crossroads in public health&#58; extending horizons&#44; envisioning the future"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "TA Glass"
                            1 => "MJ&#46; McAtee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.socscimed.2005.08.044"
                      "Revista" => array:6 [
                        "tituloSerie" => "Soc Sci Med"
                        "fecha" => "2006"
                        "volumen" => "62"
                        "paginaInicial" => "1650"
                        "paginaFinal" => "1671"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16198467"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of overweight among children in Europe"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T Lobstein"
                            1 => "ML&#46; Frelut"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Obes Rev"
                        "fecha" => "2003"
                        "volumen" => "4"
                        "paginaInicial" => "195"
                        "paginaFinal" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14649370"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Establishing a standard definition for child overweight and obesity worldwide&#58; international survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "TJ Cole"
                            1 => "MC Bellizzi"
                            2 => "KM Flegal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2000"
                        "volumen" => "320"
                        "paginaInicial" => "1240"
                        "paginaFinal" => "1243"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10797032"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Body mass index cut offs to define thinness in children and adolescents&#58; international survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "TJ Cole"
                            1 => "KM Flegal"
                            2 => "D Nicholls"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.39238.399444.55"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2007"
                        "volumen" => "335"
                        "paginaInicial" => "194"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17591624"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlates of childhood obesity in Athens&#44; Greece"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A Lagiou"
                            1 => "M&#46; Parava"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S1368980008002462"
                      "Revista" => array:6 [
                        "tituloSerie" => "Public Health Nutr"
                        "fecha" => "2008"
                        "volumen" => "11"
                        "paginaInicial" => "940"
                        "paginaFinal" => "945"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18489810"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood obesity and elevated blood pressure in a rural population of northern Greece"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "TA Mavrakanas"
                            1 => "G Konsoula"
                            2 => "I Patsonis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rural Remote Health"
                        "fecha" => "2009"
                        "volumen" => "9"
                        "paginaInicial" => "1150"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19555129"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary patterns of school-age children in Scotland&#58; association with socio-economic indicators&#44; physical activity and obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "LC Craig"
                            1 => "G McNeill"
                            2 => "JI Macdiarmid"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0007114509991942"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Nutr"
                        "fecha" => "2010"
                        "volumen" => "103"
                        "paginaInicial" => "319"
                        "paginaFinal" => "334"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19835641"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood obesity and overweight prevalence trends in England&#58; evidence for growing socioeconomic disparities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E Stamatakis"
                            1 => "J Wardle"
                            2 => "TJ Cole"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2010"
                        "volumen" => "34"
                        "paginaInicial" => "41"
                        "paginaFinal" => "47"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and deteminants of obesity in Spanish children and young people"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L Serra-Majem"
                            1 => "J Aranceta Bartrina"
                            2 => "C Perez-Rodrigo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Nutr"
                        "fecha" => "2006"
                        "volumen" => "96"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "S67"
                        "paginaFinal" => "S72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16923254"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood and adolescent obesity in Spain&#46; Results of the enKid study &#40;1998-2000&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L Serra Majem"
                            1 => "L Ribas Barba"
                            2 => "J Aranceta Bartrina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2003"
                        "volumen" => "121"
                        "paginaInicial" => "725"
                        "paginaFinal" => "732"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Spanish National Health Survey&#46; 2010&#46; Spanish Ministry of Health and Social Policy &#40;MSPS&#41;&#46;"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in excess weight and thinness among Spanish schoolchildren in the period 1992-2004&#58; the Cuenca study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "V Mart&#237;nez-Vizca&#237;no"
                            1 => "M S&#225;nchez L&#243;pez"
                            2 => "P Moya Mart&#237;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S1368980008003571"
                      "Revista" => array:6 [
                        "tituloSerie" => "Public Health Nutr"
                        "fecha" => "2009"
                        "volumen" => "12"
                        "paginaInicial" => "1015"
                        "paginaFinal" => "1018"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18752696"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictor factors for childhood obesity in a Spanish case-control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "MC Ochoa"
                            1 => "MJ Moreno-Aliaga"
                            2 => "MA Mart&#237;nez-Gonz&#225;lez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nut.2007.02.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutrition"
                        "fecha" => "2007"
                        "volumen" => "23"
                        "paginaInicial" => "379"
                        "paginaFinal" => "384"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17408922"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preventing childhood obesity&#58; the power of policy and political will"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Harkin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amepre.2007.07.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Prev Med"
                        "fecha" => "2007"
                        "volumen" => "33"
                        "paginaInicial" => "S165"
                        "paginaFinal" => "S166"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17884561"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Priming effects of television food advertising on eating behavior"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "JL Harris"
                            1 => "JA Bargh"
                            2 => "KD&#46; Brownell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1037/a0014399"
                      "Revista" => array:6 [
                        "tituloSerie" => "Health Psychol"
                        "fecha" => "2009"
                        "volumen" => "28"
                        "paginaInicial" => "404"
                        "paginaFinal" => "413"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19594263"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Advertising and feeding&#58; influence of graphical advertisements on dietary habits during childhood and adolescence&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "RA Men&#233;ndez Garc&#237;a"
                            1 => "FJ&#46; Franco D&#237;ez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Hosp"
                        "fecha" => "2009"
                        "volumen" => "24"
                        "paginaInicial" => "318"
                        "paginaFinal" => "325"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19721905"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ministerio de Sanidad y Pol&#237;tica Social&#46; National Health Survey&#44; Spanish Ministry of Health&#44; 2004&#59; 2003"
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical activity in relation to overweight and obesity in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D Molnar"
                            1 => "B&#46; Livingstone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2000"
                        "volumen" => "159"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "S45"
                        "paginaFinal" => "S55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11011955"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of overweight and obesity&#58; a Spanish approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J Aranceta"
                            1 => "C P&#233;rez-Rodrigo"
                            2 => "L Serra-Majem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S1368980007000699"
                      "Revista" => array:6 [
                        "tituloSerie" => "Public Health Nutr"
                        "fecha" => "2007"
                        "volumen" => "10"
                        "paginaInicial" => "1187"
                        "paginaFinal" => "1193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17903329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Transport&#44; environment and health&#46; 2008 SESPAS Report&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F Ballester"
                            1 => "R&#46; Peiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "53"
                        "paginaFinal" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18405553"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of exercise&#44; walking&#44; cycling&#44; and overall nonexercise physical activity on mortality in Chinese women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "CE Matthews"
                            1 => "AL Jurj"
                            2 => "XO Shu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/aje/kwm088"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Epidemiol"
                        "fecha" => "2007"
                        "volumen" => "165"
                        "paginaInicial" => "1343"
                        "paginaFinal" => "1350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17478434"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The built environment and obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "MA Papas"
                            1 => "AJ Alberg"
                            2 => "R Ewing"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/epirev/mxm009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiol Rev"
                        "fecha" => "2007"
                        "volumen" => "29"
                        "paginaInicial" => "129"
                        "paginaFinal" => "143"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17533172"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Instituto Nacional de Estad&#237;stica&#46; Padr&#243;n Municipal de habitantes a 1 de enero de 2009&#46;"
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Availability of healthy foods and dietary patterns&#58; the Multi-Ethnic Study of Atherosclerosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M Franco"
                            1 => "AV D&#237;ez-Roux"
                            2 => "JA Nettleton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3945/ajcn.2008.26434"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Nutr"
                        "fecha" => "2009"
                        "volumen" => "89"
                        "paginaInicial" => "897"
                        "paginaFinal" => "904"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19144728"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost of compliance with daily recommended values of micronutrients among a cohort of Spanish university graduates&#58; the SUN &#40;Seguimiento Universidad de Navarra&#41; Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "CN L&#243;pez"
                            1 => "MA Mart&#237;nez-Gonz&#225;lez"
                            2 => "A Alonso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S1368980009005278"
                      "Revista" => array:6 [
                        "tituloSerie" => "Public Health Nutr"
                        "fecha" => "2009"
                        "volumen" => "12"
                        "paginaInicial" => "2092"
                        "paginaFinal" => "2096"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19323866"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High monetary costs of dietary patterns associated with lower body mass index&#58; a population-based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H Schroder"
                            1 => "J Marrugat"
                            2 => "MI&#46; Covas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2006"
                        "volumen" => "30"
                        "paginaInicial" => "1574"
                        "paginaFinal" => "1579"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Child obesity associated with social disadvantage of children&#39;s neighborhoods"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "HM Greves Grow"
                            1 => "AJ Cook"
                            2 => "DE Arterburn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.socscimed.2010.04.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Soc Sci Med"
                        "fecha" => "2010"
                        "volumen" => "71"
                        "paginaInicial" => "584"
                        "paginaFinal" => "591"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20541306"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Household and food shopping environments&#58; do they play a role in socioeconomic inequalities in fruit and vegetable consumption&#63; A multilevel study among Dutch adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K Giskes"
                            1 => "FJ van Lenthe"
                            2 => "CB Kamphuis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/jech.2008.078352"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Epidemiol Community Health"
                        "fecha" => "2009"
                        "volumen" => "63"
                        "paginaInicial" => "113"
                        "paginaFinal" => "120"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18801797"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Economic contextual factors&#44; food consumption&#44; and obesity among U&#46;S&#46; adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "LM Powell"
                            1 => "E Han"
                            2 => "FJ&#46; Chaloupka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3945/jn.109.111526"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nutr"
                        "fecha" => "2010"
                        "volumen" => "140"
                        "paginaInicial" => "1175"
                        "paginaFinal" => "1180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20392882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Do working mothers raise couch potato kids&#63; Maternal employment and children&#39;s lifestyle behaviours and weight in early childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "JE Brown"
                            1 => "DH Broom"
                            2 => "JM Nicholson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.socscimed.2010.01.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "Soc Sci Med"
                        "fecha" => "2010"
                        "volumen" => "70"
                        "paginaInicial" => "1816"
                        "paginaFinal" => "1824"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20299142"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal employment and early childhood overweight&#58; findings from the UK Millennium Cohort Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "SS Hawkins"
                            1 => "TJ Cole"
                            2 => "C&#46; Law"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2008"
                        "volumen" => "32"
                        "paginaInicial" => "30"
                        "paginaFinal" => "38"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-run consequences of parental paid work hours for child overweight status in Canada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "SA Phipps"
                            1 => "L Lethbridge"
                            2 => "P&#46; Burton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.socscimed.2005.06.054"
                      "Revista" => array:6 [
                        "tituloSerie" => "Soc Sci Med"
                        "fecha" => "2006"
                        "volumen" => "62"
                        "paginaInicial" => "977"
                        "paginaFinal" => "986"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16099085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "One-year changes in activity and in inactivity among 10- to 15-year-old boys and girls&#58; relationship to change in body mass index"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "CS Berkey"
                            1 => "HR Rockett"
                            2 => "MW Gillman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2003"
                        "volumen" => "111"
                        "paginaInicial" => "836"
                        "paginaFinal" => "843"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12671121"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal perceptions of overweight preschool children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "AE Baughcum"
                            1 => "LA Chamberlin"
                            2 => "CM Deeks"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2000"
                        "volumen" => "106"
                        "paginaInicial" => "1380"
                        "paginaFinal" => "1386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11099592"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "WHO global strategy on diet&#44; physical activity and health"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; Margetts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1079/PHN2004622"
                      "Revista" => array:6 [
                        "tituloSerie" => "Editorial Public Health Nutr"
                        "fecha" => "2004"
                        "volumen" => "7"
                        "paginaInicial" => "361"
                        "paginaFinal" => "363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15153266"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of chronic diseases&#58; WHO global strategy on diet&#44; physical activity and health"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Waxman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Food Nutr Bull"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "281"
                        "paginaFinal" => "284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14564933"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Spanish strategy for nutrition&#44; physical activity and the prevention of obesity &#40;NAOS Strategy&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "JM Ballesteros Arribas"
                            1 => "M Dal-R&#233; Saavedra"
                            2 => "N P&#233;rez-Farinos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Salud Publica"
                        "fecha" => "2007"
                        "volumen" => "81"
                        "paginaInicial" => "443"
                        "paginaFinal" => "449"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18274349"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Compliance with self-regulation of television food and beverage advertising aimed at children in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "MM Romero-Fern&#225;ndez"
                            1 => "MA Royo-Bordonada"
                            2 => "F&#46; Rodr&#237;guez-Artalejo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S1368980017001914"
                      "Revista" => array:5 [
                        "tituloSerie" => "Public Health Nutr"
                        "fecha" => "2009"
                        "paginaInicial" => "1"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29061207"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preventing childhood obesity through state policy&#46; Predictors of bill enactment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "TK Boehmer"
                            1 => "DA Luke"
                            2 => "DL Haire-Joshu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amepre.2008.01.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Prev Med"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "333"
                        "paginaFinal" => "340"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18374247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib50"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "The Transport Health and Environment Pan-European Programme &#40;PEP&#41;&#46; Transport-related effects with a particular focus on children&#46; 2010&#46; Amsterdam&#46;"
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib51"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;The health of cities and their citizens &#40;urban development and municipal public health&#41;&#46; 2008 SESPAS Report&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "MD Gerez"
                            1 => "I&#46; Vel&#225;zquez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "71"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18405555"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib52"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recreational values of the natural environment in relation to neighbourhood satisfaction&#44; physical activity&#44; obesity and wellbeing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J Bjork"
                            1 => "M Albin"
                            2 => "P Grahn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Epidemiol Community Health"
                        "fecha" => "2008"
                        "volumen" => "62"
                        "paginaInicial" => "e2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18365329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib53"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Availability of recreational resources and physical activity in adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "AV D&#237;ez Roux"
                            1 => "KR Evenson"
                            2 => "AP McGinn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2105/AJPH.2006.087734"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Public Health"
                        "fecha" => "2007"
                        "volumen" => "97"
                        "paginaInicial" => "493"
                        "paginaFinal" => "499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17267710"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib54"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Availability of recreational resources in minority and low socioeconomic status areas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "LV Moore"
                            1 => "AV D&#237;ez Roux"
                            2 => "KR Evenson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amepre.2007.09.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Prev Med"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "16"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18083446"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib55"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of interventions in the prevention of childhood obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I Bautista-Castano"
                            1 => "J Doreste"
                            2 => "L&#46; Serra-Majem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Epidemiol"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "617"
                        "paginaFinal" => "622"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15461192"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib56"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;School meals&#58; state of the art and recommendations&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J Aranceta Bartrina"
                            1 => "C P&#233;rez Rodrigo"
                            2 => "J Dalmau Serra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2008"
                        "volumen" => "69"
                        "paginaInicial" => "72"
                        "paginaFinal" => "88"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib57"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nutritional planning of menus of public schools of the community of Madrid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S Del Pozo"
                            1 => "C Cuadrado"
                            2 => "M Rodr&#237;guez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Hosp"
                        "fecha" => "2006"
                        "volumen" => "21"
                        "paginaInicial" => "667"
                        "paginaFinal" => "672"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17147064"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib58"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pro children intervention&#58; applying the intervention mapping protocol to develop a school-based fruit and vegetable promotion programme"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C P&#233;rez-Rodrigo"
                            1 => "M Wind"
                            2 => "C Hildonen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000087249"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Nutr Metab"
                        "fecha" => "2005"
                        "volumen" => "49"
                        "paginaInicial" => "267"
                        "paginaFinal" => "277"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16088090"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib59"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "MSPS&#46; 2010&#46; Documento de consenso de recomendaciones sobre la alimentaci&#243;n en los centros escolares&#46;"
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib60"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Public health&#44; obesity and economics&#58; the good&#44; the bad and the ugly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J Oliva"
                            1 => "L Gonz&#225;lez"
                            2 => "JM Labeaga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "paginaInicial" => "507"
                        "paginaFinal" => "510"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19080924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib61"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The public health and economic benefits of taxing sugar-sweetened beverages"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "KD Brownell"
                            1 => "T Farley"
                            2 => "WC Willett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMhpr0905723"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "361"
                        "paginaInicial" => "1599"
                        "paginaFinal" => "1605"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19759377"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/02139111/00000024000000S1/v1_201301221241/S021391111000261X/v1_201301221241/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "683"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Pol&#243;ticas de salud y salud p&#250;blica"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/02139111/00000024000000S1/v1_201301221241/S021391111000261X/v1_201301221241/en/main.pdf?idApp=WGSE&text.app=https://gacetasanitaria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021391111000261X?idApp=WGSE"
]