RESUMO O sobrepeso e a obesidade constituem uma epidemia global atingindo níveis alarmantes nos países desenvolvidos e em desenvolvimento. O Chile não é exceção: o país tem registrado uma elevação acentuada da prevalência de obesidade, sobretudo em crianças em idade escolar. Este artigo descreve as medidas envolvendo políticas e estratégias implantadas no Chile na última década para combater este importante problema de saúde pública e destaca os principais desafios e as particularidades do processo. O país adotou políticas para rotulagem nutricional na parte da frente da embalagem dos produtos alimentícios, regulamentação da publicidade e restrições aos alimentos servidos em escolas. As novas políticas são direcionadas aos determinantes sociais da saúde por estarem associados aos ambientes e aos comportamentos alimentares da população. Além de serem adaptadas ao contexto atual do Chile, estas medidas se embasam nas melhores evidências científicas. A execução destas políticas deu início a um amplo debate entre as instituições públicas e a indústria de produtos alimentícios envolvendo de questões sobre direitos de propriedade às barreiras comerciais. Apesar das suas posições divergentes sobre alguns aspectos, os interessados diretos chegaram a um consenso político importante. As organizações internacionais esperam agora conhecer o resultado da avaliação do impacto dessas iniciativas pioneiras na América Latina.

ABSTRACT Overweight and obesity are a global epidemic with rates having risen to alarming levels in both developed and developing countries. Chile has been no exemption, with sharp increases in obesity prevalence, especially among school-age children. This paper describes the policy actions and strategies implemented to tackle this major public health concern in Chile over the last 10 years, and highlights the main challenges and nuances of the process. Chile has taken policy action that includes front-of-package labelling, advertising regulations, and school-food restrictions. New policies focus on the social determinants of health as they relate to food environments and people's behavior. These actions are not only suitable to the current context in Chile, but are also supported by the best available scientific evidence. Moreover, the implementation of these policies has produced a broad debate involving public institutions and the food industry, with discussions issues ranging from property rights to trade barriers. Despite some differences among stakeholders, a valuable political consensus has been achieved, and several international organizations are eager to evaluate the impact of these pioneer initiatives in Latin America.

RESUMEN El sobrepeso y la obesidad son una epidemia mundial, en la que se registran tasas que han aumentado hasta niveles alarmantes tanto en los países desarrollados como en los países en desarrollo. Chile no ha sido una excepción, con aumentos pronunciados de la prevalencia de la obesidad, especialmente en los niños en edad escolar. En este documento se describen las políticas y estrategias aplicadas para luchar contra este grave problema de salud pública en Chile durante los 10 últimos años, y se resaltan los principales retos y matices del proceso. Chile ha tomado medidas de política que incluyen el etiquetado frontal de los envases, la reglamentación de la publicidad y restricciones en cuanto a la alimentación en las escuelas. Las nuevas políticas se centran en los determinantes sociales de la salud pues guardan relación con el entorno en cuanto a la alimentación y el comportamiento de las personas. Estas medidas no solo son apropiadas para el contexto actual de Chile, sino que también se basan en las mejores pruebas científicas de que se dispone. Por otro lado, la aplicación de estas políticas ha generado un amplio debate con las instituciones públicas y la industria alimentaria, cuyos temas de discusión abarcan desde derechos de propiedad hasta barreras comerciales. A pesar de algunas diferencias entre los interesados directos, se ha logrado un valioso consenso político y varias organizaciones internacionales están dispuestas a evaluar la repercusión de estas iniciativas pioneras en América Latina.

Transparency as a general rule for all our professional acts casts doubts about the statement of the Hippocratic Oath that says "Whatever I see or hear in the lives of my patients, I will keep secret, as considering all such things to be private". Medical secrecy protects the intimacy of patients, who reveal to their physicians their most hidden secrets aiming to recover their health. Therefore, physicians should receive those secrets with reverence and care, as servers and not as their owners. The values associated with the respect for personal intimacy are the anthropological basis of medical confidentiality. A medical act is performed by definition between two equally honorable individuals. Therefore, the professional honors the trust of his patient, maintaining strict confidence of what is revealed. Therefore, medical secrecy must be strengthened rather than weakened, pursuing common wealth and dignity.

Health Care at population level is a complex problem. Having this in mind, the purpose of this paper is to focus on the goods that are ethically relevant in the process of caring for health at this level. We briefly analyze some of the Chilean health statistics that, although they show important improvements along the years, demonstrate that certain conditions are to be deemed as inadequate by both healthcare providers and patients. Ethics is a central component to determine how to structure and organize health care systems and how they should operate. We emphasize Human Dignity as an ethical corner stone of the Health Care System, along with other important values such as Justice and Humanization, under the scope of the Ends of Medicine, and other components such as technical competence of providers and the financing of the whole process. We conclude that as far as a health care system is organized in a way that medical practice is well ordered, primarily and fundamentally according the Ends of Medicine and the good of persons, such a health care system is ethically adequate.

The sequential change of SS in 6-16 year old Chilean schoolchildren between 1986 and 1994 was analized. Random samples were analyzed for sex, school year and economic/social status. Sample sizes in 1986 were 4 331 girls, 3 354 boys, in 1991 1 620 girls, 1 675 boys and in 1994 were 1 437 girls and 1 822 boys, taken from the cities of Santiago, Calama, Antofagasta and Temuco. Height for age below the 95% according to WHO standards was classified as SS. Regardless of sex SS decreased progressively from 1986 to 1994 (27.8%, 24.9%, 13% in girls, 31.2%, 29.6%, 18.2% in boys respectively). Classifying the children according to age, girls less than 10 yrs, or 10 and above, and boys less than 12 yrs or 12 and above, the percentage of children with SS was lower in younger children (27.8%, 24.9%, 13% in girls, 31.2%, 29.6%, 18.2% in boys) compared to that in older children (41.1%, 39.8%, 25.5% in girls, 44.2% 41.7%, 26.2% in boys) with an overall decrease in all 4 age groups. The trends in SS suggest an improvement in environmental conditions, but this growth tendency has not yet stabilized, the older group being the worst affected. It is necessary to investigate other possible environmental deficits in order to improve health programmes for an improved expression of the childrens genetic potential

Se analizó el cambio secular del retraso estatural (RE) entre los años 1986 y 1994 en escolares de 6 a 16 años de edad, de tres regiones del país (II, IX y XIII). Las muestras de cada región se obtuvo por sorteo aleatorio dando representatividad por sexo, ciclo educativo (básico o medio) y tipo de establecimiento (municipal, subvencionado o particular); quedando constituidas los años 1986 por 4 331 mujeres y 3 354 varones, en 1991 por 1 620 mujeres y 1 675 varones y en 1994 por 1 437 mujeres y 1 822 varones de las ciudades de Santiago, Calama, Antofagasta y Temuco. Se evaluó la estatura y se calificó como talla baja la adecuación estatural bajo 95% de los es-tándares OMS. En ambos sexos, se observó una disminución progresiva del porcentaje del RE al comparar los años 1986, 1991 y 1994 (de 27,8%, a 24,9% y a 13,0% en las mujeres y de 31,2%, a 29,6% y a 18,2% en los varones, respectivamente). Al separar por edad en mujeres < de 10 años (me-10), varones < de 12 años(me-12), mujeres 10 años (ma-10) y varones 12 años (ma-12); se encontró que en me-10 y me-12 el RE fue menor (27,8%, 24,9% y 13,0% en las mujeres y 31,2%, 29,6% y 18,2% en los varones) que en los ma-10 y ma-12 (41,1%, 39,8 % y 25,5% en las mujeres y 44,2%, 41,7% y 26,2% en los varones), aunque la tendencia fue la misma. El cambio secular hacia una mayor estatura, observado en escolares de estas regiones, sugiere una mejoría en la calidad del ambiente. Sin embargo, el crecimiento no se ha estabilizado y los niños en edades mayores (ma-10 y ma-12) son el grupo con mayor retraso. Es necesario investigar otros déficit para implementar programas dirigidos a continuar mejorando la calidad ambiental y de esta forma la expresión del potencial genético de crecimiento del niño chileno