Lifestyle intervention for obesity: a call to transform the clinical care delivery system in Mexico

Abstract

Obesity and its comorbidities have become the most important public health problems for Latin America. In Mexico obesity has increased dramatically to the point where the government has declared it an epidemiological emergency. The most recent national data showed overweight and obesity affects 72.5% of adults, or around 56 million Mexicans. Most Mexican adults with obesity are undiagnosed. According to data derived from a national representative survey, only 20% of adults with BMI >30 kg/m² were diagnosed with obesity by a health provider. Likewise, only 8% of individuals with obesity had received treatment for obesity. Interventions offered in the Mexican health care delivery system generally consist of traditional consultations with recommendations on diet and exercise, visits are monthly to quarterly, and validated behavior change protocols are not used. Evidence from clinical trials has shown that weight loss with this type of treatment is generally less than 1 kg per year. In contrast, intensive lifestyle interventions – protocols focusing on achieving changes in diet, physical activity, and moderate weight loss using behavioral strategies with weekly or bi-weekly sessions for the first 3 to 6 months, and a maintenance phase with trained interventionists – as implemented in the Diabetes Prevention Program and the Look AHEAD studies achieved weight loss of 7–9% at one year. Additionally, translation studies of these interventions to the community and to real-world clinical practice have achieved weight loss of around 4%. Adaptations of intensive lifestyle interventions have been implemented in the United States, both in clinical practice and in the community, and this type of intervention represents a potential model to combat obesity in Mexico and other Latin American countries. It is essential that primary care providers in Mexico implement clinical practice guidelines based on the best evidence available as discussed here to effectively treat obesity. The authors make recommendations to improve the treatment of obesity in the clinical care delivery system in Mexico using intensive lifestyle interventions.

Keywords:

• nutrition
• weight loss
• primary care
• underdiagnosis
• health care providers
• diabetes

Acknowledgment

We thank Rocio Ayala for her technical support on English editing in the first draft of the manuscript. Diaz-Zavala has received support from the University of Sonora, PRODEP Programa para el Desarrollo Profesional Docente [Professional Development Program for Professors] (103.5/13/8926) and the IAEA [International Atomic Energy Agency] (16397/R0) for the funding of previous studies in the area. PRODEP paid the cost of publishing the article.

Disclosure

RGDZ and TJMC are nutritionists and provide training courses on intensive lifestyle change programs to health care providers, where the University of Sonora receives payment for these courses. The authors do not receive any direct payment for it, but they have benefited with part of these funds for research purposes. Additionally, the Nutritional Health Promotion Center provides the protocol of the Diabetes Prevention Program to the community at a cost recovery fee. The authors report no other conflicts of interest in this work.