The new study by Díaz-Zavala (2019), entitled Lifestyle intervention for obesity: a call to transform the clinical care delivery system in Mexico, shines a light on the epidemiological emergency in Mexico.
As obesity and its co-morbidities have not only remained, but increased in prevalence in Latin America, obesity has “become the most important public health problems for Latin America”, the recently-published study states. With overweight and obesity affecting 72.5% of adults, approximately 56 million Mexicans, the government has declared it an epidemiological emergency.
A key contributing factor in Mexico is that most adults with obesity are undiagnosed. The level of non-diagnosis exists despite the number of obese women aged between 20-49 years old quadrupling to 35% in 2012 compared to 9% in 1988. The most recent statistics show that in 2016, a third (33.3%) of adults in Mexico were affected by obesity.
The long-term health concerns are visible. Obesity increases the likelihood of developing chronic non-communicable diseases — such as type 2 diabetes, cancer and cardiovascular disease — which are the leading causes of adult death in Mexico.
Non-diagnosis fuels obesity crisis
Despite the prevalence of overweight and obese people in Mexico, a national representative survey reveals that only a fifth of obese adults (those with a BMI of 30 kg/m2 ) have been diagnosed with the condition. Only 8% have received treatment from a health care provider for obesity.
There are a number of issues influencing this lack of diagnosis, which have led to the escalating obesity problem. In Mexico, insufficient and poor training of health personnel, limited time for prevention activities and minimal financial incentives are negatively impacting the country’s ability to treat obesity. Concerns and a lack of awareness surrounding weight stereotyping and the success of weight loss treatments also play a part in the rising levels of obesity and the inability to reverse the ongoing number of people affected.
Interventions are lacking and treatments are ineffective
To date, clinical health care interventions to tackle and overcome obesity have centered on traditional consultations that provide advice and guidance on diet and exercise. The frequency and the treatments offered are deemed ineffective; monthly or quarterly visits and the omission of validated behavior change protocols have resulted in less than 1 kg per year weight loss.
Primary health care providers are using a behavioral change protocol without working alongside clinical practice guidelines. The clinical care reality coupled with the significant number of adults opting for home remedies such as dietary supplements and herbal products means that despite efforts to lose weight, traditional methods adopted by the delivery system is restrictive.
Certain programs and initiatives are showing successful results, however. The Diabetes Prevention Program and the Look AHEAD studies achieved weight loss of 7–9% at the one year mark. The programs focus on intensive lifestyle interventions that center on dietary changes, physical activity and moderate weight loss. They adopt behavioral strategies with regular sessions and a maintenance phase with trained interventionists.
Intensive lifestyle interventions, such as these, have also seen real-world clinical application and success, achieving weight loss of approximately 4%. Centering on specific behavioral strategies, these interventions look at stimulus control, self-monitoring, goal setting, social support, along with providing education on nutrition and physical activity.
Handling diabetes better
In 2016, Mexico announced it was declaring an epidemiological emergency for two non-infectious health problems: diabetes and obesity. Both conditions have considerable numbers of sufferers and similar to obesity, many people with diabetes do not know they have it. In 2006, nearly 50% of those that satisfied the criteria for diabetes did not know they had it, and, in 2012, 75% of those recorded as living with diabetes did not have metabolic control over the condition.
Poor diagnosis and poor control of diabetes are considered the core reasons for its prevalence. In Mexico, the incidence rate of diabetes is creating complications, escalating costs and a reduced quality of life.
Ongoing struggles exist between those organizations and initiatives in support of tackling diabetes such as the National Agreement for Healthy Nutrition, and the sugar and food industries promoting product ranges. These conflicting interests within Mexico may be considered partly responsible for slowing down efforts to reduce the number of diabetic people in the country.
Overcoming obesity and diabetes
National efforts have been made to tackle the problem. In 2013, for example, the Mexican government introduced a national strategy focusing on overweight, obesity and diabetes. It implemented specific actions on health promotion, disease prevention, health regulation, medical care and fiscal policy.
As the National Academy of Medicine of Mexico has recently teamed up to support the strategy and provide recommendations, movements towards bettering obesity diagnosis rates look promising.
However, at present, evaluating how to best provide obesity treatments in clinical settings in Mexico and Latin American countries is “urgently needed”, the study reveals. Mexico is urged to introduce clinical practice guidelines to enable its health care providers to openly and appropriately treat obesity. Drawing upon the expertise of international specialists to provide input on the development of evidence-based clinical practice guidelines is also crucial.
Using remote technology to manage obesity also provides innovative opportunities for primary care intervention. Referrals to commercial intensive lifestyle intervention programs also offer a fresh perspective on treating and overcoming obesity.
“Considering the significant problems of obesity and diabetes in Mexico, we should aim to have a program like the US National Diabetes Prevention Program; however, it is unknown if such interventions would have the same impact on our population in terms of weight loss and diabetes prevention,” the authors reveal.
Embracing a multidisciplinary approach
To turn its obesity and diabetes crisis around, Mexico now needs to consider the current level of knowledge and awareness among health care providers and what changes should be made to its clinical practice in Mexico. It needs to focus on identifying the most appropriate and effective treatment programs, along with encouraging active collaboration between departments and organizations.
For improvements to occur, the nation requires a multidisciplinary approach and the exploration of other management strategies to best tackle obesity, the study states. Active collaboration between key health professionals including nutritionists, behavioral psychologists and experts in physical activity is required.
“We will certainly require multiple efforts at multiple levels −socioecological approaches− to fight obesity and related co-morbidities,” the report emphasized.
Source: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
2019; Volume 12, Pages 1841 – 1859, doi: 10.2147/DMSO.S208884
“Lifestyle intervention for obesity: a call to transform the clinical care delivery system in Mexico”
Authors: R.G. Díaz-Zavala et al.
