This paper is an attempt to discuss the problem of malnutrition within the framework of the global need for development and the challenges posed by the trends of neoliberalism and globalization. We argue that there is a two-way link between poverty and health in which nutrition plays an important role both as an active and as a mediating factor. Key concepts are exposed and expanded: (a) Development per se does not ensure better health; (b) unequal distribution of income has an independent effect on health indicators after adjusting for total income; (c) improving health can make an important contribution to reducing poverty; (d ) improving nutrition throughout the whole life course is an indispensable strategy for better health; (e) obesity has to be included amongst the most critical health problems, has different traits, and presents with different challenges in the developing world and in the industrialized countries.

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En la Región de las Américas ha habido, en las últimas décadas, un notable incremento de las enfermedades crónicas no trasmisibles (ECNT) asociadas a estilos de vida no saludables. Estas enfermedades y trastornos en conjunto, entre los que se encuentran la hipertensión arterial, la diabetes mellitus tipo 2, la enfermedad coronaria, los accidentes cerebrovasculares, la obesidad y algunos tipos de cáncer, son las principales causas de muerte, morbilidad, discapacidad y deterioro de la calidad de vida. Otro aspecto crítico de esta epidemia de ECNT es el alto costo que representan para los servicios de salud el tratamiento y la rehabilitación de pacientes con estas afecciones, factores que acentúan las inequidades existentes. Entre las ECNT, la obesidad merece especial atención, ya que es en sí misma una enfermedad crónica y a la vez un reconocido factor de riesgo de muchas otras. El estudio y abordaje de la obesidad no pueden desligarse de los de otras ECNT por diversas razones: 1) porque comparten algunos factores causales y subyacentes comunes, como la alimentación inapropiada y el sedentarismo; 2) porque al identificar a los sujetos obesos se está identificando a una alta proporción de los sujetos en riesgo de padecer otras ECNT; 3) porque al prevenir la obesidad-mediante la promoción de estilos de vida saludables-se previenen la mayoría de las ECNT; y, por último, 4) porque al tratar al obeso se disminuye el riesgo de que sufra complicaciones y también se reduce el efecto mediador que tiene la obesidad en relación con otros factores de riesgo. El cuadro 1 muestra la prevalencia del exceso de peso (25-29,9 kg/m 2) y de la obesidad (30 o más kg/m 2) en mujeres de algunos países de América Latina y del Caribe (1). Los valores más elevados corresponden a Jamaica, país que podría ser representativo de lo que ocurre en la mayoría de los países anglófonos del Caribe. Puede apreciarse que, con la excepción de Haití, más de 23% de la población de mujeres entre las edades de 15 y 49 años están en sobrepeso y más de un tercio presenta sobrepeso u obesidad. Es de señalar que estos datos, que corresponden a los de la mayoría de los países pobres, son reveladores de la magnitud de las tendencias en la Región. Según algunos estudios diacrónicos, los cambios se producen claramente en el sentido del aumento. En un estudio realizado en Estados Unidos (2) se notificó que en la población de origen hispano se ha incrementado la proporción de obesos de 11,6% en 1991 a 20,8% en 1998 (80% de incremento), mucho más que en otros grupos étnicos. Brasil, que dispone de datos correspondientes a tres encuestas realizadas en 1975, 1989 y 1996, muestra un aumento superior al 100% en la proporción de mujeres obesas de 20 a 34 años de edad (3). Otros datos, disponibles solo para 1975 y 1989, muestran también un marcado incremento de la obesidad en todos los estratos de población encuestados (4).

SUMMARY Objective: This study investigated whether it is possible to achieve equally satisfactory results between 37.5% hydrogen peroxide (HP) gel and 6% HP gel. We also assessed the psychosocial impact and self-perception of esthetics generated by extracoronal tooth whitening. Methods and Materials: A prospective, double-blind, randomized clinical trial was carried out. A total of 33 patients were selected from the clinic of the Faculty of Dentistry at the University of Chile. The patients included men and women over 18 years old without prior tooth whitening treatments, tooth decay, or restorations of the maxillary anterior teeth. The patients had tooth colors of A3 or less according to the Vita Classical scale, which was determined with a Vita Easy Shade spectrophotometer. The study was carried out with a “split-mouth” design. One side of each mouth was randomly treated with 37.5% HP, and the other side was bleached with 6% HP. Each group received 3 to 12 minutes of treatment with the respective gel applications. Two sessions of bleaching were carried out each week. A spectrophotometer was used to measure the total variation of color (ΔE), and a subjective evaluation was made with Vita Classical scale (ΔSGU) between the baseline (session 1) and different measurement times. We compared ΔE and ΔSGU for both agents using the Mann-Whitney test (α=0.05). Results: In both groups, there was variation among the initial color and the color in the different measurement times. In the month after the treatment was completed, ΔE was 9.06 in the 37.5% HP group and 5.69 in the 6% HP group. The difference between the two groups was statistically significant starting in the second session (p=0.000). Conclusion: There was a significant difference between the effectiveness of the bleaching gel concentrations of 37.5% and 6% HP according to spectrophotometer measurements and subjective evaluations. There was also a positive effect on psychosocial impact and esthetic self-perception among patients.

OBJECTIVE:To examine the effects of socioeconomic status (SES) on the obesity knowledge of adolescents in six Latin American cities. DESIGN: Data were collected using an anonymous, self-administered questionnaire consisting of demographic questions and a 25-item multiple-choice obesity knowledge test. Test items were clustered under five topics: the fat and calorie content of foods and beverages; weight loss methods; energy expenditure; food preparation methods; and the relationship between obesity and health. SUBJECTS: A total of 1272 ninth grade students from higher and lower SES families were recruited at schools in Buenos Aires, Argentina (n ¼ 195); Guatemala City, Guatemala (n ¼ 212); Havana, Cuba (n ¼ 213); Lima, Peru (n ¼ 218); Panama City, Panama (n ¼ 195); and Santiago, Chile (n ¼ 239). RESULTS: Mean test scores reflected a low level of obesity knowledge among adolescents from higher and lower SES groups in all six cities. Nevertheless, a trend for higher scores emerged in favor of adolescents from wealthier families. This income effect persisted after controlling for gender and weight status. The weakest knowledge areas among youth from the higher SES groups were food preparation methods and the relationship between obesity and health while those for adolescents from the lower SES groups were the fat and calorie content of foods and beverages and the relationship between obesity and health. Classroom instruction about obesity was generally more available to students from the higher SES groups. The majority of adolescents from both SES groups were interested in learning more about weight loss methods, energy expenditure, and the fat and calorie content of foods and beverages. The topic of least interest was the relationship between obesity and health. CONCLUSION: These preliminary findings suggest a need for more obesity education programs for adolescents, especially for those living in poverty.