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Mexico is going through an environmental and nutritional crisis related to unsustainable dietary behaviors. Sustainable diets could solve both problems together. This study protocol aims to develop a 3-stages, 15 weeks mHealth randomized controlled trial (RCT) of a sustainable-psycho-nutritional intervention program to promote Mexican population adherence to a sustainable diet and to evaluate its effects on health and environmental outcomes. In stage 1, the program will be designed using the sustainable diets, behavior change wheel, and COM-B models. A sustainable food guide, recipes, meal plans, and a mobile application will be developed. In stage 2, the intervention will be implemented for seven weeks, and a 7-weeks follow-up period in a young Mexican adults (18 to 35 years) sample, randomly divided (1:1 ratio) into a control group (n=50) and an experimental group (n=50), that will be divided in two arms at week 8. Outcomes will include health, nutrition, environment, behavior, and nutritional-sustainable knowledge. Additionally, socioeconomics and culture will be considered. Thirteen behavioral objectives will be included using successive approaches in online workshops twice a week. The population will be monitored using the mobile application consisting of behavioral change techniques. In stage 3, the effects of the intervention will be assessed using mixed-effect models on dietary intake and quality, nutritional status, physical activity, metabolic biomarkers (serum glucose and lipid profile), gut microbiota composition, and dietary water and carbon footprints of the evaluated population. Improvements in health outcomes and a decrease in dietary water and carbon footprints are expected.

Water scarcity and excess adiposity are two of the main problems worldwide and in Mexico, which is the most obese country in the world and suffers from water scarcity. Food production represents 90% of a person's water footprint (WF), and healthy diets can lead to less WF than do unhealthy diets related to obesity. We calculated the WF of the diet and caloric intake of adults in Mexico and analyzed its relationship with adiposity. Also, the risk of water expenditure due to adiposity and adherence to dietary recommendations regarding WF of international healthy diets were examined. A Food Consumption Frequency Questionnaire (FCFQ) was applied to 395 adults. Body mass index (BMI), associated with adiposity indicators, was used as a reference for grouping a sample into adiposity levels. The WF was calculated according to the WF Assessment Method, considering correction factors and accounting for water involved in cooking and food washing. Our results showed that the Mexican diet spends 6,056 liters per person per day (L p−1d−1) and is 55% higher than international healthy diets WF. Consumption of beef, milk, fruits, chicken, and fatty cereals represented 56% of total WF. Strong relations appeared between hypercaloric diets and high WF. Diets of people with excess adiposity generated statistically higher WF with extra expenses of 729 L p−1d−1 compared with the normal adiposity population. Following nutritional recommendations offers a protective factor in water care, whereas not adhering to these represents a risk up to 93 times greater of water expenditure regarding international healthy diets. Therefore, both for the general population and to regulate obesity, adequate diets can help mitigate the problem of water scarcity.