Childhood obesity in Mexico: social determinants of health and other risk factors

Abstract

Approximately 50 million children and adolescents in Latin America are affected by the childhood obesity pandemic. We present the case of a 5-year-old Mexican girl with obesity and gastro-oesophageal reflux disease (GORD), in whom prenatal, lifestyle and environmental risk factors were identified. Here, we demonstrate how childhood obesity is rooted since pregnancy and the perinatal stage, and how the social determinants of health like unsafe outdoor conditions, lack of infrastructure to exercise and a suboptimal physical activity curriculum in government schools strongly influence the development and maintenance of childhood obesity and complicate management.

Prevalencia y factores de riesgo asociados a la obesidad infantil: revisión sistemática

“…Aquí, se demuestra cómo la obesidad infantil está arraigada desde el embarazo y la etapa perinatal, y cómo los determinantes sociales de la salud, como las condiciones inseguras al aire libre, la falta de infraestructura para hacer ejercicio y un plan de estudios de actividad física subóptimo, influyen fuertemente en el desarrollo y mantenimiento de la niñez. obesidad y complican el manejo (Avelar Rodriguez et al, 2018). En contraste en Brasil la prevalencia de sobrepeso es de 30,7%; mientras que la prevalencia de obesidad abdominal es de 9,2 y 12,6% según circunferencia de cintura y relación cintura-talla, respectivamente.…”

The Impact of Excessive Fructose Intake on Adipose Tissue and the Development of Childhood Obesity

“…Children born from mothers with obesity or from women who developed gestational diabetes are more likely to develop obesity and metabolic problems compared to children born from healthy mothers [113]. Therefore, factors such as pre-pregnancy BMI, maternal weight gain, and glucose metabolism during pregnancy and lactation correlate with the occurrence of childhood obesity [114][115][116]. Additionally, there is a greater propensity for obesity in adulthood in children with high birthweight and an increase in the central distribution of fat in those with low birthweight, reaffirming that the gestational phase is an important moment for an increase in later body adiposity [113].…”

Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities

“…The bad health outcomes are ‘overdetermined’ by multiple, sufficient causes of disease” 44 (p27) . Underscoring the limitations of research designs that control for all but a single variable, the cited authors point out that: “In a counterfactual analysis, removing only one of the sufficient causes would suggest that it was not a ‘cause’ at all, because the disease outcomes did not change … [C]hanging this one factor is not enough to improve health.” In an illustration that I have used to good effect in teaching, a case report on obesity in a five-year-old Mexican girl that is laudably attentive to social determinants of health 45 identifies multiple contributing factors including limited exercise time in school, unsafe conditions in available exercise spaces near the family's home, five hours of daily screen time, and excessive caloric intake associated with a corporate-driven nutrition transition that has been especially rapid in Mexico. Affordability of a healthy diet was not identified as a concern by the parents, although this would be a concern to literally billions of people worldwide 46 (Chapter 3) .…”