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

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.

Perceptions, Attitudes, and Barriers to Obesity Care in Mexico: Data From the ACTION‐IO Study

“…The difference in opinions between HCPs and PwO regarding motivation to lose weight may reflect real‐life experience of HCPs or could represent an unintentional negative bias (23). In Mexico, the barriers to HCPs discussing weight management with PwO could be a contributing factor to the underdiagnosis of obesity (9).…”

“…Although medical and scientific organizations define obesity as a disease (5,13), the medical care received by PwO is often suboptimal (14,15). Therefore, the strategies adopted to manage the epidemic have not fully incorporated treating obesity as a disease into the daily approach to the problem (9). Evidence-based results regarding the visions, attitudes, perceptions, behaviors, or barriers of PwO and health care professionals (HCPs) about obesity care are warranted to develop patient-centered weight-management programs.…”

“…Use of therapeutic tools, whether nonpharmacological options, approved adjuvant medications, or bariatric surgery, are limited or only partially implemented in relation to the official guidelines or standards (8). Public primary care clinics in Mexico generally do not employ dietitians or personnel trained in behavioral management strategies, and appointments for obesity management are infrequent and consist of general diet and exercise advice (9). The offering and coverage of multidisciplinary and comprehensive evidence‐based programs for the detection, management, and follow‐up of people with obesity (PwO) in Mexico is also partial and is limited to a few large hospitals (9).…”

“…Public primary care clinics in Mexico generally do not employ dietitians or personnel trained in behavioral management strategies, and appointments for obesity management are infrequent and consist of general diet and exercise advice (9). The offering and coverage of multidisciplinary and comprehensive evidence‐based programs for the detection, management, and follow‐up of people with obesity (PwO) in Mexico is also partial and is limited to a few large hospitals (9). In general, obesity‐management interventions are not currently covered by insurance in Mexico (10); there is a limited budget to perform bariatric surgery in public institutions, and private insurers do not offer coverage (11).…”

Obesity is a strong independent risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: A national observational study

“…Obesity combined with DM, asthma, immunosuppression, and hypertension, had higher increases in mortality risk than in patients with these comorbidities but without obesity. For COPD, CVD, or CKD combined with obesity, mortality risks were not statistically significantly increased, possibly due to the low number of patients presenting these comorbidities combined (n=24, n=20, and n=11, respectively), which reflects that these comorbidities are often present with more than one concomitant disease in the general population [22][23][24].…”