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

Rolando Giovanni Díaz-Zavala,¹ Maria del Carmen Candia-Plata,² Teresita de Jesús Martínez-Contreras,¹ Julián Esparza-Romero<sup>3

1</sup>Nutrition Health Promotion Center, Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Sonora, Mexico; ²Department of Medicine and Health Sciences, University of Sonora, Hermosillo, Sonora, Mexico; ³Diabetes Research Unit, Department of Public Nutrition and Health, Research Center for Food and Development CIAD, Hermosillo, Sonora, Mexico

Correspondence: Rolando Giovanni Díaz-Zavala
Nutrition Health Promotion Center, Department of Chemical and Biological Sciences, University of Sonora, Blvd. Luis Encinas y Rosales S/N, Hermosillo, Sonora 83000, México. C.P.
Email giovanni.diaz@unison.mx

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.

Keywords: nutrition, weight loss, primary care, underdiagnosis, health care providers, diabetes