Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

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Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

Recomendaciones nutricionales para el personal de salud y el personal esencial expuesto a la COVID-19 en Latinoamérica / Nutritional Recommendations for Healthcare and Essential Personnel Exposed to COVID-19 in Latin America

Estas recomendaciones se basan en la evidencia científica actual derivada de meta-análisis y revisiones sistemáticas sobre nutrición y prevención de infecciones respiratorias causadas por los virus SARS-CoV, MERS-CoV o influenza, similares en su estructura al SARS-CoV-2. Están dirigidas al personal en la primera línea de atención de salud y al personal que presta servicios esenciales a la comunidad, con alto riesgo de infección por la COVID-19. Estas personas usan equipo de protección personal, cumplen largos turnos laborales, en ocasiones bajo condiciones extremas, lo que puede llevar a descanso insuficiente, alto nivel de estrés, depresión, pobre calidad en la alimentación y deshidratación. Todos estos factores influyen negativamente en el sistema inmune y podrían conllevar un mayor riesgo de infección. Una ingesta adecuada de micronutrientes y otros compuestos bioactivos es esencial para el desempeño óptimo del sistema inmune. Existe evidencia moderada que avala la suplementación, en forma individual, con vitamina C (2 000 mg), vitamina D (1 000-2 000 UI) y zinc (≤ 40 mg) en la prevención de infecciones respiratorias en adultos. No se encontró evidencia suficiente para avalar la suplementación con vitamina A, niacina, ácido fólico, B12, omega 3, probióticos y polifenoles, aunque si se recomienda el consumo de alimentos ricos en estos nutrientes para apoyar al sistema inmune. Se recomienda al personal seguir la recomendación de consumir 5 porciones/día (400 g) de frutas y vegetales/hortalizas, mantenerse hidratado y limitar la cafeína. No hay evidencia del consumo de alimentos alcalinos para prevenir infecciones. Estas recomendaciones son particularmente importantes durante la pandemia(AU)

These recommendations are based on current scientific evidence obtained through meta-analysis and systematic reviews on nutrition and the prevention of respiratory infections related to SARS-CoV, MERS-CoV or influenza, similar in structure to SARS-CoV-2. They are aimed at primary health care personnel and to those who provide essential services to the community and are, consequently, at high risk of COVID-19 infection. These individuals wear personal protective equipment, work long shifts, sometimes under extreme conditions, which can lead to insufficient rest, high stress levels, depression, poor nutrition and dehydration. Together, these factors have a negative impact on the immune system and could result in an increased risk of infection. An adequate intake of micronutrients and other bioactive compounds is essential for optimal immune performance. There is moderate evidence supporting supplementation, individually, with vitamin C (2 000 mg), vitamin D (1 000-2 000 IU) and zinc (≤40 mg) for the prevention of respiratory infections in adults. Insufficient evidence was found to support supplementation with vitamin A, niacin, folic acid, B12, omega 3, probiotics and polyphenols; however, the consumption of foods rich in these nutrients is recommended to support immune function. It is recommended that workers follow the recommendation of consuming 400 g/day of fruits and vegetables, remain hydrated and limit caffeine. There is no scientific evidence supporting the consumption of alkaline foods to prevent infections. The aforementioned recommendations are particularly relevant during the pandemic(AU)

The Integrated Strategy for Attention in Nutrition (EsIAN) Reduces the Prevalence of Anemia in Children 6 to 59 Months in the Context of a Conditional Cash-transfer Program in Mexico.

Objectives: EsIAN is designed to improve nutritional outcomes through a strong behavior change campaign and free distribution of nutritional products (micronutrient powders, MNP and/or a fortified complementary food, FCF) for children 6 m to 5 y of age living in poverty. Both products were distributed in rural areas and MNP only in urban. We assessed changes in the prevalence of anemia in children, in a pre-post effectiveness trial. Methods: EsIAN was implemented in 2008 in 91 health care centers in central Mexico. Effectiveness was assessed in 2012 using a mixed methods approach. Data from two crosssectional samples of children aged 6 to 59 months (Rural: 2008 n=802, 2012 n=356; 2008 n=569, Urban: 2012 n=546) were analyzed adjusting standard errors by health care center clusters. Results: In rural areas, the concentration of hemoglobin increased from 12.0±0.1 (mean±SE) in 2008 to 12.7±0.1 g/dL in 2012 (P˂0.001). The prevalence of anemia dropped significantly both in urban (23.1±2.5% in 2008; 16.1±2.0% in 2012; P<0.05) and rural areas (23.5±2.0% in 2008; 7.0±1.3% in 2012; P˂0.001). The drop was largest among children aged 6 to 23 months in rural areas (28.3±4.5% percentage points reduction). Conclusions: We document here a dramatic reduction in the prevalence of anemia in communities where EsIAN was implemented. Although this pre-post design does not allow for direct causal attribution, impact pathway review suggests that these changes are likely to be due to the EsIAN.

An Integrated Strategy for Attention in Nutrition (EsIAN) Increases Physicians' and Nurses' Nutrition Knowledge and Perceptions in Mexico.

Objectives: To assess changes in physicians' and nurses nutrition knowledge and perceptions from EsIAN. EsIAN was developed to attend to the nutritional needs of Oportunidades beneficiary families. Oportunidades is the Mexican conditional cash transfer program. In Mexico, appropriate attention to undernutrition and anemia is needed simultaneous with attention to overweight and obesity. EsIAN includes nutritional supplements and a behavior change communication strategy with nutrition counseling tools. The strategy was implemented on pilot scale; we report here the effects on health-care providers' nutrition knowledge and perceptions. Methods: EsIAN was implemented in 2008 in 91 clinics in central Mexico. Effectiveness was assessed in 2012 using a mixed methods approach. Data from two cross-sectional samples were analyzed adjusting standard errors by health care center clusters. Results: Physicians' and nurses' (PN) perceived they have more than 90% capacity to implement the EsIAN in their everyday's practice. Compared to baseline, in 2012 a significantly higher proportion of PN reported recommending exclusive breastfeeding for 6 months (85.7% vs. 23.4%) and breastfeeding techniques (79.8% vs. 12.8%) (p<0.001). More than 88% monitored children growth using weight-for-height and height-for-age indicators as recommended by EsIAN. Nutritional supplements seemed appropriate to 97.8% and 92.3% urban and rural PN, respectively. Conclusions: EsIAN is a highly accepted strategy that can be nationally implemented and is effective to improve providers knowledge and perceptions of essential nutrition actions.

Scaling up an Integrated Strategy for Attention to Nutrition (EsIAN) to Prevent Stunting, Micronutrient Deficiency and Obesity in Mexico.

Objectives: Describes the scaling-up process of the EsIAN to prevent stunting, micronutrient deficiency and obesity during the 1,000 days of life. Methods: A case study that used participant observation and document review as primary methods for data collection. Results: Lessons learned and recommendations from the pilot study were incorporated. The training was enhanced with a computer training course to facilitate that it reaches all levels of the cascade. The behavior change communication strategy was pilot tested and further reformulated to better provide answer to the needs of health providers, community volunteers and target populations. A supportive supervision system was designed and will be implemented to follow up. The political will of the new government and its need to show short-term results played a key role in the scaling-up process. Time, coordination and budget constraint represent major challenges for the scaling up and its impact. Conclusions: Strategy will reach about 80,000 health providers and volunteers and more than six million beneficiaries' families. The scaling-up of this evidence-based intervention in to the window of opportunity for healthy growth and development is a promising way to impact the health and survival of the nation´s children.

Scaling up a National Training System to Address Nutrition Transition at Primary Care in Mexico.

Objectives: Mexico, as many developing countries, is undergoing a nutrition transition characterized by the coexistence of undernutrition (stunting and micronutrient deficiencies) alongside obesity and chronic diseases. Training of health workers needs to build and reinforce the essential competences, skills, and attitudes adapted to this changing context. The objective of this paper is two-fold: 1) to describe the process of development of a national training system at the primary care level to address nutrition transition in Mexico, and 2) to identify the factors, processes, and strategies conducive to the establishment of an effective national training system. Methods: This paper is a case study that uses participant observation and document review as primary methods for data collection. Results: Based on formative research, we developed an in-person cascade training for primary care physicians, nurses, and community health workers. We tested and evaluated the training in four states in Mexico. Results showed that it was not successful in reaching the lower levels of the cascade. We redesigned the training system by: 1) developing monitoring and supervision components, 2) reducing the number of levels of the cascade, and 3) developing virtual (online and offline) training modules. In addition, instructional designers adopted a competence-based approach to redesign the training, and structured new and interactive activities to enhance learning. Conclusions: Training systems should have monitoring and supervision components to ensure adequate adoption and implementation. The use of technology and instructional design has the potential to improve the effectiveness of the training system.

Barreras y oportunidades para la regulación de la publicidad de alimentos y bebidas dirigida a niños en México / Barriers and opportunities for the regulation of food and beverage advertising to children in Mexico

Objetivos. Identificar barreras y oportunidades para la regulación de la publicidad de alimentos y bebidas para niños. Material y métodos. Estudio cualitativo. Se entrevistó a catorce informantes clave del ámbito legislativo, sector privado, funcionarios de la Secretaría de Salud y académicos involucrados en el tema de la regulación de la publicidad. Resultados. Barreras identificadas: concepción de la obesidad como problema individual, minimización de los efectos negativos sobre la salud, definición de la vulnerabilidad de la niñez acotada a su desarrollo cognitivo. Facilitadores: apoyo de varios sectores de la sociedad, a favor de la regulación, una amplia discusión científica acerca del tema, una experiencia exitosa similar con la industria del tabaco y sus lecciones. Conclusión. México cuenta con elementos clave para lograr una regulación eficaz de la publicidad.

Objective. To identify barriers and opportunities for the regulation of food and beverage advertising to children. Materials and methods. A qualitative study. Fourteen key informants from the congress, private sector, officials from the ministry of health and academics involved in the issue of regulation of advertising were interviewed. Results. Barriers identified: conception of obesity as an individual problem, minimization of the negative effects on health, definition of the vulnerability of children bounded to their cognitive development. Facilitators support from various sectors of society regulation, extensive scientific discussion on the subject, successful experience and its lessons on tabacco industry. Conclusion. Mexico has key elements for achieving effective regulation on advertising.

Contribution of formative research to design an environmental program for obesity prevention in schools in Mexico City / Contribución de la investigación formativa para el diseño de un programa para la prevención de obesidad en escuelas de la Ciudad de México

Objective. This paper describes the methods and key findings of formative research conducted to design a school-based program for obesity prevention. Materials and methods. Formative research was based on the ecological model and the principles of social marketing. A mixed method approach was used. Qualitative (direct observation, indepth interviews, focus group discussions and photo-voice) and quantitative (closed ended surveys, checklists, anthropometry) methods were employed. Results. Formative research key findings, including barriers by levels of the ecological model, were used for designing a program including environmental strategies to discourage the consumption of energy dense foods and sugar beverages. Conclusion. Formative research was fundamental to developing a context specific obesity prevention program in schools that seeks environment modification and behavior change.

Objetivo. Describir los aspectos metodológicos y principales resultados de una investigación formativa realizada para diseñar un programa ambiental para la prevención de obesidad en escuelas. Material y métodos. La investigación formativa se basó en el modelo ecológico y los principios del mercadeo social. Se utilizó un enfoque de métodos mixtos: cualitativos (observación directa, entrevistas en profundidad, grupos de discusión y foto-voz) y cuantitativos (cuestionarios cerrados, inventarios de alimentos y bebidas, antropometría). Resultados. Los principales resultados de la investigación formativa, incluyendo las barreras identificadas en los niveles del modelo ecológico, fueron contemplados para el diseño del programa, que incluyó estrategias ambientales para desincentivar el consumo de alimentos de alta densidad energética y bebidas azucaradas. Conclusión. La investigación formativa fue fundamental para diseñar un programa de prevención de obesidad para la modificación del ambiente y cambios de comportamientos, factible y adaptado al contexto de las escuelas públicas de la Ciudad de México.

Promoting healthful diet and physical activity in the Mexican school system for the prevention of obesity in children / Promoción de actividad física adecuada y alimentación saludable en el sistema educativo mexicano para la prevención de la obesidad infantil

Objective. This paper describes the rationale, design, and methods of a two-year randomized controlled trial conducted to evaluate the effectiveness of an environmental intervention in 27 elementary schools in Mexico City. Materials and methods. There were two units of analysis, school level addressing changes in elementary public part-time schools, and individual-level addressing behavioral changes in students 9 to 11 years of age. Two intensities of an intervention program were implemented (basic and plus), each containing two intervention components: physical activity and nutrition, supported by a communication/education component. Evaluation of the intervention was carried out during the school cycles 2006-2007 and 2007-2008. Results. Primary outcomes were overweight and obesity prevalence and fitness; environmental and behavioural measures were also examined. Conclusions. This is the first institutional multilevel, multifactorial project, consistent with the best practices available in current literature, carried out in Mexico to prevent childhood obesity in schools.

Objetivo. El presente trabajo describe el protocolo, objetivo, el diseño y los métodos de un ensayo controlado aleatorio de dos años realizados para evaluar la efectividad de una intervención ambiental en 27 escuelas primarias de la Ciudad de México. Material y métodos. El protocolo consta de dos unidades de análisis: el nivel escolar donde se evaluaron los cambios en el entorno escolar de escuelas primarias publicas de medio tiempo y el nivel individual que evaluó los cambios de comportamiento en alumnos de 9 a 11 años de edad. Se implementaros dos tipos de intervenciones: nutrición y actividad física apoyadas de una estrategia de educación/comunicación. Las intervenciones tuvieron dos intensidades: básica y plus. La evaluación de la efectividad se llevó a cabo durante los ciclos escolares 2006-2007 y 2007-2008. Resultados. Los resultados iniciales reportan los métodos de evaluación de conducta individual así como la prevalencia de sobrepeso y obesidad. La evaluación ambiental reporta el protocolo de evaluación del entorno escolar. Conclusiones. Este es el primer proyecto de la de intervención escolar con un diseño multinivel, multifactorial, basado en literatura científica disponible y en investigación formativa para prevenir la obesidad infantil en las escuelas de la Ciudad de México.

Uso del mercadeo social para aumentar el consumo de agua en escolares de la Ciudad de México / Use of social marketing to increase water consumption among school-age children in Mexico City

Objetivo. Incrementar el consumo de agua en escolares de la Ciudad de México a través de una intervención de mercadeo social. Material y métodos. Diseño cuasi-experimental por englomerados. Intervención de tres meses en escuelas primarias que incluyó provisión de agua potable y diseñado con base en el mercado social. Se comparó la actitud, el conocimiento y el comportamiento reportado pre y post intervención. Resultados. Los niños (n=116) aumentaron en 38% (171 ml) el consumo de agua reportado durante el horario escolar, mientras que en el grupo control (n=167) disminuyó en 21% (140 ml), diferencias (p<0.05). En una submuestra, el consumo de bebidas azucaradas reportado disminuyó 437 ml en el grupo intervención y 267 ml en el grupo control (p<0.05). Conclusión. El mercadeo social, incluyendo la modificación del ambiente, fue efectiva en aumentar el consumo de agua reportado en niños y es una estrategia que podría contribuir a mitigar la obesidad infantil.

Objective. To increase water consumption in school children in Mexico City through a social marketing intervention. Materials and methods. Cluster cuasi-experimental design. Intervention of three months in schools, including water provision and designed based on social marketing. Reported changes in attitude, knowledge and behavior were compared pre and post intervention. Results. Children of the intervention group (n=116) increased in 38% (171 ml) water consumption during school time, control group (n=167) decreased its consumption in 21% (140 ml) (p<0.05), according to their reported consumption. In a sub-sample reported consumption of sweetened beverages decreased 437 ml in the IG and 267 ml in the CG (p<0.05). Conclusion. Social marketing and environmental modifications were effective on increasing water consumption among children, strategy that might contribute to mitigate childhood obesity.

Significados culturalmente construidos para el consumo de bebidas azucaradas entre escolares de la Ciudad de México / Culturally constructed meanings for consumption of sweetened beverages among schoolchildren in Mexico City

OBJETIVO: Demostrar la importancia de los factores culturales que hoy motivan a los niños mexicanos a consumir bebidas azucaradas y examinar sus implicaciones para el diseño de programas de promoción de estilos de vida saludable. MÉTODOS: Estudio cualitativo fenomenológico. Se llevaron a cabo nueve entrevistas con pares y cuatro grupos de discusión con niños de entre 9 y 10 años de edad en cuatro escuelas públicas del sur de la Ciudad de México. Las entrevistas se realizaron con apoyo de nueve fotografías de bebidas disponibles en las escuelas y en los hogares. Se buscó identificar las reglas culinarias asociadas con el consumo de bebidas azucaradas y las diferentes valoraciones que hacen los niños acerca de las bebidas. Las entrevistas y los grupos de discusión se grabaron y transcribieron en su integridad. Se desarrollaron matrices de análisis en categorías temáticas identificadas durante el estudio. El análisis se basó en la "comparación continua" de los discursos de niños y niñas, y entre los alumnos de las cuatro escuelas. RESULTADOS: Dos principales elementos de índole sociocultural, construidos en un marco cultural determinado, explican en parte el actual patrón de consumo entre los niños. El primero, una casi inexistente conceptualización de los niños con respecto al consumo de agua, confinada a la realización de actividad física, contraria a la amplia gama de circunstancias y ocasiones que encontraron para el consumo de alguna bebida azucarada. Segundo, la identificación de tres principios que parecen estructurar el consumo de las bebidas -combinación de alimentos salados con bebidas dulces, rol protagónico de las bebidas azucaradas en eventos sociales y asociación estrecha del consumo de agua con la sed provocada por el esfuerzo físico. CONCLUSIONES: Los resultados ponen en evidencia la importancia de considerar el papel de los elementos socialmente significativos en las prácticas alimentarias y la necesidad de considerarlos también en el diseño de las intervenciones con escolares. Resalta asimismo la necesidad de transformar la concepción actual de los niños con respecto a lo que beben, guiándolos y estimulándolos para que identifiquen el agua como una bebida que se toma a lo largo del día y no exclusivamente después de un esfuerzo físico. Finalmente, es perentorio en México que se garantice el acceso libre al agua potable dentro de las escuelas y se regule la publicidad alimentaria dirigida a los niños.

OBJECTIVE: Demonstrate the importance of the cultural factors that currently motivate Mexican children to consume sweetened beverages and examine their implications for the design of programs for the promotion of healthy lifestyles. METHODS: A qualitative phenomenological study involving nine peer interviews and four discussion groups was conducted among children aged 9 and 10 years in four public schools in southern Mexico City. The interviews employed nine photographs of beverages that are available in schools and homes. The aim was to identify the culinary rules associated with the consumption of sweetened beverages and the different views held by the children about the beverages. The complete interviews and group discussions were recorded and transcribed. Matrixes were developed for analysis of the subject categories identified during the study. The analysis was based on "continuous comparison" of the statements made by boys and girls, and among students from the four schools. RESULTS: Two main sociocultural elements, constructed in a given cultural framework, partly explain the children's current consumption patterns. The first, the nearly nonexistent concept that water is for drinking, with water consumption being limited to engagement in physical activity, in contrast to the wide range of circumstances and occasions found for the consumption of a sweetened beverage. Secondly, the identification of three principles that appear to underlie beverage consumption: the combination of salty food with sweet drinks, the important role of sweetened beverages at social events, and the close association between water consumption and the thirst induced by physical effort. CONCLUSIONS: The results show the importance of considering the role of socially significant elements in dietary practices and the need to also consider these elements when designing interventions for schoolchildren. It is also important to change the children's current views about what they drink, guiding and encouraging them to think of water as a drink to be consumed throughout the day and not only after physical activity. Finally, it is imperative in Mexico to guarantee free access to drinking water in schools and regulate food advertising that targets children.

Sistema de salud de Venezuela / The health system of Venezuela

En este artículo se describe el sistema de salud de Venezuela, incluyendo su estructura y cobertura, sus fuentes de financiamiento, los recursos humanos y materiales con los que cuenta, y las actividades de rectoría que en él se desarrollan. Este sistema cuenta con un sector público y un sector privado. El sector público está constituido por el Ministerio del Poder Popular para la Salud (MS) y diversas instituciones de seguridad social, dentro de las que destaca el Instituto Venezolano de los Seguros Sociales (IVSS). El MS se financia con recursos del gobierno central, estados y municipios. El IVSS se financia con cotizaciones patronales, cotizaciones de los trabajadores y con aportes del gobierno. Ambas instituciones cuentan con su propia red de atención ambulatoria y hospitalaria. El sector privado está constituido por prestadores de servicios que reciben pagos de bolsillo y por compañías aseguradoras. El sistema de salud venezolano atraviesa por un proceso de reforma desde la aprobación de la Constitución de 1999 que plantea la creación de un Sistema Público Nacional de Salud cuya punta de lanza hoy es el programa Barrio Adentro.

This paper describes the Venezuelan health system, including its structure and coverage, financial sources, human and material resources and its stewardship functions. This system comprises a public and a private sector. The public sector includes the Ministry of Popular Power for Health (MS) and several social security institutions, salient among them the Venezuelan Institute for Social Security (IVSS). The MH is financed with federal, state and county contributions. The IVSS is financed with employer, employee and government contributions. These two agencies provide services in their own facilities. The private sector includes providers offering services on an out-of-pocket basis and private insurance companies. The Venezuelan health system is undergoing a process of reform since the adoption of the 1999 Constitution which calls for the establishment of a national public health system. The reform process is now headed by the Barrio Adentro program.

Physical activity during the school day in public primary schools in Mexico City / La actividad física durante la jornada escolar en escuelas primarias públicas en la Ciudad de México

OBJECTIVE: To quantify the physical activity (PA) of students and describe the school environment surrounding PA. MATERIAL AND METHODS: Between November 2005 and March 2006, in Mexico City, we conducted quantitative and qualitative observations to describe the PA and the school context. RESULTS: Recess and physical education class (PE) were the only opportunities to participate in PA. PE occurred one time per week with a duration of 39.8±10.6 minutes which is less than national and international recommendations. Students participated in moderate-to-vigorous PA 29.2±17.8 percent of PE. The dynamics of PE did not promote the inclusion of all students or PA. During recess there was overcrowding of the school patio and no equipment for PA or organization of PA. DISCUSSION: The PA of students in public schools in Mexico City can be improved by increasing the quantity and quality of PE and increasing opportunities for activity during recess.

OBJETIVO: Cuantificar la actividad física (AF) en niños escolares y describir el entorno escolar relacionado con la AF. MATERIAL Y MÉTODOS: Entre noviembre de 2005 y marzo de 2006 en la Ciudad de México, se realizó observación directa cuantitativa y cualitativa para describir el nivel de AF y el contexto escolar durante recreo y clases de educación física (CEF). RESULTADOS: El recreo y las CEF fueron los únicos espacios en los que se realizó AF. Las CEF se impartieron una vez a la semana y duraron 39.8±10.6 minutos, lo que está por debajo de las recomendaciones internacionales. Se participó en actividades moderadas-vigorosas 29.2±17.8 por ciento de las CEF. La dinámica de las CEF no favoreció la AF. Durante el recreo se observó saturación del patio y no se realizaron actividades organizadas ni se utilizaron materiales para promover la AF. DISCUSIÓN: Se recomienda incrementar la calidad y la cantidad de las CEF y el tiempo dedicado a jugar durante el recreo.

Overweight and obesity trends in Mexican children 2 to 18 years of age from 1988 to 2006 / Tendencias de sobrepeso y obesidad en niños mexicanos de 2 a 18 años de edad: 1988 a 2006

OBJECTIVE: To describe prevalences and trends of overweight and obesity/OW&OB in Mexican children from 1988 to 2006 at the national level and by relevant subpopulations. MATERIAL AND METHODS: Prevalences of OW&OB in children aged 2-18 years were estimated using body mass index data from three national surveys conducted in 1988, 1999 and 2006. RESULTS: Prevalences of OW&OB are high in children of all ages, particularly among school-age and adolescent groups disaggregated by regions, socioeconomic status, urban and rural areas, and ethnic groups. The overall prevalence of OW&OB in children 2 to 18 years old in 2006 was 26.3 percent. Prevalences by age groups were 16.7 percent in preschool-age, 26.2 percent in school-age, and 30.9 percent in adolescents, using the IOTF classification system. CONCLUSIONS: Upward trends were observed in school-age children and adolescents at the national level and in all subpopulations.

OBJETIVO: Describir las prevalencias y tendencias de sobrepeso y obesidad (SPyO) en niños mexicanos, de 1988 a 2006, en el ámbito nacional y por subgrupos relevantes de población. MATERIAL Y MÉTODOS: Las prevalencias de SPyO (peso no saludable) se estimaron usando cifras de índice de masa corporal de tres encuestas nacionales realizadas en 1988, 1999 y 2006. RESULTADOS: Las prevalencias de SPyO son altas en niños de todas las edades, particularmente en niños de edad escolar y adolescentes, estratificados por regiones, estado socioeconómico, áreas urbanas, rurales y grupo étnico. La prevalencia de SPyO en 2006 fue de 26.3 por ciento en el grupo de entre 2 a 18 años de edad, 16.7 por ciento en preescolares, 26.2 por ciento en escolares y 30.9 por ciento en adolescentes, usando la clasificación de The International Obesity Task Force (IOTF). CONCLUSIONES: Se observa una tendencia de sobrepeso y obesidad en aumento en niños de edad escolar y adolescentes, para todos los subgrupos de población.

Facilitadores y barreras para el consumo del complemento alimenticio del Programa Oportunidades / Facilitators and barriers for the consumption of a micronutrient supplement

OBJETIVO: Determinar y explorar los factores socioculturales que facilitan u obstaculizan el consumo recomendado de un complemento alimenticio (CA) repartido en todo el país como parte del Programa Oportunidades en niños de 6 a 59 meses de edad. MATERIAL Y MÉTODOS: Estudio cualitativo en comunidades rurales de los estados de Chiapas y Veracruz. Se realizaron 44 entrevistas semiestructuradas y se organizaron 25 grupos focales de madres beneficiarias e informantes clave. El análisis se efectuó bajo el enfoque fenomenológico. RESULTADOS: Los facilitadores fueron gratuidad, gran accesibilidad, aceptabilidad favorable del CA y alta credibilidad de las madres en las recomendaciones médicas; las barreras fueron problemas de almacenamiento y distribución, condiciones de pobreza, dilución intrafamiliar, creencias y conocimientos. CONCLUSIÓN: Los resultados permitieron sugerir elementos para promover el CA, así como identificar las incongruencias culturales y sociales entre las recomendaciones del programa y las prácticas y preferencias de la población objetivo.

OBJECTIVE: To define and explore the sociocultural factors that could enhance (facilitators) or interfere with (barriers) the adequate consumption of a nutritional supplement (NS) by children from 6 to 59 months of age, provided as part of the national program Oportunidades. MATERIAL AND METHODS: Qualitative study in rural communities of Chiapas and Veracruz. Forty-four semi-structured interviews and 25 focus groups were conducted with mothers and other key informants. The framework analysis approach was used. RESULTS: Facilitators. The NS is free, is highly accessible, is positively accepted and mothers believe the physicians’ recommendations. Barriers. Lack of adequate storage and distribution, poverty conditions, intrahousehold dilution (within the family members), beliefs regarding child feeding and the purpose of the NS. CONCLUSION: Results shows the incongruence between the Program’s recommendations and the preferences and practices of the target population and provides important elements to be considered in the promotion of the NS.