Share of food group expenditure in Mexican households according to the gender of the head of household and size of the locality.

OBJECTIVE: To evaluate differences in the percentage of expenditure on food groups in Mexican households according to the gender of the household head and the size of the locality. DESIGN: Analysis of secondary data from the National Household Income and Expenditure Survey (ENIGH) 2018. We estimated the percentage of expenditure on fifteen food groups according to the gender of the head of household and locality size and evaluated the differences using a two-part model approach. SETTING: Mexico, 2018. PARTICIPANTS: A nationally representative sample of 74 647 Mexican households. RESULTS: Female-headed households allocated a lower share of expenditure to the purchase of sweetened beverages and alcoholic beverages and higher percentages to milk and dairy, fruits and water. In comparison with metropolitan households, households in rural and urban localities spent more on cereals and tubers, sugar and honey, oil and fat and less on food away from home. CONCLUSIONS: Households allocate different percentages of expenditure to diverse food groups according to the gender of the head of the household and the size of the locality where they are located. Future research should focus on understanding the economic and social disparities related to differences in food expenditure, including the gender perspective.

Lifestyle Quality Indices and Female Breast Cancer Risk: A Systematic Review and Meta-Analysis.

Breast cancer (BC) poses an important burden of disease, which probably could be reduced by adopting healthy lifestyles like healthy body weight, healthy diet, and physical activity, among others. Many studies have reported that adherence to healthy lifestyles may decrease BC risk. The main objective of this study was to estimate a summary association of studies evaluating a healthy lifestyle index and BC risk. A systematic review and meta-analysis following the Cochrane methodology were carried out. Observational studies, including healthy lifestyle indices and their association with BC, were searched from 4 databases. For the meta-analysis, random-effects model was used to evaluate overall BC risk, BC by molecular subtype and menopausal status. Thirty-one studies were included in the systematic review, and 29 studies in the meta-analysis. When the highest vs. the lowest category to a healthy lifestyle index were compared, the study identified a 20% risk reduction for BC in prospective studies (hazard ratio [HR] 0.80 95% CI: 0.78, 0.83) and an odds ratio (OR) of 0.74 (95% CI: 0.63, 0.86) for retrospective studies. The inverse association remained statistically significant when stratified by menopausal status, except for premenopausal BC in prospective studies. Furthermore, an inverse association was found for molecular subtypes estrogen receptor (ER+)/progesterone receptor (PR+): HR = 0.68 (95%CI: 0.63, 0.73), ER+/PR-: HR = 0.78 (95% CI: 0.67, 0.90) and ER-/PR-: HR = 0.77 (95% CI: 0.64, 0.92). Most studies scored at a low risk of bias and a moderate score for the certainty of the evidence. Adherence to a healthy lifestyle reduces the risk of BC, regardless of its molecular subtypes, which should be considered a priority to generate recommendations for BC prevention at a population level. International prospective register of systematic reviews (PROSPERO) ID: CRD42021267759.

Factors influencing adults to drop out of intensive lifestyle interventions for weight loss.

Reducing ≥5% of body weight can decrease the risk of developing chronic diseases in adults with excess weight. Although Intensive Lifestyle Interventions (ILIs) that include cognitive-behavioral techniques to improve physical activity and eating habits are the best approach for losing weight, the failure to retain participants is a barrier to their successful implementation. We aimed to investigate the factors influencing adults to drop out of ILIs for weight loss at six months. We conducted retrospective multiple logistic regression analysis of 268 participants with excess weight (body mass index ≥ 25 kg/m2) from a multicenter study (n = 237, in-person ILI in five clinics, delivered by nutrition interns), and a randomized controlled trial (n = 31, one online ILI, delivered by a master's degree student). The same research team conducted both studies in Northern Mexico, using the same intervention components, and identical instruments and techniques to collect the data. We found that older participants (≥50 years) were less likely to drop out of the ILI for weight loss compared to participants <35 years old (OR = 0.34, 95% CI = 0.16-0.70). For each unit increase in the bodily pain scale of the SF-36 (less perceived pain), the risk of dropping out decreased by 2% (OR = 0.98, 95% CI = 0.97, 0.996), while a change in the interventionist during the 6-month intervention more than doubled the risk of dropping out (OR 2.25, 95% CI = 1.23-4.14). Retention in ILIs may be improved by ensuring that the same interventionist remains during the six-month intervention. In addition, ILIs may need further tailoring for younger ages and for participants with higher perceived pain.

Weight loss is hard. The best way to do it is to enroll in an intervention that includes frequent sessions with a health coach who uses cognitive-behavioral techniques to help participants improve their eating and physical activity habits. Retaining participants in these types of intervention is a challenge for health practitioners and researchers. Our objective was to identify the factors that increase the participants' risk of dropping out of the intervention. We analyzed the data of 268 Mexican adults who participated in studies that evaluated intensive lifestyle interventions for weight loss. We found that participants who are younger, experience more pain, and whose health coaches are replaced before the intervention is completed have a higher risk of dropping out of the intervention. By accounting for these factors when designing the intervention, we could increase the chances that participants stay in the intervention until the end. This way they are more likely to be successful in losing weight.

Effectiveness of the Diabetes Prevention Program for Obesity Treatment in Real World Clinical Practice in a Middle-Income Country in Latin America.

The Diabetes Prevention Program (DPP) is effective for the prevention of type 2 diabetes by weight loss with diet and physical activity. However, there is little evidence as to whether this program could be translated into real-world clinical practice in Latin American countries. The objective of this work was to evaluate the effectiveness of the DPP for the management of overweightness and obesity at 6 and 12 months in clinical practice in Mexico. This was a non-controlled intervention study implemented in five public clinics in northern Mexico. Two hundred and thirty-seven adults aged 45.7 ± 9.9 years with a Body Mass Index (BMI) of 34.4 ± 5.4 kg/m2 received group sessions with an adaptation of the DPP, in addition to nutrition counseling. One hundred and thirty-three (56%) participants concluded the 6 month phase. They showed a significant weight loss, ranging from 2.76 ± 4.76 to 7.92 ± 6.85 kg (p ≤ 0.01) in the clinics. The intention-to-treat analysis showed a more conservative weight loss. Participant retention at the end of 12 months was low (40%). The implementation of the DPP in different public clinics in Mexico was effective in the management of obesity in the short term, but better strategies are required to improve participant retention in the long term.

[OBESITY MANAGEMENT IN THE PRIMARY CARE SETTING BY AN INTENSIVE LIFESTYLE INTERVENTION]. / MANEJO DE LA OBESIDAD EN EL PRIMER NIVEL DE ATENCIÓN CON UN PROGRAMA INTENSIVO DE CAMBIO DE ESTILO DE VIDA.

OBJECTIVE: the aim of this study was to compare an Intensive Lifestyle Intervention against Traditional Treatment for obesity management in the primary care setting. SUBJECTS AND METHODS: interventional randomized controlled study with participation of 42 obese adults. Subjects assigned to the Intensive Lifestyle Intervention received a validated behavior change protocol "Group Lifestyle Balance" in 12 sessions, weekly consultations by a nutritionist and meal replacements. Traditional Treatment consisted of monthly consultations with a nutritionist that provided nutritional assessment and physical activity. RESULTS: almost all study participants (97%) were measured after 3 months of intervention. Intensive Lifestyle Intervention and Traditional Treatment subjects showed the following changes in body weight: (Median [25-75th percentile]) (-4.7 kg [-6.5, -3.1]) vs. (+0.4 kg [-0.3, 1.3]). Sixty two percent of Intensive Lifestyle Intervention group participants lost more than 5 % body weight vs. 0 % in the traditional treatment group (p < 0.001). CONCLUSIONS: this preliminary evidence showed that an Intensive Lifestyle Intervention can be an effective strategy for obesity management in the primary care setting.

Objetivo: comparar un Programa Intensivo de Cambio de Estilo de Vida con el Tratamiento Tradicional para el manejo de la obesidad en el primer nivel de atención. Sujetos y métodos: estudio de intervención aleatorizado controlado, en el que participaron 42 adultos con obesidad. Los sujetos asignados al Programa Intensivo de Cambio de Estilo de Vida recibieron un protocolo de cambio de conducta validado "Equilibrio de Estilo de Vida" en 12 sesiones, consultas semanales con un nutriólogo y remplazos de comidas. El Tratamiento Tradicional consistió en consultas mensuales con un nutriólogo que proporcionó orientación nutricional y de actividad física. Resultados: después de tres meses se midió al 97% de los participantes que iniciaron el estudio. Los sujetos del Programa Intensivo de Cambio de Estilo de Vida y del Tratamiento Tradicional mostraron los siguientes cambios en el peso corporal: (mediana [percentil 25-75]) (-4,7 kg [-6,5, -3,1]) vs. (+0,4 kg [-0,3, 1,3]). El 62% de los participantes del Programa Intensivo de Cambio de Estilo de Vida bajaron más de un 5% del peso corporal, contra el 0% en el grupo de Tratamiento Tradicional (p < 0,001). Conclusiones: este estudio es una evidencia preliminar de que un Programa Intensivo de Cambio de Estilo de Vida puede ser una alternativa efectiva para el tratamiento de la obesidad en el primer nivel de atención.

Manejo de la obesidad en el primer nivel de atención con un programa intensivo de cambio de estilo de vida / Obesity management in the primary care setting by an intensive lifestyle intervention

Objetivo: comparar un Programa Intensivo de Cambio de Estilo de Vida con el Tratamiento Tradicional para el manejo de la obesidad en el primer nivel de atención. Sujetos y métodos: estudio de intervención aleatorizado controlado, en el que participaron 42 adultos con obesidad. Los sujetos asignados al Programa Intensivo de Cambio de Estilo de Vida recibieron un protocolo de cambio de conducta validado «Equilibrio de Estilo de Vida» en 12 sesiones, consultas semanales con un nutriólogo y remplazos de comidas. El Tratamiento Tradicional consistió en consultas mensuales con un nutriólogo que proporcionó orientación nutricional y de actividad física. Resultados: después de tres meses se midió al 97% de los participantes que iniciaron el estudio. Los sujetos del Programa Intensivo de Cambio de Estilo de Vida y del Tratamiento Tradicional mostraron los siguientes cambios en el peso corporal: (mediana [percentil 25-75]) (-4,7 kg [-6,5, -3,1]) vs. (+0,4 kg [-0,3, 1,3]). El 62% de los participantes del Programa Intensivo de Cambio de Estilo de Vida bajaron más de un 5% del peso corporal, contra el 0% en el grupo de Tratamiento Tradicional (p < 0,001). Conclusiones: este estudio es una evidencia preliminar de que un Programa Intensivo de Cambio de Estilo de Vida puede ser una alternativa efectiva para el tratamiento de la obesidad en el primer nivel de atención (AU)

Objective: the aim of this study was to compare an Intensive Lifestyle Intervention against Traditional Treatment for obesity management in the primary care setting. Subjects and methods: interventional randomized controlled study with participation of 42 obese adults. Subjects assigned to the Intensive Lifestyle Intervention received a validated behavior change protocol «Group Lifestyle Balance» in 12 sessions, weekly consultations by a nutritionist and meal replacements. Traditional Treatment consisted of monthly consultations with a nutritionist that provided nutritional assessment and physical activity. Results: almost all study participants (97%) were measured after 3 months of intervention. Intensive Lifestyle Intervention and Traditional Treatment subjects showed the following changes in body weight: (Median [25-75th percentile]) (-4.7 kg [-6.5, -3.1]) vs. (+0.4 kg [-0.3, 1.3]). Sixty two percent of Intensive Lifestyle Intervention group participants lost more than 5 % body weight vs. 0 % in the traditional treatment group (p < 0.001). Conclusions: this preliminary evidence showed that an Intensive Lifestyle Intervention can be an effective strategy for obesity management in the primary care setting (AU)