Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin

SUMMARY

Maria Oria and Kristin Sawyer, Rapporteurs

Food and Nutrition Board

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin SUMMARY Maria Oria and Kristin Sawyer, Rapporteurs Food and Nutrition Board INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary THE NATIONAL ACADEMIES PRESS 500 Fifth STREET, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The activity was supported by a grant between the National Academy of Sciences and Kaiser Permanente. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number-13: 978-0-309-10325-1 International Standard Book Number-10: 0-309-10325-8 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2007 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. Cover credit: Carmen Lomas Garza, Tamalada (making tamales). Oil on linen mounted on wood, 24 × 32 inches. © 1988 Carmen Lomas Garza, used with permission. www.carmenlomasgarza.com The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Advising the Nation. Improving Health.

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary PLANNING COMMITTEE ON JOINT U.S.–MEXICO WORKSHOP ON PREVENTING OBESITY OF CHILDREN AND YOUTH OF MEXICAN ORIGIN REYNALDO MARTORELL (Chair), Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA JEFFREY KOPLAN, Woodruff Health Sciences Center, Emory University, Atlanta, GA JUAN RIVERA, National Institutes of Public Health, Morelos, México Consultant Writers SIMÓN BARQUERA, Research Center for Nutrition and Health, Morelos, México BERNARDO HERNÁNDEZ, Research Center for Population Health: Reproductive Health Division, Morelos, México RUY LÓPEZ, Research Center for Population Health: Chronic Disease Division, Morelos, México FERNANDO MENDOZA, Stanford University School of Medicine, Palo Alto, CA JUAN RIVERA, Research Center for Nutrition and Health, Morelos, México FREDERICK TROWBRIDGE, Trowbridge & Associates, Inc., Atlanta, GA Staff MARIA ORIA, Study Director VIVICA KRAAK, Study Director (until February 2006) LINDA D. MEYERS, Director, Food and Nutrition Board SANDRA AMAMOO-KAKRA, Senior Program Assistant JON SANDERS, Senior Program Assistant (until June 2006)

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary FOOD AND NUTRITION BOARD* DENNIS M. BIER (Chair), Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX MICHAEL P. DOYLE (Vice Chair), Center for Food Safety, University of Georgia, Griffin DIANE BIRT, Center for Research on Dietary Botanical Supplements, Iowa State University, Ames YVONNE BRONNER, School of Public Health and Policy, Morgan State University, Baltimore, MD SUSAN FERENC, Chemical Producers and Distributors Association, Alexandria, VA NANCY F. KREBS, Department of Pediatrics, University of Colorado Health Sciences Center, Denver REYNALDO MARTORELL, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA J. GLENN MORRIS, JR., Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore SUZANNE P. MURPHY, Cancer Research Center of Hawaii, University of Hawaii, Honolulu JOSE M. ORDOVAS, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA JIM E. RIVIERE, College of Veterinary Medicine, North Carolina State University, Raleigh NICHOLAS J. SCHORK, Department of Psychiatry, Polymorphism Research Laboratory, University of California, San Diego REBECCA J. STOLTZFUS, Division of Nutritional Sciences, Cornell University, Ithaca, NY JOHN W. SUTTIE, Department of Biochemistry, University of Wisconsin, Madison WALTER C. WILLETT, Department of Nutrition, Harvard School of Public Health, Boston, MA BARRY L. ZOUMAS, Department of Agricultural Economics and Rural Sociology, The Pennsylvania State University, University Park Staff LINDA D. MEYERS, Director GERALDINE KENNEDO, Administrative Assistant ANTON L. BANDY, Financial Associate * IOM Boards do not review or approve individual reports and are not asked to endorse conclusions and recommendations. The responsibility for the content of the report rests with the authoring committee and the institution.

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: George R. Flores, The California Endowment, San Francisco, CA Amy Luke, Loyola University School of Medicine, Chicago, IL Roberto Medina-Santillán, Mexican Academy of Medicine, México D.F. Roberto Otto Valdez, Valdez and Associates, Vienna, VA Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the summary before its release. The review of this report was overseen by Eileen Kennedy of Tufts University. Appointed by the National Research Council and Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary Preface Moved by the alarming findings in the Institute of Medicine (IOM) report Preventing Childhood Obesity: Health in the Balance (2005), which addresses the high prevalence in obesity among the Hispanic population, and motivated by follow-up discussions among members of the IOM’s Food and Nutrition Board (FNB) and the Committee on Prevention of Obesity in Children and Youth, IOM formed a planning committee to plan a workshop that would increase understanding of the obesity epidemic among Mexican and Mexican–American children and youth in the United States and Mexico. Three reasons for focusing on Mexicans on both sides of the border were the gravity of the obesity problem among Mexicans in both countries; the large population sizes involved (e.g., Mexicans are the majority of the Hispanic population in the United States); and finally, the fact that the two countries share common cultural, dietary, environmental, and economic characteristics. An early assumption was that it makes sense for the United States and Mexico to share lessons and experiences related to the obesity problem. The Instituto Nacional de la Salud Pública (INSP) in Mexico—a public health institution that seeks to redress social and health inequity through research and educational programs—was instrumental in identifying the nature of this cooperative effort and its objectives. Initial discussion on the appropriate structure for a possible meeting led to the development of a two-day workshop in which selected Mexican and U.S. leaders from government, foundations, nongovernmental organizations, academia, the food industry, and media would participate. The format of the workshop was planned to stimulate dialogue and discussion through small group and plenary discussions. As chair of the planning committee, I would like to extend a special

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary thanks to Mauricio Hernández, Director General of INSP, for his continued support and willingness to host the workshop at INSP headquarters. My sincere thanks also go to the other two members of the planning committee: Juan Rivera, Director of the Centro de Investigación en Nutrición y Salud, INSP, and Jeffrey Koplan, Vice President for Academic Health Affairs, the Woodruff Health Sciences Center of Emory University. Their leadership and contributions throughout the planning period and during the workshop were invaluable. INSP’s Ruy Lopez, Simon Barquera, and Bernardo Hernández were helpful in identifying key topics and issues relevant to the Mexican context—a difficult task when there are many unknowns and a general lack of awareness regarding Mexico’s obesity epidemic. In addition, they played a central role in identifying and inviting workshop participants who brought important insights into the prevalence of obesity, on developing interventions, and future opportunities in Mexico. Many thanks to the authors of the two thorough reviews that were commissioned to provide a background about the childhood obesity problem in Mexico (Juan Rivera, Ruy Lopez, Simon Barquera, and Bernardo Hernández) and in the United States (Frederick Trowbridge, from Trowbridge and Associates, Inc., and Fernando Mendoza from Stanford University’s School of Medicine). The authors not only offered a comprehensive picture of the epidemic but also provided insightful presentations. The presentations and group and panel discussions generated stimulating perspectives among participants. More importantly, they served as a platform for discussion focused on the ultimate goal—the feasibility of a binational program to prevent obesity in children of Mexican origin. Sincere thanks go to all the presenters, rapporteurs, and panel presenters. It was an honor to have in the audience such distinguished speakers as Jaime Sepúlveda, Coordinator of the Institutos Nacionales de Salud at the Mexican Ministry of Health, and Julio Frenk, Mexican Minister of Health. I also would like to extend my gratitude to all workshop participants, whose contributions made this event such a rich experience. I would like to thank Kaiser Permanente, financial supporter of the project, and its representatives at the meeting: Diana Bonta and Esteban Cruz. Finally, thanks to Linda Meyers, Maria Oria, Vivica Kraak, Jon Sanders, and Sandra Amamoo-Kakra from IOM/FNB and Juan Manuel Irizas from INSP for their dedication and their efforts in making this workshop a successful one. It is my hope that this workshop is only a first step toward the common goal of reversing the increasing prevalence of childhood obesity and preventing the onset of associated chronic diseases. Future collaborative activities (with Mexico or other countries) certainly will follow. Reynaldo Martorell, Chair Chair, Planning Committee

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary Contents     SUMMARY   1 1   OVERVIEW   11 2   BACKGROUND   15 3   OPPORTUNITIES AND CHALLENGES   33 4   SUMMARY AND FINAL REMARKS   63     APPENDIXES     A   WORKSHOP AGENDA   77 B   PREVENTING OBESITY IN MEXICAN CHILDREN AND ADOLESCENTS   81 C   PREVENTING OBESITY IN MEXICAN–AMERICAN CHILDREN AND ADOLESCENTS   128 D   WORKSHOP PARTICIPANTS   187 E   SPEAKERS’ BIOGRAPHIES   192

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