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Overview

The Institute of Medicine (IOM) in the United States and the National Institute of Public Health (Instituto Nacional de Salud Pública, INSP) in Mexico organized and co-sponsored a two-day workshop at INSP’s headquarters in Cuernavaca, Morelos, Mexico with support from Kaiser Permanente (see agenda in Appendix A). The primary objective of the workshop was to explore the potential for a binational obesity prevention strategy for Mexican and Mexican–American (U.S. children of Mexican heritage) children and youth; the strategy should consider the perspectives, visions, and experiences of various stakeholders—governments, research institutions, industry, nongovernmental organizations, and communities. Additional workshop objectives included assessing similarities and differences in obesity prevention for Mexican and Mexican–American children, sharing policy and program experiences so that the options to prevent the childhood obesity epidemic are selected, and identifying data and information gaps. This summary highlights discussion items focusing particularly on the nature of childhood obesity, its magnitude and distribution, and current and future policies and programs (especially on the potential of binational collaborative responses); participants also discussed lessons learned from describing current interventions. Two background papers— “Preventing Obesity in Mexican Children and Adolescents” and “Preventing Obesity in Mexican–American Children and Adolescents”—describe the perspective of the obesity problem in Mexican–American and Mexican children and youth and were the basis for much of the workshop discussions (see Appendixes B and C, respectively).



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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary 1 Overview The Institute of Medicine (IOM) in the United States and the National Institute of Public Health (Instituto Nacional de Salud Pública, INSP) in Mexico organized and co-sponsored a two-day workshop at INSP’s headquarters in Cuernavaca, Morelos, Mexico with support from Kaiser Permanente (see agenda in Appendix A). The primary objective of the workshop was to explore the potential for a binational obesity prevention strategy for Mexican and Mexican–American (U.S. children of Mexican heritage) children and youth; the strategy should consider the perspectives, visions, and experiences of various stakeholders—governments, research institutions, industry, nongovernmental organizations, and communities. Additional workshop objectives included assessing similarities and differences in obesity prevention for Mexican and Mexican–American children, sharing policy and program experiences so that the options to prevent the childhood obesity epidemic are selected, and identifying data and information gaps. This summary highlights discussion items focusing particularly on the nature of childhood obesity, its magnitude and distribution, and current and future policies and programs (especially on the potential of binational collaborative responses); participants also discussed lessons learned from describing current interventions. Two background papers— “Preventing Obesity in Mexican Children and Adolescents” and “Preventing Obesity in Mexican–American Children and Adolescents”—describe the perspective of the obesity problem in Mexican–American and Mexican children and youth and were the basis for much of the workshop discussions (see Appendixes B and C, respectively).

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary The following are highlights from welcoming remarks by Juan Rivera (INSP), Mauricio Hernández (INSP), Jaime Sepúlveda (Ministry of Health), and Reynaldo Martorell (Emory University). As Rivera emphasized, the already-high prevalence of obesity in children on both sides of the U.S.– Mexico border has been increasing. The devastating effects of obesity on health threaten to increase the burden of health services and affect not only the health but also the productivity of the population. For this reason obesity is undoubtedly one of the major problems of public health in Mexico as well as in the United States. Sepúlveda welcomed members of the audience and reflected on the decades of productive collaborations between INSP and a number of U.S. institutions—the CDC (Centers for Disease Control and Prevention), Emory University, and IOM—that provide the foundation for opportunities like this workshop. He applauded the participation of expert leaders from government (including executive and legislative councils), the private sector, the community, and the academic sector (see list of participants in Appendix D). Hernández and Martorell welcomed the audience on behalf of INSP and IOM, respectively, and described the organizations’ roles as public health institutions. Hernández explained that INSP’s mission is to contribute to social equity through research in public health, innovation of health systems, and the formation of highly qualified experts in Mexico. Reynaldo Martorell, a member of IOM’s Food and Nutrition Board, described IOM as a private, nonprofit organization that is part of the National Academies and serves as an advisor to the United States to improve health. As an independent scientific advisor, the organization provides unbiased, evidence-based advice to many sectors including policy makers, health professionals, industry, and the public. Origins and Evolution Martorell, who served as chair of the planning committee, described the program and its origins. He explained the circumstances that led to this workshop: Childhood obesity is a global health problem. Health authorities in Mexico and the United States have recognized obesity as an important public health problem and as a result have initiated the development and, in some cases, the implementation of preventative and control policies and programs. Among the U.S. population, Mexican Americans, particularly Mexican–American women, are among the most affected by this epidemic. The United States and Mexico share many similarities and are integrated in many respects—language, culture, food, media, and economy—

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary due in part to the continuous, increasing exchange of people and product trading. IOM and INSP public health experts considered these factors and initiated a dialog. It became clear that the scientific community, the healthcare community, and decision makers have the responsibility of joining efforts to prevent childhood obesity and to explore collaboration in research, prevention programs, and policies. Accordingly, leaders on both sides of the border agreed that the time was right to organize a workshop for initiating dialogue among all key players. The workshop’s general objectives were to share experiences and to consider the development of a binational agenda for preventing obesity in Mexican and Mexican–American children. The workshop planning committee [Reynaldo Martorell (Chair), Jeffrey Koplan, and Juan Rivera (with the assistance of IOM staff Maria Oria, Vivica Kraak, and Linda Meyers)] developed the workshop program. Workshop Program Appendix A is the complete workshop agenda. After the welcoming remarks, Jeffrey Koplan, chair of the Committee on Prevention of Obesity in Children and Youth, summarized highlights from the IOM report Preventing Childhood Obesity: Health in the Balance (2005), which was published at the request of the U.S. Congress and recommends an action plan for addressing childhood obesity in the United States. His presentation was followed by the summaries of the two background papers (presented by the authors) on prevention of obesity of Mexican and Mexican–American children and youth. The remainder of the workshop program focused on fostering dialogue among all participants through small working groups, panels, or plenary sessions. Three working groups—whose participants were chosen for their expertise, country of origin, and personal interests—compared the status of the obesity epidemic in the United States and Mexico and explored questions on the prevalence, associated causes, and intervention programs; identified and discussed research gaps; and developed potential strategies and specific activities appropriate and beneficial for a U.S.– Mexico program (Martorell emphasized that this deliberation would be a central focus of the workshop). The findings from the working groups are included in this summary. Representatives from various public and private sectors shared U.S. and Mexican perspectives on the roles of the private and public sectors in preventing childhood obesity; these perspectives are included in the section of this summary on “Solutions to Prevent Obesity in Children and Youth of

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Joint U.S.–Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin: Summary Mexican Origin.” Finally, the workshop concluded with remarks from Reynaldo Martorell, Jeffrey Koplan, Juan Rivera, Jaime Sepúlveda, and Julio Frenk. Verbatim remarks from Jaime Sepúlveda and Julio Frenk (Ministry of Health) are included in the “Final Remarks” section of this summary. This summary should not be perceived as a series of recommendations reached by consensus but rather as a recapitulation of the discussions of working groups and individual participants. For consistency, the definitions of obese and at-risk for obesity in this report were borrowed from those in the IOM report Preventing Childhood Obesity: Health in the Balance (2005). Hence, obese children or youth refers to those with age- and gender-specific BMI that is equal to or greater than the 95th percentile of the CDC body mass index (BMI)1 charts. The IOM report defines children and youth at-risk for obesity as those with BMI-for-age 85th percentile to less than 95th percentile. On some occasions, participants also use the terms overweight children and at-risk for overweight children. This summary and the appendixes will be available in Spanish and English. REFERENCE IOM (Institute of Medicine). 2005. Preventing Childhood Obesity: Health in the Balance. Washington, DC: The National Academies Press. 1 Body mass index (BMI) is an indirect measure of body fat calculated as the ratio of a person’s body weight in kilograms to the square of a person’s height in meters. In children and youth, BMI is based on growth charts for age and gender and is referred to as BMI-for-age, which is used to assess underweight, overweight, and risk for overweight. BMI (kg/m2) = weight (kilograms) ÷ height (meters)2 BMI (lb/in2) = weight (pounds) ÷ height (inches)2 × 703