Joint U.S.-Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin Summary (2007) / Chapter Skim
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Appendix B: Preventing Obesity in Mexican Children and Adolescents
Appendix B: Preventing Obesity in Mexican Children and Adolescents
Pages 81-127
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From page 81... ...
For older Mexican children, the lack of national trend data limits the evaluation of obesity trends during that decade. However, data from the Second National Nutrition Survey show equally alarming evidence of a growing obesity epidemic in children and youth.
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From page 82... ...
However, statistics show a significant increase in obesity and related chronic diseases such as diabetes, hypertension, and CVD in adults. High rates of malnutrition and related problems are still observed, especially among sub-populations of Mexican children.
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From page 83... ...
These are the main questions that stimulated the IOM to sponsor a joint U.S.Mexico workshop -- in collaboration with the National Institute of Public Health in Mexico (INSP) and supported by Kaiser Permanente -- that will focus on exploring a binational approach to obesity prevention and the adaptation of the IOM report recommendations to Mexican children and youth living in the United States and in Mexico.
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From page 84... ...
, is a useful indirect measurement of body fat and unhealthy weight in children ages 2 years and older and adults. It is often used as a screening tool to identify individuals who are obese and those at risk for obesity because the measurements of height and weight are easily obtained compared with skinfold thickness measurements and other complex procedures that require more training and standardization.
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From page 85... ...
For consistency with the IOM report Preventing Childhood Obesity: Health in the Balance (IOM, 2005) and with the companion paper examining the factors contributing to obesity in Mexican American children and youth, this paper uses the CDC BMI charts established in 2000 to define obesity and being at-risk for obesity for children
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From page 86... ...
In addition to these age ranges, which were employed in the First and Second Mexican National Nutrition Survey and are used in previous publications, for consistency with the IOM report (IOM, 2005) and the companion paper on MexicanAmerican children, we computed prevalences for the following age ranges (Table B-1)
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From page 87... ...
This increment was mainly driven by the proportion of children who were at risk for obesity rather than the obesity category. Among Mexican children ages 611 years, 8.8 percent were classified as obese (> 95th percentile)
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From page 88... ...
88 Socio and 95 Obese > 5.7 7 3.8 3.2 4.2 6.3 10.1 years Geographic Risk 2000) 1219 At 8595 16.6 18.3 17.4 20.7 13.4 12.8 18.2 al., et Selected and 95 Obese > 8.8 8.8 5.5 3.4 12.7 11.4 11 Age (Kuczmarski by years charts Risk 611 At 8595 9.6 8.6 12.3 15.5 11.6 15.5 13.9 Obese BMI and 95 Obese > 9 9.7 9.8 10.4 12 11.3 10.8 gender-specific Obesity for years and Risk 25 Age- At 8595 17.1 19.5 17.7 13.6 16.7 17.1 17.2 Risk at (WHO)
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From page 89... ...
89 For catego- ation. .Definitions age all popul weights for 5.7 - - - - - 7.7 7 2.2 5.9 3.2 reference charts sampling BMI - - - - - CDC 16.6 19.2 16.4 14 16.7 15.8 considering 2000 WHO/NCHS/CDC the the 8.5 9.1 7.5 4.8 2.4 9.4 3.4 13.2 11.8 14.1 10.5 percentage from a from as height percentiles for 8.7 7.3 9.9 12.1 12.4 14.2 15.7 11.6 15.4 14.4 12.5 expressed is weight of 9.7 9.6 8 8.6 9.1 gender-specific SD 11.1 12.1 10.3 11.7 11.6 10.6 2 prevalence and > All age- using women.
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From page 90... ...
. Undernutrition and Catch-Up Growth in Children and Youth in Mexico The coexistence of under- and overnutrition is a characteristic of the Mexican population, particularly among children and young women.
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From page 91... ...
Results from the Second National Nutrition Survey (Rivera et al., 2001) show that the mean height-for-age z-score is 0.4 from 011 months, drops to 1.1 at 1223 months, and remains at around 1.0 up to 59 months of age.
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From page 92... ...
FIGURE B-3 Height-for-age calculated percentiles for Mexican children ages 29 years old, according to socioeconomic status (SES)
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From page 93... ...
* Significant differences FIGURE B-4 Height-for-age calculated percentiles for Mexican children ages 29 years from the upper quartile of socioeconomic status (SES)
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From page 94... ...
The authors use available evidence to describe how the environment has changed for Mexican children and youth over the last few decades toward an "obesogenic" environment, understood as an environment that may promote obesity and encourage the expression of an individual's predisposition to gain weight. Energy Balance and Individual Factors Obesity can be viewed as a problem of a positive energy balance -- in other words, an excess energy intake relative to a given energy expenditure sustained over time.
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From page 95... ...
. In addition to energy intake, other factors, including genetics, can explain the variability between populations in linear growth.
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From page 96... ...
If nutritional insults in early life confer this extra vulnerability, then the results of combating undernutrition in early life (gestation and the first 23 years of life) will have double benefits -- adequate nutritional policies will affect not only the undernutrition-related problem but also the increasing epidemic of chronic diseases.
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From page 97... ...
Levels of Physical Activity and Inactivity Although there is limited information on levels and trends of time dedicated to physical activity and inactivity in Mexican children and youth, the available information indicates a tendency to sedentary lifestyles. In a study conducted on children and youth ages 916 years in low- and middleincome schools in the Mexico City area, they devoted an average of 4.1 hours/day to total video viewing (representing total leisure screen time except computer use)
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From page 98... ...
. A study using data from the Second National Nutrition Survey (1999)
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From page 99... ...
. Eating Pattern Trends: Nutritional Transition As stated previously, Mexico is experiencing a nutritional transition with a clear shift over the past decades to higher intakes of fat, refined carbohydrates and processed foods, and lower intakes of whole grains, vegetables, and dietary fiber that represent traditional diets (Popkin, 2001; Rivera et al., 2004a)
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From page 100... ...
. The strongest evidence of this transition comes from the contrast between adults' self-reported dietary intakes from the 1988 and 1999 National Nutritional Surveys.
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From page 101... ...
Whether or not the modification of relative prices of these food commodities during this period played an influential role in the consumer purchases is an area that requires further research. In the Second National Nutrition Survey 1999, dietary intake for school-aged children was evaluated using a 24-hour dietary recall.
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From page 102... ...
. A study conducted using data from the Second National Nutrition Survey 1999 classified foods consumed by children ages 14 years as either centrally processed or not processed.
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From page 103... ...
fat fat (mg) Fiber protein protein protein Total energy Total Saturated Cholesterol Total Animal Carbohydrates Non-animal FIGURE B-9 Contribution of centrally processed foods to total energy and nutrient intakes in children younger than 5 years old.
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From page 104... ...
Self-reported energy intake can vary considerably between non-obese and obese subjects. Based on data from the Second National Nutrition Survey 1999, researchers estimated energy under-reporting in Mexican women ages 1849 years using a 24-hour dietary recall questionnaire.
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From page 105... ...
. Not surprisingly, by 2000 85 percent of the households in Mexico had access to a television set, and this proportion reached 97 percent in Mexico City.
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From page 106... ...
. Another indicator suggesting that the Mexican population is moving toward an obesogenic environment with reduced options to engage in physical activity is the growth in the number of motorized vehicles.
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From page 107... ...
. Transnational corporations representing the fast food restaurant or quick serve restaurant industry have expanded substantially over all the major and middle-size cities across Mexico.
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From page 108... ...
Therefore, this "Mexican fast food," which is not centrally processed, is an important source of total energy in the Mexican diet, including children and youth. As with the fast food restaurant industry, the high consumption of sweetened beverages, particularly carbonated soft drinks, in Mexico is linked to large-scale marketing activities across multiple media platforms (e.g., print, radio, broadcast and cable television, Internet, outdoor signage)
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From page 109... ...
. There are presently no publicly available data documenting Mexican children's and youths' discretionary income, particularly among higher SES groups, which they may use to purchase foods and beverages without parental guidance, especially away from home settings such as fast food restaurants, shopping malls, and schools.
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From page 110... ...
Therefore, the school environment is an important influence on their physical activity behaviors and dietary patterns. The Ministry of Education implements a physical education program in elementary schools nationwide (Secretaría de Educación Pública, 1994)
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From page 111... ...
These results are similar to findings from a small pilot study in 10 schools in Mexico City. In this sample, approximately half of the schools in the pilot study did not have appropriate areas for the physical education classes; the average space available was 290 m2 for approximately 330 students.
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From page 112... ...
However, there are many other factors that are likely to influence children and youth and can be considered components of an obesogenic environment. However, there is limited research on these factors upon which to design evidence-based strategies for effectively preventing obesity in Mexican children and youth.
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From page 113... ...
. However, there is a lack of data on the effects of advertising on Mexican children's preferences, purchase requests, and influence on household purchases of food and beverage products.
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From page 114... ...
For several years a group of nutrition experts has been working on developing dietary guidelines for Mexico. After a long process that led to consensus-based guidelines, they are soon to be officially published for the Mexican population.
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From page 115... ...
Regular consumption is clearly desirable due to its high micronutrient content, approximately 100 percent of the Recommended Dietary Intake (IOM, 2001) of iron, zinc, and a number of other micronutrients known to be deficient in the diets of Mexican children and women during pregnancy and lactation (Rivera et al., 2003)
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From page 116... ...
Two studies are currently underway as part of the program evaluation activities to further clarify the impact of the program on weight gain among women and children and to strengthen the health education component of the program in reference to obesity prevention. The first is a large randomized controlled trial implemented within the context of the program.
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From page 117... ...
In addition, television advertisements focus on healthy lifestyles, nutrition, obesity prevention, and promoting the magazine to the general public. Until now, this program has not been evaluated fully; however, a recent internal baseline survey was designed and implemented to assess the coverage of the main components and to evaluate intermediate program outcomes such as prevalence of anemia, frequency of physical activity, undernutrition, overweight, and obesity.
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From page 118... ...
, the final goals for obesity prevention among childhood and youth should be to stop the current trend in rising obesity incidence and prevalence and related chronic diseases and ultimately reduce the proportion of children and youth with an unhealthy weight. This ultimate goal necessarily should include increasing the proportion of children and adolescents meeting a healthful diet and appropriate amounts of regular physical activity and following a healthy growth trajectory.
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From page 119... ...
The recommendations can be viewed as preliminary and will be modified through discussion with different stakeholders. Government Level · Underpin the idea of childhood obesity prevention as an urgent national priority, with strong participation and leadership of government at all levels in several actions including:
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From page 120... ...
, evaluate the impact and consumers' understanding of food labeling, and make necessary modifications required to support obesity prevention goals. · Review current government regulations and guidelines on the use of health claims on food products, especially nutrition-related health claims.
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From page 121... ...
· Regulate the foods and beverages offered to children and youth in and around the school environment. · Promote the enforcement of minimally established time that children and youth participate in physical education in both private and public schools, as well as physical education programs that achieve the recommended amounts of moderate to vigorous physical activity.
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From page 122... ...
2003. Energy and nutrient intake in pre-school and school-age Mexican children: Na tional Nutrition Survey 1999.
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From page 123... ...
1998. Assessment of energy intake underreporting by doubly labeled water and observations on reported nutrient intakes in children.
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From page 124... ...
2002. Marketing activities of global soft drink and fast food companies in emerg ing markets: A review.
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From page 125... ...
2003. Methods of the 1999 National Nutrition Survey.
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From page 126... ...
2003a. Iron, zinc and iodine status in Mexican children under 12 years and women 1249 years of age: A probabilistic national survey.
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From page 127... ...
2002. Assessment of physical education time and alter-school outdoor time in elementary and middle school students in south Mexico city: The dilemma between physical fitness and the adverse health effects of outdoor pollutant exposure.
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