Obesity: Decades-Long Epidemic in MexicoBy Miriam Bello | Tue, 12/15/2020 - 10:33
Before the COVID-19 pandemic, Mexico lived with everyday ailments that were categorized as epidemics. Obesity is one of those historical ailments. In 2016, obesity was declared a sanitary emergency as 72.5 percent of adults in Mexico presented obesity and overweight and 15 percent of the children in the country suffered from it. Since 2016, obesity numbers keep growing in Mexico, despite the many public and private initiatives to revert the trend. Prevention strategies have not been able to stick among the Mexican population, either.
International figures highlight the magnitude of obesity in Mexico, as just in Latin America Mexico has the highest obesity rate. Moreover, the last update to the OECD figures for obesity place Mexico first in the most aggravated countries, followed by Chile and the US.
Gaceta Médica de México describes obesity as a chronic disease of multifactorial etiology in which genetic, environmental and lifestyle aspects are involved. Obesity is characterized by a positive balance of calories (when the consumption of calories exceeds their total energetic use), causing body fat accumulation. According to a report published by ANMM, social, cultural, political and economic factors can interconnect and modify the outcomes of obesity for each individual, depending on diet and level of physical activity. INSP said the latter makes prevention and control of obesity a complex situation for individual and governments.
According to ANMM, obesity is causally associated with loss of health. It is a risk factor for development of Type 2 diabetes, high blood pressure, dyslipidemias, cardiovascular diseases (especially ischemic heart disease and strokes), osteoarticular diseases, sleep apnea and several others diseases like certain types of cancer including breast, prostate and colon. Furthermore, obesity is a cause of social stigma and it is associated with lower labor income, especially among women. Moreover, the indirect effects of obesity and its comorbidities, as well as their effects, increase the demand for health services.
Obesity in Mexico
“In Mexico City, 12 out of 100 people suffer from diabetes, 20 out of 100 people over 20 years old suffer from hypertension and 75 percent of the population over 20 years old suffers from overweight or obesity,” Oliva López, Minister of Health of Mexico City, explained to MBN.
The country has one of the highest obesity rates in the OECD. Moreover, 34 percent of obese people are morbidly obese, which is the highest degree of obesity. According to the organization’s projections, diseases related to being overweight will reduce life expectancy in Mexico by more than four years over the next 30 years. This is the largest reduction projected among OECD countries. For children, the scenario is worse and it deteriorates year after year as childhood obesity doubled from 7.5 percent in 1996 to 15 percent in 2016.
What Led Mexico to These Figures?
According to an article written by UNAM scholars, the obesity rate in Mexico started to increase when the original NAFTA came into force in 1994. The changes in the economic model of the country derived in productivity changes and a shift in food demand tied to the changes in agriculture activities, which eventually reshaped the demography of the country as people migrated to urban zones. This caused a food transition for many people in Mexico, which started to rapidly reflect on overweight and obesity rates. This changed Mexico’s epidemiological profile, which was mostly driven by infectious diseases and malnutrition.
The current magnitude of the obesity pandemic in Mexico presents a public health and economic challenge due to its impact on productivity and premature deaths. According to INSP, the majority of deaths in Mexico are associated to non-transmittable diseases. Overweight and obesity, high blood glucose levels, alcohol consumption and smoking have been identified as the main causes of death in the country. Only overweight, obesity, and high glucose caused 35.3 percent of the total deaths in the country.
In Mexico, obesity represents a GDP loss of 5.3 percent, according to the OECD. In 2017, the Ministry of Health estimated that MX$240 billion where allocated to treat obesity and a 2023 projection indicated that the expenditure tendency for the disease could increase by 13 percent. Moreover, a study by IMCO indicates that the total costs only of diabetes associated with obesity in 2013 amounted to MX$85 billion per year, of which 73 percent corresponds to expenses for medical treatment, 15 percent to the cost generated by losses due to work absenteeism and 12 percent to the cost of lost admission due to premature mortality.
According to Gaceta Medica de México, the country has strong epidemiological differences regarding obesity. Higher socio-economic groups showed a 7.5 percent higher prevalence of obesity against the lower groups. The northern part of the country has a higher obesity prevalence, whereas the south has the lowest.
How is Obesity Managed at Hospitals?
“Management may vary between hospitals. However, the basis will always be a hypocaloric diet in its different variants,” said Fabiola Cortés, President and Founder of the Mexican Institute of Nutrition, Food and Obesity (IMENAO) to MBN. Cortés explained that sometimes, patients are hospitalized to go through diets with a very low-calorie intake. “They can reach 500 calories per day. However, it is very difficult to do this.” In other occasions, according to Cortés, patients with obesity can be protocolized for bariatric surgery, depending on whether they are a candidate or not. There are facilities that offer anti-obesity drug treatments but unfortunately, this type of drug is not a priority in the basic drug basket. Therefore, the treatment is generally a hypocaloric diet and exercise.
How Is Mexico Combating the Disease?
“Mexico has shown leadership in wanting to combat obesity and diabetes,” said Roberto Martínez Director General of OECD for Mexico and Latin America, during an interview with MBN. He mentioned that the OECD has recognized the country’s effort, mostly because it has been a trans-sexennial policy that has been improved by the current administration. Martínez mentioned that “policymakers are realizing these diseases also reflect on the country’s productivity and the population’s health in the medium to long term.”
Among these actions, the OECD has recognized Mexico’s efforts on introducing taxes on sugary drinks and non-essential high-calorie foods, along with the mandatory food labeling for prepacked food. However, these efforts have been qualified as, yet, insufficient to combat obesity. The organization proposed an integral strategy that involves reshaping diets and eating habits. This also relates to the very core of the disease in Mexico, after NAFTA created a food transition.
For Cortés, obesity is not being properly addressed from public policy side. NOM-008-SSA3-2017 addresses the comprehensive treatment of overweight and obesity, clinical practice guidelines and international standards, indicating that the only treatment for healthy weight loss is based on a healthy diet, exercise, pharmacology or supplements (should the patient requires them), behavioral therapy and bariatric surgery. However, from that, many other treatments that are not endorsed or scientifically evidenced can be derived: pellets, ozone therapy, apparatus and non-endorsed medications. The weight gain following these alternatives can be even greater since the patient did not adequately modified their behavior. “From my experience, innovation in the management of diet therapy is fundamental,” said Cortés. “The issue is that many health professionals lack the information to prescribe diets like protein or keto.”
What Experts Recommend
Cortés recommends a different, integral approach to obesity. “There is no adequate training in the management of obesity,” she said. “It is not only about closing the mouth but consuming food in a conscious way.” As President and Founder of IMENAO, Cortés deems it necessary to educate the patient to eat conscientiously, enjoying their food and not suffering from eating. It is necessary for the health professional to be trained in obesity issues to give adequate and personalized treatments. The eating plan must be adapted to the person and not the person to a plan that they cannot follow. “The real goal is not weight loss but long-term weight management,” Cortés said.
UNAM’s article recommends substantial modifications in health policies and in social and economic structures regarding food production and consumption. The new supply-demand pattern replaced grains, cereals and legumes with fast and industrialized food based on refined flours and sugary drinks, which coupled with the increasingly frequent sedentary lifestyle among the population. Meanwhile, the OECD suggests regulating pricing of healthier diets. The organization mentions subsidizing healthy foods, such as fruits and vegetables, and promoting changes in the product, price, packaging and marketing strategies of the food industry, according to best practices.
El Poder del Consumidor has also analyzed Mexico’s efforts and suggested that a Law, instead of a policy, would be more effective to counteract the impact of obesity. The association proposes a General Law of Control of Obesity and Overweight, which includes strengthening education and health promotion as a key first step to change habits. Secondly, just as the OECD, it proposes subsidizing healthy food, including fruits and vegetables. Changes in marketing and advertisement are also included in El Poder del Consumidor’s recommendations to limit children’s access to unhealthy options. Just as in Oaxaca, changes in school regulations could be implemented to revert the negative children obesity trend in Mexico. Lastly, physical activity and free water at schools and public places is encouraged.