The Problem of Obesity in Mexico: A Complex Matrix

In epidemiological terms, obesity has reached pandemic levels in the last 50 years, increasing the prevalence of related diseases, such as type 2 diabetes, osteoarthritis, fatty liver, cardiovascular diseases, depression, dementia, and some types of cancers, substantially hindering long-term survival. 

According to current figures, 7 out of 10 Mexicans live with obesity, and if the epidemiological trend continues, this figure could reach 9 out of 10 in 2050 (1).

There is a genetic factor that can favor obesity, and although different genetic variations (alleles) have been identified, a very important one is FTO, which decreases the response to satiety and promotes excessive energy consumption; that is, the person takes longer to "feel full" and therefore eats more food than they need. Here, the importance of the brain in the development of obesity becomes more noticeable, since numerous pathways related to satiety, pleasure, thermogenesis (heat production) and spontaneous activity start from this organ. All this is beyond the role of the hypothalamus in the determination of the set-point; that is, the self-regulation of weight by the body, which is one of the reasons why short-term interventions fail to reduce weight effectively over time.

Although it may be logical to blame individual decisions as the only cause, obesity has turned out to be a much more complex problem than just a behavioral issue. It is a complex matrix that includes genetic, environmental, economic, psychological, labor and sociocultural (2) factors. With this in mind, we can understand that it is not just a problem of labeling ultra-processed foods, but that, even with adequate information, good decisions cannot be made for you. They are made either due to ignorance or not having the economic means to follow recommendations. 

When we talk about poverty we think of it primarily in economic terms, such as having a below-average income; however, at least when speaking about the metropolis of Mexico City, time is a resource that is greatly wasted by  a large sector of the population that travels several hours daily to get from home to work. T As a result, they have little time to prepare meals or exercise. These conditions then become environmental factors that are as important as  a person’s genetics.

We also have behavioral and psychosocial factors: habits are formed at home, there is no doubt about that. The two most relevant habits for this matrix are exercise and the consumption of different foods. Let's not forget that food also has a social role in family meetings; family meals mean much more than nutrition. These factors already impact several generations, which favors the establishment of overweight, and eventually, obesity.

Returning to the working environment, beyond the question of working hours, it is relevant to talk about sedentary lifestyles, which in many jobs, particularly office jobs, means little or no mobility for several hours. A sedentary lifestyle is another of the pillars in the development of obesity, since it favors a lower consumption of calories, and importantly, a loss of muscle mass, that metabolic asset that protects us from numerous diseases. Emotional stress contributes to a type of eating known as "emotional eating," where during prolonged periods of stress, people tend to eat unhealthy foods in large quantities in a short period, so-called binge eating, as a coping mechanism. Finally, the food options in some workplaces focus more on a cheap and satisfying diet, than on a balanced diet that contributes to the maintenance of health. This is in regard to  staff cafeterias, not the options available on the street, where although other foods may be available, their price establishes an insurmountable barrier for many people.

One of the keys to reducing the disease burden is found in the mitigation of obesity, where interventions have shown utility in the short term, but, often, in the long term, this apparent evidence of utility is blurred. Originally, we understood obesity as a condition related to an imbalance of calories: more calories enter than exit and, therefore, the person gains weight. For this purpose, different interventions were designed, such as eating plans, medications and, in some cases, metabolic surgery.

It is currently known that the management of obesity is multidisciplinary and requires a team made up of doctors, nutritionists, psychologists, physical trainers and, in special cases, bariatric surgeons and endocrinologists, all of whom continue to be part of the solution to the internal problem that generates obesity; however, the external causes of the problem require policies at the public health level that favor an environment that contributes to the preservation of health and that seeks to transition from the current obesogenic environment to a leptogenic environment. All this from a view not of  aesthetics, but simply, of public health that assumes obesity as something more than "an adaptation to the environment."

In any case, we have before us a complex panorama that requires the participation of actors far beyond patients and doctors. If the current epidemiological trend continues, we will face a complex public health crisis, since obesity is much more than “an imbalance of calories.”

Bibliography
1-https://www.forbes.com.mx/9-de-cada-10-mexicanos-tendran-obesidad-en-2050-segun-expertos/

2- https://www.nature.com/articles/s41574-019-0176-8