Don't take the context out of the picture: Contextually shaped parents' and children's obesogenic behaviors in a marginalized area of Mexico City.

Santa Fe Gully zone is a marginalized area of Mexico City where nearly 39% of children live with either overweight or obesity. Despite the extensive research on obesogenic behaviors, studies frequently overlook the contexts where such behaviors occur. This qualitative study described individual and familial obesogenic behaviors among children with obesity from Santa Fe Gully, and explained how these behaviors might be contextually shaped. We used a grounded theory approach to investigate the process of development/maintenance of obesity in our sample. Fifteen participants (seven 10-year-olds with overweight or obesity and their parents) participated in nine art-based focus groups, and parents completed individual semi-structured interviews. Data were analyzed using a structured thematic content analysis. Results showed children's weight status was part of their identity, providing children with a familial 'fitting' sense while increasing psychosocial difficulties, leading to emotional overeating as a coping strategy. Parents' use of controlling and low-structured parenting practices reinforced children's emotional overeating and failed to regulate children's dietary and physical activity behaviors. Some low-structured parenting practices were guilt-motivated or fostered by socioeconomic and cultural factors (e.g., limited food access, unhealthy food exposure, community unsafety). Future interventions in Santa Fe Gully aimed at modifying obesogenic behaviors should incorporate systemic and ecological approaches to help participants navigate through contextual obstacles, as their behaviors should be analized considering the context where they occur.

Evaluating the effect of the initiative 'Caring for the Newborn and the Mother at Home' in Mexico.

OBJECTIVE: The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women's knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children. DESIGN: Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews. SETTING: Poor rural communities in Mexico; 48 intervention and 29 control. PARTICIPANTS: Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 294 intervention). RESULTS: The intervention increased reports of exclusive breast-feeding in the first 6 months by 24·4 percentage points (pp) (95 % CI: 13·4, 35·4), mothers' knowledge of obstetric warning signs by 23·4 pp (95 % CI: 9·2, 37·5) and neonatal warning signs by 26·2 pp (95 % CI: 15·2, 37·2) compared to the control group. A non-linear dose-response relation with the number of home visits was found. Diarrhoea and respiratory diseases among children decreased in the intervention v. control group but were not statistically significant. CONCLUSIONS: Home visits should be implemented as a complementary strategy to the provision of prenatal and postnatal care in rural communities due to their potential positive effects on the health of mothers and their children.

Cut-off points for serum ferritin to identify low iron stores during the first year of life in a cohort of Mexican infants.

The aim of this study was to identify serum ferritin (SF) cut-off points (COPs) in a cohort of healthy full-term normal birth weight infants who had repeated measurements of SF and haemoglobin every 3 months during the first year of life. The study included 746 full-term infants with birth weight ≥2,500 g, having uncomplicated gestations and births. Participants received prophylactic iron supplementation (1 mg/day of iron element) from the first to the 12th month of life and did not develop anaemia during the first year of life. Two statistical methods were considered to identify COPs for low iron stores at 3, 6, 9 and 12 months of age: deviation from mean and cluster analysis. According to the K-means cluster analysis results by age and sex, COPs at 3 and 6 months for girls were 39 and 21 µg/L and for boys 23 and 11 µg/L, respectively. A single COP of 10 µg/L was identified, for girls and boys, at both 9 and 12 months. Given the physiological changes in SF concentration during the first year of life, our study identified dynamic COPs, which differed by sex in the first semester. Adequate SF COPs are necessary to identify low iron stores at an early stage of iron deficiency, which represents one of the most widespread public health problems around the world, particularly in low- and middle-income countries.

Empoderamiento y búsqueda de atención en salud: un factor ignorado de la mortalidad materna en una comunidad indígena mexicana.

Resumen: Objetivo: Indagar la vinculación entre expresiones del empoderamiento (autonomía y poder de decisión) y las prácticas de autocuidado y de búsqueda de atención durante el embarazo y posterior al parto, en relación con la mortalidad materna, en mujeres indígenas del municipio de Santa María Temaxcaltepec, Oaxaca, México. Métodos: se realizaron seis grupos focales: dos con mujeres embarazadas; dos con madres de niños <3 años de edad, y dos con hombres quienes en los últimos tres años fueron padres. Resultados: la hegemonía masculina en el contexto familiar y en las instituciones de salud, dificulta la autonomía y el poder de decisión de las mujeres sobre su salud reproductiva. Esto impacta directamente en la búsqueda de atención durante el embarazo y el parto. Conclusiones: la falta de autonomía y de poder de decisión femenino se relaciona indirectamente, con resultados adversos del embarazo. Estos hallazgos son útiles para orientar el diseño de estrategias que promuevan el empoderamiento de las mujeres y la equidad de género en el contexto de los servicios y programas comunitarios y llamar la atención de tomadores de decisiones hacia la presencia, de factores no-médicos de la muerte materna en comunidades indígenas.

Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers.

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.

[Facilitators and barriers for the consumption of a micronutrient supplement]. / Facilitadores y barreras para el consumo del complemento alimenticio del Programa Oportunidades.

OBJECTIVE: To define and explore the sociocultural factors that could enhance (facilitators) or interfere with (barriers) the adequate consumption of a nutritional supplement (NS) by children from 6 to 59 months of age, provided as part of the national program Oportunidades. MATERIAL AND METHODS: Qualitative study in rural communities of Chiapas and Veracruz. Forty-four semi-structured interviews and 25 focus groups were conducted with mothers and other key informants. The framework analysis approach was used. RESULTS: Facilitators. The NS is free, is highly accessible, is positively accepted and mothers believe the physicians recommendations. Barriers. Lack of adequate storage and distribution, poverty conditions, intrahousehold dilution (within the family members), beliefs regarding child feeding and the purpose of the NS. CONCLUSION: Results shows the incongruence between the Programs recommendations and the preferences and practices of the target population and provides important elements to be considered in the promotion of the NS .

[The role of social networks in exclusive breastfeeding]. / Papel de las redes sociales en la lactancia materna exclusiva. Una primera exploración.

OBJECTIVE: The purpose of the study was to explore the network that the social actors form around the mother with a neonate and the roles they play, either as support or as an obstacle of exclusive breast-feeding. MATERIAL AND METHODS: We applied a social network survey in two stages: in the first one, we asked mothers with babies under six months of age who had helped them breast-feed their babies and who had had a bearing on not letting them do it. Later, we asked other mothers who had told them to give formula, water, tea or solid food to the babies. With the answers we formed two "cases by actors" matrices. We computed the frequencies to find out those people that most influenced the mother for and against exclusive breast-feeding. We also graphed the results from the matrix to visualize the answers. RESULTS: The maternal grandmother of the child, the physician and the paternal grandmother appeared as those who most positively contributed with exclusive breast-feeding. Paradoxically, they are the same who most influenced its interruption. DISCUSSION: We were looking for a social network to support exclusive breast-feeding and another one to hinder it, but the two networks turned out to be very similar. The same characters who help a mother to breast-feed are the ones who make her stop. The implication for an intervention program is that it is necessary to strengthen some knowledge and inhibit some other within the same group of people.

Development of an educational intervention to promote healthy eating and physical activity in Mexican school-age children.

Mexico has the highest and most alarming rates of childhood obesity worldwide. A study conducted in the State of Mexico revealed that one of every three children presents overweight or obesity. The objective of this paper is to provide a step-by-step description of the design and implementation of an educational intervention to promote healthy eating and physical activity called "Healthy Recess". The educational intervention was designed using the six stages of the Health Communication Process. This methodological model allowed identifying the needs of school-age children on information and participation in activities. In order to improve the strategy, adjustments were made to the print and audiovisual materials as well as to assessment tools. Typography was modified as well as the color of the images in student's workbook and facilitator's; special effects of the videos were increased; the narration of the radio spots was improved and common words and phrases were included. The Health Communication Process is an effective tool for program planners to design interventions aimed at managing prevalent health problems such as overweight and obesity in school-age children.

Relación entre estatus nutricional, insatisfacción corporal y conductas alimentarias de riesgo en estudiantes de nutrición / Relationship between nutritional status, body dissatisfaction and risky eating behaviors in Nutrition students

Resumen La presión sociocultural sobre los estudiantes universitarios, y en particular los que estudian nutrición, influye de manera negativa en su imagen corporal (IC), lo que favorece la adopción de conductas alimentarias de riesgo (CAR), independientemente de su estatus nutricional (ETN). El propósito del presente trabajo fue analizar la relación entre insatisfacción corporal (INC), ETN y CAR en estudiantes de nutrición. Participaron 370 estudiantes de una universidad privada (93.5% mujeres), con edad promedio de 19.5 años (DE = 2.5). Aunque 81% de los estudiantes era normopeso, 72.3% presentaron INC. Los participantes con obesidad, sobrepeso o normopeso presentaron riesgo moderado de presentar CAR (p < .05), pero no aquellos que estaban satisfechos con su IC (p < .05). Específicamente, los estudiantes que desearon tener una silueta más delgada mostraron mayor riesgo de presentar CAR (OR = 2.97, p < .05) vs. quienes deseaban tener una más robusta (p = .76). Además, a mayor índice de masa corporal, mayor práctica de ejercicio para bajar de peso, dietas restrictivas, atracones y pérdida de control al comer (p < .05). Es necesario desarrollar intervenciones orientadas a mejorar la satisfacción corporal para prevenir CAR entre estudiantes universitarios, y con mayor énfasis en aquellos que optan por cursar la carrera de nutrición.

Abstract The sociocultural pressure on university students, and particularly those studying Nutrition, negatively influences their body image (BI), which favors the adoption of risky eating behaviors (REB), regardless of their nutritional status (NS). The purpose of this study was to describe the relationship between body dissatisfaction (BD), NS and REB in Nutrition students. A total of 370 students from a private university participated (93.5% women), with a mean age of 19.5 years (SD = 2.5). Although 81% of the students were normal weight, 72.3% had BD. Participants with obesity, overweight or normal weight had moderate risk of REB (p < .05), but not those who were satisfied with their BI (p < .05). Specifically, students who wished to have a thinner silhouette showed greater risk of REB (OR = 2.97, p < .05) vs. those who wished to have a robust silhouette (p = . 76). In addition, the higher body mass index, the more exercise to lose weight, restrictive diets, binge eating and loss of control when eating (p < .05). It is necessary to develop interventions aimed at improving body satisfaction to prevent REB among university students, with greater emphasis on those who choose Nutrition as a professional career.

Aplicabilidad de las teorías de comunicación en salud en el campo de la educación nutricional / Applicability of health communication theories in nutrition education

RESUMEN La solución de los problemas de salud relacionados con nutrición requiere el diseño, ejecución y evaluación de intervenciones efectivas que incrementen el bienestar de la población. El objetivo fue analizar la aplicabilidad de las teorías existentes de comunicación en salud para el campo de la educación nutricional. Se recopilaron y analizaron las teorías de comunicación y modelos de comportamiento en salud utilizados con mayor frecuencia para la promoción de la salud. La modificación de comportamientos relacionados con alimentación y nutrición, que conduzca a hábitos alimentarios saludables requiere de intervenciones planeadas teniendo en cuenta las características socioeconómicas, culturales, experiencias alimentarias previas, actitudes, creencias, percepciones, motivaciones, normas culturales, redes sociales y familiares y condiciones ambientales.

Energy imbalance and psychosocial imbalance in the construction of child obesity in a marginalized area of Mexico City / Desbalance energético y desbalance psicosocial en la construcción de la obesidad infantil en una zona marginada de la Ciudad de México

Abstract Introduction Child obesity is a growing phenomenon and marginalized communities in Mexico City are not exempt from it. The results achieved by frequent preventive and remedial interventions are still unacceptable. Objective To contribute to the understanding of the growing problem of child obesity and overweight through a community health approach capable of transcending the biological perspective in order to improve interventions. Method We observed and interviewed a sample of school children, some overweight, some obese, and some with a normal BMI. All observations and interviews were carried out in the children's daily environment. We also interviewed some of their mothers. Together with our field notes, we analyzed these testimonies to construct the Grounded Theory that is the output of the present study. Results We found the children and their families immersed in a toxic environment that, through several mechanisms, fosters the consumption of high-density foods and discourages physical activity. We also found that the resources and competencies that families could use to fend off this environment are, at present, very limited. Discussion and conclusion We concluded that the energy imbalance in overweight and obese children's bodies corresponds to an abysmal psychosocial imbalance between the forces that foster obesity and the resources of the families affected by it. Any intervention aimed at preventing obesity must take this psychosocial imbalance into account.

Resumen Introducción La obesidad infantil es un fenómeno creciente del cual no quedan exentas las comunidades marginales de la Ciudad de México. Las intervenciones preventivas y remediales son frecuentes, pero sus impactos todavía no son aceptables. Objetivo Contribuir a la comprensión del fenómeno creciente de la obesidad y el sobrepeso infantil con una visión de salud comunitaria, que trascienda la visión biológica del problema y mejore las intervenciones. Método En su entorno escolar y comunitario observamos y entrevistamos a escolares, unos con obesidad o sobrepeso y otros con índice de masa corporal normal. También entrevistamos a las madres de algunos de ellos. Analizamos estos testimonios y nuestras notas de campo para construir la Teoría Fundamentada producto de este estudio. Resultados Encontramos a los niños y sus familias inmersos en un ambiente tóxico que, por múltiples mecanismos, promueve el consumo de alimentos de alta densidad e inhibe la actividad física. Encontramos también que los recursos y habilidades con que las familias podrían resistir a este ambiente son, por lo pronto, muy reducidos. Discusión y conclusión Concluimos que el desbalance energético en el cuerpo de los niños con sobrepeso corresponde a un enorme desbalance psicosocial entre las fuerzas que promueven la obesidad y los recursos de las familias que la sufren. Toda intervención preventiva debe tomar en cuenta este desequilibrio psicosocial.

Variables nutricias asociadas con la ansiedad y la autopercepción corporal en niñas y niños mexicanos de acuerdo con la presencia de sobrepeso/obesidad / Nutritional variables associated with anxiety and body image self-perception in Mexican children according with the presence of overweight/obesity

Resumen: INTRODUCCIÓN: La obesidad infantil se ha asociado con la ingesta de alimentos densamente energéticos, con el sedentarismo y con indicadores de salud mental como la ansiedad manifiesta y la percepción de la imagen corporal. En México no se ha reportado la relación entre dichas variables en población infantil. OBJETIVO: Evaluar la auto-percepción corporal y el riesgo de ansiedad, de acuerdo con la presencia de sobrepeso u obesidad, controlando las variables dietéticas y los hábitos de salud en niños en edad escolar. MÉTODO: Clasificados por su Índice de Masa Corporal (IMC) se compararon 259 niños y niñas sin sobrepeso/obesidad vs. 326 quienes presentaron dicha condición, en tres escuelas públicas del Estado de México. El IMC se obtuvo por medición directa del peso y la estatura. Se exploró la relación del consumo de alimentos (dieta) y el estilo de vida con la presencia de ansiedad (cuestionario CMAS-R), auto-percepción y satisfacción corporal (test-SC). RESULTADOS: El 43% de los escolares presentan riesgo cardiovascular y 7.7% riesgo de síndrome metabólico. Los participantes sin sobrepeso/obesidad presentaron mayor satisfacción con su imagen corporal (68.3%). No se encontraron diferencias entre el IMC y la ansiedad total, ni con cada una de sus dimensiones. DISCUSIÓN Y CONCLUSIÓN: No se reportaron diferencias en la ansiedad de acuerdo con el IMC. La auto-percepción de la imagen corporal fue menos favorable, en zonas específicas del cuerpo en niñas y niños con sobrepeso u obesidad.

Abstract: INTRODUCTION: Childhood obesity has been associated with the intake of energy-dense foods and sedentary lifestyle, and with mental health indicators such as anxiety and perception of body image. In Mexico it has not been studied the relationship between these variables in children. OBJECTIVE: To assess the body self-perception and risk of anxiety according to the presence of children with normal weight for their stature and age (BMI) and children with overweight/obese, controlling for dietary variables and health habits in children of school age. METHOD: 259 boys and girls with normal BMI vs. 326 with overweight/obesity from three public schools in the State of Mexico were evaluated. Diet and lifestyle were associated with the presence of anxiety and body-image dissatisfaction. BMI was calculated from direct measures of weight and height. For anxiety assessment the CMAS-R questionnaire was used and test-SC for body image self-perception. RESULTS: 43% of school children showed cardiovascular risk and 7.7% metabolic syndrome risk. Children with normal weight have greater satisfaction with their body image and weight, compared to children with overweight or obesity (68.3% vs. 49.1%). DISCUSSION AND CONCLUSION: There were no differences in anxiety according to BM1. The self-perception of body image is less favorable in specific areas of the body, in children with overweight or obesity.

Facilitadores y barreras para el consumo del complemento alimenticio del Programa Oportunidades / Facilitators and barriers for the consumption of a micronutrient supplement

OBJETIVO: Determinar y explorar los factores socioculturales que facilitan u obstaculizan el consumo recomendado de un complemento alimenticio (CA) repartido en todo el país como parte del Programa Oportunidades en niños de 6 a 59 meses de edad. MATERIAL Y MÉTODOS: Estudio cualitativo en comunidades rurales de los estados de Chiapas y Veracruz. Se realizaron 44 entrevistas semiestructuradas y se organizaron 25 grupos focales de madres beneficiarias e informantes clave. El análisis se efectuó bajo el enfoque fenomenológico. RESULTADOS: Los facilitadores fueron gratuidad, gran accesibilidad, aceptabilidad favorable del CA y alta credibilidad de las madres en las recomendaciones médicas; las barreras fueron problemas de almacenamiento y distribución, condiciones de pobreza, dilución intrafamiliar, creencias y conocimientos. CONCLUSIÓN: Los resultados permitieron sugerir elementos para promover el CA, así como identificar las incongruencias culturales y sociales entre las recomendaciones del programa y las prácticas y preferencias de la población objetivo.

OBJECTIVE: To define and explore the sociocultural factors that could enhance (facilitators) or interfere with (barriers) the adequate consumption of a nutritional supplement (NS) by children from 6 to 59 months of age, provided as part of the national program Oportunidades. MATERIAL AND METHODS: Qualitative study in rural communities of Chiapas and Veracruz. Forty-four semi-structured interviews and 25 focus groups were conducted with mothers and other key informants. The framework analysis approach was used. RESULTS: Facilitators. The NS is free, is highly accessible, is positively accepted and mothers believe the physicians’ recommendations. Barriers. Lack of adequate storage and distribution, poverty conditions, intrahousehold dilution (within the family members), beliefs regarding child feeding and the purpose of the NS. CONCLUSION: Results shows the incongruence between the Program’s recommendations and the preferences and practices of the target population and provides important elements to be considered in the promotion of the NS.