Food Insecurity Among Haitian Migrants Living In Brazil.

OBJECTIVE: To analyze the situation of food insecurity among Haitians living in Midwest of Brazil, based on questions of the Brazilian Scale of Food Insecurity (BSFI). METHODS: A survey was carried out with a probabilistic sampling proportional to sex of Haitians aged over 18 years who lived in Cuiabá and Várzea Grande, Mato Grosso. Haitian migrants were interviewed by bilingual (Haitian Creole/Portuguese) individuals, and for the analysis of the BSFI questions. Because the BSFI is not validated for Haitians, the first eight questions of the scale were assessed separately, according to sex, debts incurred for the migration project and time of residence in Brazil. Chi-square was calculated to test the differences between groups. RESULTS: A total of 404 Haitians were evaluated, 81.9% male individuals, 60.9% aged between 18 and 36 years. Among the respondents, 64.4% were worried about running out of food before having money to buy more food, and 62.6% answered that they ran out of food before having money to buy it. Higher proportions of positive answers were observed for women and those who reported having debts to finance the migration costs to Brazil. CONCLUSION: The high proportion of positive answers to the BSFS questions by Haitians seems to indicate a situation of social vulnerability and food insecurity, especially among Haitian women, as well as among those who had debts to migrate to Brazil and those who have lived in the country for more than a year.

Sub-population differences in the relationship between the neighborhood environment and Latinas' daily walking and vehicle time.

BACKGROUND: Over 60% of Latinas report not meeting moderate to vigorous physical activity (MVPA) guidelines of 150 minutes/week. Ecological models of health posit that intrapersonal and environmental factors interact with one another to influence physical activity. Understanding their interactions in relation to transportation behaviors may inform interventions to increase Latinas' physical activity. PURPOSE: To 1) objectively estimate walking and vehicle time in Latinas, 2) examine the association of, and interactions between, intrapersonal (socio-demographics and weight status) and neighborhood environmental correlates with objective daily walking and vehicle time. METHODS: A subsample of Latinas (n=87) participating in a health intervention wore an accelerometer and GPS device for at least two valid wear days at baseline. The Personal Activity Location and Measurement System (PALMS) software estimated daily walking and vehicle time. Participants' anthropometrics were measured, and they completed a survey assessing socio-demographic characteristics and perceived neighborhood environment. Generalized linear mixed models examined main effects and interactions of four intrapersonal and five environmental factors on daily walking and vehicle time. RESULTS: On average, participants walked 16 min/day and spent 69 min/day in a vehicle. Overweight/obesity was negatively associated with walking time (p=.04) and positively associated with vehicle time (p=0.01). Household income was positively associated with vehicle time (p=0.02). For daily walking time, two interactions were significant: perceived access to destinations X household income (p=0.01), and perceived sidewalk maintenance X acculturation (p= 0.01). For daily vehicle time, two interactions were significant: perceived access to destinations X weight status (p<0.001), and perceived safety from crime X education (p=0.01). CONCLUSION: Latinas participated in relatively low walking time and high amounts of vehicle time. Findings suggest intrapersonal sub-group differences in the association of the neighborhood environment with walking and vehicle time. Improving neighborhood environments to promote walking and reduce vehicle time may help improve Latinas' overall physical activity.

Acceptance of Mobile Health in Communities Underrepresented in Biomedical Research: Barriers and Ethical Considerations for Scientists.

BACKGROUND: The rapid expansion of direct-to-consumer wearable fitness products (eg, Flex 2, Fitbit) and research-grade sensors (eg, SenseCam, Microsoft Research; activPAL, PAL Technologies) coincides with new opportunities for biomedical and behavioral researchers. Underserved communities report among the highest rates of chronic disease and could benefit from mobile technologies designed to facilitate awareness of health behaviors. However, new and nuanced ethical issues are introduced with new technologies, which are challenging both institutional review boards (IRBs) and researchers alike. Given the potential benefits of such technologies, ethical and regulatory concerns must be carefully considered. OBJECTIVE: Our aim was to understand potential barriers to using wearable sensors among members of Latino, Somali and Native Hawaiian Pacific Islander (NHPI) communities. These ethnic groups report high rates of disparate health conditions and could benefit from wearable technologies that translate the connection between physical activity and desired health outcomes. Moreover, these groups are traditionally under-represented in biomedical research. METHODS: We independently conducted formative research with individuals from southern California, who identified as Latino, Somali, or Native Hawaiian Pacific Islander (NHPI). Data collection methods included survey (NHPI), interview (Latino), and focus group (Somali) with analysis focusing on cross-cutting themes. RESULTS: The results pointed to gaps in informed consent, challenges to data management (ie, participant privacy, data confidentiality, and data sharing conventions), social implications (ie, unwanted attention), and legal risks (ie, potential deportation). CONCLUSIONS: Results shed light on concerns that may escalate the digital divide. Recommendations include suggestions for researchers and IRBs to collaborate with a goal of developing meaningful and ethical practices that are responsive to diverse research participants who can benefit from technology-enabled research methods. TRIAL REGISTRATION: ClinicalTrials.gov NCT02505165; https://clinicaltrials.gov/ct2/show/NCT02505165 (Archived by WebCite at http://www.Webcitation.org/6r9ZSUgoT).

Comparing Obesity-Related Health Disparities among Native Hawaiians/Pacific Islanders, Asians, and Whites in California: Reinforcing the Need for Data Disaggregation and Operationalization.

Since the 2000 Census, Asians and Pacific Islanders have been categorized as separate races. Government initiatives have called for greater study of Asian, Native Hawaiian, and other Pacific Islander (NHPI) health outcomes. NHPI often have worse health outcomes than Asians and Whites. Despite this, the lack of operationalization of racial definitions may affect the magnitude of health disparities. This analysis examined how utilizing different sociological race definitions could influence NHPI health outcomes when compared to Asians and Whites. Utilizing data from the 2009 California Health Interview Survey, NHPI had significantly higher age adjusted obesity prevalence than Whites under the UCLA Center for Health Policy Research (CHPR) (OR = 1.72, P = .03) and Self-Report (OR = 1.57, P = .01) definitions, but not the Census definition (OR = 1.42, P = .11). NHPI had significantly higher age adjusted obesity prevalence than Asians under all definitions (Census OR = 4.05, P < .01; CHPR OR = 4.81, P < .01; Self-Report OR = 4.46, P < .01). NHPI had significantly higher age adjusted diabetes/pre-diabetes prevalence than Whites across all definitions (Census OR = 3.27, P < .01, CHPR OR = 3.03, P < .01, Self-Report OR = 1.99, P = .01) but only the Census (OR = 2.12, P = .01) and CHPR (OR = 1.86, P = .04) when NHPI were compared to Asians. Overall, race definition changed the identification of health disparities. Future studies should operationalize racial definitions, as health disparities are masked post-hoc when utilizing different race definitions.

Fe en Accion/Faith in Action: Design and implementation of a church-based randomized trial to promote physical activity and cancer screening among churchgoing Latinas.

OBJECTIVES: To describe both conditions of a two-group randomized trial, one that promotes physical activity and one that promotes cancer screening, among churchgoing Latinas. The trial involves promotoras (community health workers) targeting multiple levels of the Ecological Model. This trial builds on formative and pilot research findings. DESIGN: Sixteen churches were randomly assigned to either the physical activity intervention or cancer screening comparison condition (approximately 27 women per church). In both conditions, promotoras from each church intervened at the individual- (e.g., beliefs), interpersonal- (e.g., social support), and environmental- (e.g., park features and access to health care) levels to affect change on target behaviors. MEASUREMENTS: The study's primary outcome is min/wk of moderate-to-vigorous physical activity (MVPA) at baseline and 12 and 24 months following implementation of intervention activities. We enrolled 436 Latinas (aged 18-65 years) who engaged in less than 250 min/wk of MVPA at baseline as assessed by accelerometer, attended church at least four times per month, lived near their church, and did not have a health condition that could prevent them from participating in physical activity. Participants were asked to complete measures assessing physical activity and cancer screening as well as their correlates at 12- and 24-months. SUMMARY: Findings from the current study will address gaps in research by showing the long term effectiveness of multi-level faith-based interventions promoting physical activity and cancer screening among Latino communities.

Characterization of metabolic syndrome among diverse Hispanics/Latinos living in the United States: Latent class analysis from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

BACKGROUND/OBJECTIVES: Empirical investigation of the adequacy of metabolic syndrome (MetS) diagnostic criteria, and whether meaningful subtypes of MetS exist, is needed among Hispanics/Latinos. METHODS: In 15,825 US Hispanics/Latinos from HCHS/SOL, latent class analysis of MetS components (waist circumference, systolic and diastolic blood pressure, HDL cholesterol, triglycerides, glucose, and antihypertensive, lipid- and glucose-lowering medication use) was used to investigate (1) whether distinct subtypes of MetS could be identified, and how component levels differed between them, and (2) how identified subtypes related to covariates and cardiovascular disease (CVD) prevalence. RESULTS: Two latent clusters emerged in both men (n=6317) and women (n=9508): one characterized by relatively healthy mean levels (Non-MetS cluster, 77.1% of men and 67.1% of women) and the other by clinically elevated mean levels (MetS cluster, 22.9% of men and 32.9% of women) across most MetS components. These clusters showed expected associations with covariates and CVD prevalence. Notable results suggest that (1) HDL cholesterol may poorly differentiate between US Hispanics/Latinos with and without MetS (mean=45.4 vs. 44.6 mg/dL for men and 51.3 vs. 52.0 mg/dL for women in the MetS vs. Non-MetS clusters, respectively) and (2) the NCEP-ATP III 88 cm waist circumference cutoff for US females may not optimize diagnosis among Hispanic/Latino women (MetS cluster mean waist circumference=102.5 cm). CONCLUSIONS: Beyond classification into having MetS or not, additional subtypes of MetS do not clearly emerge in US Hispanics/Latinos. Current diagnostic cutoffs for some components may not optimize MetS identification among this population.

School-wide programs aimed at obesity among Latino youth in the United States: a review of the evidence.

BACKGROUND: In the past 30 years, childhood obesity rates have tripled, disproportionately affecting Latino children. From 2003 to 2006, 43.0% of Mexican-American children were classified as overweight compared with 36.9% of non-Hispanic Whites. Obesity interventions targeting children can have a significant impact in the school setting. METHODS: We conducted a systematic review of evidence-based, obesity-related interventions in the school setting. Inclusion criteria included: having 50% or more Latino children in the study, and usage of obesity-related outcomes (eg, body mass index [BMI] z-score, weight, and waist circumference, and body fat). RESULTS: The majority of identified studies included interventions that targeted both nutrition and physical activity. The most successful interventions were randomized, controlled trials or quasi-experimental controlled studies and had few limitations in execution in the study; however, overall results were mixed. There are promising results for interventions targeting Latino children who are already overweight or obese, but evidence of effectiveness is sparse. CONCLUSIONS: This review is the first to gather evidence-based research systematically aimed at obesity-related interventions in the school setting that are specifically focused on Latino children. Results of the review are promising and timely, given the exigency of the needed evidence, and the current state of childhood obesity in the United States.

Terms used for people living with HIV in the Democratic Republic of the Congo.

For this study we conducted in-depth interviews with 29 youth living with HIV (YLWH) and key informant interviews with 8 HIV care/support providers. We describe terms used to portray people living with HIV (PLWH) in Kinshasa, Democratic Republic of the Congo. Labels commonly used, mostly derogatory, described PLWH as walking corpses, dangers to others, or people deserving to die before others get infected. Blame and other accusations were directed at PLWH through anchoring or objectification. Being labeled sometimes made these youth suffer in silence, afraid to disclose their status, or avoid performing actions in public, preferring to let others do them. YLWH need psychosocial support to mitigate the harmful effects of these labels and strengthen their coping skills, whereas community, institutional, and national efforts are needed for stigma reduction.

Feasibility and preliminary findings of a church-based mother-daughter pilot study promoting physical activity among young Latinas.

Physical activity (PA) rates in young Latina girls are low. This study examined acceptability and feasibility of implementing a mother-daughter intervention targeting individual and family-level correlates of PA. Eleven mother-daughter dyads participated in an 8-week intervention promoting PA in preadolescents. Preliminary data suggest increases in self-report PA, reductions in television watching, and improvements in parenting and mother-daughter communication. Focus group data suggest that participants benefited from receiving the intervention in a group format. Findings suggest that mother-daughter interventions promoting PA in young Latinas are feasible. Physical activity may improve family communication and mother-daughter relations.

Promotion of water consumption in elementary school children in San Diego, USA and Tlaltizapan, Mexico.

OBJECTIVE: Consumption of water may help promote health and prevent obesity in children by decreasing consumption of sugar-sweetened beverages. This study used evidence-based strategies to increase water consumption in Mexican-American and Mexican children. MATERIALS AND METHODS: In 2012, two schools in San Diego, USA and two other in Tlaltizapan, Mexico were recruited to Agua para Niños (Water for Kids), a program designed to promote water consumption among elementary grade students. Guided by operant psychology, the intervention focused on school and classroom activities to encourage water consumption. One control and one intervention school in each country were included. RESULTS: Agua para Niños resulted in increases in observed water consumption and bottle possession among US and Mexican students. Teacher receptivity to the program was very positive in both countries. CONCLUSIONS: Agua para Niños yielded sufficiently positive behavioral changes to be used in a future fully randomized design, and to contribute to school nutrition policy changes.

Promotion of water consumption in elementary school children in San Diego, USA and Tlaltizapan, Mexico / Promoción del consumo de agua en escuelas primarias en San Diego EU y Tlaltizapán, México

Objective. Consumption of water may help promote health and prevent obesity in children by decreasing consumption of sugar-sweetened beverages. This study used evidence-based strategies to increase water consumption in Mexican-American and Mexican children. Materials and methods. In 2012, two schools in San Diego, USA and two other in Tlaltizapan, Mexico were recruited to Agua para Niños (Water for Kids), a program designed to promote water consumption among elementary grade students. Guided by operant psychology, the intervention focused on school and classroom activities to encourage water consumption. One control and one intervention school in each country were included. Results. Agua para Niños resulted in increases in observed water consumption and bottle possession among US and Mexican students. Teacher receptivity to the program was very positive in both countries. Conclusions. Agua para Niños yielded sufficiently positive behavioral changes to be used in a future fully randomized design, and to contribute to school nutrition policy changes.

Objetivo. Explorar cómo el consumo de agua proporciona salud y previene la obesidad en los niños al disminuir el consumo de bebidas endulzadas con azúcar, a partir del empleo de estrategias basadas en la evidencia para aumentar el consumo de agua en niños mexicanos y mexicano-estadounidenses. Material y métodos. En 2012, se eligieron dos escuelas en San Diego, EU y otras dos en Tlaltizapán, Morelos, México para implementar el programa Agua para Niños (Water for Kids), diseñado para promover el consumo de agua en los niños de nivel primaria. Bajo el enfoque de la psicología operante, la intervención se centró en las actividades escolares en general y dentro del aula para fomentar el consumo de agua. Resultados. Agua para Niños logró un aumento en el consumo de agua y la utilización personal de una botella con este líquido entre los estudiantes mexicano-estadounidenses y mexicanos. La receptividad del programa por parte de los maestros fue bastante positiva en ambos países. Conclusiones. Agua para Niños produjo cambios conductuales suficientemente positivos, lo que la hace una estrategia que puede utilizarse en futuros estudios aleatorizados que contribuyan a lograr cambios en las políticas escolares de nutrición.

School-based programs aimed at the prevention and treatment of obesity: evidence-based interventions for youth in Latin America.

BACKGROUND: Rapidly rising childhood obesity rates constitute a public health priority in Latin America which makes it imperative to develop evidence-based strategies. Schools are a promising setting but to date it is unclear how many school-based obesity interventions have been documented in Latin America and what level of evidence can be gathered from such interventions. METHODS: We performed a systematic review of papers published between 1965 and December 2010. Interventions were considered eligible if they had a school-based component, were done in Latin America, evaluated an obesity related outcome (body mass index [BMI], weight, %body fat, waist circumference, BMI z-score), and compared youth exposed vs not exposed. RESULTS: Ten studies were identified as having a school-based component. Most interventions had a sample of normal and overweight children. The most successful interventions focused on prevention rather than treatment, had longer follow-ups, a multidisciplinary team, and fewer limitations in execution. Three prevention and 2 treatment interventions found sufficient improvements in obesity-related outcomes. CONCLUSIONS: We found sufficient evidence to recommend school-based interventions to prevent obesity among youth in Latin America. Evidence-based interventions in the school setting should be promoted as an important component for integrated programs, policies, and monitoring frameworks designed to reverse the childhood obesity in the region.

Worksite interventions: improving lifestyle habits among Latin American adults.

CONTEXT: Worksite-based interventions have been shown to result consistently in significant improvements in weight- and health-related outcomes among the working adult population; however, applicability and effectiveness of studies has often been limited by inadequate reporting of age and ethnicity. This study aimed to examine work-based interventions among Latinos in the U.S. and Latin America. EVIDENCE ACQUISITION: Data were abstracted (and analyzed) from "parent" study Guide to Obesity Prevention in Latin American and the U.S. (GOL), between January 2010 and December 2011. Manuscripts from 1965 to 2010 were evaluated according to inclusion criteria for interventions, including a sample population of at least 50% Latinos or results stratified by ethnicity, at least one obesity-related outcome measure evaluated before and after intervention, and worksite setting and comparison of an intervention group to a non-intervention group (including pre-post designs). EVIDENCE SYNTHESIS: Of 105 interventions abstracted, five were work-based interventions. The average participant age was 45 years, with an average of 58% women. Four of the five interventions had a pre-post study design that received a fair execution score and lowest design-suitability score, whereas one group RCT intervention had the greatest design suitability and good execution. For two studies, Cohen's d effect sizes ranged from 0.09 to 0.603. Effect sizes could not be calculated for three of the interventions. Three interventions found significant outcomes for BMI, three for weight, two for waist circumference, and one for waist-to-hip ratio. CONCLUSIONS: Few studies have focused on work-based interventions specifically aimed at Latinos. This review identified promising strategies for reducing obesity in the workplace.

Weight-related child behavioral interventions in Brazil: a systematic review.

CONTEXT: Between 1974 and 1997, the prevalence of overweight increased 300% among Brazilian children and adolescents. A systematic review was conducted between January 2010 and December 2011 of obesity-related interventions targeting Brazilian children and adolescents. EVIDENCE ACQUISITION: Manuscripts from 1965 to December 2010 were evaluated based on inclusion criteria including evaluating obesity-related outcomes and at least 50% of participants living in Brazil. Methods were adapted from the CDC's Community Guide. Evidence was based on the number of available studies, study design, execution, quality, and effect size. EVIDENCE SYNTHESIS: Sixteen articles were abstracted; five met final inclusion criteria. All intervention samples (range n=14-78; mean n=40.6) included overweight or obese children aged 8-17 years. The intervention duration range was 3-6 months, and dose frequency ranged from two to five times per week. Three of the five interventions included healthy eating and physical activity; two included only physical activity. Two interventions studies were rated as having greatest design suitability. Only one intervention had the greatest design suitability and a large effect size. CONCLUSIONS: Intervention approaches that combined physical activity and healthy eating had the strongest effects. However, small sample bias, 95% CIs of primary effects, and poor-to-moderate quality of research designs and implementation suggest the combined evidence is best rated as Insufficient. This prohibits the recommendation of specific strategies or settings. Findings suggest that more well-designed evidence-based childhood obesity interventions in Brazil are needed and that promising, but yet unproven, interventions should be evaluated rigorously.

Obesity control in Latin American and U.S. Latinos: a systematic review.

CONTEXT: Latinos are the largest and fastest-growing ethnically diverse group in the U.S.; they are also the most overweight. Mexico is now second to the U.S. in experiencing the worst epidemic of obesity in the world. Objectives of this study were to (1) conduct a systematic review of obesity-related interventions targeting Latinos living in the U.S. and Latin America and (2) develop evidence-based recommendations to inform culturally relevant strategies targeting obesity. EVIDENCE ACQUISITION: Obesity-related interventions, published between 1965 and 2010, were identified through searches of major electronic databases in 2010-2011. Selection criteria included evaluation of obesity-related measures; intervention conducted in a community setting; and at least 50.0% Latino/Latin American participants, or with stratified results by race/ethnicity. EVIDENCE SYNTHESIS: Body of evidence was based on the number of available studies, study design, execution, and effect size. Of 19,758 articles, 105 interventions met final inclusion criteria. Interventions promoting physical activity and/or healthy eating had strong or sufficient evidence for recommending (1) school-based interventions in the U.S. and Latin America; (2) interventions for overweight or obese children in the healthcare context in Latin America; (3) individual-based interventions for overweight or obese adults in the U.S.; (4) individual-based interventions for adults in Latin America; and (5) healthcare-based interventions for overweight or obese adults in Latin America. CONCLUSIONS: Most intervention approaches combined physical activity and healthy eating to address both sides of the energy-balance equation. Results can help guide comprehensive evidence-based efforts to tackle the obesity epidemic in the U.S. and Latin America.

Evidence-based obesity treatment interventions for Latino adults in the U.S.: a systematic review.

CONTEXT: Latinos have one of the highest prevalences of obesity in the U.S. Efforts to address U.S. Latino health have expanded to include obesity prevention and treatment initiatives. The objectives of this review were to (1) conduct a systematic review of obesity-related treatment interventions targeting U.S. Latino adults and (2) develop evidence-based recommendations to inform culturally relevant strategies for obesity treatment targeting U.S. Latino adults. EVIDENCE ACQUISITION: Obesity treatment interventions, published between 1990 and 2010, were identified through a systematic search of electronic databases conducted between January 2010 and December 2011. Details of the screening process and selection/exclusion criteria are reported in the Guide to Obesity Prevention in Latin America and the U.S. (GOL) parent study. EVIDENCE SYNTHESIS: Of the 325 studies identified in the GOL parent study, 105 met the inclusion criteria, and 22 involved obesity treatment interventions for Latinos and were included in the present review. The 22 studies were evaluated (between January 2010 and December 2011) for strength of study design and execution; effect sizes were also estimated for treatment effects on obesity-related outcomes. Interventions for physical activity or diet behavioral changes with strong or sufficient evidence included (1) community-based, culturally relevant, RCTs, and non-randomized controlled trials; (2) church-based interventions; and (3) promotora-led interventions. CONCLUSIONS: Most interventions targeted physical activity and/or diet behavioral modification in Latinas and were led by bicultural/bilingual professionals. Potential key intervention settings include community clinics/centers and churches. Although there was limited literature on obesity treatment interventions for U.S. Latinos, the review findings provide valuable insight to researchers and practitioners involved in obesity treatment for U.S. Latino adults.

Interventions for the treatment of obesity among children and adolescents in Latin America: a systematic review.

OBJECTIVE: The objective of this systematic literature review was to identify evidence-based strategies associated with effective healthcare interventions for prevention or treatment of childhood obesity in Latin America. MATERIALS AND METHODS: A systematic review of peer-reviewed, obesity-related interventions implemented in the healthcare setting was conducted. Inclusion criteria included: implementation in Latin America, aimed at overweight or obese children and evaluation of at least one obesity-related outcome (e.g., body mass index (BMI), z-score, weight, and waist circumference, and body fat). RESULTS: Five interventions in the healthcare setting targeting obese children in Latin America were identified. All five studies showed significant changes in BMI, and the majority produced sufficient to large effect sizes through emphasizing physical activity and health eating. CONCLUSION: Despite the limited number of intervention studies that treat obesity in the healthcare setting, there is evidence that interventions in this setting can be effective in creating positive anthropometric changes in overweight and obese children.

Interventions to increase physical activity and healthy eating among overweight and obese children in Mexico.

OBJECTIVE: The purpose of the present study was to conduct a systematic literature review of obesity interventions that focused on increasing physical activity and healthy eating among overweight and obese children in Mexico. MATERIALS AND METHODS: Data was taken from a larger literature review focused on obesity interventions for Latinos in Latin America and the United States. Study design suitability, quality of execution, and effect size were assessed for a subset of these articles. RESULTS: There were six intervention studies included in the present review. Five studies showed reductions in obesity-related outcomes, while one study reported gains in body mass index (BMI). CONCLUSIONS: Physical activity and healthy eating remain constant components in obesity treatment interventions, which highlights the importance of understanding evidence-based strategies to guide future research to reduce childhood obesity in Mexico.

Interventions for the treatment of obesity among children and adolescents in Latin America: a systematic review / Intervenciones para el tratamiento de la obesidad en niños y adolescentes en Latinoamérica: una revisión sistemática

Objective. The objective of this systematic literature review was to identify evidence-based strategies associated with effective healthcare interventions for prevention or treatment of childhood obesity in Latin America. Materials and methods. A systematic review of peer-reviewed, obesity-related interventions implemented in the healthcare setting was conducted. Inclusion criteria included: implementation in Latin America, aimed at overweight or obese children and evaluation of at least one obesity-related outcome (e.g., body mass index (BMI), z-score, weight, and waist circumference, and body fat). Results. Five interventions in the healthcare setting targeting obese children in Latin America were identified. All five studies showed significant changes in BMI, and the majority produced sufficient to large effect sizes through emphasizing physical activity and health eating. Conclusion. Despite the limited number of intervention studies that treat obesity in the healthcare setting, there is evidence that interventions in this setting can be effective in creating positive anthropometric changes in overweight and obese children.

Objetivo. El objetivo de esta revisión sistemática de la literatura fue identificar estrategias basadas en evidencia asociadas con intervenciones en salud efectivas para la prevención y el tratamiento de la obesidad infantil en Latinoamérica. Material y métodos. Se realizó una revisión sistemática por pares de intervenciones relacionadas con la obesidad, que fueron llevadas a cabo en clínicas de atención para la salud. Criterios de inclusión: implementadas en Latinoamérica, dirigidas a niños con obesidad y sobrepeso y evaluación de por lo menos un resultado relacionado con obesidad (ej. índice de masa corporal (IMC), puntaje Z, peso, circunferencia de cintura o grasa corporal). Resultados. Se identificaron cinco intervenciones dirigidas a niños obesos en clínicas de salud en Latinoamérica. Todas las intervenciones mostraron cambios significativos en IMC y la mayoría obtuvo un tamaño del efecto grande a través de la promoción de actividad física y alimentación saludable. Conclusión. A pesar del número limitado de estudios de intervención para tratar la obesidad en clínicas de salud, existe evidencia que las intervenciones en estos lugares pueden ser efectivas en alcanzar cambios antropométricos positivos en los niños con obesidad y sobrepeso.

Interventions to increase physical activity and healthy eating among overweight and obese children in Mexico / Intervenciones para incrementar la actividad física y alimentación saludable en niños mexicanos con sobrepeso y obesidad

Objective. The purpose of the present study was to conduct a systematic literature review of obesity interventions that focused on increasing physical activity and healthy eating among overweight and obese children in Mexico. Materials and methods. Data was taken from a larger literature review focused on obesity interventions for Latinos in Latin America and the United States. Study design suitability, quality of execution, and effect size were assessed for a subset of these articles. Results. There were six intervention studies included in the present review. Five studies showed reductions in obesity-related outcomes, while one study reported gains in body mass index (BMI). Conclusions. Physical activity and healthy eating remain constant components in obesity treatment interventions, which highlights the importance of understanding evidence-based strategies to guide future research to reduce childhood obesity in Mexico.

Objetivo. El propósito del presente estudio fue realizar una revisión sistemática de la literatura en intervenciones relacionadas con la obesidad enfocadas en incrementar la actividad física y alimentación saludable en niños mexicanos con obesidad y sobrepeso. Material y métodos. La información forma parte de una revisión sistemática de la literatura enfocada en intervenciones para prevenir o tratar la obesidad en población latina habitante de Latinoamérica y Estados Unidos. La adecuación del diseño del estudio, la calidad de ejecución y el efecto de la muestra fueron evaluados para una submuestra de estos artículos. Resultados. Se incluyeron seis estudios dentro de la revisión. Cinco estudios encontraron una reducción en los resultados relacionados con la obesidad, mientras que un estudio encontró ganancias en el índice de masa corporal (IMC). Conclusiones. La actividad física y alimentación saludables fueron componentes constantes de las intervenciones para tratamiento de la obesidad. Esto resalta la importancia de entender las estrategias basadas en evidencia para guiar futuras investigaciones en la reducción de la obesidad infantil en México.