Overview of Systematic Reviews of Health Interventions for the Prevention and Treatment of Overweight and Obesity in Children

(1) Background: The importance of studying the health interventions used to prevent and treat overweight and obesity in school-aged children is imperative. This overview aimed to summarize systematic reviews that assess the effects of school-based, family, and mixed health interventions for preventing and treating overweight and obesity in school-aged children. (2) Methods: The Cochrane Collaboration methodology and PRISMA statement were followed. A search was conducted using terms adapted to 12 databases. Systematic reviews reporting interventions in children from six to 12 years old with an outcome related to preventing or treating obesity and overweight were included. Studies with pharmacological or surgical interventions and adolescents were excluded. (3) Results: A total of 15,226 registers were identified from databases and citation searching. Of those, ten systematic reviews published between 2013 and 2022 were included. After the overlap, 331 interventions for children between 6 and 12 years old were identified, and 61.6% involved physical activity and nutrition/diet intervention. Multicomponent intervention, combining physical activity with nutrition and behavioral change, school-based plus community-based interventions may be more effective in reducing overweight and obesity in children. (4) Conclusions: Plenty of interventions for childhood overweight and obesity aimed at prevention and treatment were identified, but there is a gap in the methodological quality preventing the establishment of a certain recommendation.

[Disordered eating in Mexican adolescents, 2006-2018]

OBJECTIVE

To analyze the evolution in prevalence of risky eating behaviors (REB) in Mexican adolescents between 2006 and 2018.

MATERIALS AND METHODS

We employed data from Ensanut 2006 and 2018-19. We evaluated REB with the Brief Questionnaire of Risky Eating Behaviors, dis-tinguishing between normative (recommended for obesity prevention) and non-normative (not recommended) REB. We analyzed the association between REB and indicators of the sociocultural environment of adolescents (socio-economic level, urban/rural place of living.

RESULTS

The prevalence of normative REB changed from 11.9% (95%CI: 11.3-12.6) to 15.7% (95%CI: 15.0-16.5), and the prevalence of non-normative REB from 12.1 (95%CI: 11.4-12.9) to 21.9 (95%CI: 21.0-22.9). REB were more frequent among females, those with overweight or obesity, those in the higher so-cioeconomic levels, and in urban areas.

CONCLUSIONS

REB are an important issue among adolescents, and preventive strategies are required.

Life course, sociocultural factors and disordered eating in adult Mexican women

Disordered eating (DE) can appear in women of all ages and in diverse sociocultural contexts, however most research focuses on younger women in higher income countries. The purpose of this article was to explore the association of life course markers with DE, considering the effects of sociocultural factors, in a sample of adult women in Tijuana, Mexico. We employed data from a household survey (n = 2322) conducted in 2014, to evaluate the associations of DE with age, occupation, marital status and having children (life course markers), and indicators of social position and exposure to modernization (sociocultural factors). The prevalence of weight preoccupation was 69.2% (CI95% 67.3,71.1), the prevalence of dieting 24.8% (CI95% 22.4,27.3), and 2.0% (CI95% 1.4,3.0) had a probable eating disorder according to the questionnaire cutoff score. In the adjusted model, younger age, being employed, higher social position and indicators of exposure to modernization had positive associations with DE. There were interactions between marital status and body mass index, and between age and region of birth. The interaction terms showed that overweight was positively associated with DE among single and cohabiting participants, but not among the married ones; and that the negative association between DE and age was apparent from younger age groups in women born in less developed regions of Mexico. Our results replicate others in showing DE to be present in women through the life course, and point to at-risk groups in the confluences of life course, social position and modernization.

Conductas alimentarias de riesgo y correlatos psicosociales en estudiantes universitarios de primer ingreso con sobrepeso y obesidad

Introducción. El comienzo de los estudios universitarios es un estresor importante para los jóvenes que se asocia con un incremento en la incidencia de depresión, ansiedad, abuso de alcohol y CAR. Objetivo. Analizar la relación entre CAR e IMC, su asociación con variables demográficas y psicológicas y la interacción con el IMC. Método. En una muestra de 892 estudiantes universitarios de nuevo ingreso (502 mujeres y 390 hombres) (Xedad=19.7; DE=2.9) se midió peso y estatura y se utilizaron cuestionarios validados. Resultados. La prevalencia de CAR fue de 6.1% en mujeres y de 4.1% en hombres. La prevalencia de sobrepeso y obesidad en mujeres fue de 22.6% y de 7.4%, y en hombres fue de 26.6% y de 9.3%, respectivamente. Las mujeres y los hombres con obesidad 10.8% y 11.1% presentaron CAR de frecuencia alta, y las mujeres y hombres con sobrepeso 13.2% y 3.8%, respectivamente. En las mujeres el IMC aumenta el riesgo de CAR 1.6 veces (p < 0.05) y en los hombres 1.4 veces (p > 0.05). No se encontró interacción del IMC en la asociación de CAR con el resto de las variables. Discusión y conclusión. En ambos sexos, las variables relacionadas con la imagen corporal aumentan el riesgo de CAR significativamente (p < 0.05). Los síntomas depresivos, la baja autoestima y el IMC aumentan el riesgo entre las mujeres, y el deseo por la musculatura, nivel socioeconómico y el área de estudio entre los hombres. Se recomienda llevar a cabo una investigación específica sobre CAR en varones, para evitar el subregistro de casos.

Social factors, weight perception, and weight control practices among adolescents in Mexico

We evaluated the association of social factors and weight control practices in adolescents, and the mediation of this association by weight perception, in a national survey of students in Mexico ( n = 28,266). We employed multinomial and Poisson regression models and Sobel's test to assess mediation. Students whose mothers had a higher level of education were more likely to perceive themselves as overweight and also to engage in weight control practices. After adjusting for body weight perception, the effect of maternal education on weight control practices remained significant. Mediation tests were significant for boys and non-significant for girls.

Trajectories of dietary change and the social context of migration: a qualitative study

The aim of this article was to explore the influence of migration on changes in dietary practices, relating these changes to the social contexts in which they occur. Numerous studies have described how migration from poor countries and regions to more developed ones leads migrants to adopt a modern diet associated to the risk of acquiring chronic diseases. However, different contexts might influence dietary change in migrants in diverse ways. For this purpose, 28 semi-structured interviews were conducted with adult, female internal migrants to a border city in Mexico. The interviews were analyzed using thematic analysis. The results showed trajectories of dietary change to be associated to social position before and after migration. For the participants from rural areas, migration was accompanied by an increase in the consumption of processed foods, and also changes in food insecurity. Migrants who came from urban areas reported a decrease in the perceived quality of food available to them, but their eating pattern was modified only slightly. For some interviewees, migration resulted in the possibility to choose what to eat in a more autonomous way. We discuss how the effect of migration on dietary changes can be manifold, and the necessity to delve into how social context influences these changes.

A review of eating disorders research in Mexico

The objective of this paper is to summarize research findings on eating disorders and the current state of the field in Mexico. Papers published in indexed journals and graduate dissertations were retrieved, using "eating disorders," "anorexia nervosa," "bulimia nervosa," "body image," "binge eating," "restrained eating," "weight and shape concern," and "dieting" as keywords. These were combined with the Boolean operator "AND" with "Mexico" and "Latin America." Findings are presented for epidemiology, the validity of assessment instruments, comorbidity, and risk factors. A national representative survey found a prevalence of 1.8% for bulimia nervosa, and no cases of anorexia nervosa. However, the lack of studies with confirmatory clinical interview and other national or regional representative samples makes it difficult to reach conclusions about the actual prevalence. A number of instruments for the detection of eating disorders and disordered eating have been validated for the Mexican population. The comorbidity of eating disorders in Mexico includes drug and alcohol abuse, obesity, and borderline personality disorder. Risk factors found included body weight and cultural pressure to be thin. Future lines of research should include epidemiological studies with representative samples and diagnosis confirmation, longitudinal studies, and the exploration of protective and risk factors specific to this population. We want to acknowledge Dr Richard A. Gordon's encouragement to write this manuscript and his accurate comments on its preliminary and final versions. We also want to thank the participants of the seminar on publications held at the Office of Epidemiological and Psychosocial Studies of the National Institute of Psychiatry for the comments they made to this article. El objetivo de este trabajo es el de resumir los hallazgos de investigación sobre los trastornos alimentarios y el estado actual del campo en México. Se recuperó la obra publicada en revistas indizadas y tesis de grado, mediante los descriptores "trastorno alimentario," anorexia nervosa," bulimia nervosa," "imagen corporal," "atracones," "restricción alimentaria," "preocupación por el peso y la figura," y "conducta de dieta." Éstos se combinaron con el operador Booleano "AND" con "México" y "América Latina." Se presentan los hallazgos para la epidemiología, la validez de los instrumentos de medición, comorbilidad, y factores de riesgo. Una encuesta nacional representativa encontró una prevalencia de 1.8% para la bulimia nervosa, y ningún caso de anorexia nervosa. No obstante, la carencia de estudios con una entrevista clínica confirmatoria y de otras muestras nacionales o regionales dificulta el arribo a conclusiones acerca de la prevalencia real. Varios instrumentos para la detección de los trastornos alimentarios y de la alimentación desordenada se han validado en población mexicana. La comorbilidad de los trastornos alimentarios en México incluye el uso y abuso de alcohol, la obesidad y el trastorno de personalidad limítrofe. Los factores de riesgo referidos incluyen el peso corporal y la presión cultural para estar delgado. Las líneas de investigación futuras deberán incluir estudios epidemiológicos con muestras representativas y la confirmación del diagnóstico, estudios longitudinales, y la exploración de factores de riesgo y protectores específicos a esta población. L'objectif de cet article est de résumer les résultats de recherche et l'état actuel des connaissances sur les troubles alimentaires au Mexique. Les articles publiés dans des revues indexées et les thèses de doctorat ont été recensés en utilisant les mots-clés « eating disorders », « anorexia nervosa », « bulimia nervosa », « body image », « binge eating », « restrained eating », « weight and shape concern » et « dieting ». Ceux-ci furent combinés, en utilisant la conjonction « AND », avec les termes « Mexico » et « Latin America ». Les résultats sont présentés de façon à décrire l'épidémiologie, la validité des instruments d'évaluation, la comorbidité et les facteurs de risque. Une enquête normative nationale a indiqué un taux de prévalence de 1,8% pour la névrose boulimique et aucun cas de névrose anorexique. Cependant, le manque d'études utilisant des entrevues cliniques confirmatoires et d'autres échantillons normatifs nationaux et régionaux limite les conclusions sur la prévalence actuelle. Un nombre important d'instruments pour dépister les troubles alimentaires et l'alimentation inadéquate ont été validés auprès de la population mexicaine. Les principaux problèmes de comorbidité avec les troubles alimentaires au Mexique incluent l'abus de drogue ou d'alcool, l'obésité et le trouble de personnalité état-limite. Les facteurs de risque incluent le poids corporel et la pression culturelle à être mince. Les avenues de recherche futures devraient inclure des études épidémiologiques auprès d'échantillons représentatifs, de la confirmation de diagnostic, des études longitudinales et de l'exploration de facteurs de protection et de facteurs de risque spécifiques à cette population.

Another body project: The thin ideal, motherhood, and body dissatisfaction among Mexican women

In this article, we examine the bodily experiences of Mexican women, to investigate their acceptance of the thin ideal and resulting body dissatisfaction. We conducted semi-structured individual interviews with 30 adult participants in Mexico City. Interviewees accepted the thin body ideal, but experiencing their bodies as signifiers of motherhood protected them from body dissatisfaction. Instead of a personal body project, they engaged in a project of caring for their children’s bodies. We suggest that health campaigns directed to adult women should consider the relational aspects of their lives.

Disordered eating and substance use among a female sample of Mexican adolescents

The relation between disordered eating and substance use was examined among Mexican female adolescents in a probabilistic sample of 2537 high school students in central Mexico, stratified by marginalization status and migratory intensity, obtained during 2006 ?2007 school year. The Brief Disordered Eating Questionnaire and the World Health Organization and United Nations Division of Narcotic Drugs recommendations for substance use assessments were used. Prevalence and odds ratios for disordered eating and substance use items were calculated separately across low and high marginalization groups. Study's implications and limitations are noted, as well as future research and prevention strategies are suggested.

A description of disordered eating behaviors in Latino males

OBJECTIVE

To explore disordered eating and eating disorders (EDs) in Latino males.

PARTICIPANTS

Participants are 722 male college students from a larger prevalence study conducted in the University of Puerto Rico system.

METHODS

Participants were selected from a list of sections of required courses for first-year students on each campus. Self-report instruments were used to explore ED symptoms (the Eating Attitudes Test [EAT-26] and the Bulimia Test-Revised [BULIT-26-R] and the Beck Depression Inventory depression (BDI).

RESULTS

Overall, 2.26% scored above the cut-off point on the BULIT-R and 5.08% score above the cut-off point on the EAT-26. Of the males, 4.43% reported sufficient frequency and severity to approximate DSM-IV criteria for bulimia nervosa. Depression symptomatology was found in those who scored above the cut-off point on both instruments of EDs.

CONCLUSION

College health practitioners should be aware of disordered eating in Latino males and include them in efforts to detect disordered eating behaviors in college students.

Predictors of eating behaviors in a sample of Mexican women

The aim of the study was to develop a model of potential risk factors associated to the development of eating behaviors in Mexican women. A structural equation model was carried out on a sample of 425 women: high school and college students (N=425) with a mean age of 19.1 years (SD=3.8). The variables selected for the model were those that obtained significant correlations with the variable "eating behaviors": criticism by father/mother, depressed mood, body mass index, attitudes and beliefs concerning obesity and dissatisfaction with figure. The model fitted the data well, with a non-significant Chi-square. The proportion of variance explained for eating behavior by the other variables was 59, the direct effects of all the variables were significant, while the total effect of all the variables on eating behavior were also significant, particularly the effects of the "dissatisfaction with figure" and, "attitudes and beliefs concerning obesity". The model yielded similar data to the findings in international literature, since they revealed the influence exerted by social pressure on thinness, the internalization of the socio-cultural ideal of thinness and the role of excess weight in increasing the risk of body dissatisfaction and therefore with the development of eating disorders.