Opportunities to Strengthen Childhood Obesity Prevention in Two Mexican Health Care Settings

Main Article Content

Elizabeth Cespedes
Gloria Oliva Martínez Andrade
Guadalupe Rodríguez-Oliveros
Ricardo Perez-Cuevas
Marco González-Unzaga
Amalia Benitez Trejo
Jess Haines
Matthew William Gillman
Elsie Mireya Taveras


Background: The purpose of this study was to examine Mexican caregivers’ perceptions of the role of primary care in childhood obesity management, understand the barriers and facilitators of behavior change, and identify opportunities to strengthen obesity prevention and treatment in clinical settings.Methods: We conducted 52 in-depth interviews with parents and caregivers of overweight and obese children age 2-5 years in 4 Ministry of Health (public, low SES) and 4 Social Security Institute (insured, higher SES) primary care clinics in Mexico City and did systematic thematic analysis.Results: In both health systems, caregivers acknowledged childhood overweight but not its adverse health consequences.  Although the majority of parents had not received nutrition or physical activity recommendations from health providers, many were open to clinician guidance. Despite knowledge of healthful nutrition and physical activity, parents identified several barriers to change including child feeding occurring in the context of competing priorities (work schedules, spouses’ food preferences), and cultural norms (heavy as healthy, food as nurturance) that take precedence over adherence to dietary guidelines. Physical activity, while viewed favorably, is not a structured part of most preschooler’s routines as reported by parents.Conclusions: The likelihood of success for clinic-based obesity prevention among Mexican preschoolers will be higher by addressing contextual barriers such as cultural norms regarding children’s weight and support of family members for behavior change. Similarities in caregivers’ perceptions across 2 health systems highlight the possibility of developing comprehensive interventions for the population as a whole.

Article Details

Health Promotion
Author Biographies

Elizabeth Cespedes, Harvard Pilgrim Health Care Institute

Obesity Prevention Program, Department of Population Medicine

Gloria Oliva Martínez Andrade, Mexican Institute of Social Security

Epidemiology and Health Services Research Unit

Guadalupe Rodríguez-Oliveros, National Institute of Public Health

Centre for Health Systems Research

Ricardo Perez-Cuevas, Inter-American Development Bank

Division of Social Protection and Health

Marco González-Unzaga, Mexican Institute of Social Security

Epidemiology and Health Services Research Unit

Amalia Benitez Trejo, Hospital Infantil de México Federico Gómez

Community Health Department

Jess Haines, University of Guelph

Department of Family Relations and Applied Nutrition

Matthew William Gillman, Harvard Medical School/Harvard Pilgrim Health Care Institute

Director, Obesity Prevention Program, Department of Population Medicine


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