The mid-afternoon bell rings at a local high school in the sprawling Coyoacán district of Mexico City, signaling the beginning of the recess period. There are no designated areas for physical activity during recess, though some young boys have put together a makeshift soccer game in an empty lot across from the school campus.
Please find attached: The Final Case Study (attachment 1) and PowerPoint presentation (attachment 2) for the group assignment. The group assignment will only be 20 minutes per team. In addition, you will complete on your own, an individual final policy brief (attachment 3. The third attachment is your individual final policy brief final assignment which you will also use to develop your policy brief for the team (group) assignment In the group assignment Each of you will have only have 3 minutes to present your individual policy as part of the final group presentation of 20 minutes total.
Requirements: 4 days
The mid-afternoon bell rings at a local high school in the sprawling Coyoacán district of Mexico City, signaling the beginning of the recess period. There are no designated areas for physical activity during recess, though some young boys have put together a makeshift soccer game in an empty lot across from the school campus. Many students, like Hector Gonzalez, rush to the campus snack bar to grab chocolate candy bars, bags of chips, fried empanadas, all washed down with sodas or sweetened fruit drinks. After school, students head home, confronted by several sidewalk vendors selling cakes, ice cream, french fries, and other snacks.
Hector, like many of his classmates, is quite heavy for his age. Tall and round, he is technically considered obese, but he doesn’t really think much about this. He doesn’t even know what the word means, though he’s heard it once or twice. His mother tells him that he is a ‘growing boy’, and his peers don’t say anything about his weight. Although Hector is sometimes embarrassed by his size, he knows that he will one day grow tall and his weight will ‘disappear’ naturally. In the meantime, it is just too hard to resist all the snacks offered at school. After all, they taste great! And it just a few harmless snacks, anyway. No big deal.
Once considered a problem that existed almost entirely in the developed world, childhood obesity has increasingly become more prevalent in lower- and middle-income countries as well. It is estimated that globally, 340 million children and adolescents aged 5-19 were considered overweight or obese in 2016 (WHO, 2018).
Health and Education Consequences of Childhood Obesity
The consequences of childhood obesity encompass both medical and psychosocial problems that not only have an immediate impact on a child’s health but can also have significant bearing on health in adulthood. Medical complications from childhood obesity include increased insulin resistance, hypertension, Type 2 diabetes, dyslipidemia, sleep apnea, osteoarthritis, cancer, and progressive and chronic endothelial damage, which can develop into atherosclerosis (Perichart-Perera, 2007). Psychosocial problems associated with childhood obesity include low self-esteem, depression, and eating disorders. Additionally, studies have shown that overweight and obese individuals face more societal discrimination (Ebbeling, et al., 2002). Children who are a healthy weight, are 13% more likely to do well in school and go on to higher education, compared to children who are obese who are dissatisfied with life and are often bullied at school (OECD, 2019.)
Apart from the last two decades, malnutrition was a much larger concern in Mexican school children than obesity. However, over the past two decades, there have been dramatic rises in obesity rates across all age groups in Mexico. The last Mexican National Nutrition and Health Survey administered in 2016 found that of school-age children (aged 5-11) 15.1% of the girls were overweight and 19.7% were obese, and 20.5% of the boys were overweight and 10.9% were obese (Shamah-Levy, et al., 2019). Overweight and obesity were defined according to Body Mass Index (BMI) standards established by the International Obesity Task Force (Cole, et al., 2000).
Mexico at a Glance (Central Intelligence Agency, 2021)
Federal republic governance structure (32 states) and the federal district of Mexico City
Population of 130,207,371 (July 2021 est.)
Median age of 29.3 years
Urban population accounts for 80.7% of the total population (2020)
Roman Catholic 82.7%, Pentecostal 1.6%, Jehovah’s Witness 1.4%, other Evangelical Churches 5%, other 1.9%, none 4.7%, unspecified 2.7% (2010 est.)
21.782 million MEXICO CITY (capital), 5.179 million Guadalajara, 4.874 million Monterrey, 3.195 million Puebla, 2.467 million Toluca de Lerdo, 2.140 million Tijuana (2020)
Mexico’s economy is the 11th largest in the world
Mexico City at a Glance (World Population Review, 2021)
Federal district and capital of Mexico
Mexico City’s 2021 population is now estimated at 21,918,936 and is home to 20% of Mexico’s entire population.
Mexico City is known for being one of the largest financial in the American continent and the largest Spanish-speaking city in the world.
Economic Costs of Obesity
Economic and health studies demonstrate that the health consequences of obesity are already straining the Mexican health care system considerably. Based on the most recent Heavy Burden of Obesity study by Organization for Economic Development (OECD) (2019), approximately 30% of Mexico’s population is obese, coming in second to the United States of the OECD members. Economically, the effect of overweight on GDP for Mexico is –5.3%, which is one of the most affected countries in the study (OECD, 2019). Mexico is the OECD country where overweight, obesity and related diseases will have the greatest impact on GDP between 2020 and 2050 (Gurria, 2020). Of the OECD countries, obesity has the greatest impact in Mexico where it reduces life expectancy by 4.2 years (OECD, 2019).
Obesity accounts for a significant percentage of the total national mortality in Mexico and is causing healthcare expenditures to rise at a substantial rate (Barquera, et al., 2013). According to the OECD (2019) overweight and obesity accounts for 8.9% of healthcare expenditures. In addition, overweight and obesity negatively impacts the labor market through illness, hospitalization, and lost wages by the equivalent of 2.4 fulltime workers per year (OECD, 2019).
Childhood Obesity Trends in Mexico
According to Gurria (2020) Mexico’s child obesity doubled from 7.5% in 1996 to 15% in 2016. According to the Heavy Burden of Obesity report from the OECD (2019), the prevalence of pre-obesity and obesity in children in 2016 in Mexico was 20.6% and 14.8% respectively. The Mexican National Health and Nutrition Survey showed an increase in obesity in adolescent girls from 10.9% in 2006 to 13.3% in 2016 (Shamah-Levy, et al., 2019). During that same timeframe, obesity in adolescent boys also increased from 13.0% to 14.9% (Shamah-Levy, et al., 2019). The results of the Mexican National Health and Nutrition Survey in 2016 showed the highest prevalence of overweight and obesity in adolescent girls and boys out of all age groups (Shamah-Levy, et al., 2019). The National Health and Nutrition Survey also looks at nutrition and food security. Of interest, the prevalence of female obesity was found connected to higher food insecurity levels compared to males (Shamah-Levy, et al., 2019).
Obesogenic Environment
To provide the most feasible and sustainable set of recommendations for Mexico City, it is important to examine the factors driving childhood obesity. Over the last twenty years, socio-cultural conditions in Mexico have shifted to favor an ‘obesogenic’ environment defined as “the sum of influences that the surroundings, opportunities, or conditions of life have on promoting obesity in individuals or populations” (Lake & Townshend, 2006).
Arredondo (2007) pointed out that food carts are a likely contributor to the high rates of obesity in Mexico, which are as prevalent as fast-food restaurants in the United States. The school environment in Mexico is another obesogenic environment with unhealthful snacks, lack of school lunch programs, and an abundance of nearby food carts (Arredondo, 2007). The foundational study by Perichart-Perera et al., (2007), demonstrated that school-age children living in Mexico City had an excessive intake of protein and carbohydrates and low fiber intake, the dietary intake was not stratified by weight category and was by self-report. Vilchis-Gil et al., (2015) showed that the obesogenic environment of elementary schools in Mexico City was associated with the risk of obesity. Students who had better dietary habits (eating breakfast at home, bringing a school lunch, and not bringing money to purchase food), ate higher quality food, and exercised more, had a lower risk of obesity (Vichis-Gil et al., 2015). Consistent with the theory of the obesogenic environment, we understand that family, social, and school environments shape the child’s eating patterns. Thus, it is important to consider the areas outside of the home as we look at places where school-age children might be influenced toward unhealthy eating patterns and without parental influence.
There is evidence that food and physical activity with children living in Mexico is connected to home, school, and their social life. Turnbull et al., (2019) interviewed children, parents, and teachers in three government elementary schools in Mexico City to ascertain their perceptions of the connection of obesity to food and physical activity. In the home, food showed parental caring, parents typically gave in to children’s preferred foods and let them make the decisions about what they ate (Turnbull et al., 2019). Parents also used convenient and unhealthy food options at home and sent children to school with unhealthy foods, combating any healthy programs the school might try to implement (Turnbull et al., 2019). Physical activity wasn’t seen as important within the home, additionally, parents felt the streets were not safe, and parks and outdoor gyms were not used (Turnbull, et al., 2019). Again, the overall environment in Mexico City, home, school, and the streets was seen as obesogenic, contributing to the childhood obesity epidemic in Mexico.
Another major contributor to childhood obesity in Mexico is the school environment, particularly in urban areas such as Mexico City. In Mexico, basic education is divided in three stages: primary school (primaria), comprising grades 1-6; junior high school (secundaria), comprising grades 7-9; and high school (preparatoria), comprising grades 10-12, which is free. The following issues have been identified as contributing to an obesogenic school environment in Mexico City, rotten infrastructure, no furniture, no water, school building destroyed by the 2017 earthquake, poor teaching quality, which means that children do not attend school (Cullman, 2018).
The Mexican government offers several food assistance programs, including Oportunidades (reaching 18.8% of the population), Liconsa (milk distribution, 9.7%) and School Breakfasts (12.2%) (Mundo-Rosas, et al., 2013). Oportunidades is a social program that gives cash to selected families who meet poverty guidelines who agree to send their children to school and to regular health visits (World Bank, 2012). Prospera is another social welfare program in Mexico that has been in place since 1997. Prospera has evolved over the years and provides cash incentives to enrollees for attending doctors appointments, keeping their children in school, and attending informational events about health (Quijada, 2017).
Team Presentation
Each team’s objective is to present the background of the problem and identified gaps that need to be filled by policy implementation to address the challenges of the childhood obesity epidemic in Mexico City. A presentation template is provided, outlining the components of the presentation that must be included: Background of the Problem; Themes in the Relevant Literature; Identified Gaps that Need to be Addressed by Policy; Individual Policies; Conclusions.
Each team member will present their proposed public health policy as if they would be presenting to city government representatives, school officials, and representatives of Mexico City’s business community. This group (the faculty and students attending the presentation) will determine which of the proposed public health policies would be most suitable for city-wide implementation throughout Mexico City.
Individual Assignment:
Your individual assignment, the health policy, must consider the various groups and stakeholders affected by your decisions, including business interests, educators, health experts, and the concerns of the population as a whole. The policy should be sustainable, financially justifiable, and acceptable. You may propose any combination of obesity prevention programs, media campaigns, school-based and/or family-based interventions, etc. You should define and justify your choice of target population, i.e., are you only focusing on adolescents or on all children, and your choice of intervention(s) related to your proposed public health policy. The individual assignment is your final assignment for Residency 2.
References:
Arredondo, E. (2007). Predictors of Obesity among Children Living in Mexico City. Research.
Barquera I. Campos J. A. Rivera. (2013). Mexico attempts to tackle obesity: the process, results, push backs and future challenges.
Centers for Disease Control and Prevention. “Overweight and Obesity”. Accessed February 12, 2021 from:
CIA (2021) The World Factbook: Mexico. Accessed February 12, 2021 from:
Cole T, Bellizzi M, Flegal K, Dietz W. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.
Cullman, V. (December 6, 2018). One million school children left behind because of poverty. Aztec Reports. Accessed February 16, 2021 from:
Ebbeling C, Pawlak D, Ludwig D,. (2002) Childhood obesity: public-health crisis, common sense cure, The Lancet, 360 (9331):473-482.
Gurría, A. (2020, January 8). Launch of the Study: “the Heavy Burden of Obesity: The Economics of Prevention.”
Health risks—Overweight or obese population—OECD Data. (n.d.). Retrieved February 22, 2021, from https://data.oecd.org/healthrisk/overweight-or-obese-population.htm/
Lake, A. & Townshend, T. (2006). Obesogenic environments: exploring the built and food environment. Journal of the Royal Society for the Promotion of Health, 126(6), 262–267.
Morales-Ruán MC, Shamah-Levy T, Mundo-Rosas V, Cuevas-Nasu L, Romero-Martínez M, Villalpando S, Rivera-Dommarco JA. Food assistance programs in Mexico, coverage and targeting. Salud Publica Mex 2013;55 suppl 2:S199-S205.
Perichart-Perera O (2007). Obesity increases metabolic syndrome risk factors in school-aged children from an urban school in Mexico city. Journal of the American Dietetic Association, 107(1): 81-91.
Quijada, D. (May 6, 2017). Mexican anti-poverty program is model for the world. Cronkite News. Accessed February 16, 2021 from:
Shamah-Levy, T., Romero-Martínez, M., Cuevas-Nasu, L., Méndez Gómez-Humaran, I., Antonio Avila-Arcos, M., & Rivera-Dommarco, J. A. (2019). The Mexican National Health and Nutrition Survey as a Basis for Public Policy Planning: Overweight and Obesity. Nutrients, 11(8), 1727.
Turnbull, B., Gordon, S., Martínez-Andrade, G., & González-Unzaga, M. (2019). Childhood obesity in Mexico: A critical analysis of the environmental factors, behaviours and discourses contributing to the epidemic. Health Psychology Open, 6.
Vilchis-Gil, J., Galván-Portillo, M., Klünder-Klünder, M., Cruz, M., & Flores-Huerta, S. (2015). Food habits, physical activities and sedentary lifestyles of eutrophic and obese school children: a case-control study. BMC Public Health, 15(1), 1. Accessed February 16, 2021. https://doi.org/10.1186/s12889-015-1491-1
World Bank. (2012). Social protection in Mexico: great opportunities and a new big
challenge ahead. Accessed February 16, 2021 from:
WHO (2018), Obesity and overweight, Accessed February 16,2021 from:
World Population Review (2021). Mexico City. Accessed February 16,2021 from:
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