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RESUMEN Introducción: El cierre de escuelas por la pandemia de COVID-19, representa un factor de riesgo para el desarrollo de obesidad en los niños, debido al aumento de conductas no saludables. Las intervenciones de cambio de estilo de vida en línea en escolares podrían ayudar a mitigar este problema. Sin embargo, en nuestro conocimiento no se han realizado ensayos controlados aleatorizados para prevenir obesidad en escolares durante COVID-19. El objetivo del presente estudio es evaluar el efecto de una intervención en línea de cambio de estilo de vida sobre el puntaje Z de IMC de escolares mexicanos a 4 meses durante la pandemia por COVID-19 en un grupo intervención en comparación a un control. Material y Métodos: Protocolo de un ensayo controlado aleatorizado piloto cegado a los evaluadores. Se invitará a participar a escolares de una primaria pública de Hermosillo, Sonora, México. Los participantes serán aleatorizados a un grupo de intervención o a un grupo control. La intervención incluirá 3 sesiones semanales en línea de educación nutricional y actividad física (60 minutos por sesión, 30 minutos de educación nutricional y 30 minutos para la actividad física) e información para padres de familia. El grupo control recibirá un folleto digital con recomendaciones de una dieta saludable al inicio del estudio y acceso a los materiales del programa al finalizar. Las mediciones del estudio se realizarán al inicio y a los 4 meses. La variable primaria será el puntaje Z de IMC. Las variables secundarias serán circunferencia de cintura, porcentaje de grasa, conocimientos en nutrición, parámetros de estilo de vida, retención, aceptación y participación en la intervención. Los cambios de las variables se analizarán mediante pruebas de comparación de medias por intención de tratamiento. El protocolo fue aprobado por el Comité de Ética en Investigación del Departamento de Enfermería de la Universidad de Sonora y registrado en la plataforma Clinical Trials. Conclusión: En nuestro conocimiento, el estudio aportará la primera evidencia de la evaluación de intervenciones en línea para la prevención de obesidad en escolares derivada de un ensayo controlado aleatorizado, lo cual podría ser útil en el combate de la obesidad infantil.

Obesity and its comorbidities have become the most important public health problems for Latin America. In Mexico obesity has increased dramatically to the point where the government has declared it an epidemiological emergency. The most recent national data showed overweight and obesity affects 72.5% of adults, or around 56 million Mexicans. Most Mexican adults with obesity are undiagnosed. According to data derived from a national representative survey, only 20% of adults with BMI >30 kg/m2 were diagnosed with obesity by a health provider. Likewise, only 8% of individuals with obesity had received treatment for obesity. Interventions offered in the Mexican health care delivery system generally consist of traditional consultations with recommendations on diet and exercise, visits are monthly to quarterly, and validated behavior change protocols are not used. Evidence from clinical trials has shown that weight loss with this type of treatment is generally less than 1 kg per year. In contrast, intensive lifestyle interventions - protocols focusing on achieving changes in diet, physical activity, and moderate weight loss using behavioral strategies with weekly or bi-weekly sessions for the first 3 to 6 months, and a maintenance phase with trained interventionists - as implemented in the Diabetes Prevention Program and the Look AHEAD studies achieved weight loss of 7-9% at one year. Additionally, translation studies of these interventions to the community and to real-world clinical practice have achieved weight loss of around 4%. Adaptations of intensive lifestyle interventions have been implemented in the United States, both in clinical practice and in the community, and this type of intervention represents a potential model to combat obesity in Mexico and other Latin American countries. It is essential that primary care providers in Mexico implement clinical practice guidelines based on the best evidence available as discussed here to effectively treat obesity. The authors make recommendations to improve the treatment of obesity in the clinical care delivery system in Mexico using intensive lifestyle interventions.

School-based obesity prevention programs are key to promoting healthy habits. The aim of this study was to evaluate the effect of the Planet Nutrition program on BMI z-score and other parameters compared to a control group of Mexican schoolchildren after 9 weeks of intervention. The effect of the summer holidays on the BMI z-score was also evaluated at 23 weeks. A pilot randomized controlled trial design was used and 41 schoolchildren were randomized (21 intervention group and 20 control). The program included 18 nutrition education sessions, 20 physical activity classes and six brochures for parents. At 9 weeks, no significant differences were found between the intervention and control groups in the change in BMI z-score (&minus, 0.11, 95% CI &minus, 0.23, 0.01). Significant differences were observed in some secondary outcomes: body fat percentage (&minus, 1.72, 95% CI &minus, 3.42, &minus, 0.02), waist circumference (&minus, 3.45, 95% CI &minus, 5.55, &minus, 1.36), physical activity (0.44, 95% CI 0.01, 0.88) and nutrition knowledge (1.15, 95% CI 0.27, 2.03). Summer holidays negatively affected the BMI z-score in both groups, reducing the difference observed between groups at 9 weeks (&minus, 0.07, 95% CI &minus, 0.22, 0.07). The Planet Nutrition program showed favorable effects in some obesity and lifestyle parameters in the short term.

The Diabetes Prevention Program (DPP) is effective for the prevention of type 2 diabetes by weight loss with diet and physical activity. However, there is little evidence as to whether this program could be translated into real-world clinical practice in Latin American countries. The objective of this work was to evaluate the effectiveness of the DPP for the management of overweightness and obesity at 6 and 12 months in clinical practice in Mexico. This was a non-controlled intervention study implemented in five public clinics in northern Mexico. Two hundred and thirty-seven adults aged 45.7 &plusmn, 9.9 years with a Body Mass Index (BMI) of 34.4 &plusmn, 5.4 kg/m2 received group sessions with an adaptation of the DPP, in addition to nutrition counseling. One hundred and thirty-three (56%) participants concluded the 6 month phase. They showed a significant weight loss, ranging from 2.76 &plusmn, 4.76 to 7.92 &plusmn, 6.85 kg (p &le, 0.01) in the clinics. The intention-to-treat analysis showed a more conservative weight loss. Participant retention at the end of 12 months was low (40%). The implementation of the DPP in different public clinics in Mexico was effective in the management of obesity in the short term, but better strategies are required to improve participant retention in the long term.

Introduction: Obesity is the main modifiable risk factor for the development of chronic diseases in Mexico. Several randomized controlled trials have shown that intensive lifestyle programs are efficacious for the management of obesity. These programs include frequent sessions (14 or more contacts in the first 6 months) focused on diet and physical activity and use a behavior change protocol. However, most Mexican primary care clinics and public hospitals apply traditional treatments for obesity management with limited results on weight loss. The purpose of the study is to evaluate the effectiveness of the Diabetes Prevention Program (DPP) “Group Lifestyle Balance” for weight loss among adults with overweight and obesity from baseline to 6 months and from baseline to 12 months in primary care clinics and public hospitals from Sonora, Mexico.Material and Methods: This is a translational, multi-center, non-controlled, 6 and 12-month follow-up clinical study with a pre-test and post-test design. Healthcare providers from two primary care clinics, two hospitals and one university clinic will be trained with the DPP protocol to implement on their patients with overweight and obesity. Body weight, body mass index, waist circumference, systolic and diastolic blood pressure, depression, quality of life and stress scales will be measured in participants receiving the program at baseline, 6 and 12 months. Biochemical parameters will be measured at baseline and 12 months. The primary outcome is the change in body weight at 6 and 12 months.Discussion: This study will provide scientific evidence of the effectiveness of the DPP protocol as a model for obesity management in real world clinical practice among the adult Mexican population.