title: Opportunities to Strengthen Childhood Obesity Prevention in Two Mexican Health Care Settings.
abstract: 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.
authors.affiliation: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 US.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cespedes
authors.affiliation: Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Edificio anexo a la farmacia 3er Piso. Cuauhtémoc 330, Col. Doctores. Del. Cuauhtémoc. CP 06720, México D.F., 525-5627-6900.
authors.forename: Gloria Oliva Martínez
authors.initials: GO
authors.lastname: Andrade
authors.affiliation: Centre for Health Systems Research, National Institute of Public Health; Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, México CP 62100.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Rodríguez-Oliveros
authors.affiliation: Division of Social Protection and Health. Inter-American Development Bank. Ave. Paseo de la Reforma 222, Juárez. Mexico DF 10200 Mexico. Phone +52 55 51412496.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Perez-Cuevas
authors.affiliation: Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Edificio anexo a la farmacia 3er Piso. Cuauhtémoc 330, Col. Doctores. Del. Cuauhtémoc. CP 06720, México D.F., 525-5627-6900.
authors.forename: Marco A
authors.initials: MA
authors.lastname: González-Unzaga
authors.affiliation: Community Health Department. Hospital Infantil de México Federico Gómez; Doctor Márquez 162 Doctores, Cuauhtémoc, 06720 Mexico, D.F.;
authors.forename: Amalia Benitez
authors.initials: AB
authors.lastname: Trejo
authors.affiliation: Department of Family Relations and Applied Nutrition, Room 226, Macdonald Stewart Hall, University of Guelph, 50 Stone Road East, Guelph, Ontario, Canada N1G 2W1, , ext 53780.
authors.forename: Jess
authors.initials: J
authors.lastname: Haines
authors.affiliation: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 US.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.affiliation: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 US.
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
keywords: Mexico; behavior; childhood obesity; clinical settings; pediatric; qualitative research