The Mexican video “What did Poncho die of?”, aired on social media, tells a horrific cautionary tale.
The almost five-minute film purports to show the moment when a grossly overweight 12-year-old, Alfonso Rodríguez, known as Poncho, collapses in his school playground, the grainy black-and-white images captured by a security camera.
Poncho dies shortly afterwards in hospital. The film – interspersed with testimony from his parents, interviews with doctors and shots of a birthday party the day before at which he complained of feeling tired and appears breathless – concludes starkly: Poncho died of a heart attack caused by obesity.
The authenticity of the video could not be verified, but the message could not be more real: Mexico is grappling with an explosion in obesity, affecting children in particular. Indeed, the Latin American country has more obese children than anywhere else in the world.
A quarter of a century ago, two-thirds of Mexicans were of normal weight, according to official statistics. Now, about a third of the population is clinically obese, and more still are overweight – adding up to a supersized segment of adults second only to the US.
The explosion coincided with Mexicans’ embrace of US fast food alongside their beans and tortillas, plus less exercise – almost a third of children spend four hours a day in front of computer screens, for example – compounding a genetic propensity to accumulate fat, the state health service, IMSS, says.
Adult female obesity was found to have reached epidemic proportions in 1999. “We have to treat it as an epidemic,” says Dr Abelardo Avila, director of nutrition at the Salvador Zubirán National Institute of Medical Sciences and Nutrition in Mexico City. “If not, we’ll pay the consequences.”
He says more than 200,000 deaths a year in Mexico are linked to metabolic syndrome and 80,000 to diabetes, with obesity a key trigger.
Mexicans like to say they are sustained by “Protein T” – tortillas, tacos and tamales – and eating is a national pastime, with street vendors churning out fried, greasy or cheese-laden snacks seemingly on every street corner, usually washed down with a sugary drink.
But for the past year, the government of Enrique Peña Nieto has been exhorting Mexicans to “get checked up, get healthy, get moving” in a nationwide campaign.
Just in case the president’s encouragement is not enough, the government is also wielding a stick in the form of a tax introduced last year on junk food and fizzy drinks. The question remains whether that stick will prove big enough. The government reckons the tax will raise 15.3bn pesos ($1.14bn) next year, up from the 5.6bn pesos forecast for 2014.
Some Mexicans seem set in their ways. Alejandro López, who works in a shop selling snacks and salads, drinks three to four litres a day of Coke and the tax has not swayed him. “I’m not diabetic, even though everyone in my family died of diabetes,” he says, adding his weight hovers between 90kg and 110kg. “When I wake up, the first thing I do is drink Coke and I drink it all day.”
But many are waking up to the personal and public health benefits of slimming down. “It’s cheaper to educate people than to deal with the problems of being overweight causes, says Argenis Bastida, 31, who is about to start a diet to lose 35kg – he currently weighs 132kg.
“I am convinced we can beat obesity,” says Dr Javier Dávila, medical director for IMSS, which treats about 60 per cent of Mexico’s 119m people. “I am certain prevention and health promotion are the key.”
Nearly 6 per cent of IMSS patients aged under five are obese. That rate doubles among older children and teens. Roughly one in three adults is obese.
So are the campaigns working? Though IMSS statistics show slight rises in the child obesity rates, Dr Dávila says that is because more cases are showing up, as more people get health checks. The IMSS registered a rise of nearly 2m people getting preventive checks last year, compared with 2012.
Some studies suggest Mexicans are predisposed to obesity because of a gene that regulates how fats and sugars are absorbed, but doctors say this is in no way the cause of nationwide obesity.
However, two-thirds of Mexico’s poor are overweight or obese, and Dr Avila says there is a link between malnutrition as a child and becoming obese later. Because poor Mexicans have less access to healthcare, such a situation “ends up being catastrophic,” he says.
Ultimately, prevention is the only cure. Lucía Molina, who sells snacks on a street stall in Mexico City, has been on a diet for a month, aiming to lose 15kg. Her husband, who has to lose 12kg, is joining her. “It was hard at first,” the 32-year-old mother-of-two says.
“But I’m doing this for the children. Otherwise, they’ll end up like us.”
High-tech healthcare services being offered in Nuevo León
“Do you want to see our robot?” said Sebastian Viramontes looking intently across the table in the Zambrano Hellion Medical Centre lounge. The smartly-dressed hospital business director was not joking. Earlier this year the Zambrano Hellion Medical Centre, which is run by private university Tecnológico de Monterrey, acquired a BEAM robot (short for Biology, Electronics, Aesthetics, and Mechanics), allowing doctors to “beam” themselves into the hospital to treat patients, writes Amy Stillman.
The R2-D2-like machine zips around the emergency ward on wheels with a large screen that projects the doctor’s face. Equipped with cameras, microphones and speakers, physicians and patients can see and talk to one another through its interface. “Say you get a patient with gastritis that flares up at 3am,” says Dr Miguel Ángel Sanz, the chief medical officer at the Zambrano Hellion emergency unit. “You can treat them immediately without ever leaving your home. It’s a great comfort to the patients and makes our jobs easier.”
At a price tag of $20,000, the robot is unlikely to beam its way into the majority of less affluent Mexican hospitals soon. But it is a good indication of the increasingly high-tech healthcare services being offered in Mexico’s northern state of Nuevo León.
Healthcare in Nuevo León accounts for 5.4 per cent of the national gross domestic product, while the state’s overall contribution to Mexico’s GDP is 7.2 per cent. With a vast network of state-of-the-art hospitals and clinics, it is the only Mexican state capable of providing all types of transplants. Nuevo León has also made important advances in treating Mexico’s obesity epidemic, stabilising the high percentage of overweight and obese children in the state at 30 per cent over the past four years.
Nuevo León’s foray into telemedicine, which at the high end looks something like the BEAM robot, is also well-advanced. The state health department telemedicine programme, launched in 2000, was the first of its kind in the country – utilising a teleconferencing system through an agreement with Telmex, the Mexican telecommunications conglomerate, to deliver specialised healthcare services to remote areas. The project has grown quickly. It now covers 24 rural areas of Nuevo León, up from seven 14 years ago, and the goal is to include a further 36 areas in the next 12 months, says Dr Jesús Zacarías Villarreal, Nuevo León’s state health secretary.
Through the programme, rural patients can receive remote consultations from medical specialists in the state capital Monterrey without making the costly and time-consuming journey. A consultation through telemedicine costs the state government about 408 pesos ($30). This is less than 15 per cent of the price for a rural patient to receive a medical consultation in Monterrey, at 2,800 pesos including travel and meals.
The technology has had multiplier effects. “When we first launched telemedicine in Doctor Arroyo, the poorest municipality in Nuevo León, there were only four phones in the whole city,” says Dr Villarreal. “Now everyone has phones because we brought in Telmex, it’s exploded.”
Such medical advances in Nuevo León are in large part the result of the state’s early formation as a private healthcare hub. In the early 1940s its industrial and manufacturing business elite created their own private clinics for employees, filling a vacuum left by the non-existent state healthcare system. At the same time that Mexico was starting to introduce public healthcare, with the 1943 creation of the ministry of health and the Mexican social security institute (providing health insurance for formal workers), Nuevo León’s private clinics were already developing into world class medical centres.
The state’s higher education sector contributed to the advance. Universities such as Tecnológico de Monterrey and the Autonomous university of Nuevo León developed their own hospitals and medical research departments, with financing from organisations such as the national council of science and technology (Conacyt), the federal technology innovation fund.
Yet joining up Nuevo León’s private push with the slower-moving national healthcare system has proved to be challenging. A decade ago only half the Mexican population was covered by public health insurance because it was linked with formal employment. In 2004, the government introduced basic healthcare coverage for all Mexicans through seguro popular (“popular insurance”), reaching universal coverage in 2012. But the system remains patchy and the quality of healthcare provision varies greatly by state. Moreover, the gradual increase of patients has stretched resources and led to congestion at public hospitals.
One solution being tested in Nuevo León is the migration of publicly-insured patients to private hospitals for some procedures such as births and cataract surgery. “The metropolitan area of Nuevo León is growing fast, so to avoid overcrowding we have agreements with 12 private institutions to take our patients,” explains Dr Villarreal. “We’re convinced that the best way of managing healthcare in Mexico is to merge the public with the private.”
The federal government has also announced plans to invest $5.6bn in hospital infrastructure by 2018, and it is advancing healthcare education to rural communities through its mobile health programme Caravanas de Salud (“health caravans”).
Nuevo León is an exemplar of the project, with the number of towns reached rising from 30 to 124 in six years. It has also sought to bring its telemedicine programme to Caravanas de Salud, but less forward-thinking federal authorities have been unimpressed by the high expense.
As for the Zambrano Hellion robot, there are some limitations too, sniffs one of the more privileged doctors at the private hospital. “You still can’t access it on an app”.
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