University of North Carolina, Chapel Hill, Estados Unidos de América
Introduction/objectives: To describe the major research gaps as related to prevention of childhood obesity in Latin America. Development: We focus on some unique research challenges in Latin America and propose a research agenda tailored to needs and opportunities for guiding progress in obesity prevention and control in the Latin America region. (We do not address obesity treatment, which in itself is another major global issue.) We address these needs in relation to five major clusters: (1) the growth process and lifecycle and within this the relative importance of food, beverage, and activity patterns specific to this region; (2) the major direct and underlying drivers of dietary and physical activity/inactivity patterns including current food and physical activity environments; (3) the quality of current surveillance and measurement and the major gaps; (4) the efficacious interventions for behavioral change; and (5) the policy arena, the current options underway and their evaluation and potential future options. In so doing, we intend to signal adequate windows of research opportunity to contribute to broader, evidencebased childhood obesity prevention in Latin America, an approach that will require both cross-disciplinary research and renewed innovative capacity building efforts in the region and the connection of evidence (research) to policy and practice. First, Latin America is further along the nutritional transition than other LMIC regions, having reduced undernutrition with a few exceptions, and now facing high levels of overweight, obesity, and related NCDs in most countries. Many Latin American children are getting taller, but they are also becoming fatter, simultaneous shifts that have been well documented in population-wide profiles in that include both distributions of height (length)-for-age and weight relative to height (length). The existence of, transition to, and prevention of current double or triple burdens of malnutrition, as well as their determinants, have important research and programmatic implications, and suggest a need to move from targeted projects focused directly on under-nutrition mainly during the first 1000 days of life to more population-wide programs focusing more broadly on diet quality and activity throughout the life course as they relate to obesity prevention and health promotion. A second and related distinguishing factor for the Latin American region is that the region has faced, earlier than other regions and at higher velocities, major international migration to the United States and internal urbanization. This rapid urbanization- which has been accompanied by the significant entry of major processed, packaged food and beverage companies, increased “fast” and processed food availability, a decrease in fresh food availability, and a lack of space for physical activity- has negatively impacted the health and weight of populations. A third unique characteristic of Latin America is the stronger collective nature of government policies adopted to control obesity. The Latin American region has emerged as a leader in addressing environmental factors that impact diet and activity patterns; however, rigorous evaluations of many major initiatives (e.g., Brazilian school feeding changes, ciclovia) are lacking and all the new large-scale regulatory initiatives require serious evaluations. A fourth characteristic that is not unique to the region, but is worthy of mention, is that Latin America is not comprised of a homogenous ethnic group. Conclusions: Latin America possesses strong research groups, but there are major gaps in the research as it relates to obesity and its key determinants and options for prevention. Key gaps exist in many countries on dietary and physical activity patterns and trends. Across the region for various age-gender-race-ethnic subpopulations there is a lack of understand of key diet and activity pattern determinants as well as minimal rigorous evaluation of many large-scale regulatory interventions for which the region is a global leader. Key words: child obesity, food system, diet, physical activity, research gaps.