Overweight and obesity prevention in Mexico: An intersectionality-based policy analysis

Abstract

Excess weight (i.e., overweight and obesity) is higher among less educated groups, women, ethnic minorities, and in urban areas. Consistent with the intersectionality perspective, excess weight is more frequent in those who experience disadvantages in more than one area of inequity, e.g., women from a low social position. However, greater attention is paid to individual lifestyle factors, recommending behavioural lifestyle shifts rather than addressing social structural and intermediary determinants. Most public policies and interventions have focused on individual lifestyle components, despite evidence revealed that these interventions have a minimal impact and that it is necessary to move the field forward interventions on the contextual social determinants. Mexico is a unique scenario to analyze public policies and interventions to prevent excess weight from an intersectional perspective, given its concomitants features of high prevalence of excess weight (the second highest country in the world, with more than 75% of the adult population with overweight, including 36.1% of obesity), and high degree of social and gender inequality. Previous evidence in Mexico showed that interventions at the individual-level had little impact to prevent excess weight in lower social position groups. On the other hand, population-based strategies, such as the tax on sugar-sweetened beverages, appeared to be beneficial for all population groups, but especially for those at the bottom of the social hierarchy. Intersectionality has emerged as a highly regarded equity-informed tool for analyzing public policy. The Intersectionality-based Policy Analysis (IBPA) framework developed by Hankivsky (2014, https://pubmed.ncbi.nlm.nih.gov/25492385/) could contribute to identify and address multidimensional inequities and could lead to more effective and responsive policy decisions. The objective of this study is to analyze current nationally adult excess weight prevention public policies and interventions in Mexico, from an intersectionality perspective. Governmental websites, academic papers in English or Spanish, international and non-governmental organizations were searched for current strategies at the national level to prevent excess weight. Particular attention was paid to the current policies, interventions and actions to prevent adult obesity considered by the Global Obesity Observatory (https://data.worldobesity.org/). A total of 7 public policies and interventions were selected to develop a documental analysis (content analysis). First, the PROGRESS Plus framework was used to systematize the social axis of inequality mentioned in the public policy and intervention documents. PROGRESS is an acronym that aims to represent 8 dimensions of inequalities: place of residence, race/ethnicity, occupation, gender/sex, religion, education, socioeconomic status and social capital. Second, the selected documents were e analyzed through the IBPA framework. The questions of the IBPA framework have been adapted to the aims of this study, based on Kakar et al. (2021, https://www.sciencedirect.com/science/article/abs/pii/S0967070X20309276) research applying the IBPA framework for documental analysis. The selected documents were analyzed in order to disentangle to what extent they mention axes of social inequality, whether intersectionality is considered in framing the problem and or the potential solutions.