Today, people of all ages around the globe are immersed in a culture that intakes more energy than it can use. Mass media encourage children to eat foods that are dense in saturated fat, refined sugars, and salt [27]. Meanwhile, educational and health institutions promote healthy dietary habits and physical activity but fail to counteract the greater culture. The result is an obesity epidemic that has coined the term “Globesity” in an attempt to address both the causes of this epidemic and its severe and onerous consequences [28].
In this study, HOMA-IR changes were observed in obese children belonging to IG, this may be associated with a change in children’s nutritional status but mainly by changes in eating habits. Likewise, it has been observed that people who are obese and reduce their body weight improve their metabolic biomarkers and increase their insulin sensitivity [29, 30] . Programs encouraging healthy eating should be promoted among the population as a way of improving lipid profiles and preventing or reverting insulin resistance, as well as preventing chronic disease.
In the present, more than a third of children in Mexico of ages 5-11 and adolescents 12-19 are overweight and obese [9]. Hypothetically speaking, if they were all to seek help for their problem from health services, these institutions would be unable to cope. On the other hand, conditions are so limited that health workers often issue parents diets for their children and physical activity recommendations the way they would prescribe medication. This medical-style approach has not had the expected results. Modifying habits, in this case dietary habits, requires an educational process that involves mothers because they are largely in charge of household food practices [31, 32]. This educational intervention, where the mothers of obese children participated in a group, took place in a clinical setting, in a hospital, and not in homes. However, its messages sought to modify daily or routine feeding behaviors at home, in the micro system where obese children reside according to Bronfenbrenner’s ecological model [33], as opposed to having to prepare a menu as prescribed in the usual nutritional consultation, to which children would have to adhere to improve their health. The priority during education sessions was for mothers to identify behaviors that promoted greater energy intake either by quantity, density or frequency, to then modify their children's dietary habits and improve their nutritional status. The content provided at the sessions did not include information or activities for increasing physical activities that would promote energy output.
By the end of the study, there was an improvement in IG feeding behaviors, such as reducing portion sizes, avoiding full plates, not forcing children to finish their meals and accepting food substitutions. Both groups became less prone to putting salt and bottled soft drinks on the table, and reduced the habit of repeating servings, but without difference between groups. In terms of food consumption, the IG participants increased fruit and vegetable intake in their diets, a change that is key within the healthy diet model [19], while CG participants increased their consumption of grilled or shallow-fried foods.
Regarding beverages, IG participants decreased their intake of domestic and industrially-produced sweetened beverages, while CG participants only reduced their consumption of natural juice. A noteworthy observation is that neither group modified their water intake, which suggests that the information given to families highlighted the risk of sugary drinks to the health of obese children more than the benefit of simple water intake. Other studies conducted on school-aged children and their parents addressing a range of components including greater fruit, vegetable, and water intake have had positive impacts on children [34, 35].
In other noted behaviors, CG children became less prone to finishing their meal in under 30 minutes; the occurrence of IG children watching television at mealtimes decreased, which, as is known, encourages them to taste their food without distractions or subliminal messages from advertisers [27, 36].
After three months, aside from a decrease in BMI percentile that registered no difference between groups, changes in eating behaviors did not improve anthropometric indicators in children from either group. In a study conducted in a school setting in which parents and children attended 15 educational sessions promoting healthy eating and physical activity, as opposed to another group that only attended two sessions, participants in the group with the highest number of contacts improved their anthropometric indicators [37]. Other studies on children ages 4-12 that were conducted in homes over a one year-period achieved minimal changes in diet, physical activity, and body weight [38].
Among the weaknesses encountered during this study, the high desertion rate is the most relevant. Holding face-to-face sessions for mothers who live in large cities such as Mexico City can be complicated by distance, prolonged travel times, and transport costs. Another important consideration is the reduced size and scarcity of spaces for educational activities within health institutions. For these reasons, technological alternatives such as the internet and mobile phones must be explored as means of sending users relevant information and as a way of eliminating the need for mothers to travel to health clinics [39]. Also, parents who are less participative in these duties may become more engaged [40]. Another important consideration is that follow-up sessions and duration of contact between researchers and mothers was not enough to achieve the desired anthropometric objectives [17].
In regards to strengths, behavioral changes in IG children surrounding meals and food preparation can be considered relevant, along with a significant HOMA-IR index decrease which was significant between groups. Metabolic profiles in obese children have been found to improve with physical activity interventions that do not include dietary provisions [41]. In this study, which did not address physical activity, we found that modifying dietary habits can also achieve these benefits, possibly in a longer-lasting way.
Involving the mothers of obese children in group sessions where they are given information on how to modify dietary habits in the home micro system leads to beneficial health changes in their children, though more time is required to achieve effects on anthropometric measurements.