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1. The main limitation of the program is that it lacks sufficient performance assessment. •  While quantitative information as noted above is available, no information is

available on the long-term effectiveness of these information sessions or workout routines.

•  Moreover, while the “Muévete y Métete en Cintura” website highlights program participation figures, it never explains how “participation” is defined, nor does it give statistics on whether or not these participants adopted a healthier lifestyle after their involvement with the program.

2. A second limitation of the program is that it does not specifically target at-risk populations. •  Involvement was by individuals who voluntarily decided to attend community

workshops and events. •  This “friendly” approach of inviting community members to program events is likely

to appeal most to people who already pay attention to their health and weight, while those who are in poor health or who are overweight or obese may avoid these events out of shame, embarrassment, or laziness.

•  Another concern regarding the program is its timing of group events and information sessions.

•  Because many of the program’s events take place outside, they are usually held during the day, when many adults are at work.

•  Though the program holds many events on weekends, those who are poorest (and statistically at the highest risk for overweight and obesity) are likely to need to work on weekends to support themselves and, are therefore unable to attend program events (Food Research and Action Center, 2010).

•  According to the Organization for Economic Cooperation and Development (OECD), in 2010, approximately 69.5% of Mexican citizens aged 15 years and older were either overweight or obese (Romo, 2011).

•  This number marks a tripling in the rates of overweight and obesity in Mexico since 1980; a sharp incline that has alarmed public health officials as well Mexican President Felipe Calderon (Romo, 2011).

•  These elevated rates pose a major public health concern because overweight and obesity are key risk factors for diabetes mellitus, cardiovascular disease, cancer, infertility, respiratory disease, musculoskeletal disorders, depression and psychological disorders, as well as other medical conditions (Harvard School Public Health, 2012).

•  To address this issue, the Mexico City Government created “Muévete y Métete en Cintura” (“Move It and Get in Shape”), a program implemented in November 2008 to address the high rates of overweight and obesity in Mexico.

•  “Muévete y Métete en Cintura” targets children and adults living in Mexico City and surrounding areas, and is still going on at the present time.

•  Primarily an awareness campaign, “Muévete y Métete en Cintura” sponsors information sessions, rallies, group exercise events, and an online discussion forum, all of which promote “healthy lifestyle decisions,” including eating a balanced and nutritious diet, exercising regularly, and incorporating more physical activity into the lives of children and adults.

BACKGROUND0

•  Because most of the literature on the campaign focuses on the types of events and services delivered by the program, it is difficult to find data on the effectiveness of “Muévete y Métete en Cintura”.

•  However, some data exist on the campaign’s outreach. •  According to the Mexico City government, the program reached a total of 1.5 million

participants in 2011. (PMFARMA, 2011). •  It is also reported that in September 2012, approximately 34,000 physical activity

workshops had been held, and more than 641,000 health education pamphlets and educational materials had been distributed at campaign events and rallies. (Noticieros Televiso, 2012).

•  In addition, 241,000 people attended an estimated 30,000 nutrition education sessions, and 110,000 employers implemented one or more of the health tips recommended by the program. (Carrasco, 2011; Noticieros Televiso, 2012).

RESULTS0

•  The official goal of the program was “to create a social movement organized to promote healthy lifestyles “that reduce the prevalence of overweight and obesity in the general population, through healthier eating and more physical activity” (No a la Obesidad, 2011).

•  Some of the “healthy lifestyle decisions” promoted by the program included eating a nutritious and balanced diet, cutting back on soft drink consumption, and incorporating more physical activity and regular exercise into the lives of children and adults (Salud D.F., 2012).

•  Because the program was developed for Mexico City, the majority of its workshops, rallies, and events were held at parks and public facilities in the city and its surrounding areas.

•  At these events, program directors dispensed pamphlets and promotional fliers about healthy eating and nutrition, and also offered free body mass index (BMI) and waist-to-hip ratio screening.

•  Those who were found to be at-risk for obesity were referred to nearby health clinics to seek help getting back to a healthy weight.

•  A final component of program was exercise promotion; program volunteers and staff led participants in group exercise activities and presented ways to be more active in daily life.

•  The daily life interventions were broken down into six “get moving” categories, each with specific tips for incorporating more exercise into one’s daily life.

•  The purpose of these six intervention categories was to provide interventions designed for the various strategies to employ where daily life is fulfilled or affected: city, park, office, school, everyday life, health.

•  The program’s website, entitled “No a la Obesidad” (“No to Obesity”) features these six categories and strategies for achieving each of them.

•  The online community also offers free workout plans and videos, healthy meal plans and recipes, dietary guidelines and weight loss tips, and a discussion forum for participants.

METHODS0

CONCLUSIONS0

•  Though the goals of the campaign “Muévete y Métete en Cintura” are clearly defined and well-intentioned, the program is weakened by its lack of progress assessment and evaluation.

•  Furthermore, the program inefficiently targets the overweight and obese populations of Mexico City; its broad approach to health promotion is not fully accessible to those who need it most.

•  To become a more effective and successful campaign, focus must shift from the program’s efforts and outreach to its results and long-term health impacts.

•  The program design must be altered to better serve populations at-risk for the adverse health effects of overweight and obesity.

•  The current program model conflicts with the social determinants of health framework because the program design is inconsiderate of its target audience and does not take into account the lifestyle and work commitments of the groups who would most benefit from its interventions.

•  To better target populations at-risk for overweight and obesity, the program directors should schedule more workshops, information sessions, and rallies in the evenings so that people who are working during the day are able to attend.

•  In addition, the program could make itself more appealing to overweight and obese citizens by holding separate workout sessions and BMI screening for those who already know they want to lose weight, since overweight individuals may feel self-conscious participating in physical activity alongside fitter individuals.

•  If better program assessment and documentation of results of this program could be employed, it would be feasible to expand the program to a national level.

REFERENCES0Carrasco, S. (2011). El Universal: Miguel Hidalgo se suma a "Muévete y Métete en Cintura". Retrieved from

http://www.eluniversaldf.mx/miguelhidalgo/nota29966.html.   Food Research and Action Center. (2010). Relationship Between Poverty and Overweight or Obesity. Retrieved

from http://frac.org/initiatives/hunger-and-obesity/are-low-income-people-at-greater-risk-for-overweight-or-obesity/

Harvard School of Public Health. (2012). The Obesity Prevention Source: Health Risks. Retrieved from http://

www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/health-effects/#health-consequences.

  No a la Obesidad. (2011).Campaña Muévete y Métete en Cintura. Retrieved from http://

www.noalaobesidad.df.gob.mx/index.php?option=com_content&view=article&id =70&Itemid=55.   Noticieros Televisa. (2012). Celebra GDF cuatro años de “Muevete y Metete en Cintura”. Retrieved from http://

noticierostelevisa.esmas.com/df/505506/celebra-gdf-cuatro-anos-muevete-y-metete-cintura/.   PMFARMA (Portal Iberoamericano de Marketing Farmacuetico). (2011). "Muévete y Métete en Cintura" ha activado

a millón y medio de personas. Retrieved from http://www.pmf arma.com.mx/noticias/6106-muevete-y-metete-en-cintura-ha-activado-a-millon-y-medio-de-personas.html.

  Romo, R. (2011) Mexico’s Other Enemy: Obesity Rates Triple in Last 3 Decades. Retrieved from http://

articles.cnn.com/2011-01-04/world/mexico.obesity_1_obesity-rates-obese-people-junk-food?_s=PM:WORLD.   Salud D.F.: Portal Ciudadano del Gobierno del Distrito Federal. (2012). Programa Muévete y Métete en Cintura.

Retrieved from http://www.salud.df.gob.mx/ssdf/index.php? option=com _content&task=view&id=4049. IMAGE/LOGO CITATIONS: City Wide Bicycle Event. Digital image. Noticieros Televisa. N.p., 29 Sept. 2012. Web. 24 Mar. 2013. http://noticierostelevisa.esmas.com/df/

505506/celebra-gdf-cuatro-anos-muevete-y-metete-cintura/. Muévete en la Oficina. Digital image. LatinoCalifornia. N.p., 23 May 2012. Web. 13 Apr. 2013. http://latinocalifornia.com/home/2012/05/

muevete-y-metete-en-cintura-baja-de-peso-en-la-casa-del-d-f/. Muévete Y Métete en Cintura Image, No a la Obesidad Logo,& School Nurse Image. Digital image. No a La Obesidad. Secretary of Health of

Mexico D.F., n.d. Web. Muévete y Métete en Cintura Logo. Digital image. Noticias Sobre Ciudad Juárez. N.p., n.d. Web. <http://ciudadjuarezaqui.wordpress.com/

2012/12/07/inculcan-habito-del-ejercicio-entre-alumnos-juarenses-de-nivel-basico/activacion-fisica/>. Muévete y Métete en Cintura Rally. Digital image. Memoria Presente. N.p., n.d. Web. http://memorianarrativa.blogspot.com/2011/09/

aniversario-muevete-y-metete-en-cintura.html. Secretary of Public Health of Mexico D.F. Digital image. Muévete Y Métete En Cintura En La Oficina. N.p., n.d. Web. <http://

vpn.salud.df.gob.mx:88/muevete/>. UCLA Logo. Digital image. UCLA Graphic Identity Program. Regents of the University of California, n.d. Web. Waist-to-hip ratio measurement. Digital image. The Health Risks of Obesity and Being Overweight. Whitehouse Pharmacy, n.d. Web.

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GeCng0People0Moving0in0Mexico0City:0A0Program0Analysis0

“Muévete y Métete en Cintura” program logo

The image on the left shows a medical professional measuring a patient to determine his waist-to-hip ratio. The two images on the right are logos associated with the “Muévete y Métete en Cintura” campaign and “No a la Obesidad” online community.

The image on the left shows a school nurse measuring the height and weight of a young student to calculate her BMI (body mass index). The image on the right shows an example of a rally sponsored by the program promoting healthy eating habits and physical activity.

This image shows a city-wide exercise promotion event, a bicycle race through one of the main streets of the capital.

This image shows an example of a workplace in Mexico City that is participating in the “Get Moving in the Office” (“Muévete en la Oficina”) intervention.

LIMITATIONS0OF0PROGRAM0

Mexico D.F. Public Health Services logo, Sponsor of “Muévete y Métete en Cintura” program