In recent decades, Mexico has gained notoriety as one of the countries most heavily afflicted by the global epidemic of obesity. Ranking second only to the United States in terms of prevalence, a full two-thirds of the adult Mexican population are nowadays classified as overweight or obese. “This is a crisis affecting not only individuals, but also the future financial viability of the national healthcare system, which bears enormous costs from related conditions like cardiovascular disease and diabetes,” warns Karla Alcazar, SVP and President LatAm at Eli Lilly.
To tackle this spiralling public health challenge, Mexico’s newly elected President Claudia Sheinbaum has already introduced a nationwide education campaign aiming to raise awareness about the dangers of obesity and its linkage to life-threatening chronic diseases such as hypertension and diabetes. To be implemented within schools, workplaces, and public spaces, the campaign shall focus upon reducing the consumption of unhealthy foods and promoting healthy lifestyle choices.
“The authorities have been undertaking serious efforts to address these issues at source and have co-opted both international organizations and the private sector to help promote preventative behaviours,” confirms Valney Suzuki, VP and general manager at Danish diabetes-focused specialty outfit, Novo Nordisk.
“That’s how we come to be involved in parnerships like our alliance with UN Children’s Fund (UNICEF) and the ‘Ciudades Más Saludables’ (Cities for Better Health) project in cities like Merida in Yucatan which aims to understand and mitigate the environmental factors contributing to obesity,” he adds.
Meanwhile, the incoming administration has given schools nationwide 6 months to implement a government-sponsored ban on junk food or face heavy fines in an attempt to get a grip on what many analysts fear might be the worst childhood obesity problem in the world.
According to UNICEF’s latest calculations, Mexico’s children register the highest consumption of junk food in Latin America with many deriving as much as 40 percent of their total caloric intake from it, while over 37 percent of the country’s school-age children can be designated overweight.
Companies like Lilly, however, identify a need to go even further. “For our part, we have been working hard to address the stigma and misconceptions around obesity as still too many stakeholders perceive the condition to be a lifestyle choice rather than the chronic disease that it is. While prevention is both necessary critical, it doesn’t on its own offer a complete or satisfactory solution and this needs to be properly understood,” affirms Alcazar.
“A multitude of factors – including genetics and environmental influences – contribute to its prevalence so many patients might diligently follow diets and exercise regularly yet still struggle to lose weight. We therefore require a paradigm shift in how we go about collectively managing this issue to drive meaningful change,” she argues.
“Tackling obesity is not just about the physicians or medical associations, nor solely the responsibility of pharmaceutical companies or governments,” adds Suzuki. “Every stakeholder in the healthcare system—across all countries—needs to take on a more proactive role. Without collective effort and increased awareness, we will not be able to change the dramatic situation we are facing with obesity.”
Holistic Approaches
When it comes to obesity related co-morbidities such as diabetes and cardiovascular disease, the profound impact on the state of Mexico’s public health profile becomes even more evident. “Diabetes has become a health emergency affecting an estimated 13 million, people a significant portion of whom still remain undiagnosed. As a progressive disease, early diagnosis and treatment is imperative and we encounter numerous cases of foot amputations, vision loss, and renal impairment every year as a direct consequence of late and sub-standard management of the condition,” recounts Rafael Quintanilla, director of Pharma and Biologics at Laboratorios Silanes, a local drug developer. “Indeed, diabetes complications now account for the highest proportion healthcare expenditure by the government,” he adds.
To try and turn around such a situation companies like Roche have been going all out to screen the most at-risk segments of the population. “We are adopting an end-to-end approach encompassing early diagnosis, treatment, and monitoring across cardiometabolic conditions including diabetes,” says Joao Carapeto, country manager at Roche Diagnostics. “Presently we are deploying a biomarker that can identify which patients with type 2 diabetes have a higher risk of developing heart failure. This saves lives and significantly reduces healthcare costs,” he reveals.
“Predictive medicine of this kind can be a real gamechanger in leveraging genetic insights to forecast potential health issues and tailor lifestyle recommendations accordingly,” agrees, Hector Valle, CEO of FUNSALUD, a leading Mexican think tank focused on improving public health through research, advocacy, and promoting public-private partnerships. “Moreover, this leads seamlessly into personalised, precision-targeted pharmaceutical choices that are customized based on individual genetic predispositions, thus likely to be far more effective both in terms of healthcare end outcomes and smart resource allocation,” he ventures.
When it comes to actual treatment, Big Pharma is understandably impatient to bring their latest and most-innovative therapies to market. “There’s been plenty of innovation in this space in recent years with more patient-centric therapies coming on stream that can increase adherence. It’s really that time Mexico moves away from the outdated approach of starting with older treatments and waiting too long to adopt newer, more effective options. Mexican patients deserve the best care from the outset,” argues Lilly’s Alcazar.
One example of an advanced treatment recently introduced is Roche’s treatment for alleviating diabetic macular edema. “We discovered that 30 to 36 percent of Mexican diabetics were developing some form of retinopathy to the detriment not only of the patients, but their caregivers and the country socio-economically as a whole. The great benefit of this therapy, which received local approval last year, is it allows greater spacing out of the doses meaning convenient, more efficient care, reduced stress for patients, and significantly less of a burden to the healthcare system,” affirms Roche Pharma’s General Manager, Monica Palomanes.
Iconic medtech outfit, Baxter Kidney Care/Vantive, meanwhile, has been deploying the latest generation, patient-centric renal technologies to transform the outlook of diabetes patients suffering from kidney complications. “As a result of Mexico’s elevated diabetes prevalence, an estimated 12 million people are left facing some level of renal impairment, with as many as 2,000 patients per million receiving dialysis, placing Mexico 3rd globally in the use of peritoneal dialysis, after the U.S. and China,” notes Carlos Escobar general manager for Mexico, Central America and the Caribbean at Baxter Kidney Care/Vantive.
“One of our main contributions has been to transition Mexican patients from manual peritoneal dialysis, which requires multiple daily sessions, to automated peritoneal dialysis. This system allows patients to perform dialysis while they sleep, freeing them to maintain much more normal routines during the day, thus massively improving the patient experience,” he describes.
Disease Management
Then there is the tricky issue of disease management. “We have to acknowledge that patients with diabetes require more than just pharmaceutical products; these form only part of the treatment. Strong emphasis must also be placed on ensuring that patients achieve their glucose level goals,” insists Silanes’ Quintanilla. He points out that a full “two-thirds of diagnosed and treated Mexican diabetes patients are currently failing to reach their necessary health goals through poor adherence and because they rely solely on medication without making associated lifestyle changes.”
For Gisela Ayala, executive director of the Mexican Diabetes Federation, the starting point to correcting this “has to be about educating patients and their families about their health rights and the importance of self-managing the condition.” “This awareness helps patients understand that they are entitled to proper care and treatment, which can embolden them to seek the support they need, as well as to take greater responsibility” she adds.
Gabriela Allard, president of the Mexican Diabetes Association (AMD) very much concurs. “Self-monitoring is not just for the doctor; it is for the patient to make informed decisions themselves and to know how to resolve acute problems. In this way, self-monitoring becomes an empowerment tool, enabling the patient to become more conscious about their health scenario and to take control,” she observes.
To facilitate this, Allard considers it beneficial to establish support communities by co-opting families and engaging civil organizations wherever possible. “Diabetes represents an especially complex condition because glucose can be affected by all manner of factors from diet and exercise to stress and hormones. It therefore requires a multi-layered management approach.”
It’s also why Novo Nordisk has rolled out a dedicated patient support program called ‘Nuevo Yo.’ “The idea is to accompany individuals along the way in eliciting the best day-to-day lifestyle choices and it even addresses the psychological and emotional aspects of managing a chronic disease,” explains Suzuki.
FUNSALUD’s Hector Valle agrees. “We believe that the most effective strategies for combatting health scourges of this kind will be participatory,” he declares. “Participatory, emphasizes equipping individuals to take a much more pro-active role in managing their own health, which includes fostering supportive group environments – where individuals with similar health challenges can share experiences and support each other – and mobilizing across the spectrum collective action.”
The Mexican Diabetes Federation has even gone as far as to mobilize the food industry in helping diabetes sufferers make the optimum nutrition choices. “While this collaboration has undoubtedly been controversial, we believe it’s essential,” says Ayala. “The food industry needs to understand what people with diabetes consume and why, and people with diabetes deserve higher-quality products. By engaging the private sector in this way, we strive to improve the availability of healthier options tailored to the needs of those managing diabetes,” she elaborates. “After all, our goal is to be seen not just as critics but as constructive partners, offering solutions and advocating for comprehensive diabetes management nationwide.”
Many also perceive digital health and telemedicine to be transformational in eliciting better day-to-day management of the disease. “The application of digital tools to this space has been fundamental, and its advancements have been spectacular,” believes the AMD’s Gabriela Allard. “Nowadays, it’s much easier to keep a glucose record. Technology allows glucose monitoring through sensors connected to the phone, facilitating decision-making and communication with the doctor. There are also glucose sensors that give us trends of hypoglycaemia or hyperglycaemia, sending alerts to act in time, which not only provides peace of mind to the person using it but also to their informal caregivers who are in charge or accompanying the process,” she details.
Silanes is exploring the development and implementation of a digital companion that could serve as a valuable resource for diabetes management. “This initiative is part of a global trend, and we are investing in it despite the obvious challenges. While we anticipate that it will take time to overcome barriers and fully integrate such tools into the Mexican healthcare landscape, we are convinced that it is worth persevering,” says Quintanilla.
Hector Orellana Vice President for North & Latin America at Medtronic concurs. “Mexico might only be ranked a lowly 39th globally for early technology adoption, but it is becoming increasing clear that disruptive digital innovation like telemedicine and remote monitoring offer tremendous potential outside traditional hospital settings, enhancing patient care and accessibility across the country, and can offer a real leap forward in countering some of the country’s most pressing public health challenges. We think it is only a matter of time before these solutions start getting real traction within the local market setting.”
“Presently, within our healthcare system, there is still no generalized access to self-monitoring. Many patients are forced to purchase their own glucose meters and test strips out of their own pockets. Moreover, large swathes of the population are not yet aware of these devices or financially able to afford them, making systematized self-care and proper glucose control difficult. This is the next big hurdle to cross,” concludes Allard.
