Estrategias de prevención de la obesidad infantil en el primer nivel de atención: Una revisión de la efectividad y barreras de implementación

Denise Muñoz; Carlos María Gómez; Shirley Michelle Huang Liao; Pamela Mercedes Cousirat Guillén; Marcos Monges; Ruth Leiva; Sandra González

Autores/as

Denise Muñoz Hospital General de Itapúa, Encarnación, Paraguay Autor/a https://orcid.org/0009-0003-7551-2211
Carlos María Gómez Facultad de Ciencias Médicas, Universidad Privada del Este, filial Presidente Franco, Paraguay Autor/a https://orcid.org/0009-0006-9798-6567
Shirley Michelle Huang Liao Hospital General de Itapúa, Encarnación, Paraguay Autor/a https://orcid.org/0009-0006-9021-6711
Pamela Mercedes Cousirat Guillén Universidad Católica «Nuestra Señora de Asunción», Asunción, Paraguay Autor/a https://orcid.org/0009-0002-1444-0982
Marcos Monges Hospital General de Itapúa, Encarnación, Paraguay Autor/a https://orcid.org/0009-0006-3024-5094
Ruth Leiva Hospital General de Itapúa, Encarnación, Paraguay Autor/a https://orcid.org/0009-0001-4106-4284
Sandra González Facultad de Ciencias Médicas, Universidad Privada del Este, Ciudad del Este, Paraguay Autor/a https://orcid.org/0009-0003-9851-7867

Palabras clave:

obesidad pediátrica, atención primaria de salud, servicios de salud preventivos, intervención en el estilo de vida, relaciones médico-paciente, costo-efectividad

Resumen

Introducción: La obesidad infantil es un problema de salud pública crítico que requiere intervención temprana. Si bien la atención primaria de salud (APS) es el entorno ideal para la prevención durante la «ventana de oportunidad» de la primera infancia, existe una brecha significativa entre las guías clínicas y la práctica real. El objetivo de esta revisión fue analizar la efectividad de las intervenciones en APS para niños de 2 a 12 años e identificar las barreras para su implementación.

Métodos: Se realizó una revisión integrativa bajo el marco metodológico de Whittemore y Knafl. Se analizaron estudios publicados entre 2015 y 2025 provenientes de PubMed, Scopus y literatura gris, incluyendo ensayos clínicos, estudios cualitativos y análisis de costo-efectividad. Se excluyeron intervenciones exclusivamente escolares o farmacológicas.

Resultados: La evidencia confirma que las intervenciones tempranas son eficaces, pero sufren un «efecto de desvanecimiento» (fade-out) al llegar a la edad escolar si no hay refuerzo continuo. Mientras que las intervenciones escolares demostraron ser altamente costo-efectivas (aprox. $900/QALY), las intervenciones clínicas enfrentan barreras sistémicas (falta de tiempo, entrenamiento insuficiente) y relacionales (subestimación del peso por los padres) que perpetúan la inercia terapéutica. Los modelos más exitosos fueron aquellos que integraron componentes comunitarios y herramientas de mHealth.

Conclusiones: La prevención aislada en el consultorio es insuficiente. Se propone un cambio hacia un modelo híbrido donde el médico de APS actúa como «detector y conector», liderando el tamizaje de riesgo y coordinando la derivación a recursos comunitarios y escolares para asegurar la sostenibilidad del cambio conductual.

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