El Health Advisor como facilitador del cambio conductual en adultos con obesidad
Resumen
La obesidad es una condición crónica y multifactorial cuyo manejo exige intervenciones sostenidas que integren educación sanitaria, modificación del estilo de vida, autorregulación y seguimiento. Sin embargo, la formulación de recomendaciones clínicas no garantiza su incorporación estable a la vida cotidiana. Este estudio desarrolló un modelo conceptual y operativo del Health Advisor como facilitador del cambio conductual dentro de programas multidisciplinarios de salud metabólica. Se empleó investigación conceptual aplicada basada en la sistematización de experiencia profesional acumulada en atención comunitaria, educación preventiva, coordinación clínica, investigación en salud y health coaching, complementada con una síntesis narrativa de la literatura sobre obesidad, alfabetización en salud, adherencia, coaching y ciencias del comportamiento. Como resultado se desarrolló el Modelo de Acompañamiento Conductual en Salud Metabólica (MACSM), compuesto por cinco dimensiones: alfabetización sanitaria aplicada, construcción colaborativa de objetivos, autorregulación y retroalimentación, gestión de barreras y adherencia, y continuidad con coordinación clínica. El modelo establece funciones, indicadores de fidelidad, criterios de escalamiento y proposiciones contrastables. Se concluye que el Health Advisor puede conceptualizarse como facilitador de implementación conductual dentro de equipos interdisciplinarios, sin sustituir funciones diagnósticas, prescriptivas o terapéuticas correspondientes a profesionales clínicos habilitados.
Descargas
Citas
American Diabetes Association Professional Practice Committee. (2025a). 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of Care in Diabetes—2025. Diabetes Care, 48(Suppl. 1), S167–S180. https://doi.org/10.2337/dc25-S008
American Diabetes Association Professional Practice Committee. (2025b). 3. Prevention or delay of diabetes and associated comorbidities: Standards of Care in Diabetes—2025. Diabetes Care, 48(Suppl. 1), S50–S58. https://doi.org/10.2337/dc25-S003
American Diabetes Association Professional Practice Committee. (2025c). 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes—2025. Diabetes Care, 48(Suppl. 1), S86–S127. https://doi.org/10.2337/dc25-S005
Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman.
Berry, R., Kassavou, A., & Sutton, S. (2021). Does self-monitoring diet and physical activity behaviors using digital technology support adults with obesity or overweight to lose weight? A systematic literature review with meta-analysis. Obesity Reviews, 22(10), e13306. https://doi.org/10.1111/obr.13306
Boehmer, K. R., Álvarez-Villalobos, N. A., Barakat, S., de Leon-Gutierrez, H., Ruiz-Hernandez, F. G., Elizondo-Omaña, G. G., Vaquera-Alfaro, H., Ahn, S., Spencer-Bonilla, G., Gionfriddo, M. R., Millan-Alanis, J. M., Abdelrahim, M., Prokop, L. J., Murad, M. H., & Wang, Z. (2023). The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis. Patient Education and Counseling, 117, 107975. https://doi.org/10.1016/j.pec.2023.107975
Burgess, E., Hassmén, P., Welvaert, M., & Pumpa, K. L. (2017). Behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity: A systematic review and meta-analysis. Clinical Obesity, 7(2), 105–114. https://doi.org/10.1111/cob.12180
Carraça, E. V., Encantado, J., Battista, F., Beaulieu, K., Blundell, J. E., Busetto, L., van Baak, M., Dicker, D., Ermolao, A., Farpour-Lambert, N., Pramono, A., Woodward, E., Bellicha, A., & Oppert, J. M. (2021). Effective behavior change techniques to promote physical activity in adults with overweight or obesity: A systematic review and meta-analysis. Obesity Reviews, 22(Suppl. 4), e13258. https://doi.org/10.1111/obr.13258
Knowler, W. C., Barrett-Connor, E., Fowler, S. E., Hamman, R. F., Lachin, J. M., Walker, E. A., Nathan, D. M., & Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine, 346(6), 393–403. https://doi.org/10.1056/NEJMoa012512
Makin, H., Chisholm, A., Fallon, V., & Goodwin, L. (2021). Use of motivational interviewing in behavioural interventions among adults with obesity: A systematic review and meta-analysis. Clinical Obesity, 11(4), e12457. https://doi.org/10.1111/cob.12457
Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42. https://doi.org/10.1186/1748-5908-6-42
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
Patel, M. L., Wakayama, L. N., & Bennett, G. G. (2021). Self-monitoring via digital health in weight loss interventions: A systematic review among adults with overweight or obesity. Obesity, 29(3), 478–499. https://doi.org/10.1002/oby.23088
Pearson, E. S. (2012). Goal setting as a health behavior change strategy in overweight and obese adults: A systematic literature review examining intervention components. Patient Education and Counseling, 87(1), 32–42. https://doi.org/10.1016/j.pec.2011.07.018
Rubino, F., Puhl, R. M., Cummings, D. E., Eckel, R. H., Ryan, D. H., Mechanick, J. I., Nadglowski, J., Ramos Salas, X., Schauer, P. R., Twenefour, D., Apovian, C. M., Aronne, L. J., Batterham, R. L., Berthoud, H. R., Boza, C., Busetto, L., Dicker, D., De Groot, M., Eisenberg, D., … Dixon, J. B. (2020). Joint international consensus statement for ending stigma of obesity. Nature Medicine, 26(4), 485–497. https://doi.org/10.1038/s41591-020-0803-x
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. https://doi.org/10.1037/0003-066X.55.1.68
Sforzo, G. A., Kaye, M. P., Faber, A., & Moore, M. (2023). Dosing of health and wellness coaching for obesity and type 2 diabetes: Research synthesis to derive recommendations. American Journal of Lifestyle Medicine, 17(3), 374–385. https://doi.org/10.1177/15598276211073078
Sieczkowska, S. M., de Lima, A. P., Swinton, P. A., Dolan, E., Roschel, H., & Gualano, B. (2021). Health coaching strategies for weight loss: A systematic review and meta-analysis. Advances in Nutrition, 12(4), 1449–1460. https://doi.org/10.1093/advances/nmaa159
Upton, A., Spirou, D., Craig, M., Saul, N., Winmill, O., Hay, P., & Raman, J. (2025). Health literacy and obesity: A systematic scoping review. Obesity Reviews, 26(6), e13904. https://doi.org/10.1111/obr.13904
Wolever, R. Q., Simmons, L. A., Sforzo, G. A., Dill, D., Kaye, M., Bechard, E. M., Southard, M. E., Kennedy, M., Vosloo, J., & Yang, N. (2013). A systematic review of the literature on health and wellness coaching: Defining a key behavioral intervention in healthcare. Global Advances in Health and Medicine, 2(4), 38–57. https://doi.org/10.7453/gahmj.2013.042
Derechos de autor 2026 Carlos E. Cepeda
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
.png)
.png)
1.png)
