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Currently, in all regions of the world apart from Africa, more deaths are linked to non-communicable diseases (NCDs) than communicable diseases (WHO, 2010). Being overweight is a major contributory risk factor for NCDs such as high blood pressure, coronary heart disease and type II diabetes. Of the six WHO-designated regions, the Region of the Americas has the highest prevalence (>60%) of overweight adults (aged 20+ years). Mexico is no exception—the proportion of Mexican adults who are overweight or obese has increased from 61.8% in 2000 to 69.7% in 2006 to 71.2% in 2012.1 The prevalence of overweight and obese adolescents is, however, of even greater concern; for example, the prevalence of overweight and obesity among girls (12–19 years old) has grown rapidly in less than 30 years; in this period, the prevalence has more than tripled, rising from 11.1% in 1988 to 28.3% in 1999 to 33.4% in 2006, and is now standing at 35.8% in 2012.2 This situation sent strong alarm bells to the Government and Ministry of Health in Mexico as the prevalence of NCDs represents an important economic impact for families and countries. In 2008, medical expenditure on overweight and obesity in Mexico amounted to US$4.5 billion (∼0.5% of the gross domestic product).3

Following a detailed evaluation of successful ‘Community-based Interventions’ for adolescents involving sport, the Mexican Ministry of Health found that, in 2006, Fédération Internationale de Football Association (FIFA) recognised the unique role that football could play in the promotion of exercise and health behaviours to reduce the burden of NCDs through an initiative entitled ‘Football for Health’.4 The role that sport could play in combating NCDs was later reinforced by the International Olympic Committee.5 ,6 In 2009, FIFA began implementing the ‘FIFA 11 for Health’ programme in Africa.4 ,7 ,8

Implementing the ‘FIFA 11 for Health’ programme as a community-based intervention to tackle obesity and NCDs in Mexico offered many potential benefits: there are 22 million adolescents, many of whom are overweight or obese, a large financial burden on the universal public-health system and there is an opportunity for a positive collaboration with the Mexican Football Federation capable of providing access to huge and active numbers of football players and fans all around the country. An additional incentive was the enormous current popularity of football in Mexico as national teams had recently won the FIFA U-17 World Cup in 2011 and the 2012 Olympics Football Tournament. A collaborative group, consisting of the Mexico Ministries of Health and Education, Mexico Football Federation and FIFA, decided to implement the ‘FIFA 11 for Health’, Mexico first as a pilot study in three cities—Toluca, Puebla and Mexico City—supported by three professional football teams and coaches—Toluca, Puebla and Cruz Azul—to evaluate the logistics and resources within the country followed by a staged-nationwide implementation.

The ‘FIFA 11 for Health’ programme was specifically adapted for implementation with boys and girls within Mexican schools over an 11-week period. The programme consisted of 11 ‘Play football’ sessions: Passing, Heading, Dribbling, Shielding, Defending, Trapping, Building fitness, Shooting, Goalkeeping and Teamwork, with 11 complimentary ‘health messages’: Play football, Respect girls and women, Protect yourself from HIV and sexually transmitted diseases, Avoid drugs, alcohol and tobacco, Control your weight, Wash your hands, Drink clean water, Eat a balanced diet, Get vaccinated, Take your prescribed medication and Fair play. Each ‘health message’ is supported by an international football star: Chicharito (Mexico), Diego Forlan (Uruguay), Neymar (Brasil), Cristiano Ronaldo (Portugal), Samuel Eto'o (Cameroon), Carles Puyol (Spain), Marta (Brazil), Lionel Messi (Argentina), Didier Drogba (Ivory Coast), Gianluigi Buffon (Italy), Vicente del Bosque (Spain). The implementation methodology for the ‘FIFA 11 for Health’ programme was taught to 21 physical activity schoolteachers and nine football team coaches during a 5-day training course. These teachers and football coaches subsequently presented the programme to 842 high school first-grade children. The programme not only delivered increases in the children's knowledge on health issues and football skills, but also was loved by the children who recommended the programme to other children because of its fun and ease of participation.

After the successful pilot study in 2012, it was decided at the ministerial level to go ‘nationwide’ with the project in four phases, involving public and social institutions: Foundations (Fundación Mexicana para la Salud (FUNSALUD), Fundacion Rio Arronte, Fomento Banamex), Football Federation. The aim is to expand the implementation, from the 21 schools involved in the 2012 pilot study to a nationwide implementation of 32 135 public schools in 2015; from 21 physical activity teachers in 2012 to 22 141 teachers in 2015; from 840 children in 2012 to 2 173 406 children in 2015. The ‘FIFA 11 for Health’, Mexico project is an ambitious project that aims to reach the whole country, to share successful preventive interventions, to promote health and to tackle the problem of obesity and NCDs in Mexico.