Overweight and undernourished
Big business is getting Brazil and other developing nations hooked on junk food, and obesity follows
FORTALEZA, Brazil — Children’s squeals rang through the muggy morning air as a woman pushed a gleaming white cart along pitted, trash-strewn streets. She was making deliveries to some of the poorest households in this seaside city, bringing pudding, cookies and other packaged foods to customers on her sales route.
Celene da Silva, 29, is one of thousands of door-to-door vendors for Nestlé, helping the world’s largest packaged food conglomerate expand its reach into a quarter-million households in Brazil’s farthest-flung corners.
As she dropped off variety packs of Chandelle pudding, Kit-Kats and Mucilon infant cereal, there was something striking about her customers: Many were visibly overweight, even small children.
She gestured to a home along her route and shook her head, recalling how its patriarch, a morbidly obese man, died the previous week. “He ate a piece of cake and died in his sleep,” she said.
Da Silva, who herself weighs more than 200 pounds, recently discovered that she had high blood pressure, a condition she acknowledges is probably tied to her weakness for fried chicken and the Coca-Cola she drinks with every meal, breakfast included.
Nestlé’s direct-sales army in Brazil is part of a broader transformation of the food system that is delivering Western-style processed food and sugary drinks to the most isolated pockets of Latin
America, Africa and Asia. As their growth slows in the wealthiest countries, multinational food companies like Nestlé, PepsiCo and General Mills have been aggressively expanding their presence in developing nations.
A New York Times examination of corporate records, epidemiological studies and government reports — as well as interviews with scores of nutritionists and health experts around the world — reveals a sea change in the way food is produced, distributed and advertised across much of the globe. The shift, many public health experts say, is contributing to a new epidemic of diabetes and heart disease, chronic illnesses that are fed by soaring rates of obesity in places that struggled with hunger and malnutrition just a generation ago.
The new reality is captured by a single, stark fact: Across the world, more people are now obese than underweight. At the same time, scientists say, the growing availability of high-calorie, nutrient-poor foods is generating a new type of malnutrition, one in which a growing number of people are both overweight and undernourished.
“The prevailing story is that this is the best of all possible worlds — cheap food, widely available. If you don’t think about it too hard, it makes sense,” said Anthony Winson, who studies the political economics of nutrition at the University of Guelph in Ontario. A closer look, however, reveals a much different story, he said. “To put it in stark terms: The diet is killing us.”
Even critics of processed food acknowledge that there are multiple factors in the rise of obesity, including genetics, urbanization, growing incomes and more sedentary lives. Nestlé executives say their products have helped alleviate hunger, provided crucial nutrients, and that the company has squeezed salt, fat and sugar from thousands of items to make them healthier. But Sean Westcott, head of food research and development at Nestlé, conceded obesity has been an unexpected side effect of making inexpensive processed food more widely available.
“We didn’t expect what the impact would be,” he said.
Part of the problem, he added, is a natural tendency for people to overeat as they can afford more food. Nestlé, he said, strives to educate consumers about proper portion size.
The story is as much about economics as it is nutrition. As multinational companies push deeper into the developing world, they are transforming local agriculture, spurring farmers to abandon subsistence crops in favor of cash commodities like sugar cane, corn and soybeans — the building blocks for many industrial food products. It is this economic ecosystem that pulls in mom-andpop stores, big-box retailers, food manufacturers and distributors, and small vendors like da Silva.
The rising clout of big food companies also translates into political influence, stymieing public health officials seeking soda taxes or legislation aimed at curbing the health impacts of processed food.
“At a time when some of the growth is more subdued in established economies, I think that strong emerging-market posture is going to be a winning position,” Mark Schneider, chief executive of Nestlé, recently told investors. Developing markets now provide the company with 42 percent of its sales.
Industry defenders say that processed foods are essential to feed a growing, urbanizing world of people, many of them with rising incomes, demanding convenience.
“We’re not going to get rid of all factories and go back to growing all grain. It’s nonsense. It’s not going to work,” said Mike Gibney, a professor emeritus of food and health at University College Dublin and a consultant to Nestlé. “If I ask 100 Brazilian families to stop eating processed food, I have to ask myself: What will they eat? Who will feed them? How much will it cost?”
In many ways, Brazil is a microcosm of how growing incomes and government policies have led to longer, better lives and largely eradicated hunger. But now the country faces a stark new nutrition challenge: Over the last decade, the country’s obesity rate has nearly doubled to 20 percent, and the portion of people who are overweight has nearly tripled to 58 percent. Each year, 300,000 people are diagnosed with Type 2 diabetes, a condition with strong links to obesity.
Brazil also highlights the food industry’s political prowess. In 2010, a coalition of Brazilian food and beverage companies torpedoed a raft of measures that sought to limit junk food ads aimed at children. The latest challenge has come from the country’s president, Michel Temer, a business-friendly centrist whose conservative allies in Congress are now seeking to chip away at the handful of regulations and laws intended to encourage healthy eating.
“What we have is a war between two food systems, a traditional diet of real food once produced by the farmers around you and the producers of ultraprocessed food designed to be over-consumed and which in some cases are addictive,” said Carlos A. Monteiro, a professor of nutrition and public health at the University of São Paulo.
“It’s a war,” he said, “but one food system has disproportionately more power than the other.”
Da Silva reaches customers in Fortaleza’s slums, many of whom don’t have ready access to a supermarket. She champions the product she sells, exulting in the nutritional claims on the labels that boast of added vitamins and minerals.
“Everyone here knows that Nestlé products are good for you,” she said, gesturing to cans of Mucilon, the infant cereal whose label says it is “packed with calcium and niacin,” but also Nescau 2.0, a sugar-laden chocolate powder.
She became a Nestlé vendor two years ago, when her family of five was struggling to get by. Though her husband is still unemployed, things are looking up. With the $185 a month she earns selling Nestlé products, she was able to buy a new refrigerator, a television and a gas stove for the family’s three-room home.
Started a decade ago in Brazil, the program serves 700,000 “low-income consumers each month,” according to its website. Despite the country’s continuing economic crisis, the program has been growing 10 percent a year, according to Felipe Barbosa, a company supervisor.
Nestlé increasingly also portrays itself as a leader in its commitment to community and health. Two decades ago, it anointed itself a “nutrition health and wellness company.” Over the years, the company says it has reformulated nearly 9,000 products to reduce salt, sugar and fat.
Nestlé’s portfolio of foods is vast and different from that of some snack companies, which make little effort to focus on healthy offerings. They include Nesfit, a whole-grain cereal; lowfat yogurts like Molico that contain a relatively modest amount of sugar (6 grams); and a range of infant cereals, served with milk or water, that are fortified with vitamins, iron and probiotics.
Gibney, the nutritionist and Nestlé consultant, said the company deserved credit for reformulating healthier products.
But of the 800 products that Nestlé says are available through its vendors, da Silva says her customers are mostly interested in only about two dozen of them, virtually all sugar-sweetened items like Kit-Kats; Nestlé Greek Red Berry, a 3.5-ounce cup of yogurt with 17 grams of sugar; and Chandelle Pacoca, a peanutflavored pudding in a container the same size as the yogurt that
has 20 grams of sugar — nearly the entire World Health Organization’s recommended daily limit.
“On one hand, Nestlé is a global leader in water and infant formula and a lot of dairy products,” said Barry Popkin, professor of nutrition at the University of North Carolina. “On the other hand, they are going into the backwoods of Brazil and selling their candy.”
More than 1,000 miles south of Fortaleza, the effects of changing eating habits are evident at a brightly painted day care center
in São Paulo, Brazil’s largest city. Each day, more than a hundred children pack classrooms, singing the alphabet, playing and taking group naps.
When it was started in the early 1990s, the program, run by a Brazilian nonprofit group, had a straightforward mission: to alleviate undernutrition among children who were not getting enough to eat in the city’s most impoverished neighborhoods.
These days many of those who attend are noticeably pudgy and, the staff nutritionists note, some are worryingly short for their age, the result of diets heavy in salt, fat and sugar but lacking in the
nourishment needed for healthy development.
The program, run by the Center for Nutritional Recovery and Education, includes prediabetic 10-year-olds with dangerously fatty livers, adolescents with hypertension and toddlers so poorly nourished they have trouble walking.
“We are even getting babies, which is something we never saw before,” said Giuliano Giovanetti, who does outreach and communications for the center. “It’s a crisis for our society because we are producing a generation of children with impaired cognitive abilities who will not reach their full potential.”
Nearly 9 percent of Brazilian children were obese in 2015, more than a 270 percent increase since 1980, according to a recent study by the Institute for Health Metrics and Evaluation at the University of Washington. That puts it in striking distance of the United States, where 12.7 percent of children were obese in 2015.
The figures are even more alarming in the communities served by the center: In some neighborhoods, 30 percent of the children are obese and another 30 percent malnourished, according to the organization’s own data, which found that 6 percent of obese children were also malnourished.
The rising obesity rates are largely associated with improved economics, as families with increasing incomes embrace the convenience, status and flavors offered by packaged foods.
Busy parents ply their toddlers with instant noodles and frozen chicken nuggets, meals that are often accompanied by soda. Rice, beans, salad and grilled meats — building blocks of the traditional Brazilian diet — are falling by the wayside, studies have found.
Compounding the problem is the rampant street violence that keeps young children cooped up indoors.
At the São Paulo day care center, health care workers keep tabs on the children’s physical and cognitive development, while nutritionists teach parents how to prepare inexpensive, healthy meals.
Juliana Dellare Calia, 42, a nutritionist with the organization, put it bluntly: “Unlike cancer or other illnesses, this is a disability you can’t see.”
Celene da Silva, one of thousands of door-to-door vendors for Nestlé, and her daughter Sabrina make deliveries in May in Fortaleza, Brazil.
Nestlé products line the shelves of a pharmacy in Muana, Brazil, in July. Across the world, more people are now obese than underweight. At the same time, scientists say, the growing availability of high-calorie, nutrient-poor foods is generating a new...