Over­weight and un­der­nour­ished

Big busi­ness is get­ting Brazil and other de­vel­op­ing na­tions hooked on junk food, and obe­sity fol­lows

Santa Fe New Mexican - - FRONT PAGE - By An­drew Ja­cobs and Matt Rich­tel

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.”

Door-to-door de­liv­ery

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.”

Ir­re­sistible foods

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.”

WIL­LIAM DANIELS/THE NEW YORK TIMES

Ce­lene da Silva, one of thou­sands of door-to-door ven­dors for Nestlé, and her daugh­ter Sab­rina make de­liv­er­ies in May in Fortaleza, Brazil.

WIL­LIAM DANIELS/THE NEW YORK TIMES

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 type of mal­nu­tri­tion, one in which more people are both over­weight and un­der­nour­ished.

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