PARANÁ, Brazil – The nation that has historically fought malnutrition now faces another challenge: the battle of the bulge.
About 30 years ago, 37% of Brazilian children were malnourished, according to a study by the International Food Policy Research Institute (IFPRI). The rate fell to 7% between 2006 and 2007, according to the IFPRI.
But while malnutrition has diminished, more Brazilians are becoming overweight.
In 2009, one out of three children between 5 and 9 years of age was over the weight recommended by the World Health Organization (WHO), according to the Household Expenditure Survey (POF, 2008-2009) by the Brazilian Institute of Geography and Statistics (IBGE) and the Ministry of Health.
The same trend is prevalent among adults, who have shown a continuous weight gain since 1974.
The percentage of men older than 20 who are overweight has almost tripled in the past 36 years – from 18.5% in 1974 to 50.1% in 2008-2009. Among women, it jumped from 28.7% to 48%.
And then there’s obesity.
For adults, overweight and obesity ranges are measured by using weight and height to calculate the “body mass index” (BMI). A person who has a BMI between 25 and 29 is considered overweight, with those having a BMI of at least 30 are determined to be obese, according to the U.S. Centers for Disease Control and Prevention.
Obesity has increased more than four times among overweight men – from 2.8% to 12.4% – and more than twice among women, from 8% to 16.9%.
Obesity among overweight adult women is higher than among men in all the country’s regions. The highest percentage was recorded in southern Brazil (19.6%), with the lowest rate (15.2%) found in the northern and northeastern regions.
Psychologist Luci Yoshie Koga, 45, fought overweight since childhood. She once carried as much as 118 kilograms (263 pounds) on her 5-feet, 4-inch frame, giving her a BMI of 45.1.
Six years ago, Koga, who lives in the city of Maringá, in the state of Paraná, underwent bariatric surgery, an operation that reduced the size of her stomach 95%.
“I lost 34 kilograms (75 pounds), but I know I can’t abuse [my diet],” she says. “I still only drink coffee with sweetener.”
Number of surgeries to reduce stomach size six times higher
In 2009, 30,000 bariatric surgeries were performed in Brazil – six times more than in 1999 – according to the Brazilian Society of Bariatric Surgery.
The procedure is recommended only for those whose obesity has put their life in jeopardy, says Ricardo Meirelles, the president of the Brazilian Society of Endocrinology and Metabology (SBEM).
The procedure is performed at public health system facilities, but there’s a long list of people wanting the surgery.
“More people die in the waiting list than on the surgical table,” says Meirelles, who recommends those who are overweight eat a healthier than undergo surgery. “Surgery should be done only as the last alternative.”
Obesity may be hereditary, but it also can be a consequence of poor eating habits and living a sedentary lifestyle, Meirelles says.
“That’s a cycle. Obesity is a cause and also may be a consequence,” said Koga, mentioning depression, anxiety and stress among other factors leading to weight gain.
Besides, obesity is considered a chronic disease and a risk factor to other diseases like diabetes, renal and circulatory problems, according to Meirelles.
In 2009, 24.4% of the adult population in Brazilian state capitals was diagnosed as hypertensive, and 5.8% as diabetic, according to the research Surveillance of Risk and Protective Factors for Chronic Diseases (Vigitel) by the Ministry of Health.
Type 2 diabetes increases among children
Households with a higher monthly income have a higher prevalence of overweight children, according to the POF 2008-2009. The survey shows 33.5% of the children from 5 to 9 are overweight, and 13.4% are obese.
“When the family has a higher income, there are other kinds of distractions at home,” Meirelles says. “They [the children] spend more time in front of a [TV or computer] than running on the street playing.”
Cases of type 2 diabetes among children also are more frequent. Meirelles said the disease is more common among 40-year-olds or older, obese adults.
“That’s worrying,” he says. “Because of weight gain, children have been developing the same type of diabetes as the adults.”
In the city of Presidente Prudente, in the state of São Paulo, a group of volunteers from São Paulo State University (Unesp) is fighting childhood and teenage obesity.
The Super-Ação (Super Action) project, which started nearly a decade ago, provides free treatment for children and teenagers who are overweight or obese.
A multi-disciplinary team of physicians, nutritionists, physical education teachers, psychologists and social assistants treats patients for five months. Patients learn healthy eating concepts and an exercise regimen that focuses on improving motor coordination and strength.
“With the program, they gain three kilograms (6.9 pounds) of lean muscle mass and lose four kilograms (8.8 pounds) of fat mass on average,” says Ismael Forte Freitas Júnior, Super-Ação’s coordinator.
The project started with 10 children. In 2010, enrollment reached 250, says Freitas Júnior, who is a physical education teacher.
But has it been successful?
Just ask Juliana Idakawa, 14.
“I began weighing 80 kilograms (176 pounds) and now I’m weighting 59 kilograms (130 pounds).”
Parents who have kids involved in the program become Super-Ação students once a month.
“After my daughter worked out, I couldn’t offer her an ice cream or a snack. I had to prepare a healthy meal,” says Juliana’s mother, Rosimeire Losano Pereira da Silva. “The lectures provided me good guidance.”
In southern Brazil, in the city of Maringá, Koga uses her creativity when preparing a healthy meal for her 15-year-old son Rafael. She’ll make a salad but serve it in the shape of a car or animal.
“We also created juices, with Rafael’s collaboration,” Lilian says. “Sometimes the juices were undrinkable, but it was very funny!”
Koga’s sister-in-law, Lilian, is taking steps to make sure her son, also named Rafael, doesn’t become overweight.
Lilian also has always encouraged her son to engage in physical fitness – from running after the dog to playing basketball and boxing.
“The secret is the family’s participation,” Lilian Koga says, adding she’s aware obesity runs in her family. “One for all and all for one!”
Public policies encourage balanced diet
Brazil was the first country to present concrete measures to regulate food advertising, according to the Pan American Health Organization (PAHO).
The Directors’ Collegiate Resolution (RDC) 24/2010 of the National Health Surveillance Agency (ANVISA) prohibits false advertising. It also monitors foods having high amounts of sugar, fat and sodium, and drinks containing low nutritional value.
In November, the Ministry of Health extended the Healthy Diet Forum, an agreement signed with the Brazilian Association of Food Industry (ABIA) to improve Brazilians’ diet, for three more years.
The Healthy Diet Forum, established in 2007, sets goals to reduce unsaturated fat, also known as trans fat. Studies by ABIA show that 230,000 tons of trans fat were vanished from supermarket shelves in 2009 compared to 2008. The next goal is to reduce sodium, sugar and saturated fat in the food produced nationwide.
Eduardo Augusto Fernandes, substitute coordinator of the Food and Nutrition Policy at the Ministry of Health, says controlling the food industry’s advertising is an important step in the fight against obesity. But even more important, he says, is to encourage the public to develop healthy eating habits.
“We’ve trained family health teams to guide the population and collect data like weight and height,” he says. “This information helps us to better define strategies for preventing and fighting obesity.”
Diet at school
But the fight against obesity doesn’t stop at home.
It’s continued in the school system, where officials are trying to stop students from becoming overweight.
The School Diet National Program, headed by the National Education Development Fund (FNDE), grants R$0.30 (US$0.17) per day to make the lunches healthier for students in kindergarten, elementary and high schools, as well as those enrolled in educational programs for young and adults at public institutions.
Day care centers and schools located in indigenous and communities of descendants of slaves receive R$0.60 (US$0.34).
The program forbids funds to be invested in drinks of low nutritional value, like soft drinks and artificial juices, or in canned food, sweets and frozen or concentrated food having a high amount of sodium or saturated fat.
The FNDE enforces the quality of the menu funded by the government.
But the government of Paraná is a step ahead. In July, it passed a groundbreaking law ordering all schools – public and private – to hire a nutritionist.
The aim is that all educational institutions in the state have a nutrition specialist through 2015 to work toward improving the nutritional quality of school lunches.
But the goal of the law extends beyond the menu. The aim is to make healthy food part of the curriculum, says Márcia Cristina Stolarski, a nutritionist and coordinator of School Diet and Nutrition at the Paraná’s Secretariat of Education.
“From the teachers to the women who prepare the meal, everyone has been trained to understand they’re part of an educational process,” she says.
In Paraná, school cafeterias are required to be healthful. Since 2005, the state legislation has prohibited the sales of food containing empty calories and drinks of low nutritional value, like soda.
But parents’ bad eating habits and the media tending to portray the consumption of junk food in a positive light makes convincing students to eat healthfully more challenging, Márcia Cristina says.
“That’s a work of behavior change that begins in the school,” she says. “Education should promote health.”