Published On: November 3, 2017

Obesity and Prosperity

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Celene da Silva, who lives in Fortaleza, is one of the 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. Celene, who weighs more than 90 kilos, 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, unleashing a marketing juggernaut that is upending traditional diets from Brazil to Ghana to India.

Celene da Silva, rear, making her deliveries

Celene da Silva, rear, making her Nestlé deliveries

Across the world, more people are now obese than underweight. There is 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.

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 food is killing us.”

Nestlé products

Nestlé products

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, provide 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.

There are now more than 700 million obese people worldwide, 108 million of them children, according to research published recently in The New England Journal of Medicine. The prevalence of obesity has doubled in 73 countries since 1980, contributing to four million premature deaths, the study found.

Pepsi products

Pepsi products

For a growing number of nutritionists, the obesity epidemic is inextricably linked to the sales of packaged foods, which grew 25 percent worldwide from 2011 to 2016, compared with 10 percent in the United States, according to Euromonitor, a market research firm.

An even starker shift took place with carbonated soft drinks; sales in Latin America have doubled since 2000, overtaking sales in North America in 2013, the World Health Organization reported. The same trends are mirrored with fast food, which grew 30 percent worldwide from 2011 to 2016, compared with 21 percent in the United States.

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 II diabetes, a condition with strong links to obesity.

Fortaleza favela

Fortaleza favela

“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 ultra-processed 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.”

Celene da Silva reaches customers in Fortaleza’s favelas, 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 R$600 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 at the edge of a fetid tidal marsh.

Celene at home

Celene, rear, at home

Sagging incomes among poor and working-class Brazilians during the last two years of recession have been a boon for direct sales of Nestlé products. That’s because unlike most food retailers, Nestlé gives customers a full month to pay for their purchases. It also helps that saleswomen — the program employs only women — know when their customers receive Bolsa Família, a monthly government subsidy for low-income households.

But of the 800 products that Nestlé says are available through its vendors, Celene 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 cup of yogurt loaded with sugar; and Chandelle Pacoca, a peanut-flavored pudding that has 20 grams of sugar — nearly the entire World Health Organization’s recommended daily limit.

On the streets of Fortaleza, where Nestlé is admired for its Swiss pedigree and perceived high quality, negative sentiments about the company are rarely heard. The home of Joana D’arc de Vasconcellos, another vendor, is filled with Nestlé-branded stuffed animals and embossed certificates she earned at nutrition classes sponsored by Nestlé.

Joana D’arc de Vasconcellos with her daughter, Vittoria

Joana D’arc de Vasconcellos with her daughter, Vittoria

In her living room, pride of place is given to framed photographs of her children at age 2, each posed before a pyramid of empty Nestlé infant formula cans. As her son and daughter grew up, she switched to other Nestlé products for children: Nido Kinder, a toddler milk powder; Chocapic, a chocolate-flavored cereal; and the chocolate milk powder Nescau. “When he was a baby, my son didn’t like to eat — until I started giving him Nestlé foods,” she said proudly.

Joana has diabetes and high blood pressure. Her daughter, who is now 17 years old, weighs more than 110 kilos, has hypertension and polycystic ovary syndrome, a hormonal disorder strongly linked to obesity. Many other relatives have one or more ailments often associated with poor diets: her mother and two sisters (diabetes and hypertension), and her husband (hypertension.) Her father died three years ago after losing his feet to gangrene, a complication of diabetes. “Every time I go to the public health clinic, the line for diabetics is out the door,” she said. “You’d be hard-pressed to find a family here that doesn’t have it.”

Joana previously tried selling Tupperware and Avon products door to door, but many customers failed to pay. Six years ago, after a friend told her about Nestlé’s direct sales program, Ms. Vasconcellos jumped at the chance. She says her customers have never failed to pay her. “People have to eat,” she said.

Joana's proud pictures of her daughter

Joana’s proud pictures of her daughter as a baby

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. 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 pre-diabetic 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 close to the United States, where 12.7 percent of children were obese in 2015.

Children at the Center for Nutritional Recovery and Education with a dessert made from fruit

Children at the Center for Nutritional Recovery with a dessert made from fruit

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. “It’s just too dangerous to let my kids play outside, so they spend all their free time sitting on the couch playing video games and watching TV,” said Elaine Pereira dos Santos, the mother of two children, 9 and 4 years old, both overweight.

Like many Brazilian mothers, she was pleased when her son began to gain weight as a toddler, not long after he tasted his first McDonald’s French fry. “I always thought fatter is better when it comes to babies,” she said. She happily indulged his eating habits, which included frequent trips to fast-food outlets and almost no fruits and vegetables.products-splash

One of the fundamental challenges is persuading parents that their children are sick. “Unlike cancer or other illnesses, this is a disability you can’t see,” said Juliana Dellare Calia, a nutritionist. Although staff members say the program has made significant strides in changing the way families eat, many children will nonetheless face a lifelong battle with obesity. That’s because research suggests that childhood malnutrition can lead to permanent metabolic changes, reprogramming the body so that it more readily turns excess calories into body fat.

Even as nutrition experts fear the growing obesity crisis — and the potential long-term medical costs — one aspect of Brazil’s processed food revolution is undeniable – the industry’s expansion provides economic benefits to people up and down the ladder. Nestlé, which says it employs 21,000 people in Brazil, two years ago started an apprenticeship program that has trained 7,000 people under age 30.

Celene da Silva feels optimistic about the future despite her mounting health woes. Life has been a struggle since she dropped out of school at 14 when she became pregnant with her first child. Now she talks about fixing the missing teeth that mar her tentative smile and buying a proper home, one that does not leak during heavy rains. She has Nestlé to thank.

“For the first time in my life, I feel a sense of hope and independence,” she said. She is aware of the connection between her diet and her persistent health problems, but she insists that her children are well nourished, gesturing to the Nestlé products in her living room. With an expanding roster of customers, Celene has set her sights on a new goal, one she says will increase business even more. “I want to buy a bigger refrigerator.”


[This story originally appeared in The New York Times in slightly different form.]

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