Since it was established in 1982, the Brazilian NGO Pastoral da Criança used weight to ascertain whether a child was unhealthy. Recently, that had to change when they started to see more and more obesity in poor communities. "As we started noticing some children were overweight, we had to change our practices entirely," says nutritionist Paula Pizzatto. "Now height and the BMI [body mass index] are also taken into consideration."
When Pastoral da Criança first started its work, malnutrition and lack of basic childcare were the cause of high infant mortality rates – 8.3% in 1980 (pdf). By engaging and training community leaders to carry out regular visits to local families, the organisation encouraged more breastfeeding and prenatal care. At the same time, the government's zero hunger programme took millions of Brazilians out of extreme poverty and more than halved (pdf) the rates of child mortality. According to the World Food Programme, hunger affects only 6.9% of Brazil's population now. However, these impressive statistics do not mean that most Brazilians are healthy. The last figures released by the health ministry show that 51% of country's population are overweight and one in three children age five to nine is overweight (pdf).
A cash transfer scheme known called Bolsa Família allowed many who were once excluded from the free market to become consumers. "Parents who were undernourished as children can now put a bottle of Coca-Cola on their tables. It is a matter of status. They feel proud," says Pizzato.
Companies quickly understood there was a market of new consumers to explore. Door-to-door selling of affordable products as well as tailor-made payment options allowed slum dwellers and remote communities to get food without travelling to the supermarket, so processed products became more accessible than fresh fruit and vegetables.
Most people in the poorest communities in Brazil are under-educated, making them more vulnerable to advertising. For instance, Nestle's floating supermarket navigates the Amazon with a powerful market campaign that claims to "offer access to nutrition, health and wellbeing to the remote community of the north region". But it mainly sells yoghurts, ice cream and chocolate.
"Quality of the food is now more of an issue than access to it," says Arnoldo de Campos, secretary for the National Secretariat for Food and Nutritional Security. "We still have a small fraction of people that don't have access to food, in isolated rural areas or indigenous communities, but the most serious problem now is obesity."
Pastoral's follow-up nutritional programme focuses on the first 1,000 days of life of the infant, including the time he or she is in the womb. Providing healthy nutrition during this first stage of life is essential to prevent both malnutrition and obesity. The programme is still new and has only been introduced in 23 of the 27 Brazilian states. "So far, we have nearly 13,000 children under the nutritional programme," says Pizzato. "Around 11% are overweight or obese and about 2% are undernourished." A lack of playgrounds in needy communities and national maternity leave of only four months, which means that babies cannot be breastfed exclusively for the first six months, contributes to the problem.
The full results of the nutritional programme haven't been published yet, but Pastoral is very aware of the challenges that lie ahead. "It is easier to introduce a new feeding habit when dealing with malnutrition, but it is definitely more difficult to correct existing ones, when the entire family is involved," said Pizzatto.
The government recognises the seriousness of the problem. In 2011, it created the Intersectoral Strategy for Control and Prevention of Obesity, which started, among other things, the promotion of health feeding habits in public schools. But despite all the efforts, combating obesity will be an arduous task.
"We have a poorly legislated production system which is addicted to bad-quality food and unregulated advertising practices," says de Campos. "For instance, the latest Coca-Cola slogan is 'open happiness', for a soft drink full of sugar. It is more difficult to tackle obesity than hunger."
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