Food, Culture, & Obesity in Latin America Dan Fenyvesi, MS, RD - - PowerPoint PPT Presentation

Food, Culture, & Obesity in Latin America

Dan Fenyvesi, MS, RD

If there were no health consequences, would you rather eat…

If there were no health consequences, would you rather eat…

If there were no health consequences, would you rather drink…

Lessons from Padre Ramos

Hierarchies

Nicaragua by the Numbers

— 6 million inhabitants — Ethnicity — 70% Mestizo — 16% White — 9% African heritage — 5% Indigenous — Average income is the equivalent

• f $5-10 (USD) per day

— 57% have at least a fifth-grade

education

Top Public Health Issues

— High infant death rate

—

Born underweight

—

Poor maternal health

—

Pregnancies in quick succession

— Endemic sickness (dengue, malaria, STDs) — Unsafe workplace conditions: toxic chemicals lead

to neurological problems; kidney, liver disease

— Mental health and alcoholism — Disabilities (violence, accidents) — Malnutrition and chronic disease/obesity

(cardiovascular, diabetes, and renal problems)

— Cancers

The Nutrition Transition in a Nutshell

— Currently over half

• f all Nicaraguans

are overweight or obese.

— For most of the 20th

century, over half of the Nicaraguan population was undernourished

2015 interview with a 25-year-old whose BMI was 28. What are the consequences of continued weight gain?

Nicaragua’s Four Dietary Stages

Diet Timeline Key Foods

1 Hunter- Gatherer From 20,000 BCE game, seafood, wild-gathered plants (grains, legumes, seeds, tubers) 2 Agricultural From 7,000 BCE–present beans, corn, vegetables 3 Processed Agricultural Mid-20th century–present white rice, vegetable oil, sugar 4 Modern Processed Urban: 1990s–present Rural: 2000s–present processed food and drink, and factory-farmed animal products

Modernization After World War II

— Land redistribution: Subsistence

farmers were moved to smaller plots of less-fertile land. The best land became large plantations focusing on export-

• riented agriculture.

— Beef, cotton, sugar, tobacco, chocolate,

and coffee were exchanged for foreign investment and money for modernization

Modernization After World War II

— Sugar, rice, and oil became widely available

and were promoted by the government and NGOs to meet calorie deficits.

Nicaragua’s traditional agrarian diet shifted to a processed agrarian diet in the space of 50 years.

Traditional agrarian meal (above) Processed agrarian meal (left)

Calorie Sources

• All beverages are sweetened in the processed diets
• The volume of food is similar in both diets but calories

are higher in the processed diet *animal products are eaten when available or when budget allows

Calorie Sources

Sample Traditional Agricultural Diet

Breakfast Egg, beans, tortillas, corn-based drink (pinol) Lunch Soup with squash, carrot,

• nion, beans, and meat*

Dinner Beans, tortillas, cabbage salad, mango, juice

Sample Processed Agricultural Diet

Breakfast Fried rice, beans, coffee, tortillas Lunch Fried rice, meat,* cheese,* juice, coffee Dinner Fried rice, beans, Tang, fried plantains, cabbage salad

Three Nicaraguan Diets at a Glance

Modern processed foods Instant noodles, hot dogs, pastries, candies, canned goods, sweet beverages, factory-farmed meat and dairy, etc. Processed agrarian foods White rice, sugar, oil Animal foods meat, fish, eggs, cheese Plant foods Beans, corn, plantains, vegetables, fruit

As the percentage of processed food increases, calorie density and overall calorie intake rise.

Whole-Foods Agrarian Diet of the Rural Poor Processed Agrarian Diet of the Rural Poor Modern Processed Diet of the Urban Poor

Concentration in Fuel Sources

Levels of increasing energy density

Fairly simple processing Industrial processing Millenia

• f human

selection

Raw plants Cooked plants Meat, dairy, and seafood Processed foods Pairs of roughly comparable fuel sources Same fuel source

Structure is Meaning

The Barrio Fritangas

The Barrio Fritangas

2015 Namlo Study

Overview Survey of 50 households in rural Nicaragua — More than 60% of calories come from oil, rice, and sugar — Deficiencies in vitamins A, B6, B12, E, and all the minerals — Deficiencies affect bone density, brain development;

are causes of cavities, anemia, growth stunting, and obesity —

Nutrients for brain development include protein, iron, zinc, selenium, iodine, folate, vitamin A, choline, EFAs

— Borderline protein deficiency

Incidence of overweight/obesity

(BMI of more than 25%)

Location % overweight El Quebracho 57% Las Palmas 44% La Labranza 37% Los Pinares 36% Barrio Nuevo 35% Macronutrient Processed Agrarian Traditional Agriculture Carbohydrate 57% 60-70% Protein 7% 10-15% Fat 36% 10-20% Differences in diet composition from traditional to modern

2015 Namlo Study

Overweight and Diet

Nuts and Seeds

A closer look

One ounce of almonds is about 22-25 nuts

Compare corn kernels and cashews. Per calorie, corn has the same amount of protein. All nuts and seeds are raw, one-ounce portions. Serving size calculated without inedible shells/hulls. Data comes from the USDA. 1 tortilla = 1.5 g 1 average ear = 3 g 1 cup = 4/5 g

These tables are derived from estimating the average dietary intake of the 200 study participants based on their 24-hour dietary recalls

Vitamin Percent of US RDA

A 18% B3 54% B5 81% B6 58% B12 23% D 4% E 68%

Mineral Percent US RDA

Calcium 18% Magnesium 73% Potassium 39% Selenium 57% Zinc 58%

2015 Namlo Study

Nutrition Deficiencies

Perceptions of Diet

Traditional

All food is good Food is fuel Food is all grown locally Diet is highly repetitive Fewer people are overweight, and being overweight carries status Love to eat but rarely discuss food Prepare all meals at home

Modern

Complex hierarchy of food (status) Food can be used as entertainment, status, drug Little (local) food production Diet is varied Being overweight is regarded negatively Food is heavily discussed Less cooking

Instant Gratification in Diet, in Finance

— Credit is not easily attainable in

Latin America

— Latinos arrive in the USA and are

• ffered credit cards, loans, variable

rate mortgages

— As with diet the long term

implications are often underestimated or misunderstood

— Differences in prices/quantities

(“Walmart” effect)

Common Health Beliefs

— Many see sickness and disease as fate. A common phrase

people use is “que Dios quiere” (“what God wants”)

— Few, including many doctors, understand the connection

between diet and disease.

— People find it hard to grasp problems caused by obesity,

finding the onset too gradual to connect and the future detriment too vague

— Excess food, especially after a legacy of deprivation,

is seen as exciting and a sign of high social status.

Is modern always better?

Sensory Budgets of Cultures

Hearing

Hearing

Taste

Taste Smell Smell Touch Touch Sight Sight

Nicaragua United States

Cycle of Exploitation

— Raw agricultural

products are exported

— Refined foods and

prescription drugs are imported

Addictive, cheap food Obesity and disease Need for treatment $$ dependence Stress of poverty and exploitation

Solutions

Nicaragua’s “Food Cob”

(dietary guidelines)

— Grains and legumes are the

base, and together with fruits and vegetables (“protectors”) should be eaten every day

— Meat and diary (“shapers”)

should be eaten three times per week)

— Fats and sweets (“energy”)

are to be eaten in moderation

Cooking Class

Breakfast, no frying: 357 calories Fried breakfast: 507 calories

Healthier Breakfast

Healthy Dessert

Easy-to-make, delicious banana ice cream

Nutrition Sports Club

Greenhouses

Chronic Disease Awareness

I was my own patient.

— 170 lbs. (5’6”) — Cholesterol: 230 — Waist: 35” — BMI: 28 — Knee pain, digestive problems — Low energy, high stress

2006

Tips for counseling Latino immigrants

— Consider status of food — Other cultures lack familiarity with impact of S.A.D. — Lack of familiarity with long term RX use/regimen — Newness to culture of recreational sports/activities

(particularly for adults)

— Vulnerability to marketing/health fads/diets/pills — Lack of distinction between titles, I.E. life coach vrs RD — All processed foods are very cheap in USA in comparison to

salaries and in particular…

— Animal foods are cheaper in the USA

Learn more…

Free on YouTube! Educators are using this to spark dialogue A Faustian Bargain

Obesity in Nicaragua/ Obesidad en Nicaragua

References

Prevalence of obesity, tobacco use, and alcohol consumption by socioeconomic status among six communities in Nicaragua. TS, Bert PJ, González M, Unruh M, Aragon A, Lacourt CT. Rev Panam Salud Publica. 2012;32(3):217–255. Childhood Obesity: CDC Childhood Obesity Prevention Fact Sheet, 2015. Atlanta, GA: Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion. “Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants” The Lancet, Volume 387 (2016): 1513-1530 National Center for Health Statistics. Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD; U.S. Department of Health and Human Services (2016): 271-272 Zhong et al. “Age and Sex Patterns of Drug Prescribing in a Defined American Population.” Mayo Clinic Proceedings. 88 (2013): 697–707 United States Agency for International Development Nutrition Assessment Sector for Nicaragua Managua, Nicaragua. May 14, 1976 http://pdf.usaid.gov/pdf_docs/PNAAF434.pdf

References

John Price, “Latin America’s Booming Pharma Industry Is A Local Affair,” Latin Trade, October 8, 2013. Darna L. Dufour, “Diet and nutritional status of Amerindians: a review of the literature.” Cadernos de Saúde Pública 7 (1991), 481-502. Hoebink, Paul. Sugar from Nicaragua. Nijmegen, Netherlands: Centre for International Development Issues Nijmegen, Radboud University www.ru.nl/publish/pages/.../nicaragua_sugar_report_-_final_version_02062014.pdf Dapi L.N., Omoloko C., Janlert U., Dahlgren L., Håglin L. “I eat to be happy, to be strong, and to live. Perceptions of rural and urban adolescents in Cameroon, Africa.” Journal of Nutrition Education Behavior; 39(6) 2007 Nov-Dec: 320-6. Trends in dietary patterns of Latin American populations. Bermudez OI, Tucker KL Cad Saude Publica. 2003;19 Suppl 1:S87-99. Epub 2003 Jul 21. http://www.ncbi.nlm.nih.gov/pubmed/12886439 The Nutrition Transition: Evidence from Nicaragua, Costa Rica, and Chile by Pawloski, Moore, Waters, Rojas Global Studies Review http://www.globality-gmu.net/archives/2158 Christiane Berth “Food Policy and Consumption in Nicaragua 1965-1995” Dialogues Electronic Journal of History, Volume 15 Number 1 February/August 2014