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Food, Culture, & Obesity in Latin America Dan Fenyvesi, MS, RD

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Page 1: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Food, Culture, & Obesity in Latin

America

Dan Fenyvesi, MS, RD

Page 2: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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

Page 3: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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

Page 4: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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

Page 5: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Lessons from Padre Ramos

Page 6: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished
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Hierarchies

Page 8: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Nicaragua by the Numbers� 6 million inhabitants

� Ethnicity� 70% Mestizo� 16% White� 9% African heritage� 5% Indigenous

� Average income is the equivalentof $5-10 (USD) per day

� 57% have at least a fifth-grade education

Page 9: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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

Page 10: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

The Nutrition Transition in a Nutshell� Currently over half

of all Nicaraguansare 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?

Page 11: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Nicaragua’s Four Dietary StagesDiet 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–presentRural: 2000s–present

processed food and drink, and factory-farmed animal products

Page 12: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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-oriented agriculture.

� Beef, cotton, sugar, tobacco, chocolate, and coffee were exchanged for foreign investment and money for modernization

Page 13: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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 dietin the space of 50 years.

Page 14: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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

Calorie Sources

Page 15: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

• 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 SourcesSample Traditional Agricultural DietBreakfast Egg, beans, tortillas,

corn-based drink (pinol)Lunch Soup with squash, carrot,

onion, beans, and meat*Dinner Beans, tortillas, cabbage

salad, mango, juice

Sample Processed Agricultural DietBreakfast Fried rice, beans, coffee,

tortillasLunch Fried rice, meat,* cheese,*

juice, coffeeDinner Fried rice, beans, Tang, fried

plantains, cabbage salad

Page 16: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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 foodsmeat, 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-FoodsAgrarian Diet of the Rural Poor

ProcessedAgrarian Diet of the Rural Poor

Modern ProcessedDiet of theUrban Poor

Page 17: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Concentration in Fuel Sources

Levels of increasing energy density

Fairly simpleprocessing

Industrialprocessing

Milleniaof human selection

Raw plants Cooked plants Meat, dairy, and seafood Processed foods

Pairs of roughly comparable fuel sources

Same fuel source

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Structure is Meaning

Page 19: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

The BarrioFritangas

Page 20: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

The Barrio Fritangas

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2015 Namlo StudyOverview

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

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Incidence of overweight/obesity (BMI of more than 25%)

Location % overweightEl Quebracho 57%Las Palmas 44% La Labranza 37%Los Pinares 36%Barrio Nuevo 35%

MacronutrientProcessedAgrarian

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

Page 28: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Nuts and SeedsA 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 g1 cup = 4/5 g

Page 29: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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 StudyNutrition Deficiencies

Page 30: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Perceptions of DietTraditional

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

Page 31: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Instant Gratification in Diet, in Finance � Credit is not easily attainable in

Latin America � Latinos arrive in the USA and are

offered credit cards, loans, variable rate mortgages

� As with diet the long term implications are often underestimated or misunderstood

� Differences in prices/quantities (“Walmart” effect)

Page 32: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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.

Page 33: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Is modern always better?

Page 34: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished
Page 35: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Sensory Budgets of Cultures

Hearing

Hearing

Taste

Taste Smell

Smell

Touch

Touch

Sight

Sight

Nicaragua United States

Page 36: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Cycle of Exploitation

� Raw agricultural products areexported

� Refined foods and prescription drugs are imported

Addictive,cheap food

Obesityand disease

Need for treatment

$$ dependence

Stress of poverty and exploitation

Page 37: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Solutions

Page 38: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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 timesper week)

� Fats and sweets (“energy”) are to be eaten in moderation

Page 39: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Cooking Class

Page 40: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Breakfast, no frying:

357 calories

Fried breakfast: 507 calories

Healthier Breakfast

Page 41: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Healthy Dessert

Easy-to-make, delicious banana ice cream

Page 42: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Nutrition Sports Club

Page 43: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Greenhouses

Page 44: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Chronic Disease Awareness

Page 45: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

I was my own patient. � 170 lbs. (5’6”)� Cholesterol: 230� Waist: 35”� BMI: 28� Knee pain, digestive problems� Low energy, high stress

2006

Page 46: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

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

Page 47: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

Learn more…

Free on YouTube!

Educators are usingthis to spark dialogue

A Faustian Bargain Obesity in Nicaragua/

Obesidad en Nicaragua

Page 48: Food, Culture, & Obesity in Latin America · 9/21/2018  · Unsafe workplace conditions: ... For most of the 20th century, over half of the Nicaraguan population was undernourished

ReferencesPrevalence 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

http://pdf.usaid.gov/pdf_docs/PNAAF434.pdf
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ReferencesJohn 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

http://www.ru.nl/publish/pages/.../nicaragua_sugar_report_-_final_version_02062014.pdf
http://www.globality-gmu.net/archives/2158

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