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

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

Calorie Sources Sample Traditional Agricultural Diet Sample Processed Agricultural Diet Breakfast Egg, beans, tortillas, Breakfast Fried rice, beans, coffee, corn-based drink (pinol) tortillas Lunch Soup with squash, carrot, Lunch Fried rice, meat,* cheese,* onion, beans, and meat* juice, coffee Dinner Beans, tortillas, cabbage Dinner Fried rice, beans, Tang, fried salad, mango, juice plantains, cabbage salad • 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

Three Nicaraguan Diets at a Glance As the percentage of processed food increases, calorie density and overall calorie intake rise. 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 Whole-Foods Processed Modern Processed Agrarian Diet of Agrarian Diet of Diet of the the Rural Poor the Rural Poor Urban Poor

Concentration in Fuel Sources Raw plants Cooked plants Meat, dairy, and seafood Processed foods Pairs of roughly comparable fuel sources Fairly simple processing Same fuel source Industrial processing Millenia of human selection Levels of increasing energy density

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

2015 Namlo Study Overweight and Diet Differences in diet composition Incidence of overweight/obesity from traditional to modern (BMI of more than 25%) Location % overweight Processed Traditional Macronutrient Agrarian Agriculture El Quebracho 57% Carbohydrate 57% 60-70% Las Palmas 44% Protein 7% 10-15% La Labranza 37% Fat 36% 10-20% Los Pinares 36% Barrio Nuevo 35%

Nuts and Seeds A closer look One ounce of almonds Compare corn kernels and cashews. Per calorie, corn has the same is about 22-25 nuts 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

2015 Namlo Study Nutrition Deficiencies Vitamin Percent of US RDA Mineral Percent US RDA A 18% Calcium 18% B3 54% Magnesium 73% B5 81% Potassium 39% B6 58% Selenium 57% B12 23% Zinc 58% D 4% These tables are derived from estimating E 68% the average dietary intake of the 200 study participants based on their 24-hour dietary recalls

Perceptions of Diet Traditional Modern All food is good Complex hierarchy of food (status) Food is fuel Food can be used as entertainment, status, drug Food is all grown locally Little (local) food production Diet is highly repetitive Diet is varied Fewer people are overweight, and Being overweight is regarded negatively being overweight carries status Love to eat but rarely discuss food Food is heavily discussed Prepare all meals at home Less cooking

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)

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 Taste Smell Smell Sight Hearing Taste Sight Touch Touch Hearing Nicaragua United States

Cycle of Exploitation Stress of Addictive, poverty and cheap food — Raw agricultural exploitation products are exported — Refined foods and prescription drugs are imported Obesity $$ dependence and disease Need for treatment

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

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

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