The prognosis is far from favourable. According to the World Atlas of Obesity, half of the planet’s inhabitants will be overweight in 2035, and among Brazilians, 40% will be obese.
In a scenario in which fresh food, home-cooked meals and outdoor sports and leisure activities are disappearing – we are eating worse and exercising less -, reversing the situation represents an enormous challenge.
Health specialists consider that political interventions are urgent to reduce the influence of “obesogenic environments”, those that favor less healthy choices. There is no “silver bullet”, a single solution to solve all the factors that contribute to the development of obesity, but there are several fronts to be worked on.
In a series of reports published over the last five weeks, the metropolises was dedicated to showing why Brazil is becoming an obese country, how this impacts people’s health and the neglect of treatment in the public health network. The texts also detailed the latest research on the causes of obesity and the stigmas surrounding overweight people. But how are we going to solve this problem?
“We need urgent decisions to contain the explosion of obesity. This is a collective phenomenon and the solutions need to be collectively agreed upon”, says nutritionist Inês Rugani, from the Brazilian Association of Collective Health (Abrasco).
What do children eat
Responsible for the National Study of Child Food and Nutrition (Enani), Inês says that 10% of children up to 5 years old are overweight in Brazil and, among mothers, the rate reaches 60%. An aggravating factor: research shows that children of obese mothers are more likely to be overweight in the future.
The nutritionist points out that childhood obesity anticipates health problems for youth that used to be seen only in middle-aged people, such as, for example, high cholesterol, hypertension and type 2 diabetes.
“In addition to individual suffering, with children being victims of bullying and stigma, there is also growing pressure on the health system, which needs to deal with increasingly younger patients”, explains Inês.
The public up to the age of 18 is considered strategic for obesity prevention actions. This is because, at the beginning of life, people are still forming their eating habits and are more sensitive to advertising and marketing appeals.
The Desiderata Institute, a civil society organization (Oscip) dedicated to the promotion of child health, has been producing evidence to ensure that public managers do not ignore the issue. According to surveys by the entity that use data from the Ministry of Health, being overweight is already a reality for three out of ten individuals aged between 0 and 19 years.
Oscip works to prohibit chocolates, bonbons, chewing gum and cookies from being at eye level for small children on the shelves of commercial establishments. “The organization of a supermarket results from very well thought out sales strategies. We need to know this method and intervene”, comments nutritionist Carolina Rocha, a health analyst at the Desiderata Institute.
Another Oscip initiative is the prohibition of ultra-processed foods in school canteens. In general, this type of food goes through several industrial stages and has a high amount of added sugars, trans fats, sodium and preservatives. It has already been proven that ultra-processed foods are harmful to health and there is evidence that they can lead to binge eating if consumed in excess.
Desiderata wants to nationalize the rule for canteens after the norm has already been adopted in several Brazilian municipalities. “We chose the school as a focus for prevention because it is where children and adolescents spend most of their time. In addition, the habits that are embraced by students, generally, impact the whole family”, says Carolina.
tax changes
Another front of battle against obesity, and perhaps the most discussed, is in the field of taxes. The discussion on the food taxation regime is the hottest thing among organized civil society. The tax reform has already been announced as one of the priorities of the Federal Government, and activists are mobilizing to try to implement rules that discourage the consumption of ultra-processed products and promote the consumption of fresh foods.
“There are distortions that need to be corrected: it is not uncommon for an in natura or minimally processed food to be more expensive than the ultra-processed option”, comments economist Arnoldo de Campos who, commissioned by ACTPromoção da Saúde, produced the study Why Is healthy food far from Brazilian tables?.
He cites as an example the consumer dispute between whole and organic grape juice and its industrialized and sugary version. “Higher quality food pays more taxes, which ends up making its price prohibitive for most people”, comments Campos, who is a former member of the National Council for Food and Nutritional Security (Consea).
The civil society proposal, which has the support of the Ministry of Health, is called the 3S Tax Reform (healthy, sustainable and solidary). She advocates that there be a specific federal tax for ultra-processed foods, alcoholic beverages, cigarettes and pesticides. The measure would discourage the purchase of items that are harmful to health and cause damage to the environment.
Activists also demand greater financial incentives – either through tax breaks or the granting of credits – for family farming and street markets. The intention is to lower farmers’ costs and, consequently, prices of horticultural products. Traveling fairs, as points of direct distribution of food to the consumer, would help combat “food deserts”, where only food of low nutritional quality is found.
“Current tax rules benefit the ultra-processed food industry. This is one of the reasons why they are cheaper. In addition, farmers are more subject to bad weather and their products spoil faster. The competition is uneven”, comments the Innovation and Strategy coordinator at ACT Health Promotion, Marília Sobral Albiero.
The World Health Organization (WHO) itself has already pointed out the taxation of sugary drinks as one of the most cost-effective measures for health, being able to reverse the growth of obesity and diseases related to the condition. The taxation of these foods has been implemented in 73 countries and, in Latin America, a successful example is Mexico, where the consumption of soft drinks, nectars and industrialized juices has dropped by almost 20% since the beginning of the rule, in 2014.
The Brazilian Association of Soft Drinks and Non-Alcoholic Beverages (ABIR) rebuts. Manufacturers stress that the relationship between obesity and their products is not direct. According to them, the consumption of soft drinks in Brazil has been falling without a direct impact on the epidemiological indicators of overweight. In addition, the tax on sugary industrialized beverages corresponds to 36.9%, much higher than that of Mexico, which is 28%.
healthy basic food basket
Another point evaluated as important by the activists is the composition of the basic food basket. Items, as they are considered essential to survival, deserve a differentiated tax regime, which makes them more accessible to families. The problem is that the definition of what goes in the basic food basket, made by the finance secretaries of the Brazilian states, does not always take into account what is healthier.
“They have a basic basket with sausage, nuggets and instant noodles”, comments Marília, from ACT Health Promotion. “Our claim is that it be adapted to the Food Guide for the Brazilian Population”, completes the coordinator of the non-governmental organization.
Published by the Ministry of Health, the guide is considered a reference document in the fight against obesity. Among its premises are the use of natural or minimally processed ingredients and the recommendation that meals be prepared at home.
The food industry reacts strongly to the role of villain in the context of the obesity epidemic. The main argument is scientific: there is no single cause for being overweight. In addition to food, lifestyle habits such as sleep, stress and sedentary lifestyle also count. Not to mention the relationship between obesity and genetics and brain function.
“Obesity is a multifactorial disease, there are no simple solutions. The food industry is in favor of consumers having more and more information about food, a balanced diet and the necessary amount of food to satisfy their daily needs”, says João Dornellas, executive president of the Brazilian Food Industry Association (ABIA).
The industry representative highlights the manufacturers’ agreements with the Ministry of Health to reduce sugar, salt and trans fats in industrialized products and investments in research to diversify the supply of food to society. “The food industry has always been concerned about the health of the population, we invest in innovation to constantly improve products and processes. In addition, all ingredients used are approved by health authorities”, he guarantees.
For ABIA, the changes in food taxation will penalize the poorest part of the population, which has the most vulnerable budget. The manufacturers’ position is that, instead of “nutritional deserts”, we would increase “territories of hunger” in Brazilian cities.
simpler labels
Amidst the disputes, there are advances to be celebrated. The new labeling system, which came into effect in October 2022, is one of them. The rules have improved the readability of food labels, helping consumers to make more informed choices. “Warnings and clear information are important to guide healthier purchases. The new labeling opens up possibilities for better food decisions”, says researcher Renata Bertazzi Levy, from the University of São Paulo (USP).
The National School Feeding Program (PNAE), which benefits 70 million public school students, is another achievement. The initiative obliges municipal and state managers to include fruits, vegetables, fresh meat, milk and grains on students’ plates. The regional culture is valued with the presence of typical foods, such as moqueca, couscous and carreteiro rice.
Endocrinologist Bruno Halpern, president of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso), recalls that the solution to the obesity problem is not unique, the strategies are not simple to implement and few initiatives have worked in the world to date. . He argues that it is important to find ways to prevent excess weight, but without ignoring the treatment of people who are already obese — working together is essential.
“We need to work with the food industries, have tax increases on unhealthy foods and vegetable subsidies. It is necessary to improve the school lunch menu, including more vegetables and fruits. Encouraging physical exercise, well-designed labeling and reducing advertisements for unhealthy foods should also be part of the equation. For it to work, we need to do it all together,” he says.
The theme is complex, divides opinions and involves different interests, including financial ones. The certainties are that the matter is in the sphere of public health, it cannot be postponed, it requires collective attitudes and political decisions. In the same way that a patient should not ignore a bad prognosis, Brazil can no longer turn a blind eye to this epidemic.
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