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In developing countries where the poor go hungry, the upper classes are eating too much.
RIO DE JANEIRO, Brazil — Just two blocks from the panorama of skimpy swimwear and taut skin bronzing on Copacabana beach, you’ll find a store that does a brisk business clothing an increasingly more common Brazilian silhouette.
“I’m the type,” said Kalina Guerra, 46, senior manager of Citwar, a boutique for plus-sized women. In a loose purple blouse and matching nails, Guerra appraised herself with a shrug. “I’m bigger,” she said.
The company began with just one wholesale shop but has since grown into a chain with five locations across the city, including Guerra’s store.
“No one wants to go to the gym anymore,” Guerra said, explaining her store’s popularity. “Women here are getting fatter.”
The men are, too. One half of Brazilians are now overweight and 15 percent are obese, according to Brazil’s Ministry of Health. Doctors and health officials say the trend is linked to fattening food, rising incomes and falling physical fitness — and the same pattern is playing out across the globe. The pace and scope of change is such that even in developing-world countries where the poor still go hungry, the new upper and middle classes suffer from diseases caused by eating too much.
“Developing countries are now seeing a double burden,” said Francesco Branca, a doctor specializing in nutrition with the World Health Organization in Geneva. “It is indeed a crisis. It is indeed an epidemic.”
More than 1.6 billion adults over the age of 15 worldwide are overweight, according to the World Health Organization’s latest data, and at least 400 million adults are obese. Taken together these numbers account for more than a third of people on Earth. In five years, the agency predicts the number of overweight people worldwide will rise to 2.3 billion. The number of obese people is set to jump to 700 million, or more than twice the population of the United States.
Non-communicable diseases are now the world’s biggest killers, accounting for some 60 percent of all deaths by the WHO’s count. After high blood pressure, smoking, high cholesterol and a lack of exercise, the agency calls obesity and excessive weight “the fifth leading risk factor for death world wide.” It has eclipsed malnutrition as a killer.
About 7 percent of Brazilian children between 5 and 9 years old are undernourished. Among poor families, 11 percent of boys and 10 percent of girls qualified as malnourished, with even higher numbers in the country’s rural north. That’s far less than in 1975, when nearly a third of all children were chronically hungry. But now, a different, equally worrying, problem is on the rise.
“Obesity is already really high,” said Ana Beatriz Vasconcellos, the food and nutrition coordinator at the Brazilian Ministry of Health. “The data is there, and it’s incontestable.”
Forty-eight percent of Brazilian adult women and 50 percent of men are overweight, according to a survey released this year. More than a quarter of those qualify as obese. Those numbers jumped almost 10 percent from just five years ago, and have more than doubled in the last 35 years.
If the trend continues, the ministry says that 10 years from now this emerging nation will become as paunchy as developed nations like the United States, where 68 percent of adults are overweight and half of those are obese.
“We are already at a stage of alert,” Vasconcellos said. “If we don’t do anything these numbers are just going to keep going up.”
Vasconcellos estimates that 30 percent of Brazilian adults suffer from high blood pressure. A recent study by the health ministry concluded 11 percent of the population has diabetes.
These are changes Dr. Silvia Bretz has seen firsthand in her 28 years as an endocrinologist in Rio de Janeiro. Bretz said she’s treating more obesity-related case of insulin resistance, diabetes and high cholesterol all the time. And she's seeing something else, too.
“The difference in my waiting room is now I'm seeing children and adolescents,” Bretz said. “They are really getting fatter, you can see it."
The statistics back up her observations. In 1975, about 10 percent of Brazilian children between the ages of 5 and 9 were overweight. According to the most recent study, that proportion has now risen to more than 30 percent. Worldwide, the WHO estimates at least 20 million children under the age of 5 years are overweight.
There are many reasons for the growing epidemic, but health officials say part of the problem is people in countries like Brazil are consuming more processed foods, particularly soda, while exercising less. In many poor neighborhoods, it’s hard to find fresh vegetables, while fast food is marketed aggressively and priced to sell.
“There is a lower cost of fat and sugar, in dollars per calorie, when compared to fruits, vegetables and protein,” said Paul Garwood, a WHO spokesman. “The pressure of the heavy marketing of processed food products has led to changes in cultural norms.”
That may be the case even in pricier neighborhoods like Copacabana. While Citwar, the plus-sized boutique, is tucked into a gallery of luxury shops, the closest restaurant is as down-market as it is popular.
It’s a McDonald’s and it’s right across the street. And every day at lunch, there’s a line out the door.