Carlos Augusto Monteiro

Socioeconomic status and obesity in adult populations of developing countries: a review

A landmark review of studies published prior to 1989 on socioeconomic status (SES) and obesity supported the view that obesity in the developing world would be essentially a disease of the socioeconomic elite. The present review, on studies conducted in adult populations from developing countries, published between 1989 and 2003, shows a different scenario for the relationship between SES and obesity. Although more studies are necessary to clarify the exact nature of this relationship, particularly among men, three main conclusions emerge from the studies reviewed: 1. Obesity in the developing world can no longer be considered solely a disease of groups with higher SES. 2. The burden of obesity in each developing country tends to shift towards the groups with lower SES as the countrys gross national product (GNP) increases. 3. The shift of obesity towards women with low SES apparently occurs at an earlier stage of economic development than it does for men. The crossover to higher rates of obesity among women of low SES is found at a GNP per capita of about US

Chronic non-communicable diseases in Brazil: burden and current challenges

2500, the mid-point value for lower-middle-income economies. The results of this review reinforce the urgent need to: include obesity prevention as a relevant topic on the public health agenda in developing countries; improve the access of all social classes in these countries to reliable information on the determinants and consequences of obesity; and design and implement consistent public actions on the physical, economic, and sociocultural environment that make healthier choices concerning diet and physical activity feasible for all. A significant step in this direction was taken with the approval of the Global Strategy on Diet, Physical Activity and Health by the World Health Assembly in May 2004.

Profits and pandemics: prevention of harmful effects of tobacco, alcohol and ultra processed food and drink industries

Non-communicable diseases (NCDs) have become a major health priority in Brazil--72% of all deaths were attributable to NCDs in 2007. They are also the main source of disease burden, with neuropsychiatric disorders being the single largest contributor. Morbidity and mortality due to NCDs are greatest in the poor population. Although the crude NCD mortality increased 5% between 1996 and 2007, age-standardised mortality declined by 20%. Declines were primarily for cardiovascular and chronic respiratory diseases, in association with the successful implementation of health policies that lead to decreases in smoking and the expansion of access to primary health care. Of note, however, the prevalence of diabetes and hypertension is rising in parallel with that of excess weight; these increases are associated with unfavourable changes of diet and physical activity. Brazil has implemented major policies for the prevention of NCDs, and its age-adjusted NCD mortality is falling by 1·8% per year. However, the unfavourable trends for most major risk factors pose an enormous challenge and call for additional and timely action and policies, especially those of a legislative and regulatory nature and those providing cost-effective chronic care for individuals affected by NCDs.

Disponibilidade domiciliar de alimentos no Brasil: distribuição e evolução (1974-2003)

The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public-private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public-private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.

Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil.

OBJETIVO: Descrever a distribuicao da disponibilidade domiciliar de alimentos no Brasil em 2002-2003 e avaliar sua evolucao nas areas metropolitanas do Pais no periodo 1974-2003. METODOS: A principal base de dados do estudo e a Pesquisa de Orcamento Familiar de 2002-2003 realizada pelo Instituto Brasileiro de Geografia e Estatistica em 48.470 domicilios brasileiros. Em cada domicilio, num periodo de sete dias consecutivos, foram registradas todas as aquisicoes, monetarias ou nao monetarias, de alimentos e bebidas para consumo familiar. As quantidades de alimentos adquiridas foram transformadas em calorias e macronutrientes, usando tabelas de composicao alimentar. RESULTADOS: Caracteristicas positivas do padrao alimentar, encontradas em todas as regioes e em todas as classes de rendimento, foram a adequacao do teor proteico das dietas e o elevado aporte relativo de proteinas de alto valor biologico. Caracteristicas negativas, tambem disseminadas no Pais, foram excesso de acucar e presenca insuficiente de frutas e hortalicas na dieta. Nas regioes economicamente mais desenvolvidas, no meio urbano e entre familias com maior rendimento houve tambem excesso de gorduras em geral e de gorduras saturadas. A evolucao nas areas metropolitanas do Pais evidenciou declinio no consumo de alimentos basicos, como arroz e feijao, aumentos de ate 400% no consumo de produtos industrializados, como biscoitos e refrigerantes, persistencia do consumo excessivo de acucar e insuficiente de frutas e hortalicas e aumento no teor da dieta em gorduras em geral e gorduras saturadas. CONCLUSOES: Padroes e tendencias da disponibilidade domiciliar de alimentos no Brasil sao consistentes com a importância crescente de doencas cronicas nao transmissiveis no perfil de morbi-mortalidade e com o aumento continuo da prevalencia da obesidade no Pais.

The dual burden household and the nutrition transition paradox

OBJECTIVE To assess time trends in the contribution of processed foods to food purchases made by Brazilian households and to explore the potential impact on the overall quality of the diet. DESIGN Application of a new classification of foodstuffs based on extent and purpose of food processing to data collected by comparable probabilistic household budget surveys. The classification assigns foodstuffs to the following groups: unprocessed/minimally processed foods (Group 1); processed culinary ingredients (Group 2); or ultra-processed ready-to-eat or ready-to-heat food products (Group 3). SETTING Eleven metropolitan areas of Brazil. SUBJECTS Households; n 13,611 in 1987-8, n 16,014 in 1995-5 and n 13,848 in 2002-3. RESULTS Over the last three decades, the household consumption of Group 1 and Group 2 foods has been steadily replaced by consumption of Group 3 ultra-processed food products, both overall and in lower- and upper-income groups. In the 2002-3 survey, Group 3 items represented more than one-quarter of total energy (more than one-third for higher-income households). The overall nutrient profile of Group 3 items, compared with that of Group 1 and Group 2 items, revealed more added sugar, more saturated fat, more sodium, less fibre and much higher energy density. CONCLUSIONS The high energy density and the unfavourable nutrition profiling of Group 3 food products, and also their potential harmful effects on eating and drinking behaviours, indicate that governments and health authorities should use all possible methods, including legislation and statutory regulation, to halt and reverse the replacement of minimally processed foods and processed culinary ingredients by ultra-processed food products.

Obesity and inequities in health in the developing world

OBJECTIVE:The purpose of this study is to document the prevalence of households with underweight and overweight persons (henceforth referred to as dual burden households) and their association with income and urban residence. The explorations by urban residence and income will test whether dual burden households differ from ‘underweight only’ and ‘overweight only’ households, respectively. These comparisons are relevant to differentiating or adapting nutrition-related interventions wherever obesity and undernutrition cluster at the household level.POPULATION:Data analysis is based on national surveys conducted in Brazil, China, Indonesia, the Kyrgyz Republic, Russia, Vietnam and the United States.METHODS:All persons were first classified into categories for underweight and overweight, using body mass index (BMI) cutoffs, and then all households were categorized into four types: dual burden, overweight, underweight and normal. Income and urban residence were explored as key risk factors for being a dual burden household, with the effects modeled separately for each country. Multiple logistic regression was used to explore income and urban risk factors, controlling for household size, region of residence and either urban residence or income, as appropriate.RESULTS:In six of the countries studied, 22–66% of households with an underweight person also had an overweight person. Countries with the highest prevalence of dual burden households were those in the middle range of gross national product (GNP). The dual burden household is easily distinguished from the ‘underweight only’ households in Brazil, China, Indonesia, the United States and Vietnam. In these five countries dual burden households were more likely to be urban and more likely to be among the highest income tertile. There were no significant differences between dual burden and ‘underweight only’ households in Russia and the Kyrgyz Republic. In contrast, dual burden households were not easily distinguished from the ‘overweight only’ households in China, Indonesia, the Kyrgyz Republic, the United States and Vietnam. In Brazil and Russia dual burden households were more likely to be lower income and urban than ‘overweight only’ households.CONCLUSION:The prevalence of dual burden households presents a significant public health concern, particularly for those countries in the middle range of GNP. In some countries (China, Indonesia, the Kyrgyz Republic, the United States and Vietnam), dual burden households share sociodemographic profiles with overweight households, raising concerns for underweight individuals who may inadvertently become the focus of obesity prevention initiatives. For this reason, obesity prevention efforts should focus on messages that are beneficial to the good health of all, such as increasing fruit and vegetable intake, improving overall diet quality and increasing physical activity.

Shifting obesity trends in Brazil

OBJECTIVE: To update the social distribution of womens obesity in the developing world and, in particular, to identify the specific level of economic development at which, if any, womens obesity in the developing world starts to fuel inequities in health.DESIGN: Multilevel logistic regression analyses applied to anthropometric and socioeconomic data collected by nationally representative cross-sectional surveys conducted from 1992 to 2000 in 37 developing countries within a wide range of world regions and stages of economic development (gross national product (GNP) from US

Health conditions and health-policy innovations in Brazil: the way forward.

190 to 4440 per capita).SUBJECTS: In total, 148 579 nonpregnant women aged 20–49 y.MEASUREMENTS: Body mass index to assess obesity status; quartiles of years of education to assess womans socioeconomic status (SES), and GNP per capita to assess countrys stage of economic development.RESULTS: Belonging to the lower SES group confers strong protection against obesity in low-income economies, but it is a systematic risk factor for the disease in upper-middle income developing economies. A multilevel logistic model—including an interaction term between the countrys GNP and each womans SES—indicates that obesity starts to fuel health inequities in the developing world when the GNP reaches a value of about US

Mudanças na composição e adequação nutricional da dieta familiar nas áreas metropolitanas do Brasil (1988-1996)

2500 per capita.CONCLUSIONS: For most upper-middle income economies and part of the lower-middle income economies, obesity among adult women is already a relevant booster of health inequities and, in the absence of concerted national public actions to prevent obesity, economic growth will greatly expand the list of developing countries where this situation occurs.