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EIU - GFSI 2013 - Nutrition in Chile Report
EIU - GFSI 2013 - Nutrition in Chile Report
Nutrition in Chile
Global challenges,
local solutions
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Nutrition in Chile Global challenges, local solutions
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Nutrition in Chile:
Global challenges, local solutions
Each year, US$53.5trn in social and economic costs Several trends that transcend national
is lost to malnutrition—the equivalent of US$500 boundaries explain the dramatic increase in
for every person on the planet. Although the obesity worldwide. Widespread industrialisation
challenges of malnutrition were once confined to has increased the availability of processed foods
undernourished and underweight populations, high in fat, carbohydrates and sugar, and has
today they include the overweight and the obese as reduced the need for manual labour in farming and
well. Indeed, global obesity rates have doubled in industrial production. At the same time,
the last 30 years, and obesity today is the urbanisation has led to a relative increase in
underlying cause of 2.8m adult deaths annually sedentary occupations, and the rising standard of
worldwide.1 Whereas obesity was once considered a living has improved access to motorised
problem of the rich world, it is now emerging in transportation and other labour-saving devices.8
low- and middle-income countries, even among The result is that people are consuming greater
those that still struggle with underweight and amounts of energy-dense foods while expending
undernourished populations.2,3 According to the fewer calories in their day-to-day lives, leading to a
World Health Organisation (WHO), obesity and global increase in body mass.
excess weight is now the fifth-leading risk to global
health. The condition is linked to more deaths Obesity in Chile: The challenge
globally than underweight maladies.4 Fighting obesity has become a national struggle in
The increase in obesity is alarming public-health Chile. Indeed, Chile in many ways epitomises the
agencies worldwide. Excess weight is linked to classic nutritional and health transition scholars
higher risk of heart disease, stroke, breast cancer, describe in emerging markets. In the 1970s,
colon cancer and many other health problems, malnutrition and infectious diseases were the
including premature death.5,6 As a result, the primary national food-security and health
economic burden of obesity is staggering, with challenges, particularly among the rural poor.9 The
treatment costs running into the hundreds of rapid modernisation and urbanisation, of the
billions of dollars in the United States alone. As 1980s and 1990s changed the lifestyles of many
obesity rates rise in other countries, so, too, do Chileans and thus the country’s health profile. By
costs.7 the end of the 1980s, undernutrition had virtually
1 World Health Organization (WHO), 2013. vanished, but obesity was on the rise.10 Today,
2 Ibid.
3 Ibid. obesity is considered one of the nation’s top health
4 Ibid.
5 Oxford Journals, The medical complications of obesity, August 2006. 8 “What is the Nutrition Transition?,” University of North Carolina, website, accessed
6 Haslam, D. W., & James, W. P. (2005), “Obesity”. Lancet, 366, 1197-1209. June 2013.
7 “Economic Costs,” The Obesity Prevention Source, Harvard School of Public Health, 9 Vio del Rio, F., The Nutrition Transition in Chile, 2007.
website, accessed June 2013. 10 Albala et al., Nutrition in Chile: Determinants and consequences, 2002.
*Or nearest year. Sources: OECD Health Data 2011; national sources for non-OECD countries.
fibre.23,24 Fat consumption rose by more than 50% sufficient progress in reducing obesity rates.30 The
over 1988–97.25 Ministry of Health launched additional initiatives in
Daniela Montecinos Godoy, who grew up in the 2005 and in 2010 to reduce the prevalence of
southern region of Los Lagos, explained the ways obesity, including the Global Strategy Against
in which eating habits have changed: “Before, Obesity (EGO Chile)31 and Elige Vivir Sano (Choose to
mothers used to pack simple foods for their Live Healthily), a national programme to encourage
children’s school lunches, things like a sandwich healthy eating and physical activity. Elige Vivir
and a piece of fruit. Today, students are sent to Sano increased physical-activity requirements in
school with supermarket-bought foods, like a schools from two to four hours a week, “active
package of crackers and a juice box, nothing that plazas” were created through the installation of
would be considered ‘natural’.” Even though Chile exercise equipment, and media campaigns
exports fruits, vegetables and salmon to external encouraged exercise at home using household
markets,26 only half of Chileans consume the items like a kilo of rice.32 Although it is too early to
recommended amount of fruits and vegetables and know the full effects of these programmes, the
only 17% consume the recommended amount of government considers them a success.
fish.27 Policymakers also enacted the Sistema Elige Vivir
Sano law, which further institutionalised the
Obesity in Chile: The response programme at the national level and guarantees
Compared with other countries, Chile’s nutritional funding for future efforts.33
transition has been particularly rapid.28 Having Partnerships between the private sector and
dedicated resources to the underweight and the non-governmental organisations (NGOs) have also
undernourished for so many years, the Chilean offered promising results in recent years. The
government was faced with a sudden need to international programme 5 al Día (5 a Day) is an
switch strategies. Although obesity began to example of a partnership between university
increase nationally in the 1980s, it was not until researchers, the private sector, the national
1998 that the national food policy was changed to government and international health organisations
address obesity rather than undernutrition. such as the United Nations. The programme, which
The 1998 shift marked the start of an aggressive began in 2004, brings together the government
effort to combat obesity—a process that has, and food producers to create policies aimed at
nonetheless, proved challenging. In 1998, the increasing fruit and vegetable production and
newly-created National Board for Health Promotion quality. These include multimedia educational and
(VIDA Chile) introduced a calorie-reduction policy marketing campaigns to encourage Chileans to eat
in Chilean schools. The board co-ordinated with five servings of fruits and vegetables a day. As a
schools and the Ministry of Education to reduce the result of the campaign, Chileans in the target
amount of calories in the school food programme, group consumed more fruit and vegetables.34
cutting fat, sugar and salt while incorporating Despite 15 years of concerted efforts, obesity in
greater amounts of fruits, vegetables, fish and Chile continues to grow. In 2007, Dr Fernando Vio
legumes.29 In spite of the strength of the early VIDA del Rio, an academic who has been studying
Chile policies and other governmental efforts, it nutrition in Chile for more than 20 years, noted
was clear by 2005 that the country was not making that although governmental efforts have increased
Chilean’s knowledge about nutritional eating, they
23 Chilean National Institute of Statistics, National Household Budget Survey, Nov
2006 – Oct 2007.
24 Fundación Chile, Chile Saludable, 2012. 30 Ibid.
25 Mendoza et al., Evolucion de la situacion alimentaria en Chile, Revista chilena de 31 Chilean Ministry of Health, Global strategy against obesity (EGO-Chile), accessed
nutricion, Mar 2007. online June 2013.
26 Vio del Rio, F., The Nutrition Transition in Chile, 2007. 32 Marianela Jarroud, Inter Press Service Noticias, 25 Mar 2013.
27 Fundación Chile, Chile Saludable, 2012. 33 Elige viver sano, website, accessed June 2013.
28 Albala et al., Nutrition in Chile: Determinants and consequences, 2002. 34 Corinna Hawkes on behalf of the FAO, Promoting healthy diets through nutrition
29 Vio del Rio, F., The Nutrition Transition in Chile, 2007. education and changes in the food environment, 2013.
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14
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10
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Note: The data measure obesity among children entering first grade
Estimate Source: Chilean National Board of Student Aid and Scholarships (Junta Nacional de Auxilio Escolar y Becas)
have been insufficient to change Chilean’s habits. maintain healthier lifestyles. The transformation of
“The population knows both what healthy eating the social, institutional and political environment
means and the benefits of engaging in physical of a country can be a slow and challenging
activity, but many people persist in eating foods undertaking; therefore, governments are focused
that are high in sugar, fat and salt, and in leading on incremental changes and successes.
inactive lives,” Dr Vio del Rio said.35,36 Because of the global emphasis on reducing and
preventing childhood obesity, many governments
Global challenges and responses have made schools their first point of attack in the
Chile is not alone in its challenge with obesity. A fight against obesity. Mexico and Peru have been
variety of approaches are being tried in other particularly active in this area. In Mexico, where
countries, and although many of them are 26.2% of school-aged children are obese,37 a 2010
relatively new, several promising strategies have law prohibits the sale or advertisement of “junk
emerged. Broadly, health research suggests that food” in primary and secondary schools. The law
the most effective programmes combine strategies also requires 30 minutes of physical activity per day
that change not only individual behaviours that and requires healthier foods in school cafeterias.
lead to obesity but also the broader social, Peru implemented a similar law in 2012.38 Although
institutional and policy environment in which both laws are new and it is too early to judge the
those behaviours occur. In environments where results, other research suggests that this approach
making a healthy choice is easier than making an has promise. A 2012 study conducted in the United
unhealthy choice, individuals find it easier to States found that students living in states with
35 Dr. Fernando Vio del Rio, publications available through Instituto de Nutricion y 37 Barquera et al., Obesity and central adiposity in Mexican adults: results from the
Tecnologia de los Alimentos. Mexican National Health and Nutrition Survey 2006, Salud publica de Mexico. 2009.
36 Vio del Rio, F., The Nutrition Transition in Chile, 2007. 38 Chilean Ministry of Health, Ministerial resolution, 2012.
laws regulating the nutritional value of food in environment, a number of countries have
schools showed a smaller body-mass index (BMI) introduced programmes and policies to encourage
than students living in states with weak or non- healthy eating and exercise. In 2008, the Mexican
existent laws.39 government launched a national campaign, Vamos
Outside of schools, governments have also tried Por un Millón de Kilos (Let’s Go For a Million Kilos)
different strategies to limit the availability and to encourage people to exercise. The programme,
consumption of high-calorie foods. In Denmark which provided Mexicans with access to
and the US, governmental policies have targeted personalised weight-loss and physical-activity
the sale of high-calorie foods by restaurants and guidance from doctors,47,48 generated considerable
vendors. In 2004, Denmark became the first and excitement: more than a million people
only country to ban the use of trans fats in all participated, and they lost a collective 2.5m
products.40 In 2007, New York city officials banned pounds (over 1m kilos). The US launched a similar
restaurants from using trans fats. A subsequent campaign with Let’s Move!, and the UK with
study found that New York’s policy significantly Change4Life. National programmes such as these
reduced trans-fat consumption.41 emphasise the enjoyable aspects of a healthy
In another approach, governments have tried to lifestyle and, in so doing, try to shift attitudes and
manipulate the cost of healthy and unhealthy norms about healthy behaviour. These efforts also
foods. Denmark, France and Norway used taxes, provide citizens with information about healthy
subsidies and other methods to alter the prices eating and exercise. Although such programmes try
consumers pay for foods.42 Perhaps the most- to support millions of citizens in the effort to lose
widely-reported recent effort was Denmark’s 2011 weight or prevent weight gain, it may be years
implementation of a “fat tax” on foods composed before their effect on large-scale obesity reduction
of more than 2.3% saturated fats. Although the tax is known.
was rescinded after only a year, because of political
pressure, one study found a 10–20% drop in the The path forward in Chile:
sales of margarine, butter and oil, suggesting that An integrated approach to local
the new, higher price may indeed have led to a
solutions
healthy shift in consumer behaviour.43 Other
countries, including France and Norway, tax The experiences of the past decade in the global
products containing excessive sugar. Evidence fight against obesity have made it clear to
from France suggests that consumption of soft governments and food and health professionals
drinks has decreased as a result.44 Although taxes alike that an integrated approach is needed for
on sugar-sweetened beverages have affected meaningful results. Indeed, Fundación Chile’s Chile
consumption patterns, little if any evidence exists Saludable (Healthy Chile) report calls for
on the long-term effectiveness of these policies in “integrated intervention from multiple actors at
reducing obesity.45,46 multiple levels”, combining changes in individual
To complement efforts to modify the food behaviour with environmental changes in schools,
homes and workplaces, along with system-wide
39 Taber et al., Weight status among adolescents in states that govern competitive
food nutrition content, Pediatrics, Sep 2012.
changes in food production, transportation
40 Caroline Scott-Thomas, Trans fat reducation policies are working to reduce networks, the educational system, and urban
consumption, says WHO, Food navigator, 09 Apr 2013.
41 Angel et al., Change in Trans Fatty Acid Content of Fast-Food Purchases Associated planning.49
with New York City Restaurant Regulation: A Pre-Post Study, 2012.
42 OECD, Obesity update 2012. Perhaps the best evidence to support an
43 “Denmark’s food taxes: A fat chance”, The Economist, 17 Nov 2012.
44 Ben Bouckley, Soft drinks stall in France as consumers trade down: Canadean,
Beverage daily, 24 Apr 2013. 47 Jaime A. Zea, “Campaign calls for Mexicans to lose 2 million pounds,” USA Today,
45 Chriqui et al., “A typology of beverage consumption,” Journal of Public Health 28 Sep 2008.
Policy, May 2013. 48 Mileno, Finaliza con éxito campana nacional ‘Vamos por un million de kilos’,”
46 Fletcher et al., Substitution patterns can limit the effects of sugar-sweetened 28 July 2008.
beverage taxes on obesity, Preventing Chronic Disease, 2013. 49 Fundación Chile, Chile Saludable, 2012.
integrated approach comes from a study Food-security experts in Chile and other
undertaken in Finland in the 1970s. The North countries face a new challenge today: develop
Karelia Project tried to reduce mortality from heart complementary strategies to ensure that people
disease in Finland by curbing the intake of get enough to eat while not eating too much of the
saturated fat, increasing the consumption of fruits unhealthy foods that lead to obesity. Although the
and vegetables, and encouraging physical activity. problem of obesity is global, each country needs to
The project team partnered with a trusted develop strategies and solutions appropriate to its
community organisation to create healthier local context. Nonetheless, the most effective
versions of traditional dishes, and it successfully strategies share a common blueprint: they focus on
urged legislators to create policies to reduce the understanding and changing the broader
fat content of school lunches. The team also environment in which individual behaviours occur.
lobbied the government to reduce subsidies for the They also target multiple settings, such as the
producers of high fat foods and worked with other school, home and workplace. Finally, they enjoy
food producers to create lower-fat versions of co-operation and collaboration among a wide
foods such as sausages to meet the emerging group of stakeholders, both public and private. A
market demand for healthy food. At the same time, single policy, however well-intentioned, cannot
the project team worked with local governments to reduce a country’s obesity rates; multiple,
increase infrastructure that enables physical complementary policies, however, can often create
activity, such as walking paths and bike lanes.50 By healthier environments and, by default, healthier
altering the availability, attractiveness and individuals.
affordability of healthier options, the North Karelia There is reason for optimism in Chile. Although
Project reduced deaths from premature heart obesity continues to rise, the rate of its ascent is
disease in men by 75% and contributed to lower slowing.54,55 A recent consumer survey in Chile
levels of obesity that continued into the 1990s. showed increased interest in healthy food, opening
Although Finns have become more obese in the last the door for private companies to develop and
decade,51,52 the programme still offers important market healthy, tasty products.56 Companies that
lessons for communities trying to implement do so will be helped by a new law that takes effect
obesity-reduction policies. The success of the in July 2013, the first in the world to mandate
programme hinged on three factors: the co- warning labels on foods with high sugar, fat or salt
operation of the national food industry, the content. With each new policy, Chile moves towards
political will to implement the project team’s a critical mass of successful programmes that can
recommendations and a focus on the entire collectively slow, and eventually reverse, the
population, as opposed to solely those at risk of obesity epidemic.
heart disease.53
50 Joyce Hendley and Rachael Moeller Gorman, How the people of Finland took a
healthy message to heart, Eating Well, website, accessed June 2013. 54 “Chile esta entre los 10 paises con mas sobrepeso del mundo” La Tercera, April 2nd
51 OECD, Finland country page, website, accessed June 2013. 2013.
52 OECD, Health at a glance 2011. 55 OECD, Obesity update 2012.
53 Karen Allen, Fighting fat the Finnish way, BBC, 5 Feb 2004. 56 Fundación Chile, Chile Saludable, 2012.
Whilst every effort has been taken to verify the accuracy of this
information, neither The Economist Intelligence Unit Ltd. nor the
sponsor of this report can accept any responsibility or liability
for reliance by any person on this white paper or any of the
information, opinions or conclusions set out in the white paper.
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