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Obesity and the food system transformation in Latin America
Article in Obesity Reviews · December 2017

DOI: 10.1111/obr.12694
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obesity reviews doi: 10.1111/obr.12694
Public Health/Nutrition
Obesity and the food system transformation in

Latin America
B. M. Popkin1 and T. Reardon2
1
Department of Nutrition, Gillings School of Summary
Global Public Health, Carolina Population The Latin America and the Caribbean (LAC) region faces a major diet-related
Center, University of North Carolina at Chapel health problem accompanied by enormous economic and social costs. The shifts
Hill, Chapel Hill, NC, USA, and 2 Department of in diet are profound: major shifts in intake of less-healthful low-nutrient-density
Agricultural, Food, and Resource Economics, foods and sugary beverages, changes in away-from-home eating and snacking
Michigan State University, East Lansing, MI, and rapid shifts towards very high levels of overweight and obesity among all ages
USA along with, in some countries, high burdens of stunting. Diet changes have
occurred in parallel to, and in two-way causality with, changes in the broad food
Received 6 December 2017; revised 1 March system – the set of supply chains from farms, through midstream segments of pro-
2018; accepted 16 March 2018 cessing, wholesale and logistics, to downstream segments of retail and food service
(restaurants and fast food chains). An essential contribution of this piece is to
Address for correspondence: BM Popkin, marry and integrate the nutrition transition literature with the literature on the
Professor of Nutrition, Carolina Population economics of food system transformation. These two literatures and debates have
Center, University of North Carolina at Chapel been to date largely ‘two ships passing in the night’.
Hill, 123 W. Franklin St. Carolina Square, This review documents in-depth the recent history of rapid growth and transforma-
Chapel Hill, NC 27516-3997, USA. tion of that broad food system in LAC, with the rapid rise of supermarkets, large
E-mail: popkin@unc.edu processors, fast food chains and food logistics firms. The transformation is the
story of a ‘double-edged sword’, showing its links to various negative diet side
trends, e.g. the rise of consumption of fast food and highly processed food, as well
as in parallel, to various positive trends, e.g. the reduction of the cost of food,
de-seasonalization, increase of convenience of food preparation reducing women’s
time associated with that and increase of availability of some nutritious foods like
meat and dairy. We view the transformation of the food system, as well as certain
aspects of diet change linked to long-run changes in employment and demographics
(e.g. the quest for convenience), as broad parameters that will endure for the next
decades without truly major regulatory and fiscal changes.
We then focus in on what are the steps that are being and can be taken to curb
the negative effects on diet of these changes. We show that countries in LAC are
already among the global leaders in initiating demand-related solutions via
taxation and marketing controls. But we also show that this is only a small step
forward. To shift LAC’s food supply towards prices that incentivize consumption
of healthier diets and demand away from the less healthy component is not
simple and will not happen immediately. We must be cognizant that ultimately,
food industry firms must be incentivized to market the components of healthy
diets. This will primarily need to be via selective taxes and subsidies, marketing
controls, as well as food quality regulations, consumer education and, in the
medium term, consumers’ desires to combine healthier foods with their ongoing
quest for convenience in the face of busy lives. In the end, the food industry in
LAC will orient itself towards profitable solutions, ie those demanded by the
broad mass of consumers.
© 2018 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation Obesity Reviews
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited and is not used for commercial purposes. 2018
2 Obesity and food system transformation B. M. Popkin and T. Reardon obesity reviews
Keywords: Food service, food system, obesity, retailers.
Introduction and a greater vulnerability to diabetes and hypertension at

lower BMI levels than in non-Hispanic Whites in the region
In the Latin America and the Caribbean (LAC), extensive (11–14). Finally, many people have faced wasting and
child and adult obesity, poor diets and inadequate physical stunting during the first 1,000 d of life and are now
activity are causing high levels of diabetes, hypertension confronting the consequent nutritional challenges (15–20).
and other noncommunicable diseases (NCDs) (1–5). At In the Americas and the Caribbean, aside from the wasting
the same time, large proportions of the children in many na- and chronic undernutrition found in Haiti and limited
tions in the region are malnourished and stunted from poor subgroups, stunting is the major issue (1,2,7,21).
feeding during the first 1,000 d of their lives (6–8). While Our review first documents the problem of obesity and
the causes this review discusses are complex, the basic solu- the double burden of obesity and malnutrition, even in the
tions lie with changes in food systems and diets. This review same household. We describe the dynamic annualized
focuses on how we got here, what we can do to prevent increases in obesity and the minimal declines in undernutri-
further escalation and ultimately how we can produce a tion with stubborn pockets of malnutrition, mainly stunting
healthier population. (which is extreme in Haiti), highlighting the issue’s dimen-
In the 1980s, the region’s diets began to change, and the al- sions and current accelerating trends. We then discuss diet
terations accelerated in subsequent decades. Declines in shifts and provide examples of detailed diets at two or more
physical activity have contributed to the obesity problem points in time to address the direct and underlying causes.
but not to the malnutrition issues (9). With the limited data We then discuss the drivers of and trends in the transforma-
from the region and more complex data from other regions, tion of the broader food system, and its links back to diet
we will describe briefly the modern technological revolution change. We then conclude with policy implications and
in market production. Aspects of employment, home produc- agenda for the debate.
tion, transportation and leisure have contributed to the prob- We believe we contribute to the empirical and conceptual
lem, but while they importantly impact good health, they do literature in several ways. First, we contribute to the litera-
not represent the solutions for this region. Rather, the food ture on measuring the nutrition transition, undernutrition
system and dietary shifts must be addressed to ensure that and obesity dynamics by country for the region, and we link
the nations’ healthcare systems are not burdened by sizable these dynamics with food system changes. Second, we
proportions NCDs among of their populations (10). contribute to the literature on food systems and, in particu-
Modern food systems impact LAC supply and demand lar on food industry transformation, by updating and
through midstream and downstream processing and whole- expanding analysis of this in LAC, with several integrative
sale, retail and transportation methods. These are combined dimensions that have not yet been undertaken in prior liter-
with liberalization and privatization, foreign investment, in- ature. For retail, there has been no update of a systematic
frastructure investment and urbanization. Supermarkets, view of supermarket sales growth since 2002 in LAC, and
large processors and fast food chains are fed by modernized we provide that and show a remarkable similarity with the
procurement systems and the coevolution among these decade in Asia. Even in 2002 and before, sales data of major
segments. As a result, urban and even rural LAC areas are retail chains were not even available, and just rough esti-
experiencing a rapid and ubiquitous transformation. mates of growth trends were provided in earlier literature.
The diet shifts and declines in physical activity have led to For fast food restaurants in LAC, there has never been in
high levels of adult obesity, and now most LAC nations the literature a systematic review of sales growth over coun-
show rapid increases in child obesity. Consequently, the tries, either for a snapshot view or, as we do, over a decade.
complications of obesity, including prediabetes, diabetes For food manufactures, in prior literature, there has not
and other health problems, are emerging among children been an in-depth discussion of the rise of non-nutritious
and adolescents (1). In addition, a portion of the population processed food supply in LAC, nor its links to foreign direct
in the region is at greater risk for these problems owing to investment (FDI) and intra-regional as well as extra-
genetic and race–ethnic complexities. This portion of the regional trade.
population is experiencing a large rightward shift in the en- Beyond the treatment of the individual segments of the
tire body mass index (BMI) distribution, a rapid increase in food industry, we believe we have made a contribution to
body fat around the liver and the heart (often measured by the literature (not just in LAC but also applicable to other
increased waist circumference) at unchanged BMI levels emerging markets) of the linkages across the segments of
Obesity Reviews © 2018 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation
obesity reviews Obesity and food system transformation B. M. Popkin and T. Reardon 3
the food industry that mutually reinforce in their engender- Table S1 presents the countries, the years of the surveys
ing ease of access to non-nutritious foods, e.g. in processors’ and the sample sizes with anthropometry and age data. To
relations to fast food chains via specialized wholesalers. We compare trends in the prevalence of underweight and over-
believe it is important for the obesity research literature to weight, we calculated an annualized percentage point
have a broad and integrated view of these inter-industry change in the prevalence rates for each country. We have
linkages and dynamics, and their relations to diet used similar methods in other studies (34).
changes, to understand the nature of the challenge facing We also provide some sense of the double burden of
policymakers in addressing obesity in the region. Finally, wasting and stunting plus overweight and obesity facing
we discuss how these dynamics in systemic change limit LAC countries. We used only surveys for which we could
the future policy options in this region and raise challenges access the raw data and could systematically clean and cal-
for both the agricultural and health sectors. culate identical anthropometric measures of undernutrition
and overnutrition. Note that the data of several national
surveys, e.g. the STEPwise Approach to Surveillance survey
in Barbados and a Colombian nationally representative
Methodology: data and methods used
survey to be released next year, were not available to the
authors for this analysis.
Background data and measures
We do not address micronutrient malnutrition here but
Anthropometry rather focus on the rapid shift towards overweight and
The Demographic and Health Surveys (DHS), a series of na- obesity with continued stunting and some wasting. In a pa-
tionally representative surveys (available at http://www. per forthcoming in 2018, we will address micronutrient
measuredhs.com), provide most of the information on obe- malnutrition and its contributions to the nutrition burden.
sity trends across the LAC region. For the prevalence re- However, its solutions are unique and outside the scope of
sults, we used all data from any country with quality data this paper, although many of the actions to address
without excessive outliers. For the changes in the double nutrition-related NCDs will also impact positively micronu-
burden, we used only countries with two surveys with trient malnutrition. Table S1 provides each country’s data
mother–child pairs, so we could study prevalence levels for each figure presented in the text.
and trends in the prevalence. We selected the earliest and
latest surveys. Details of the DHS sampling methodology Defining double high burden countries
are described elsewhere (22–24). Additional data are from For children, for the severity of the double burden at the
the Mexican National Health and Nutrition Surveys country level, we used the recent WHO-UNICEF guidelines
(25,26) and the national nutrition surveys of the Brazilian for severe anaemia and high levels of overweight/obesity,
Institute of Geography and Statistics (Instituto Brasileiro wasting and stunting (35). The prevalence levels we used
de Geografia e Estatística). These are large national or to designate a country’s population as high in wasting, over-
nationwide randomly sampled, representative surveys with weight or stunting are ≥15%, ≥ 15% and ≥ 30%, respec-
comparable measured anthropometry (27,28). tively. For women, there is no clear cut-off for overweight
We have data from two time periods for Bolivia, Brazil, and obesity. We use a 40% cut-off because overweight and
Colombia, the Dominican Republic, Guatemala, Guyana, obesity are so prevalent in the region.
Haiti, Honduras, Mexico, Nicaragua and Peru. Only one As background, it is important to note that the govern-
survey, the most recent in Brazil, does not include data on ments of Mexico and Brazil have repeated nationally repre-
preschoolers. We restricted all analyses to nonpregnant sentative surveys with weight and height data. Analyses of
women aged 15–49 years. The data on trends in overweight the 1988, 1999, 2006 and 2012 surveys reveal that over-
and obesity for children, adolescent boys and adult men are weight and obesity emerged in Mexico earlier than else-
inadequate. where in the region (36–38). These surveys show that
We directly calculated all measures to ensure quality con- Mexico’s rates of overweight and obesity were already high
trol. All surveys used standardized protocols to measure but that in the last 20 years they rose higher and became a
weight and height. We calculated BMI as weight in kilo- more serious problem. Studies in Brazil show lower levels
grams divided by height in square metres. Wasting, stunting of overweight and obesity in the 20th century but rapid in-
and overweight designations for preschoolers are from the creases more recently (39–42). The rapid increases in the
World Health Organization (WHO) standards and calcula- past two decades in Brazil and Mexico echo the changes
tion algorithms (29,30). We defined overweight according we find in smaller studies in other countries, like Chile
to the WHO recommendation, BMI ≥ 25 kg m 2 (24), (1,43,44). Our focus is on a broader regional pattern rather
and also used the WHO standards for wasting (31). We than these large country studies.
used the International Obesity Task Force cut-offs for Unfortunately, we do not have directly measured nation-
overweight for women aged 15–18 (32,33). ally representative data for the Caribbean. A recent
Caribbean Public Health Agency report suggests over- cross-sectional presentation of global dietary data does
weight and obesity levels between 28% and 35% in (53). The data do appear quite accurate in terms of SSB
Caribbean countries with high trajectories for children trends in both volume and kilocalories (kcals), as they
and adults but does so partially from unpublished data (45). correspond very closely with our own research on trends
However, this seems like an underestimate when we con- in SSB purchases and dietary intakes in the USA (54) and
sider surveys that measure overweight. For example, in Mexico (55,56).
Barbados, 74.2% of women and 57.5% of men in a na- The Euromonitor data leave an important gap, as they do
tionally representative survey were overweight or obese not report actual sales for the Caribbean and include only
(46). In much larger Trinidad and Tobago, researchers modelled sales for several islands. These results appear in-
found that 70.7% of women and 55.5% of men were over- correct, because the Coca-Cola Company reported that
weight or obese (47). Jamaica was its fastest-growing market globally for the last
4 years (40% per year annual growth) but also noted that
Coca-Cola was not yet but would soon be the top-selling
Diet analysis data and methods
soda in Jamaica (57). For this reason and because other
Mexico is the only country in the region that has repeatedly local food and diet data suggest much higher levels of SSB
collected in-depth dietary intake data through its 1988, intake, we put the Euromonitor data for the Caribbean
1999, 2006 and 2012 national dietary intake surveys countries into the Supporting Information and do not
(25,26,48,49). The raw data from 1988 were lost, but all discuss them in the text in detail.
the other data are available and have been used to under-
stand food, beverage and nutrient intake changes over time.
Colombia in a year or more will have available 2005 and Food and Agriculture Organization Corporate Statistical
2015 national dietary intake surveys, but the data are not Database
available yet. Otherwise there have been few national nutri- We also used food balance data on available foods from
tion surveys, Brazil having the most recent. We did not have the Food and Agriculture Organization (FAO) of the
access to a few other national dietary surveys performed United Nations (58). These are aggregate data compiled
sporadically in South America. We do have sales trends from each country’s estimates of production minus waste,
from Euromonitor International that are useful for under- imports and exports, so it is essentially food available for
standing increases in selected categories of foods (50), and consumption. Food and Agriculture Organization Corpo-
we have many small surveys on selected areas and rate Statistical Database (FAOSTAT) is the only major
subpopulations. global source for food consumption trends of reasonably
comparable data. We present them per capita. The
Euromonitor International data Euromonitor data have been shown to capture trends
We used data on global sales of beverages and less healthy quite accurately, whereas the FAOSTAT data can miss
foods from the Euromonitor International Passport data- changes that affect estimates of production, waste, exports
base (51,52), which has been used in other studies on and imports.
sugar-sweetened beverages (SSBs) (50). We defined as SSBs
caloric soft drinks (carbonated, noncarbonated), fruit
drinks (sweetened beverages of diluted fruit juice and often Retail and food service sector sales data
other caloric sweeteners and flavouring) and the fast- The data for sales over years are drawn from our analysis of
growing categories of energy drinks, sports drinks and raw data in www.Planetretail.net. The retail and restaurant
sugar-sweetened (often flavoured) waters (combined in our chains are all the chains followed by Planet Retail per coun-
figures as sports and energy drinks). We combined sales try. For the retail firms, we limited our analysis to those
for off-trade volume (i.e. supermarkets and retailers) and which sold at least some food. Planet Retail follows the lead
on-trade volume (i.e. restaurants and cafeterias) reported chains at mainly the national level but not the local and re-
in millilitres per capita per day. The caloric data are avail- gional chains, so the totals shown in the tables are an under-
able only for off-trade sales. We weighted countries in the estimate of the overall food-selling modern retail chains’
region by population to create regional averages. Limita- and restaurant chains food sales in the countries. Because
tions of the data set are that the data are likely to omit many most of the retail and restaurant sectors are still somewhat
small local bottlers and informal sector products. A few fragmented, this may be a significant underestimate. There
countries, notably Colombia, were off by a large (possibly are no official data with which to compare. Details of the
50–60% of the total) amount; the data are average sales companies followed are noted in the tables. Despite the un-
for the country and include waste but do not shed insights derestimates, as with the Euromonitor data, we feel the
on per capita consumption for the key age groups most trends established are fairly representative of each country
likely to consume SSBs (especially ages 10–35) as a recent and the region.
Trends in undernutrition, overweight and obesity overweight and obesity (1). Table S2 provides these data
on wasting, stunting, wasting and stunting, and overweight
Most recent prevalence results or obese.
For the regional child estimates, we were limited to the
Overweight and obesity
ages available in the DHS data, ages 0–4, so results do not
Latin America and the Middle East and North Africa are the
match the published data. We find slightly lower levels for
two most obese low-income and middle-income regions
children than the 0–5 or 0–6 categorizations. Surprisingly,
globally (refer to Tables S2 and S3 for detailed LAC country
the DHS plus Mexican national survey results do not show
data for children aged 0–4 and women aged 15–49, respec-
the same rapid increases in overweight for children noted in
tively). Over half of the women in Latin America are over-
many countries. But this could be an artefact of older data
weight or obese, and in many countries, e.g. Chile and
(Table S2).
Mexico, the figures reach two-thirds of the women and over
Several regional dimensions make these levels of over-
half of the men. The data are old for most countries other
weight and obesity far more critical in terms of health and
than Mexico, so we would expect to see a much higher ag-
economic impact. First, the severity of the rightward shift
gregate weighted average in the most recent data. However,
in the BMI distribution among those overweight and obese
rates of increase are well over one percentage point per year
has worsened (14). Second, we have found in related re-
in many Latin American countries, and in some cases, like
search that over the past 20 years waist circumferences in
Brazil, they appear to be accelerating. After a decline of obe-
many countries have grown for the same BMI level
sity among educated women in the 1990s, Brazil has seen a
(11,14). Third, as we have shown for Mexican Americans
sharp reversal and a rapid increase in the new millennium
living in the USA and others have shown in Latin
(59,60). Figure 1 provides the levels and rates of change
America, the risk of diabetes at each BMI level above 22 is
for all the countries in the region for which we have data.
much higher for Latinos than for non-Hispanic Whites
Child overweight levels have lagged adult levels, and only
(13). This seems also to be true for Indo-Caribbeans, who
recently have overweight and obesity increased significantly
appear particularly vulnerable to diabetes (64). Figure 1
and rapidly among children (61). At the same time, over-
presents the most recent prevalence of overweight for
weight is widespread among children under 5 years old,
women and the annualized change in the percentage points
particularly in Chile and Mexico, 9.3% and 9.8%, respec-
of prevalence for each country for which we have two or
tively (2,62). There is less systematic evidence for older chil-
more years of data.
dren, but available reports and articles regarding adolescent
girls suggest that their prevalence of overweight and obesity
exceeds 25% in some countries (2,34,63). While smaller Wasting and stunting
country surveys or ones whose raw data were unavailable Aside from Haiti and Guyana, there is minimal wasting or
to us point to recent rapid increases in child obesity, the lack acute malnutrition in the region, as Table S2 shows. In addi-
of data from Brazil, Chile and some other countries means tion to low levels of wasting, we find a meaningful annual-
we are reporting a tiny annualized decline in child ized decline in wasting. For all countries, the annualized
percentage point change in wasting shows a decline of
0.22 per year. In contrast, stunting levels remain high, but
we see even larger annualized drops in stunting. In the
smaller Central American countries and Haiti, we find sig-
nificant levels of wasting. Stunting is related to poor infant
feeding, including low breastfeeding rates, short periods of
exclusive breastfeeding and poor weaning and infant foods.
Overall for the region, only 16.6% of preschoolers are
stunted, yet many smaller countries, including Bolivia,
Guatemala, Guyana, Haiti, Honduras and Nicaragua, have
rates above 20% among preschoolers.
Thinness in women
Underweight is not a problem among women in this region.
Except in Haiti and Guyana, we find low levels and a signif-
icant 0.22 annualized decline. Therefore, we do not present
Figure 1 Latin America and the Caribbean: prevalence and annualized
change of undernutrition and overweight burden (percentage point preva-
data on thinness except in Table S3. Figure 1 summarizes
lence change per year). the overweight and underweight data for the most recent
survey (refer to Table S1 for dates of each survey) and the
oldest survey from the 1990s and the annualized rates of the major shifts, none of which are healthful. All of the re-
change for women aged 15–49 and children aged 0–4. gion’s shifts indicate a need for government programmes
and policies and changes in the culture of food preparation
and eating to adequately address obesity and stunting. We
Double burden of underweight and overweight
draw on but do not present data and information from the
One can understand this double burden at the national,
studies (50,51,58,68–78). Mozaffarian and colleagues used
household or community level.
individual dietary surveys of varying quality and representa-
When we look at individual households, we find that
tiveness from across the globe to compile a careful review of
about 10% of households have both stunted or wasted chil-
consumption of SSBs, fruit juices, milk, fats, oils and dietary
dren and overweight or obese mothers. But as an important
quality. Later, we address trends that are central to the diets
indicator of intergenerational complexities, we find that less
of the Americas.
than 2% of the children are both stunted and overweight.
The dietary data come from a combination of sales data,
We know from cohort studies in Guatemala and Brazil that
which are very useful for understanding trends. However,
children who are stunted have an increased risk of abdomi-
these Euromonitor sales data do not represent total sales
nal obesity, type 2 diabetes and hypertension (17,18,65,66).
or consumption. Similarly, the other major data used from
The important issue for this region is that the double bur-
the FAO of the United Nations are based on national per
den of undernutrition and overnutrition at the household
capita food available for consumption. They are useful for
level is low, and it is declining. This is related to the region’s
trends and general consumption but generally are 20% or
low levels of wasting and stunting relative to many other
more higher per capita than true dietary intake. But they
low-income and middle-income countries (LMICs) (67). Re-
provide a relative picture of trends for various foods. In con-
fer to Fig. 2 for a summary of regional double burden data.
trast, few Latin American countries have nationally repre-
The WHO would classify Bolivia and Guatemala among
sentative dietary intake data, but we do use studies based
the LAC countries as high for stunting, none for high over-
on such data when the results fit the topic.
weight in children and all except Haiti for high overweight
or obesity in women. Only Bolivia and Guatemala in the
last decade would qualify as high double burden countries,
Increased intake of unhealthy food
whereas in in the 1990s, Honduras, Nicaragua and Peru
were the only double burden countries (67). Global diet shifts
A recent review looked at global sodium increases on the
basis of dietary and urinary sodium excretion studies (79).
Major dietary trends Our work and in-depth studies by others in China, Brazil,
Mexico and elsewhere show that consumption of foods
Dietary shifts remain the major driver of current and future
with added sugars, added salt and refined carbohydrates;
shifts in both undernutrition and overnutrition in the re-
grain-based desserts; and savoury snacks has grown
gion. From smaller studies and reviews, we pulled together
(74,80–83). Latin American countries experienced these di-
etary shifts earlier than most other LMICs, and for some of
the shifts, they are global leaders.
The proportion of kcal per day from macronutrients

Figure 3 shows the proportion of energy per capita derived
from major macronutrients in the three major geographic
areas of the region. We see in general a decline in carbohy-
drates and noticeable increases in total fats. The largest in-
crease, as expected, is in vegetable fats owing to the global
trend towards processed vegetable oils from a variety of oil-
seeds (84).
Sugar is a major element in all Latin American foods and
beverages, particularly coffee, pastries, packaged foods and
SSBs, as it is globally. Three of the world’s five highest SSB-
consuming nations are in Latin America, and the levels of
SSB intake are increasing in the region as a whole (50,82).
Figure 2 Latin America and the Caribbean: double burden of undernutri-
Latin Americans consume very high levels of added sugar,
tion and overweight and annualized change (percentage point prevalence more than triple that recommended by the WHO (73,83).
change per year). Beverages are the largest source of sugar in the diets of most
Figure 3 Change in macronutrient percentages of total daily per capita kilocalorie food balance by source, 1961–2013. Source: FAOSTAT.
children, adolescents and young adults in the region selected countries. Figure 6 shows the most recent levels in
(72,73,82). grams per capita per day, and Fig. 7 shows the trends by cat-
Figure 4 shows the overall levels of SSB sales in Latin egory. These foods, except for salty snacks, are high in
America overall and four countries in 2016, and Fig. 5 added sugar and saturated fats, and many are high in so-
tracks the trends in SSB sales by category in the same areas. dium, including salty snacks.
Mexico, Argentina and Chile are three of the five countries The FAO food balance data record the general trends in
with the highest measured per capita sales of calories from total per capita sugar available in food in the region from
SSBs (50). We do not have accurate sales measures for the 1961 to 2013, the most recent data. These levels are very
Caribbean, but we know from other sources that intake in high, but clearly the per capita calories available for con-
much of the area is exceptionally high (57). As carbon emis- sumption are an overestimate of the amount actually con-
sions and water use become greater concerns in some of the sumed. Figure 8 presents the numbers for 1990 and 2013
region’s countries, SSB use looms as one critical issue related to demonstrate the long-term shifts. These data do not re-
to excessive water use (85–88). flect the shift from consuming sugar in food to consuming
more sugar in SSBs and other beverages.
Junk food
Figures 6 and 7 demonstrate the large amounts of junk food Refined carbohydrates
or nonessential food sold in Latin America overall and the Diets rich in refined carbohydrates are defined by excessive
intakes of foods we might term junk food or nonessential
foods that contain much sugar, saturated fat and sodium
and are often highly processed (83,89–91). While the trend
towards higher consumption is global, it seems to be accen-
tuated in the Caribbean, where fewer data are available but
all policy documents speak of excessive refined carbohy-
drates in diets. In Brazil, these foods are an increasingly im-
portant part of food expenditures (76,77). As Monteiro
et al. state in a set of papers, ultra-processed foods com-
posed of refined carbohydrates, excessive sodium and satu-
rated fats represent the key threat (75,76,92–97).
Figure 4 Total daily per capita sales of sugar-sweetened beverages in

Latin America and select countries, 2017. Source: Euromonitor Interna-
Snacking
tional Limited 2018© All rights reserved. We have documented in the USA that increased eating occa-
sions, driven by snacking, represent a major portion of
Figure 5 Trends in daily per capita sugar-sweetened beverage sales by category in Latin America and select countries, 2005–2017. Source: Euromonitor
International Limited 2018© All rights reserved.
reflect only a proportion of the sodium consumed. They

omit measurements of salt in home-prepared food, salt
added during consumption and salt consumed at away-
from-home informal sources, nonchain restaurants and fast
food eateries. These results are far higher than the levels rec-
ommended by the WHO and other national and global bod-
ies. The data on the region and four countries are in Fig. 9.
Animal products
Animal source foods appear to be consumed at high levels
that are increasing across the region. There is an extensive
Figure 6 Total daily per capita junk food sales in Latin America and se- literature on changes in animal source food intake and the
lect countries, 2017. Source: Euromonitor International Limited 2018© All effects on health, climate, water use and antibiotics in water
rights reserved.
supplies, so these issues are not repeated here (80,102–107).
The food balance data in Fig. 10 suggest very large increases
increased caloric intake (98–100). This has been docu- in animal source food consumption across the region fol-
mented in Mexico, Brazil and other countries in the Latin lowing the income growth and regional cooperation on
American region as a critical element of unhealthy eating trade that begun in 2005–2007.
(75,89–91). If the limited studies in the larger countries in
the region are indicative, snacking has become a major com-
Away-from-home consumption
ponent of the diet. In Brazil, among those over the age of 10,
While eating away from home could be positive and health-
21% of kcals per day comes from snacks. Among the seg-
ful, in general, the studies of LMICs support the conclusion
ment of the population that does snack (74%), the propor-
that fast food and unhealthy street foods, often deep-fried
tion rises to 34% (101).
and high in saturated fats, sodium, sugar and refined carbo-
hydrates, dominate. The Pan American Health Organization
Sodium (PAHO) and most of the region’s countries have voiced con-
Powles and colleagues looked at sodium increases globally cern about both imported fast food and local vendors that
(79). In the Americas, a combination of highly processed sell such unhealthy foods. But data are sparse, and it is be-
junk food, eating away from home and added sodium is re- yond the scope of this review to undertake rigorous analysis.
sponsible for high levels of sodium intake, particularly in Most of the Monteiro et al. papers highlight ultra-processed
the Caribbean (102). foods as a major problem, but this away-from-home sector is
The data for Central and South America combined on so- complex and is composed of both global and national chains
dium sales from packaged foods and chain restaurants and small vendors. Euromonitor data on per capita yearly
Figure 7 Trends in per capita daily junk food sales by category in Latin American countries, 2005–2017. Source: Euromonitor International Limited 2018©
All rights reserved.
expenditures on away-from-home food and nonalcoholic

beverage expenditures over the past two decades indicate a
large increase in many countries (Fig. 11).
Reductions in healthier food options

Legumes
Once staples for the region, these healthy low-fat, high-fibre
and high-protein foods have declined as a critical part of the
diet over the past decade. Legumes now represent less than
5% or 10% of the daily energy intake (Fig. 12). It is one
of the items that Monteiro and others who promote
returning to a traditional diet would like to see take a cen-
tral place (75,108).
Figure 8 Sugar and sweetener food balance, 1990 and 2013 (kcal/ Fruits and vegetables
capita/day). Source: 7 FAOSTAT. In Latin America, as globally, we find low intake of this com-
ponent of a healthy diet (109–112). We show that even the
quantities of fruits and vegetables available for consumption
in this region are remarkably low (Figs 13 and 14). No coun-
try comes close to consuming the five to seven servings per
day of fruits and vegetables that we wish all adults to con-
sume (113,114).
Whole grains
No accurate measure of consumption of whole grains for
the region exists. If the FAOSTAT data in Fig. 15 were to
be believed, the bread that Chileans consume would all be
whole grain. However, Chilean nutritionists claim that it is
made from highly refined white flour. It is hard to know if
the other countries’ measures of whole grains are accurate.
Figure 9 Combined retail and food service daily per capita sodium
Mexican scholars often state that their tortillas, mainly
sales, 2010 and 2015. Source: Euromonitor International Limited 2018© made from commercial masa flour, are whole grain owing
All rights reserved. to the high fibre–carbohydrate ratio. Yet one of the current
Figure 10 Trends in animal product food balance, 1961–2013. Source FAOSTAT.
Midstream and downstream food system

changes that facilitate diet shifts
Meta-conditioners of food system change

Five ‘meta-conditioners’ have encouraged and facilitated
food system changes and diet changes. These conditioners
are themselves mutually dependent: income growth, policy
liberalization, infrastructure improvement, urbanization
and the rise of rural nonfarm employment. We briefly treat
each in turn.
Income growth
‘Over the past 30 years most of the LAC countries moved
several steps up the scale towards becoming high-income
Figure 11 Per capita away-from-home food and nonalcoholic beverage
yearly expenditures, 1995–2017. Source: Euromonitor International Lim- and low rural poverty nations’ (115). The gross income of
ited 2018© All rights reserved. LAC was approximately 1 trillion current USD in 1980
and 6 trillion in 2014 (https://data.worldbank.org/region/
latin-america-and-caribbean). The population rose from
authors spoke with one of the two millers who dominate the 364 million to 624 million. Thus, income rose from
tortilla flour market, and the miller noted that he or she re- $2,742 to $9,615 per capita, or 3.5-fold per capita, over
fines the corn and removes the bran. So we are unsure the period. Bennett’s law (a statistical regularity linked with
whether whole grains are significant in the diets of any two concepts: the ratio of starchy and lower-quality foods
countries in the region. Figure 15 data suggest very high goes down as income rises [i.e. the quality of the diet in-
levels for Chile, whereas dietary data suggest that the major creases as income increases] and the poor spend a great pro-
source of grain is bread made with refined white flour. portion of their income on food) shows a positive
Figure 12 Trends in bean, pea and other legume food balance, 1961–2013 (kcal/capita/day). Source: FAOSTAT.
Figure 13 Trends in fruit and vegetable food balance in Latin America and the Caribbean, 1961–2013 (kcal/capita/day). Source: FAOSTAT.
correlation (in fact a disproportionate increase) between in- Policy liberalization and privatization spurring private
come increase and the share of the diet from fruits, vegeta- sector investment
bles, meats, fish, dairy and fats; Bennett’s law has been The bulk of policy liberalization and agri-food parastatal pri-
borne out in empirical studies in LAC (116). Studies also vatization occurred during the 1980s and 1990s in LAC.
show a correlation between income and the purchase of Large private sector companies (e.g. Bimbo in Mexico,
processed food in LAC (75,117–120). discussed in detail later) and small-size and medium-size
Figure 14 Trends in fruit and vegetable food balance in select countries, 1961–2013(kcal/capita/day). Source: FAOSTAT.
enterprises (SMEs) developed rapidly, stepped into the void

left by privatized parastatals and proliferated to meet urban
market demand. For example, Farina (121) discussed the
wheat flour milling sector in Brazil. After the privatization
of the wheat milling parastatals, a proliferation of milling
SMEs diversified the quality of the product available.
Privatization also led to the entry of large foreign firms,
e.g. processors, supermarkets and fast food chains. The
massive ingress of foreign companies was abetted by liberal-
ization of the once-ubiquitous FDI regulations in the 1980s
and 1990s. For example, Farina et al. (122) analyse the in-
gress of multinationals, e.g. Nestlé, in the dairy sector of
Argentina and Brazil after FDI liberalization. In many sec-
Figure 15 Daily per capita whole grain consumption in select countries,
tors, the large companies merged with and acquired the
1900 and 2015 (kcal/capita/day). Source: Institute for Health Metrics and SMEs that had emerged in the immediate post-liberalization
Evaluation. period.
One striking aspect of the conditioners of food system from-home-prepared food, purchased-for-home processed
transformation in LAC is that the central influential policy food or ready-to-heat food) and women working outside
was dismantling of government control of the food system the home (125–128).
– liberalization of FDI, elimination of food price controls The latter is itself correlated with the opportunity cost of
and subsidies, privatization of the government systems of time for food preparation. In LAC, urban women increas-
food and farm input distribution – that was largely not ac- ingly work outside the home. A World Bank report (129)
companied by regulations that managed the rapid develop- shows the share of women in the overall workforce rose
ment of the private food system, with the exception of from 1990 to 2016 in Argentina from 36% to 41%, in
some public food safety and phytosanitary standards. The Bolivia 38% to 44%, in Brazil 35% to 43%, in Chile
latter were regulations encouraged by global food compa- 31% to 41%, in Colombia 30% to 43%, in the
nies. However, the social consequences of the food system Dominican Republic 34% to 41%, in Ecuador 34% to
transformation, e.g. the impacts on health we discuss here, 39%, in Guatemala 26% to 35%, in Honduras 39% to
were not part of the public debate. There was also little 37%, in Mexico 30% to 37%, in Nicaragua 31% to 40%
or no regulatory attention to curbing bad health effects and in Peru 38% to 45%. The employment rate of women
(e.g. taxes on sodas and required caloric labelling). Debates outside the home has also grown fast. Novta and Wong
on them have only recently begun in LAC. In the Policy (130) note that
implications section, we recommend that these be further
developed. LAC, as a region, saw the largest gains in female labor
force participation in the world during the past two de-
Improvement of infrastructure and reduction of transaction cades. Women in LAC are becoming increasingly active
costs in paid work, closing the gap with men and catching up
The Economic Commission for Latin America and the to the counterparts in advanced economies. In 1990, only
Caribbean shows that there was a reversed J curve in public 44 percent of women in LAC participated in the labor
and private infrastructure investment rates in the 1980s force. In 2014 this ratio increased to 54 percent, close to
(highest rate) and 1990s (lowest rate). Then in a resurgence levels seen in the United States and East Asia.
in the 2000s through the mid-2010s, half the countries
attained the 1980s rate, and the other half were not far from
it. The report cites gaps and insufficiencies, e.g. regional Rural nonfarm employment and rural women’s opportunity
connectivity, power grids, drinking water and sanitation. costs of time
Cerra et al. (123) note that road density and quality in Rural nonfarm income (RNFI) grew quickly in the 1990s
LAC are well below those in the USA and emerging Asia. (131), reaching about half of the total rural income by the
But we think it is difficult to compare LAC with emerging mid-2000s (132). By the late 1990s, the majority of rural
Asia in this regard, as the population density is far lower women’s income in most Latin American countries was
in LAC. RNFI (131). Moreover, 25% of the population is in rural
However, Economic Commission for Latin America and areas, and the majority of the rural population is near a
the Caribbean notes that in the 1980s and again in the city. Barbier and Hochard (133) show that less than 10%
2000s, most of the infrastructure investment was for trans- of the rural population lives far from a town or a city
port. The number of vehicles per 1,000 people rose quickly (134). As we show later, that implies proximity to proc-
in LAC from 113 to 177 over just 10 years (2002–12) essed food stockists and large companies’ van networks.
(www.energy.gov). Also, urbanization (discussed next) The rise of RNFI and women’s important role in it implies
compared with rural areas constitutes, by definition, an ag- the rise of women’s opportunity costs of time, as in cities.
glomeration and a densification of roads and other infra- That means the growth of demand for convenience foods,
structure. The combination of transport infrastructure, e.g. processed foods, in rural areas just as it did in cities.
vehicles and urbanization has reduced transaction costs in The proximity of most rural households to urban areas
LAC food systems over the past several decades. means that packaged processed foods are accessible and
penetrate rural areas.
Urbanization, women’s work outside the home and All of these changes in employment and opportunity cost
opportunity cost of time of time along with access to modern technology have shifted
LAC urbanized early compared with other developing re- the demand for convenience foods but also sharply de-
gions. The urban share was roughly 40% in 1950, 55% in creased the time women spend on food preparation and
1970, 65% by 1990 and 75% by 2010 (124). As urbaniza- cooking. We do not have accurate time use data on cooking
tion proceeded, supply chains to feed cities had to lengthen for this region, but studies in the USA and globally have
and food had to become more storable. Many studies show shown marked changes in overall time allocation, increased
a relation between demand for convenience food (away- time in leisure and reduced cooking time (9,135–140).
General patterns of the evolution of food systems in The sectors did not transform all at once but in a cascade
the region of ‘waves of diffusion of transformation’ over time and
segments, as follows:
Structure-conduct stages of food systems
We use the concept of the transformation of food systems or 1 Wholesale transformation occurred earliest, its first
value chains and identify stages of that transformation phase in the 1950s to the 1980s with public sector in-
(141). vestment in wholesale markets and parastatals, and
The least advanced stage is the ‘traditional’ system. This continued thereafter as private sector transformation
tends to be spatially short (‘local’) and fragmented in struc- of that segment.
ture, using technologies with little capital and much labour, 2 Processing transformation occurred mainly in the
with no contracts or formal standards and with spot mar- 1960s and 1970s with government grain, meat and
kets linking all segments. The next stage is the ‘transitional’. dairy enterprises.
It is spatially long (as cities grow and their catchment areas 3 Retail transformation as a public sector phenomenon
are larger) but still fragmented. Chain actors use a mix of coincided with the rise of urbanization from the
labour-intensive and capital-intensive technologies. Public 1950s through the 1980s.
standards of quality emerge, but spot market relations still 4 The private sector ‘supermarket revolution’ was
dominate. The most advanced stage is ‘modern’. It also is mainly from the 1990s to the present.
usually spatially long, but it consolidates in a number of seg-
To illustrate the heterogeneity over countries, urban ver-
ments (e.g. retail and the rise of supermarkets). There is also
sus rural spaces, and products, we discuss details of the re-
some disintermediation, e.g. supermarkets buying directly
tail waves in the next section.
from processors or urban wholesalers directly from farmers.
The timing of the transformation of each segment is ap-
Private standards emerge along with some use of contracts.
proximate, as the timing differs by sub-region and country.
Capital intensification is common, as the modern stage
There is substantial heterogeneity over sub-regions and
tends to coincide with higher wages and the food industry
countries and even within countries (e.g. Southern Brazil
demands more quality and safety control.
vs. the Northern states) in the LAC region, with the earlier
‘waves’ of transformation (and current extent of transfor-
Recent phases of food system transformation mation) figuring more in the larger or higher-income and
The bulk of the transformation of food systems in LAC has more urbanized countries of South America (e.g. Brazil
occurred in two phases. The first, ‘preparatory’ phase was and Chile) and Mexico and the later waves in either the
from fully traditional value chains to partly traditional poorer and less urbanized areas (e.g. in Central America
and partly transitional systems initiated by governments in or Bolivia) or countries that underwent periods of conflict
the region, mostly in the 1960s through the 1980s. Govern- or other processes that initially slowed food system transfor-
ments set up grain and processed products parastatals in mation. In what follows, while we continue to refer to these
wholesale, processing and retail, and they invested widely waves of transformation and heterogeneity, as indeed that is
in municipal wholesale markets. important for differentiated policy and strategy approaches
The second phase was liberalization and the privatization now, but in general we emphasize an image of a ‘moving
and globalization of the LAC food system. The isolation of average’ of transformation of food systems in the region,
that system from FDI ended in the 1980s and 1990s with as indeed there is a tendency to convergence.
liberalization. Constraints to the domestic food systems’ in-
ternal development and restructuring ended or waned with
liberalizations of state-mandated pricing, product move-
Retail segment transformation
ment and other business regulations. Most of the parastatals
(except the public wholesale sector) ended with privatiza- Evolution of retailers and modern food processors
tion of these entities. Traditional retailers – small shops, wet markets and street
Privatization and liberalization initiated rapid investment hawkers – tend to have a limited product assortment and
by foreign firms, especially in retail and processing, and by no self-service. The initial evolution of these stores is a shift
domestic large private sector firms in retail, processing, to self-service and expansion of product diversity. To help
wholesale and logistics. Liberalization plus infrastructure them with the latter, stockists buy from wholesalers or fac-
improvement helped not only the entry of large firms but tories and resell products to small retailers (142). Stocking
also a proliferation (especially early in the second phase) small stores with processed products has modernized in
of SMEs, particularly in processing, wholesale and logistics. two ways in LAC. First, cash-and-carry chains, e.g. Sam’s
This brought transformation of the food system into the Club of Walmart, supply small retailers. Second, as noted
‘transitional’ and ‘modern’ stages during the past three de- later with the example of Bimbo, as processing firms be-
cades (roughly the mid-1980s to present). come large, they invest in fleets of vans or trucks (or hire
third parties) to distribute their branded items directly to re- The third wave involved countries with growth in the
tailers in rural or urban areas. 1990s and 2000s or in which liberalization occurred in the
This evolution of ‘traditional’ retail enables small stores 1990s, e.g. Bolivia, Nicaragua (158) and Peru. In some
to carry at least a limited assortment of key brands of proc- cases, like Peru, there was some earlier transformation, a
essed products – the brands also found in supermarket lull with internal crises and a restart of transformation
chains. If the store is convenient and accessible to con- along with overall economic growth. For the third wave, re-
sumers, it may withstand competition from supermarket tail modernization took off in the late 1990s or early 2000s,
chains and convenience stores. The trend, however, has reaching 10–20% of the national food retail by circa 2003
been that competition from modern retailers forces small and 20–30% by 2016, as in Peru (159,160).
stores selling processed foods out of the market. Supermar- The LAC differs from Asia and Africa in the temporal
ket chains set up large distribution centres and specialized correlation of urbanization and the rise of supermarkets.
or dedicated wholesalers and buy directly from large proces- In Asia, for example, supermarket development was closely
sors, cutting margins of intermediation that small stores correlated with urbanization. By contrast, in Latin America
must retain (143). In Chile, Faiguenbaum et al. (144) found urbanization (assumed to be a sine qua non of supermarket
that over the 1990s, about half of the small stores selling development) took place by the early 1980s, before the rise
processed dry foods, beverages, meats and dairy exited ow- of supermarkets. By 1980, at the very start of liberalization,
ing to supermarket competition. This is a common story in more than 50% of the population in 14 Caribbean coun-
other countries in the region. tries, 4 (of 8) Central American countries and 11 (of 14)
South American countries were urban (161,162). That prior
urbanization was a necessary but not sufficient condition
Waves of supermarket revolution for supermarket diffusion. The other factors were economic
There has been a much heterogeneity in the evolution of re- growth and especially liberalization.
tail over products, over firms, over countries, over sub- In 2017, the fastest growth in the modern food retail sec-
regions in LAC and over time, but some general patterns tor is mainly in the second and third waves (as is usual in the
can be observed. The first transformation wave involved diffusion of new technologies or institutions). The global re-
the LAC countries with the earliest post-World War II tail development index of retail growth prospects (163) puts
growth and industrialization, in particular the larger South Peru, Colombia, the Dominican Republic, Paraguay, Bolivia
American countries, e.g. Argentina and Brazil. The retail and Brazil at global ranks 9, 10, 13, 19, 28 and 29, respec-
transformation took off in the early 1990s, when supermar- tively. Moreover, modern retail was spreading in most LAC
kets’ average share of food retail went from 10% to 20% countries by the early 2000s. But sales data from leading
circa 1990 to 50–60% by the early 2000s (143,145). Com- firms in the region show that supermarket sales continued
pare that to the 75–80% share that supermarkets had by to grow over the past decade. Table 1 reports retail chain
2005 in the USA and western Europe, and one sees a pro- sales of edible groceries for 2002, 2006, 2011 and 2016
cess of convergence. The front runners, Argentina with a along with compound annual sales growth rates compared
60% supermarket share in 2002 (146) and Brazil with a with real gross domestic product (GDP) growth rates. The
75% share (147), saw in a single decade the supermarket data are from Planet Retail, a retail services and analysis
diffusion that took some five decades in the USA and the company that tracks the leading chains per country. Planet
UK. We class with the first wave a second set of countries Retail does not track smaller local chains, regional (in-coun-
at the end of the first wave and the start of the second wave. try) chains or independents, so the sales data underestimate
Examples include Costa Rica and Chile with circa 50% by all modern food retail. But we think this provides a rough
the early 2000s (143,148,149) and the higher-income idea of trends, and no official data exist for comparison.
Caribbean countries, e.g. Trinidad and Tobago (150). We show data for 12 countries covering about 100 chains.
The second wave involved the countries whose growth We excluded food service (e.g. coffee chains or fast food),
started later or who had strong internal pressure to limit as that is in another table. The countries in the table are
FDI. These limits were often directed more at retail than at grouped in the three waves discussed earlier.
processing. Hence in Colombia, Mexico and Central Several points emerge in Table 1. First, the total food sales
America, private sector processing transformation took off of the chains increased from 40 billion USD in 2002 to 154
in the 1980s, but retail transformation did not start until billion in 2011, a fourfold increase. The real increase is less,
the mid to late 1990s. The modern retail share went from but because the inflation data were ambiguous, we report
5–10% in 1990 to 30–50% by the mid-2000s, e.g. nominal increases here. For comparison, in Asia, Reardon
Mexico with 56% supermarket share of total food retail et al. (164) used the same method over approximately the
(151–153), Ecuador with 40% in 2003 (154), Colombia same period for nine countries and included 195 chains
with 47% (155), Guatemala with 36% in 2002 (156) and whose sales were about 51 billion USD in 2002 and 198 bil-
the Dominican Republic with 40% (157). lion in 2009, also a fourfold increase. This means that in
Table 1 Edible grocery sales of leading modern retail chains and gross domestic product (GDP) growth in selected Latin American countries (2002–16)
in nominal millions of USD
Compound Compound Compound Compound Compound Compound

sales growth real GDP sales growth real GDP sales growth real GDP
Sales Sales 2001–2006 growth 2002– Sales 2006–2011 growth 2006– Sales 2011–2016 growth 2011–
Waves 2002 2006 (%) 2006 (%) 2011 (%) 2011 (%) 2016 (%) 2016 (%)
First wave
Argentina 3,057 5,036 13 9 12,207 19 4 13,656 2 0.2
Brazil 19,110 36,853 18 4 92,039 20 4 72,019 5 0.4
Uruguay 344 504 10 4 1,253 20 6 1,450 3 3
Second wave
Costa Rica 563 1,059 17 5 2,058 14 4 2,711 6 4
Chile 2,101 4,778 23 6 11,300 19 4 11,536 0.4 3
Colombia 2,032 3,099 11 5 5,892 14 5 6,038 0.5 4
Ecuador 566 853 11 5 1,576 13 4 2,251 7 2
Guatemala 377 512 8 4 1,055 16 3 1,036 0.4 4
Mexico 11,368 17,155 11 3 24,331 7 2 22,027 1 3
Third wave
Bolivia 28 43 11 4 92 17 5 179 14 5
Nicaragua 46 128 29 4 290 18 3 563 14 5
Peru 251 365 10 6 2,251 44 7 2,856 5 4
Source: Authors’ analysis of raw data in www.Planetretail.net. The sales figures are for the food retail chains Planet Retail followed per country. Planet Retail
follows the leading national chains, not smaller chains, independents or regional chains in a country. The total sales for a given country are thus an under-
estimate of all modern food retail sales. There are no official data with which to compare. In Argentina, Planet Retail followed 11–13 chains in this period, in
Brazil 22–23, in Uruguay 3, in Costa Rica 4–5, Chile 8 in 2002 and 5–6 thereafter, in Colombia 7–8 in 2008 and 10–12 thereafter, in Ecuador 3–4, in
Guatemala 2, in Mexico 13–14 in 2002 and 10–11 thereafter, in Bolivia 1, in Nicaragua 1–2, and in Peru 3 in 2002 and 5 thereafter. Any major shifts were
due to companies being acquired or exiting or major firms coming in. For example, the fall in the number of retailers in Chile between 2002 and 2006 can be
attributed to a number of mergers (Falabella bought Supermercados San Francisco in 2004, and D&S bought Carrefour in 2003) and to Ahold Delhaize
leaving the region in 2003. Brazil’s fall in sales from 2011 to 2016 can be explained by the 2015–2016 crisis, when GDP fell and a number of the major
retailers (Casino, Carrefour and Walmart) reported a decrease in their sales.
LAC and Asia food retail sales grew at a similar rate over that of chains spreading in waves over the richest and larg-
the 2000s. For both regions, supermarket sales grew faster est market first owing to profit per capital invested. Compe-
than the GDP per capita, indicating a structural shift. tition and saturation of the initial base drive investment by a
Second, the average yearly sales growth rates for the first given chain into the series of subsequent markets. While the
wave countries were 10% in the first half decade and 20% gross return declines, there are cost savings due to econo-
in the second with little sales growth in the third. Note the mies of scale and procurement system changes. Often a mul-
anomaly (among all the waves in the third half decade) that tinational chain acquires or enters a joint venture with a
the Argentine and Brazilian economies actually contracted large domestic chain, and both acquire smaller local chains
slightly in real terms, while all the other countries and waves operating regionally in a country. The competition from a
in the sample roughly maintained their real GDP growth over larger chain in turn pushes a chain based in an intermediate
the 15 years. For the second-wave countries, the averages city to extend into hinterland towns, seeking refuge from
were about 14%, 14% and 2%, and for the third-wave coun- the increasing competition in its base market. This process
tries, they were about 17%, 26% and 11% for the three pe- accelerates the diffusion of supermarkets over space. Exam-
riods. Thus, the third-wave countries’ modern retail sales ples of the latter pattern are published for Argentina (146),
growth rates were roughly 30%, nearly double those of the Chile (144) and Mexico (152). What begins as a transfor-
first and second waves (which also had substantial growth). mation of big city retail ends as a transformation of rural
This is as expected, because the more mature modern retail small town retail. Haggblade et al. (132) review illustrative
sectors grow more slowly than those starting from a lower evidence of supermarket chains extending into rural small
base. Interestingly, the Asia results show a similar relation towns in Mexico.
in the first and second waves, also with annual rates of about Controlling for the pattern of spatial diffusion, we find
15%, versus the third wave, with annual rates of 40% (164). similar waves of diffusion over socioeconomic groups-
cum-consumer segments. Obeying the same business logic
Diffusion over space and consumer strata as in spatial diffusion, supermarkets focus first on upper-
Supermarkets in LAC have tended to start in large cities and income consumer segments, move into the middle class
spread to intermediate cities and towns and then to small and finally move into the markets of the urban poor. For ex-
towns in rural areas. The business strategy is the same as ample, in Peru, a third-wave country, over the 2000s, the
diffusion of modern retail went from nearly all of the super- discount stores, convenience stores and small supermarkets.
market sector concentrated in Lima to two-thirds of the su- A typical example is Mexico, where Walmart and Soriana
permarkets in Lima and the rest in other cities by 2016. The are opening small format supermarkets in small towns. To
penetration rate (share of supermarkets in total food retail) penetrate suburbs and large cities, where transportation is
was still incipient, just 30% in Lima and 12% in other cit- available, chains use large supermarket and hypermarket
ies. The diffusion went from middle-class and upper-class formats. Chains also open small, focused ‘hard discount’
districts to lower-middle-income districts by 2016 (160). stores and convenience formats to compete with traditional
The factors allowing the extension into lower-income neighbourhood shops on prices, e.g. what Carrefour did
areas in Peru and in other LAC countries include (i) reduc- with the brand Dia in Argentina in the late 1990s. This for-
tion of prices owing to increasing efficiency in procurement mat is larger than a convenience store in assortment but
and economies of scale; (ii) diversification into discount for- smaller than a supermarket and can focus on inner city set-
mats with less product diversity but cost savings to con- tings, where traditional shops dominate. Castellanos notes
sumers; (iii) diffusion into neighbourhoods with small that in Mexico, Walmart has medium-size supermarkets,
supermarkets (e.g. in the Dominican Republic) (157) and hypermarkets and warehouse clubs for the middle-income
convenience stores to target lower-income consumers and and upper-income segments (153). For the lower-middle-
encourage those without cars to shop there (e.g. the prolifer- income and lower-income strata, Walmart uses the Bodega
ation of ‘gas marts’ in the Dominican Republic), selling Aurrerá format with bulk goods and cheaper prices.
mainly snacks and soft drinks; (iv) consumer credit (with Fonseca reports that in Brazil during the recent recession,
linked deep discounts); (v) promotions of key products; retail firms developed further the cash-and-carry format as
and (vi) one-stop shopping for services beyond food retail, discounters, with prices about 15% lower than those of
having under one roof or in the same commercial centre other formats and with a 40% penetration of the consumer
banking services, restaurants, pharmacies, bakeries, elec- market (167). Vasquez reports that in Guatemala, the lead-
tronic stores and so on. ing chains also have formats for lower-middle-income and
Especially in first-wave and second-wave countries, this lower-income consumers (168).
extension of modern retail into poorer areas and even rural As many chains started operations in the tight real estate
areas has displaced a large portion of the traditional small markets of large cities, or in commercial centres or as parts
food stores (144,165). The small shops had the advantage of department stores, in the early 1990s, the supermarket
of proximity, credit and small packages, all of which mod- format was predominant. Subsequently, to facilitate the spa-
ern retailers now offer, especially via small format stores. tial and consumer segment differentiation, other formats
However, traditional neighbourhood stores and mom-and- have proliferated. One such format is the convenience store.
pop stores have sometimes evolved with the competition In the early 2000s, modern retail chains rapidly developed
from modern retail. Carvajal and Marston (157) note this convenience store chains. While the stores are numerous,
for the Dominican Republic, where the ‘colmados and each is small, and the aggregate share of modern retail is
colmadones’ have shifted their product compositions and generally 10–20%. However, the importance of conve-
added services (e.g. bars, slot machines, store credit and de- nience stores has been growing, as they can penetrate dense
livery) to reinforce their local positioning. Moreover, banks urban areas and are very convenient because they are open
also use small shops as part of their growing information late into the night (as noted for Honduras by Pavon) (169).
technology-based and mobile phone-based banking A new format is ecommerce, which promises to penetrate
services, as in Peru, according to Elton (166). into dense urban settings even more easily than convenience
Note that the penetration rates beyond the initial core of stores as the product is brought to the consumer. It lends it-
a chain’s operation (large city, upper-income segment) de- self, in particular, to dry processed foods. For Mexico,
pends on several interrelated factors: (i) the wave (the more Castellanos notes that Walmart launched superama movil,
advanced the general penetration, the broader the diffu- an app for mobile phones (153). This has become common
sion), (ii) the degree of the leading chains’ procurement sys- in Chile. Some firms have been providing Internet access to
tem modernization (hence cost reduction that can be passed supermarket purchases and deliveries and have expanded
on, while maintaining profits, into price reductions to win the services, e.g. Telemercados (https://www.telemercados.
over poorer consumers) and (iii) the product category (with cl). Moreover, in Chile, large supermarket and hypermarket
broader diffusion in processed product retail, second in chains have started online ordering services for consumers,
semiprocessed and last in fresh products). e.g. Jumbo (http://www.jumbo.cl/FO/LogonForm) and
As modern retail spreads, there tends to be format diver- Walmart’s Lider (https://www.lider.cl).
sification to facilitate the spatial and consumer segment dif- Finally, akin to format diversification is modern retail’s
ferentiation and penetration. For example, to penetrate the increasing horizontal integration into food service. An ex-
markets of inner cities and small towns, where space is lim- ample is Walmart’s purchase of the VIPS restaurant chain
ited and product assortment can be more limited, chains use in Mexico and the Wong chain in Peru to sell prepared
products or to branch into meal delivery. This is a sort of Chile (144), Brazil and Argentina (122). This is important,
mirror of processors vertically integrating into food service, as 20–25% of supermarket sales fit this category.
as we show later. Moreover, large chains of convenience An important qualifier should be noted. One might imag-
stores have begun to lease space to fast food chains for ine that supermarkets and convenience stores introduced
drive-through and carryout services (169). processed food to the LAC food market, penetrating a mar-
ket hitherto bereft of processed food. While this is to some
extent true for traditional wet markets and grain and pro-
Penetration of modern retail by food product category duce markets that mainly sell raw products that consumers
Supermarkets penetrate food retailing by food categories. process and prepare at home, those markets usually have a
The first category affected is processed foods – canned, processed foods section also. Moreover, the hundreds of
dry and packaged items, e.g. rice, noodles and edible oils – thousands of small shops in LAC typically carry snacks,
due to the economies of scale in procurement and direct re- beverages and prepared foods (which are mainstays of their
lations with processed food manufacturers. Typical of many sales) and did so before the rise of supermarkets. For exam-
developing countries, supermarkets quickly took over staple, Pavon (169) notes that convenience store chains in
ples and packaged food retail in Argentina in the 1980s Honduras sell such prepared items as hot dogs, pizza,
and 1990s (146), in Chile in the late 1990s (144) and in roasted chicken, snacks (candy, ice cream, cookies) and bev-
Mexico in the late 1990s (152). Processed foods are usually erages (soda, beer). He notes that small traditional shops
two-thirds of supermarket sales, so this penetration is im- (pulperias) also sell similar items. The difference is that the
portant. In Brazil, e.g. the Brazilian Association of Super- traditional shops have fewer items that tend to be more ex-
markets (ABRAS), cited in Fonseca (167), found that food pensive (and have less diversity) than have supermarkets
is 78% of modern retail. Of that, at least two-thirds is proc- and convenience stores, because traditional shops lack econ-
essed food: 27% dry groceries (processed), 14% perishable omies of scale in sourcing and pay the margins of the stock-
processed food (e.g. canned beans and vegetables), 16% liq- ists who distribute the items. Vasquez (168) notes that soft
uid groceries (milk, juice), 7% bakery and 2% prepared or drink suppliers in Guatemala estimate that 80% of their
deli foods. The fresh (nonprocessed) foods are 19% meat sales are in traditional markets and small shops.
(including processed meat), 12% fresh produce and 2% The third category is fresh produce (fruits and vegetables)
fish. Interestingly, these shares are close to the average diet and is by far the slowest for supermarkets to develop. In the
shares of these categories in LAC consumption studies. In USA, this category accounts for about 15% of supermarket
the early years of supermarkets in Latin America, the sales sales. Reardon et al. (152) show that in Mexico the share is
were disproportionately processed foods (as for supermar- 10–15%, depending on the chain. A rough rule of thumb
kets in the USA), as they had economies of scale and eventu- emerging from empirical studies is that the supermarket
ally of scope in warehousing and retailing. In those early share of fresh produce retail is lower than the supermarket
days, supermarket sales were skewed (compared with na- share in overall food retail but that this gap closes as the
tional diets) towards processed products. However, as we overall share rises. For instance, the supermarket share of
have shown, over time, the importance of processed food fresh produce retail in Guatemala in 2003 was about
in the overall diet has grown greatly in LAC. The causes 10%, whereas the supermarket share of overall food retail
are of course complex, but it is clear that the processing sec- was about 35% (rising to 40% in 2007). Hence, the super-
tor, supermarket sales of processed foods and consumer de- market penetration rate for produce is one-third of the over-
mand for processed foods evolved together and reinforced all food penetration. By contrast, in Brazil, the supermarket
each other. shares were 50% of fresh produce versus 75% overall, or
The second category is semiprocessed foods, e.g. dairy fresh produce was two-thirds of the overall share (147).
products with extensive or minimal processing and chicken, The Asociación Nacional de Tiendas de Autoservicio y
pork, beef and fruit with minimal processing and packag- Departamentales in Mexico (151) reported that in 2005,
ing. As with processed foods, supermarket chains have ad- on the basis of consumer surveys, the supermarket share
vantages over mom-and-pop stores and wet market of fresh produce was 25%, the share of cheese was 53%
operators owing to economies of scale and relations with and the share of packaged foods was 84%.
processors and packers. For chicken in Argentina (146)
and beef in Chile (144) and Costa Rica (170), supermarkets Concentration of modern food retail
developed large chilling facilities and arranged lower costs A common pattern is that initially family owned supermar-
with processors relative to traditional butchers. (The excep- kets or department stores with food sections become domes-
tions are where the meat is not a commodity but a highly tic chains. As domestic chains proliferate, foreign chains
differentiated product, e.g. beef in Argentina (146).) Taking enter the market in large cities and push domestic chains
over the retail of dairy products, supermarkets boost dairy into secondary and tertiary cities and towns. In LAC by
market development and product diversification, as in the 2000s, foreign chains usually occupied the top lucrative
spots and large domestic chains the next spots, and small discuss the patterns and drivers of that sequence and exam-
domestic chains or independents focused on particular re- ine recent growth.
gions (143,144). Loza and Beillard (160) illustrate this for Initially the restaurant sector in the 1940s and 1950s and
Peru, where two Chilean chains and one Peruvian chain earlier was fragmented. LAC has a rich tradition of small-
are the top 3. Pavon (169) illustrates this for Honduras, scale food service, e.g. street vendors selling simplified meals
where Walmart, which acquired the large domestic chains (e.g. taquerias in Mexico); independent (nonchain) sit-down
Paiz and Maxi Despensa, PriceSmart (USA owned) and La restaurants in cities; fixed or mobile vendors of snacks made
Colonia (Honduras owned) hold the top 3 positions and a of grain or roots, tubers or plantains and oil and sugar (e.g.
large share of the market. In Mexico, Walmart has 32% churro vendors in Colombia); and bakeries, tamalerias and
of supermarket sales, and the domestic Soriana, which tortillerias. In 1960–1980, domestic food service chains pro-
merged with Comercial Mexicana in 2014, has 16% of su- liferated. Urbanization brought mega-cities and secondary
permarket sales, the second largest share. cities, urban incomes rose, women increasingly worked out-
In terms of structural concentration, Brazil, the largest side the home, and men and women often commuted to work;
country and has population and the leading economy in and as a result, the food service sector rapidly expanded.
LAC, is a partial exception. Like elsewhere in LAC, the con- Economies of scale became possible, and chains emerged
centration in large food retailers is growing (in 2015, the and served the poor and emerging middle-class markets. For
top 10 chains constituted 35% of modern retail sales), as example, Giraffas was founded in 1981 in Brazil and, in
is multinationalization (the four largest companies are 2017, is in 130 cities with 410 outlets (www.giraffas.com.br).
French, US and Chilean). But there is also a vibrant sector In the 1990s, large domestic or foreign processors and
of small supermarket chains and independents. Using fast food umbrella firms began to acquire domestic chains.
ABRAS’s definition of a supermarket as having two or more Earlier, we noted that domestic food service companies
checkouts, small stores still comprise 55% of stores and grew into chains spanning many cities in their countries.
19% of the total volume of the food retail sector (167). From a business perspective, they became ‘ripe’ for acquisi-
Some of this fragmentation is due to Brazil’s large size and tion in the 1990s and 2000s. They supplied large networks
geographic and cultural regionalization, and some is be- of skilled labour and physical assets, in particular real es-
cause the small neighbourhood supermarkets offer greater tate, and well-known brand names that were usually main-
convenience to consumers through proximity and shorter tained after acquisition. From their purchasers, domestic
times spent shopping (122). In some countries, small chains companies gained capitalization, links to large procurement
and independent supermarkets have formed procurement systems for economies of scale and in some cases technology
associations to achieve economies of scale and bargaining transfer and multinational markets. The effect was the
power, e.g. the national union of low-cost supermarkets in growth of food services. The acquirers are of four types:
the Dominican Republic (157).
First, various multinational supermarket chains
wanted to add food service divisions to their portfolios,
Interface of consumers and modern retail
and FDI liberalization in the 1990s opened that door,
Despite the importance of processed food in diets and super-
e.g. Walmart Mexico’s acquisition of VIPS.
markets in the supply chain, there have been few empirical
Second, large domestic umbrella food service firms
studies of the links among consumers, processed food and
bought individual chains to form a portfolio of chain
supermarkets in LAC. An exception is that of Asfaw
brands, e.g. Alsea’s acquisition of VIPS from Walmart in
(171), who analysed consumer expenditure data and found
2013. In turn, the umbrella handled franchising and com-
that, controlling for the endogeneity of shopping at super-
mon procurement systems.
markets, supermarket customers purchased a higher share
Third, foreign umbrella firms invested their brand
of partially and highly processed foods than did those who
names and chains in LAC. A major example is the spin-
shopped only at traditional stores. While Monteiro and
off in 1997 of Yum! from the US giant PepsiCo, which be-
other Latin American scholars present the same hypothesis,
gan with beverages and became a leader in snacks and
longitudinal research on this topic is lacking (76,92,172).
food services in the 1990s. Yum! owns KFC, Pizza Hut
and Taco Bell, which have 17,000 outlets in ‘emerging
Fast food revolution markets’ and are important in most LAC countries. Pizza
To understand the rise of fast food restaurants and other Hut has 154 outlets in Brazil, KFC has 341 outlets in
food services, it is necessary to take a half-century perspec- Mexico and Taco Bell has 48 outlets in Guatemala.
tive. As with supermarkets and food processing, we find Fourth, large processed food conglomerates buy do-
that the food service sector started locally on a small scale mestic (and foreign) fast food chains. In many cases, they
in the 1950s and 1960s. The sector rose gradually at first vertically integrate, supplying processed intermediate in-
and then grew rapidly in the 1990s and 2000s. Here we puts, e.g. Bimbo’s acquisition of El Globo in 2005 or
the acquisition in 2014 of the hamburger chain El Corral earlier that McDonald’s, for example, has in its portfolio
in Colombia by the giant Colombian food processing many pastry centres as individual outlets, and the
company Nutresa (which has about 60% of the processed Guatemala McDonald’s have pastries and ice cream. Along
food market in the country) (173). Note the similarity with it hamburgers and hot dogs, the Colombian chain El
with PepsiCo’s acquisition of fast food chains in the Corral has cassava fries, brownies, pies and ice cream
1980s and 1990s. (www.elcorral.com). The Giraffas chain in Brazil has ham-
burgers and restaurant-fare meals (e.g. a plate of rice, French
Individual chains also made massive investments in the fries, sausage and steak) and salads as well as deep-fried
1990s and 2000s. McDonald’s started in the 1980s and items (onion rings, French fries with cheddar and bacon),
grew quickly. In 2007, for management efficiency, it central- ice cream drinks and pastries (www.giraffas.com.br).
ized its franchise management in the LAC company Arcos The reasons for the take-off of fast food and other food
Dorados S.A., which became its largest franchisee in the service chains in the 1990s and 2000s in LAC include, on
world. In LAC, Arcos Dorados manages 2,119 restaurants, the demand side, rising incomes in the region and urbaniza-
335 McCafés and 2,526 pastry centres in 20 countries. tion in the 1980s and 1990s and changing employment pat-
McDonald’s entered Mexico in 1985 and now has 500 sales terns. Many women entered the labour market outside the
outlets in 87 Mexican cities. home, and male and female workers commuted to work.
The differing product penetration patterns of fast food As in the USA and Western Europe before in LAC, these fac-
chains versus restaurants are of special interest for this re- tors increased the opportunity cost of time and thus the quest
view. Restaurants in LAC have long offered foreign food for the convenience of eating out and incomes allowing
but have tended to emphasize sit-down dining and menus snacking. Home delivery from fast food chains and
with primarily local, traditional dishes, e.g. VIPS’s in ecommerce has magnified the convenience of ordering meals
Mexico. However, the great majority of fast food chains of- from these chains. This common service of international fast
fer products that are not traditional in LAC, e.g. pizzas, food chains has been taken up by domestic chains, e.g. that
hamburgers, US-style fried chicken and French fries. Some in the works at El Corral (175). Also the larger chains use
fast food not traditional in the USA (pizzas, hamburgers, an array of marketing techniques via all media, from chil-
French fries) had in fact shifted from special event food to dren’s gifts to characters like Ronald McDonald (176,177),
everyday food before the 1960s (174). The ‘vector’ of food to generate demand and customer loyalty.
habit changes in the USA from the 1960s to the present, On the supply side, two large sources of investment cre-
represented by cheap and easy food from fast food chains, ated a discrete jump beyond the traditional and transitional
is remarkable, and those foods have entered LAC. food service supply chains discussed earlier to modern food
International chains introducing nontraditional foods service supply chains. Many countries in the region liberal-
have induced competitive investment but also mimicry ized FDI in retail and food service in the 1990s. This initi-
among domestic chains, e.g. the successful hamburger chain ated an avalanche of FDI from chains, e.g. McDonald’s,
El Corral in Colombia or Giraffas in Brazil. Domestic and KFC and Pizza Hut. Just as equity firms, processing compa-
foreign chains often include local snacks on the menu, e.g. nies and supermarket chains poured investment into the
churros, but the main fare is nontraditional (gradually be- emerging fast food chains in the 1970s and 1980s in the
coming traditional). Also, chains modify sauces and condi- USA, domestic and foreign firms poured investment into
ments to adapt the taste to local expectations, even for foreign and domestic chains in LAC. The process could take
nontraditional foods. The latter have succeeded in the face place with less risk and more information from prior inno-
of strong competition in similar ingredients and meal vation than had occurred in the USA and Western Europe,
niches. Perhaps surprisingly, as local researchers had pre- thus accelerating the process.
dicted this could not happen, hamburger chains have made Another factor on the supply side is the modernization of
headway in Argentina, which has a tradition of beef quality fast food chain procurement systems, which has proceeded
and preparation. Argentina also has a long-standing tradi- with many parallels to that of supermarket chains. The
tion of European-style coffee shops and bakeries, but chains themselves tend to have centralized procurement
McDonald’s grew tenfold there in the 1990s. and distribution centres, allowing economies of scale,
Paradoxically, fast food chains have even been a vector of bargaining power and lower costs than has the traditional
diffusion of dishes from one LAC country to another, at least restaurant sector with which they compete. Umbrella food
in an approximation of the dishes. The US firm Taco Bell has service and processing companies owning the chains further
many outlets selling a US version of Mexican food in broaden that advantage. Key suppliers and wholesalers (e.g.
Guatemala and other LAC countries (except Mexico). Ham- Marfrig in Brazil) have distribution centres as well, so they
burger and chicken chains are not only vectors of diffusion of cut out the middleman and the supplier link. This is similar
high-fat fried meats, fried potatoes and sugary drinks; but to the kind of coordination and transaction cost savings we
most also sell many desserts, snacks and pastries. We noted noted in the retail segment.
As with supermarkets, specialized and dedicated whole- A further facilitator of rapid expansion has been franchis-
salers have emerged to handle sourcing and distribution ing, thus leveraging SME capital, e.g. Mrs. Fields Cookies
for food service retailers, allowing smaller chains and inde- franchises in Mexico (181). Another major driver of fast
pendents to obtain economies of scale and scope and access food chains first in the USA and then in LAC has been inno-
specific collective assets they could not obtain on their own, vations in food processing and preparation technologies,
e.g. large distribution centres and logistics. In the USA, this which allow mass production in a given outlet or by off-site
trend started in the 1970s, e.g. with the rise of Sysco, now processors. For example, KFC invented the oil pressure
the largest wholesaler for food service in the world. Some cooker in the 1960s, OSI developed the freezing and
US processing and wholesale firms, e.g. OSI (specializing compacting of hamburger patties in the 1970s and Birds
in providing meats to fast food chains), moved into Latin Eye invented French fry and fish stick freezing technologies
America in the 1980s. OSI innovated with frozen beef patty in the 1920s. Large fast food chains invested in this equip-
technology in the early 1970s and became one of the main ment, reducing preparation time costs (and customer
beef suppliers of McDonald’s, growing with it. OSI took waiting time) and increasing food safety, thus gaining a
the innovation and business model to Brazil and Mexico competitive edge over traditional food services. The cooking
in the 1980s and 1990s to supply the emerging fast food technologies involved intensive use of oil, thus of course
chains and restaurants. Domestic firms with the same struc- contributing to the fat content of the meals.
ture and aim of OSI, rising in their own context of growing The upshot of the demand side and supply side drivers of
fast food chains, then bought the beef, chicken and pork op- fast food chain development in LAC has been the evolution
erations of OSI in Brazil and Europe in 2008 (178). The Eu- and growth of chains in the 1990s and 2000s. We illustrated
ropean acquisition is an example of how emerging market that with data from individual companies. We now present
firms grow along with their markets and acquire first- broader recent data from Planet Retail to show the sales
generation firms and themselves multinationalize. trends of some leading fast food chains (and other food ser-
Among the domestic firms that supply fast food chains in vices) in the past 8 years. Tables 2A and 2B present the data
LAC is Marfrig Global Foods (http://www.marfrig.com.br/ in a form similar to that in Table 1. Table 2A shows the sum
en), which focuses mainly on beef (including patties, like of the leading fast food chains, café chains and regular res-
OSI). It is a LAC company that has become multinational taurant chains that Planet Retail followed in 2008, 2011,
through acquisitions and by supplying multinational food 2014 and 2016. Table 2B breaks out fast food chains. The
service companies. Marfrig has production, sales and distri- majority of Table 2A is sales at fast food chains except for
bution units in LAC (Brazil, Chile and Uruguay), the USA Mexico, where VIPS is a restaurant and is included in
and Asia. Marfrig started in 2000 as a beef processor and Table 2A but not in Table 2B.
distributor (Marfrig Beef); began expansion investment in As with supermarket chains, Planet Retail follows the
beef, pork and chicken in Brazil, Argentina and Chile in leading chains, and for food service, it mainly follows mul-
2006–2008; acquired OSI’s operations in Brazil in 2008; tinationals except for several domestic Mexican firms. The
and in 2010 acquired Keystone Foods (179), a large special- firms followed include Baskin-Robbins, Burger King,
ized US wholesaler for food services. Keystone, which California, Domino’s, Domino’s Pizza, Doña Tota, KFC,
started in 1960, is known for supplying frozen chicken for McDonald’s, Pizza Hut, Subway, Taco Bell and Wendy’s.
McDonald’s Chicken McNuggets. This, of course, misses the many domestic chains, e.g. El
The coevolution of processors and farmers has facilitated Corral and Pan Pa’ Ya! in Colombia. Moreover, sometimes,
fast food chains’ needs. Ghezan et al. (180) note the vertig- country totals change a bit because of changes in coverage.
inous rise of McDonald’s in Latin America from only 100 For example, Costa Rica’s sales went down in the table
outlets in 1985 to 699 in 1996 and to 1,581 by 2001. In when Wendy’s left after 2014. But we think the table indi-
Mercosur (Argentina, Brazil, Paraguay and Uruguay, all tra- cates broadly the direction and speed of change of the sector
ditional beef-cuisine countries), McDonald’s went from six in Latin America.
outlets in 1985 to 318 in 1996 and to 822 by 2001. Ghezan Several points emerge in Table 2A. First, sales growth has
et al. note that in the mid-1990s, McDonald’s shifted from been fast: 8.9 billion USD in 2008 and 16.3 billion USD in
local suppliers to the multinational suppliers that supplied 2016, approximately doubling sales in 8 years. Second, there
McDonald’s in other markets, e.g. Keystone Foods and Mc- is more variation of sales growth over countries than in the
Cain, the large Canadian multinational that produces case of supermarkets. As with supermarkets, however, there
French fries for fast food chains internationally (180). In was some steadiness in the first two periods (3 years each)
Argentina, McDonald’s replaced imports with a local po- and then a slowing in the last period from 9% to 9% to
tato supply contracted by McCain, inducing a shift from ta- 6%. Third, the differences between the first-wave and
ble potatoes to processing potatoes (the Atlantic variety). third-wave countries are less clear. The rates of growth are
This supply shift was crucial to McDonald’s rapid expan- similar in the first period, but then, like supermarkets, the
sion there. growth rates are faster in the third wave in the latter periods.
Table 2A Total banner sales of leading fast food chains, café chains and restaurant retailers and gross domestic product (GDP) growth in selected Latin
American countries (2008–2016) in nominal millions of USD
Compound Real GDP Compound Real GDP Compound Real GDP

sales growth growth sales growth growth sales growth growth
Sales Sales 2008–2011 2008–2011 Sales 2011–2014 2011–2014 Sales 2014–2016 2014–2016
Waves 2008 2011 (%) (%) 2014 (%) (%) 2016 (%) (%)
First wave
Argentina 475 606 8 3 617 1 0 631 1 0
Brazil 3,784 6,313 19 4 5,969 2 2 9,153 24 4
Uruguay 60 67 4 6 69 1 4 63 4 1
Second wave
Costa Rica 200 233 5 3 312 10 4 283 5 5
Chile 306 352 5 3 456 9 4 458 0 2
Colombia 151 275 22 4 458 19 4 696 23 3
Ecuador 207 234 4 4 287 7 5 334 8 1
Guatemala* 446 611 11 3 368 16 4 372 1 4
Mexico† 2,939 3,009 1 1 3,669 7 3 3,808 2 2
Third wave
Bolivia‡ 25 28 5 4 29 62 6 43 21 4
Nicaragua 43 54 8 2 41 9 5 45 4 5
Peru 170 227 10 5 389 20 5 381 1 4
*Guatemala’s fall in sales can be attributed to a fall in McDonald’s sales (which had reported a fall in sales in Latin America). If McDonald’s is taken away,
the growth in sales would have been 5%.
†
Mexico’s data from 2014 to 2016 are approximate, as Planet Retail did not provide sales information on VIPS. Given that it is an important chain restaurant,
we generated our own projections of its growth yet maintained the number of outlets.
‡
We had to use 2010 data from Bolivia instead of 2011, as there seems to be an inconsistency with this year. Planet Retail reported 13 locations in 2011,
whereas in 2010, it reported 26 locations, and in 2012, it reported 22.
Table 2B Total banner sales and number of outlets of leading fast food chains in selected Latin American countries (2008–2016) in nominal millions
of USD
2008 2011 2014 2016
Waves Sales Outlets Sales Outlets Sales Outlets Sales Outlets
First wave
Argentina 459 234 576 318 542 456 526 516
Brazil 3,737 2,156 6,232 3,636 5,746 6,490 8,889 8,292
Uruguay 60 29 67 34 69 59 63 54
Second wave
Costa Rica 200 204 231 247 301 324 265 255
Chile 292 213 320 236 375 289 347 354
Colombia 134 134 250 255 423 568 656 738
Ecuador 196 169 218 198 255 275 302 323
Guatemala 441 259 599 295 349 330 346 345
Mexico 2,095 2,462 2,145 2,662 2,669 3,339 2,566 3,320
Third wave
Bolivia 25 24 28 26 29 39 39 52
Nicaragua 43 37 54 32 41 46 45 56
Peru 163 138 207 177 313 306 280 288
Transformation of food processing in Latin America from 310 to 937 million tons, roughly tripling, while the
and the Caribbean population doubled from 284 million in 1970 to 611 mil-
lion in 2013. Much of the nonstaples growth was in meat
Trends in the growth of meat, dairy, feed and soy
and dairy. In 1965, meat consumption per capita was
production and first-stage processing
31.7 kg and by 2015 doubled to 65.3 kg. Whole milk equiv-
From 1970 to 2013, cereal consumption (by disappearance, alent consumption per capita was 80 kg in 1965 and by
calculated from FAOSTAT) in millions of tons in LAC grew 2015 rose to 125 kg.
from 99 to 230, roughly doubling. By contrast, nonstaples For per capita consumption to double as the population
(food products other than cereals, roots and tubers) grew doubled means that meat and dairy output quadrupled over
those 40 years. The great majority of that went to domestic course, consumption of these foods is age-old, as house-
consumption. Home consumption and home processing of holds long made or bought first-stage processed ingredients,
meat and dairy declined over those 40 years (based on e.g. maize or wheat flour, oil and sugar, and made tortillas,
scattered case study evidence), which implies that first-stage arepas, bread, cookies and churros. Brazilians used cassava
processing of livestock and dairy rose at least 400% and flour to make tapioca and Caribbeans’ cassava bread. In
probably around 600% over that period. The effect on con- that sense, second-stage processed products, even ultra-
sumer prices was equally substantial. For example, the price processed, with substantial oil, sugar and refined flour, are
of milk dropped quickly in Brazil in the 1990s as consump- traditional and traditionally homemade. Several forces
tion steeply rose (147). Livestock and dairy production and moved these products from homemade to purchased.
to an even greater extent first-stage processing of those con-
centrated rapidly, especially in the 1990s and 2000s. Large Demand side trends developing the second-stage
companies, e.g. JBS, Marfrig and Perigao in Brazil and processed food sector
Bachoco (an integrated feed, farming, and processing firm) On the demand side, as women increasingly worked outside
in Mexico, emerged then. Furthermore, to literally feed that the home, especially in urban but also in rural areas (131),
large increase in livestock and dairy production required in their opportunity costs of time to prepare these products in-
the early period mainly grazing land and gathered inputs creased, and they sought the convenience of ready-to-heat
and later mainly commercial concentrated feed from soy or ready-to-eat products (97). In Mexico, this shift towards
and yellow corn. The use of feed concentrates doubled from small store, or retailer made tortillas started much earlier
1980 to 2005 (64 million tons to 114 million tons in but accelerated in the past two decades (182). This started
25 years), keeping up with the increase in livestock and at low-income levels (poor women also needed to save time),
dairy production. As feed processing rose, sector concentra- but the capacity and incentive to buy these products increased
tion occurred, and Brazil’s BFR and Mexico’s Bachoco with rising incomes. Some households moved from making
became the number 3 and number 4 feed companies, respec- maize tortillas at home to buying bread, so there was a prod-
tively, in the world by 2015. The rise of feed processing uct composition shift towards more convenient cereals and
made livestock and dairy production more intensive and forms (182). This trend was evident by the 1970s, as in Peru
efficient, adding to its growth. (183). Some items that had been festival foods increasingly
The translated effect of the rapid increase in feed process- became common foods, e.g. cookies, and some seasonal foods
ing on soy production was massive. For example, soy out- increasingly became everyday items, e.g. dairy products. As
put in Brazil went from 1.5 million tons in 1970 to 102.0 Bennett’s law (116) predicts, the demand side for processed
million tons in 2017. (As does the USA, Brazil exports about food started with purchases of processed staples and moved
58% of its soy.) This implied a significant increase in first- to processed dairy products and meats and only recently to
stage processing of soy, and as soy processing rose, sector processed fruits, e.g. packaged fruit juices.
concentration occurred. Huge integrated operations In addition to the economic reasons on the demand side,
emerged, like Grupo Maggi (with a million hectares under there were two sets of psychosocial reasons. The first set is
soy, owned or contracted, as well as logistics and process- emulation coupled with former luxuries becoming cheap
ing) in Brazil. A large wave of FDI in first-stage processing, commodities: luxury foods and festival foods purchased of-
like the US Archer Daniels Midland, started in Brazil in ten as they became cheap and storable. The other set is that
1997 and in Argentina in 1998. the rise of advertisement by large processing companies ap-
In the next section, we treat second-stage processed pears to have played an important demand side role, per-
foods, including as a subset highly processed, fattening haps especially for ultra-processed foods (75,120). The
foods. But first we should note that the benefit to consumers WHO and other major health organizations worldwide
of the essential ‘industrialization’ of proteins discussed ear- point to pervasive, unhealthy food marketing to children
lier is the cheapening and consistent supply of proteins to as a significant risk factor for childhood obesity (184–
LAC consumers in the form of animal products. There is a 191). Children are exposed daily to food marketing where
reverse side, however. Those products, cheapened and made they live, learn and play – on TV, at school and sports prac-
easily available, have also been combined with oil, salt and tice, in stores, at the movies, on mobile devices and online
bread to produce the fast food boom. (191–194). While TV has historically been the medium of
choice to reach children, marketing via newer online, mo-
The rise and consolidation of second-stage food bile, viral and social media has exploded, with elements of
processing immersion, interactivity, user-generated and peer-to-peer
As shown in sections General patterns of the evolution of content, and sophisticated location-based and
food systems in the region and Retail segment transforma- demographic-based targeting that offer marketers more
tion, LAC consumers have increased purchases of second- tools to target young audiences (191,195–197). Foods and
stage processed foods over the past several decades. Of drinks are promoted to children more than any other
product type and in far greater proportions than to adults Bimbo also made them more attractive to consumers with
(184,190,198). Product packaging with characters linked flavourings as well as packaging.
with brand identification and specific foods has also been Nestlé and Tetra Pak, large processors and packaging
an important component. firms, transferred processing and packaging technologies
The vast majority of promoted products are calorie dense to LAC by co-locating and co-evolving in Brazil and
and nutrient poor, with added sugar, saturated fats and so- Argentina. Nestlé brought in the most advanced milk pro-
dium well above recommended levels (e.g. sugary breakfast cessing technology for production of ultra-high temperature
cereals, soft drinks, candy, salty snacks and fast food) (190– (UHT) pasteurized milk when it intensified its FDI in Brazil
194,198–202). The food, beverage and restaurant indus- at the end of the 1980s. Tetra Pak of Sweden brought in its
tries spend billions of dollars every year to reach children vacuum packaging technology for UHT milk (later also ap-
with targeted marketing and lobbying against laws that plied to juices in Brazil). These firms, along with Parmalat
might prevent them from doing so, demonstrating the value and several other major competitors, rapidly transformed
they see in the children’s market (193,201,203–206). As the milk processing industry in Brazil in the 1990s, greatly
noted in the diet section, this has led to increased intake of reducing the consumer price of milk, bringing UHT shelf-
ultra-processed foods and beverages, snacking and many stable milk to both middle-class and poor areas of Brazil
other unhealthy behaviours linked with excessive intake of and diversifying products in collaboration with supermar-
energy, sugar, sodium and unhealthy saturated fats (75,89). ket chains (122,147).
Pan Pa’ Ya! in Colombia also transferred processing and
Supply side trends developing the second-stage freezing technologies to LAC (173). It started in Bogotá as
processed food sector a small bakery and then partly through acquisition of other
On the supply side, three major trends led to second-stage small firms and partly through franchising; it spread to
processed foods becoming far cheaper and storable over many cities in Colombia. Executives attended a food pro-
time. First, there was a massive cascade in the 20th century cessing technology show in the USA in 1997 and obtained
of processing and food technology innovations that reduced new processing equipment and deep freeze technology.
the cost, increased the shelf life and augmented the hedonic The company started a deep freeze firm to supply its chain
attributes of processed products. For instance, in baking, and other bakeries and developed a line of products, includ-
there were advances in extrusion, frozen dough production, ing bread, pasta and pizza, that it sold to supermarkets,
emulsifiers and enzymes, microwaves, ovens and automa- small shops and the food service chain it started in the
tion (207). These technological advances were mainly un- 2000s. The vertical integration between processing and a
dertaken in Europe and the USA first and then transferred restaurant chain and adoption of advanced technology
to LAC. The shift from butter and lard to vegetable oils is allowed Pan Pa’ Ya! to hold its own against international
one of the many dynamics that, when combined with major competitors with FDI in Colombia, e.g. Bimbo, and large lo-
agricultural breeding shifts for oilseeds, led to a shift in cal processors. This example also shows how the new tech-
global diets (84,208). nologies do not just create a bimodal sector with small
Second, packaging technology advances have been crucial traditional and large modern processors but small-size and
to second-stage processing in LAC. These include (i) can- medium-size modern firms as well.
ning, paperboard and folding cartons (first used by Nabisco A third supply side factor facilitating the rise of second-
in the USA in 1896), invented in the 1800s; (ii) cellophane, stage processing in LAC has been innovation in the indus-
invented in Switzerland in 1908; (iii) plastics for packaging trial organization of the industry. This occurred in three
developed in the 1920s and 1930s; (iv) milk cartons devel- phases.
oped in 1934; (v) frozen food packaging developed in The first phase corresponds to the ‘traditional stage’ of
1940; (vi) Tetra Pak 1951; (vii) polypropylene in 1954; food systems as defined earlier. This is when (and where,
and (viii) cheap soft drink cans in 1966. Bimbo of Mexico, as it still exists in parallel to later phases) the products are
now the largest baking company in the world (discussed produced by small-scale enterprises using traditional tech-
more later), was among the first to adopt and implement nologies (labour-intensive, small equipment). These include,
these technologies on a large scale in LAC. Bimbo was e.g. the many small tortillerias and traditional bakery shops
founded in 1943 and by 1945 sold bread in storable cello- still operating in Mexican cities and rural areas.
phane bags, an advantage over small traditional bakeries. The second phase is the rise of small-size or medium-size
Bimbo sold cakes in individual packages by 1958, funda- companies in the 1940s and 1950s that then grew rapidly in
mentally changing the cake market from event cakes bought the following decades with urbanization and income in-
whole to snack cakes. In the early 1970s, Bimbo built the creases and the growth of distribution networks from large
largest bread bakery in Latin America, among the top 10 cities to small cities, towns and villages.
in the world, putting out 1.5 packaged bread loaves per sec- The third phase is the rise of large processing firms, both
ond, reducing the price of bread and other baked goods. foreign (e.g. Nestlé, the largest food manufacturer in the
world, which has FDI operations in nearly all LAC coun- Sabritas, which produces cheese puffs, potato chips and
tries, and PepsiCo’s Mexican company Sabritas) and large similar items for city and rural markets. It has an extensive
domestic-based multinationals (e.g. Bimbo in Mexico and direct distribution system of warehouses and trucks that
Nutresa in Colombia). deliver to retailers.
The early role of multinational firms was fundamental in Nutresa started in Colombia in 1920 as a chocolate com-
this third phase. Cook (209) analyses the entrance into pany and acquired or started coffee, cookie and meat firms
Mexico in the 1980s of key companies in the very competi- and flour mills through the 1990s. In the 2000s, it
tive and rapidly consolidating packaged foods industry, in- established distribution companies in Mexico, Ecuador,
cluding Nestlé, Carnation (before Nestlé acquired it), Puerto Rico, the USA, Panama, Nicaragua, Guatemala, El
General Foods and Anderson-Clayton (before Quaker Oats Salvador, Honduras and Venezuela and bought Nestlé’s
acquired it and PepsiCo subsequently acquired Quaker cookie and chocolate factory in Costa Rica, the French
Oats). These firms mounted advertising campaigns to Danone’s share in Galletas Noel (Nutresa’s large cookie
change Mexican food preferences towards their (US and company), a Guatemalan cookie company, a large Panama-
European) products. They shifted from direct distribution nian meat company, a Colombian pasta and ice cream com-
to specialized wholesalers-cum-stockists to deliver to pany, a Peruvian confections company and a Mexican
fledgling supermarkets and to small shops. At that time, chocolate company. The point of this detail is to demon-
Cook notes, food manufactures were rapidly consolidating strate that in many ways Nutresa followed the path of other
(pushing out small Mexican processors), and wholesale global multinationals, starting from a single processed prod-
and retail were still relatively fragmented. Large multina- uct and over decades acquiring companies in its home and
tional processors also provided volume discounts and pro- regional markets to become a regional multinational. In
motions to induce retailers to shift to their products, save the process, it injected technology and capital into a series
costs and win consumers with lower product prices. of medium-size domestic processors and developed a home
But a number of domestic firms developed fast and be- market share of 60% of the processed food.
came large second-stage processors. They often inherited or- Logistics and wholesale sector investments have been cru-
ganizational and food processing technologies from the cial to the rapid and deep penetration of second-stage proc-
international sector. Two examples from Mexico, Bimbo essed products. This has included both the proliferation of
and Sabritas, and one from Colombia, Nutresa, fascinat- traditional stockists and the spread of modern logistics, cold
ingly show the path of processed foods from local, tradi- chains and warehousing companies. As noted above, the
tional and labour intensive to large scale, capital intensive largest firms typically have fleets of vans or trucks distribut-
and diverse. ing their products in cities and rural areas (as we illustrated
Bimbo started as a small company in Mexico City, build- for Bimbo).
ing from small bakeries as in the aforementioned first phase. Moreover, imports of processed foods have played an im-
It established bakeries and factories in other large Mexican portant role, particularly in the smaller countries with less
cities an, then in other LAC countries and then in the USA, developed domestic processing sectors. Loza and Beillard
Europe and China. Beginning as a bread bakery, it diversi- (160) note that Peru imports 10% of the consumer products
fied into other baked and snack products and ventured into in its modern retail. Brazil imports 2%, but Costa Rica im-
restaurant chains. The Bimbo Group is now a multinational ports 50% (165). In some cases, imports of snacks are rising
company with processing operations in Mexico, a number quickly. For example, in the Dominican Republic, imports
of other LAC countries, the USA, Canada, Chile, Spain of snacks from the USA rose 300% between 2009 and
and China. It distributes products all over LAC, Europe, 2014 (157).
the USA and Asia. It makes bread, cookies, doughnuts, po- By contrast, in larger countries and some smaller coun-
tato chips, corn chips and other baked goods. Bimbo also tries, exports of processed foods to other LAC countries
operates a chain of bakeries and coffee shops. Its factories have become important to their industries as well as to im-
are in cities, but it delivers its products to large and small reports in the receiving LAC countries. For example, since
tailers in large cities, small cities, rural towns and villages 2008, with the Dominican Republic–Central America Free
via its own distribution network of vans and trucks. This Trade Agreement, there imports of processed foods have in-
network is an important way processed food has penetrated creased substantially among Central American countries, as
beyond cities into villages. In the process, Bimbo and similar have imports of Central American products in the
large urban-based processors have displaced small local Dominican Republic and US products in both. Mexico’s
firms, e.g. local bakeries and tortillerias (210). proximity and huge processed food sector ensures strong
Sabritas was founded in Mexico City in the 1940s as a processed food exports to Central America. For
small firm that delivered to small shops with a bicycle net- Honduras, Pavon (169) shows the shares of competing ex-
work. Later it expanded to other cities and formed truck porters (for imports of 136 million USD) to the snack mar-
distribution networks. In the 1960s, PepsiCo purchased ket (where local processed food is plantain chips and potato
chips): 39% from Guatemala, 30% from El Salvador, 12% important in the initiation in the region of
from Mexico and 7% from the USA. For Guatemala, supermarketization, fast food chain diffusion and the rise
Vasquez (168) reports that consumer agri-food imports are of large processors. Eventually, domestic firms also ex-
29% from the USA, 17% from Mexico and 33% from panded to very-large-scale and regionalized presences in
other Central American countries. Of Peru’s snack imports the liberalized and market-opportune region and acceler-
of 81 million USD, 47% is from Colombia, 10% from ated food system change. Only now are LAC countries
Brazil, 6% from China, 6% from the USA and 4% from attempting to address some of the adverse health conse-
Argentina. The integration of the LAC snack market has quences of one aspect of this enormous food system change,
proceeded apace. the increase in consumer access to ultra-processed foods
(75,76,120).
With control of food systems moving away from govern-
Link between food system transformation and diet
ments towards a small number of large, powerful domestic
change
and international companies and given the complexity of fo-
Earlier, we documented the food system transformation in cusing agricultural research and country subsidies on
LAC in the past several decades. That transformation al- redirecting prices from less healthy to more healthy prod-
tered the food environment for tens and then hundreds of ucts, countries have tried fiscal and other regulatory
millions of LAC consumers. It also altered their behaviours approaches. Moreover, the culture and norms surrounding
as food consumers, and that changed behaviour sent a sig- food, the time expended in food preparation (9,137) and
nal to the private sector to invest further in the food trans- their roles in the process of consumption have been
formation, so that the process was iterative, a snowball. transformed.
The food system transformation led to obesity by changing Many in the Americas are trying to direct their countries
the food LAC consumers have access to and the way con- back to a traditional diet dominated by unprocessed and
sumers relate to food. This occurred at a time when technol- moderately processed foods and ingredients, but it is clear
ogy significantly reduced physical activity in all daily they have and will continue to clash with the modern food
behaviours (9). sector (108,211). There is a push led by Monteiro and many
others in Latin America and food writers in the USA and
around the world to eat wholesome food in traditional ways
Policy implications
(75,92,108,172,212–214).
We have described the shifts in LAC towards overweight However, to turn away from convenience food is to do
and obesity and provoked by changes in diets. While de- battle against a strong food industry and to go against the
clines in physical activity have been an important causal grain of demand by the mass of consumers for convenience
component of obesity, we cannot return to labour-intensive amid increasing opportunity costs of time with the trends
market and home production or transportation where most noted earlier. Moreover, this clashes with a culture of eat-
of the energy expenditure decline occurred (9) nor replace ing, which has changed drastically as evinced by increased
this fully with new modes of physical activity, so our focus snacking between meals and by the ready-to-eat and
is on the food sector. This is where diet, obesity and the re- ready-to-heat convenience revolution (90,97,101).
lated NCDs must be addressed. The complexities of so do- This article highlights the modern food system supplying
ing are immense because of the changes in foods and food the bulk of ultra-processed foods, a large component of
service technology, marketing and distribution. At the same the diet available from the fast food sector and modern re-
time, urbanization and income increases have accelerated tailers. In a sense, the modern food system revolution
the trend towards a diet dominated throughout the merely accelerated, intensified and made more efficient the
Americas towards highly processed or ultra-processed foods shift to processed foods that had already started in tradi-
and beverages. The levers of change have also moved, as tional shops in response to consumer demand and lifestyle
governments no longer have direct control over the food changes. Even before modern processed foods were sold in
supply or demand. As noted earlier, the transformation in small shops, traditional highly processed, salty, sugary, re-
the food system happened when many governments in fined and fatty snacks, like churros, were common and were
LAC were liberalizing and dismantling policies and consumed as much as incomes allowed. That the consump-
privatizing state functions, so there was little to no public tion of these products soared with income increases and that
governance of this process or of its ‘externalities’, e.g. the convenience products were sought as lifestyles changed is
impacts on health. That liberalization had at first its main basic economics of consumer choice. In its fundamental
impact in allowing, in a context of increasing market oppor- form, this has happened in all the urbanizing industrializing
tunities brought by other meta-conditioners e.g. income in- societies in more or less the same ways for the same reasons.
creases in rural and urban areas, and urbanization, the These basic economic reasons for the shift will not go away
ingress of extra-LAC multinational firms that were but will intensify.
As incomes rise, as health concerns arise and importantly be accomplished by ignoring the unhealthy components of
as the economics and technologies develop for processing traditional diets. Eating excessive sugar in any form, salt
and packaging healthy foods, e.g. whole grain snacks and or unhealthy fats will not work. And the traditional diet
those with healthy oils, consumers will have affordable was consumed at a time of very heavy energy expenditures
and accessible alternatives. The evidence is that consumers that no longer exist, so portion sizes must also adapt. The
turn to these alternatives as incomes rise. We think the modern food system that we have shown exists in LAC will
movement to traditional food styles and delivery is currently change only if we can attain these shifts in cost, keep the
a small niche that will not become mainstream without fully convenience and retain the taste but provide healthy
implemented regulatory changes. It is not possible to show options.
that this can be performed to such an extent that the An array of policies affecting food supply and demand
lower-education and income groups and those trying to find can improve the diets of Latin America, but it remains a
cost-saving ways to eat can attain it. global challenge to accomplish a truly healthy diet for all.
At the same time, the industrialization of healthy alterna- No country has succeeded to date, but the LAC countries
tives will be the third phase of eating in Latin America. The are making a challenging, long-term effort. Some of the ac-
process started years ago with traditional foods (not unlike tions that countries are initiating and that can be refined
in other regions) and then moved to industrialized, com- and expanded address demand and in the process the refor-
moditized unhealthy processed foods (along with cheaper mulation of food. However, this might mean less added
nutritious processed food, like dairy). In the third stage, sugar, less sodium, healthier saturated fats and possibly in
the differentiated processed healthy products will become very few cases increased whole grains. But these changes
viable commodities. In the nutrition transition, this is might just shift to new refined carbohydrate-based foods
termed the final phase of shifting to a mode of healthy eat- and not truly lead to a healthy diet. To truly provide healthy
ing and healthy activity, but to date, this approach serves packaged processed food requires a revolution and many
a small niche market in a number of countries (138,215). decades of advocacy and policy initiatives.
When the market expands, diets will change. Hence the pol- However, there is already much evidence of that future in
icies we discuss here attempt to accelerate this transition pe- the food supermarkets sell to the middle and upper classes
riod and prepare for the third phase rather than eschew in most countries. An expansion area (that the US exporters
understanding of the basic economics of the food transition. also discuss) is health foods, healthy snack foods and alter-
The clock will not be turned back to traditional food, which native processed foods. These are already rolling into the
includes handmade but unhealthy churros, traditional torti- market, and businesses consider them profitable growth
llas packed with lard and so on. areas alongside healthy processed foods, like milk and plain
It is unclear whether the bulk of Latin America can return yoghurt, and unhealthy snack foods. Businesses see those
to a different way of eating that is much healthier, but poli- three food components as expansion paths and currently
cies in place are attempting to limit unhealthier foods and feasible, albeit with higher-income consumers, as usual (as
beverages in several countries as a first step. And it is not when industrial processed food came on the market), the
clear from any literature that the traditional diet in any first in line. The change in diets usually occurs top-down,
country, e.g. Brazil or Mexico, was healthy, as the diets with businesses trying to attract the most profitable markets
contained generous sugars, heavy creams and fatty animal first, the upper-middle and middle classes. With organic
source foods rather than whole grain tortillas, beans and foods in the USA and Europe, e.g. only the educated and
vegetables, except amid the rural poor. And if these coun- elite bought them at first, and subsequently even the
tries today went back to traditional foods and cooking lower-middle class considered them mainstream.
methods, there is no sense that Mexicans would not use It is clear, we should note, that the ideal healthy diet dom-
highly refined cornmeal to make their tortillas and excessive inated by vegetables, fruits, whole grains and legumes must
sugar in their agua frescas and coffees or that Brazilians or also increase fish and seafood intake and other low energy-
Chileans would not eat excessive amounts of white bread, intensive and water-intensive sustainable animal source
confectionaries and sugar. Lard would be replaced by foods and reduce other animal source foods (particularly
healthier vegetable oils, but it would be equally complex beef), so the diet becomes climate friendly and reduces the
to reduce intake of refined carbohydrates, sugar, salt and to- carbon and water footprint of the Latin American diet
tal fat to create a truly healthy diet and reduce portion sizes (85,105,216). However, the challenges to get there are enor-
and the number of eating events to achieve a total caloric in- mous. As horticulture, aquaculture and aviculture have
take that is not excessive. risen quickly in Latin America, there has in fact been a steep
When the private sector, policymakers and scholars find a rise in domestic consumption of those products, as well as
way to make healthy eating as we now understand it much dairy, in a short time. The faster these foods become cheaper
less expensive, less time intensive and also tasty, we will see and commoditized, the faster the diet will shift towards
the popularity of this type of diet explode. But this cannot them, as has happened in other regions. The shift to whole
grains is not a farming investment but a processing invest- to retailer, and building infrastructure focused on major
ment. It is fully feasible and profitable now in terms of the crops. To date, there have been few attempts to focus poli-
technology of making and packaging breads and tortillas cies on creating demand for healthier food and reducing
made with whole grains. It only awaits a stronger and consumption of ultra-processed food. But these two catego-
clearer signal from consumers (or government policies that ries should be distinguished.
shift relative costs of these foods), just as it did during the For example, there are major public investment, diversifi-
transition in Europe and is only recently emerging in the cation, extension and infrastructure programmes (like
USA. wholesale markets and cold chains) to spur the fruit and
We will briefly outline some policies currently used to im- vegetable industry in Latin America. This effort has grown
prove diets and then address in our three segments – retail, over several decades, partly for export but also for internal
food service and food processing – additional policies. To consumption. This fact does not usually enter the nutrition-
consider policies, one should keep two sets of qualifiers in ist debates, because healthy foods, like dairy, fruits and veg-
mind. etables, both highly favoured and invested in in Latin
On the one hand, there are global constraints. First, trade America, have been lumped with the consumption of
liberalization mandates that countries must tax and control ultra-processed foods. It is true that governments and pri-
imports and domestic companies and products equally in vate entities have made efforts to spur production and mar-
most cases following the World Trade Organization agree- keting of healthy products, like vegetables and milk, but it is
ments (the example of the western Pacific Islands provides also true that there have been minimal policy efforts to
evidence of this topic, and there are other trade exam- make it less profitable to sell and more expensive to buy
ples (217–220)). Second, many policies that affect free junk food. Minimal evaluations of this area exist, and only
speech and other civil liberties need stronger scientific the marketing and taxation areas have major evaluations
evidence and the support of the WHO and other global underway. Mexico and Chile are the regional leaders in in-
bodies. Latin America is unique in that constitutions in stitutions heading rigorous evaluations of their policies.
many countries incorporate rights for children that can al- This is a major gap needing future research (221).
low for more marketing and other controls than found in
many higher-income countries. Third, all these changes
Fiscal policies impacting retailers and food services
have shifted the entire culture of food from purchasing to
preparation to consumption. To shift towards healthier We are in the early stages of learning what will work in the
eating norms will not be simple nor quick. way of taxation and subsidies, and most work has focused
On the other hand, as noted earlier regarding the diffu- on taxation of very limited sets of products to improve diets.
sion of changes in food systems, there is substantial hetero- The Mexican taxes on sugary beverages (about 10% excise
geneity over sub-regions and countries (and zones within tax) and nonessential foods (about 8% tax) are among the
countries) in LAC with respect to the meta-conditioners of most rigorously studied. Both have been shown to have a
change (income growth, urbanization, liberalization, infra- negative impact on purchases, but their overall impact on
structure and rural nonfarm employment). Where these diets and food purchases and their long-term obesity pre-
conditioners are most advanced, system change has gone vention effects are the subjects only of simulation studies
the furthest, and in those places, there is bound to be al- to date (55,56,222–227). Other countries, like Chile, have
ready a greater diet health challenge to be addressed. In instituted quite small taxes, and their evaluations are not
these more urbanized places, the policy need might be more published yet. Other fiscal policies need to be considered
urgent, and the administrative capacity greater for imple- as they relate to issues, e.g. using tax funding to subsidize
mentation, but also the shift of the governance node to large in workable ways purchases of legumes, vegetables and
companies in the food system will have proceeded further. fruits that focus on the poor. The economic perspective is
There might then be a paradox of greater incentive for pol- that the best use of these subsidies and public investments
icies but a lower capacity to change or manage the course of is to remove infrastructural constraints to horticulture and
the nutrition transition. In any case, a differentiated strategy dairy, fish and chicken production. This is fundamentally
and policy approach will be needed to fit to heterogeneous concerned with roads, electricity, cold chain facilities,
situations. wholesale markets and breeding programmes.
Policies impacting consumer demand Marketing controls

The agriculture sector has a long history of focusing on pol- The global focus has been on marketing controls aimed di-
icies to increase demand for selected cash crops, basic sta- rectly at children via schools and TV and has ignored expo-
ples and animal source foods by increasing productivity, sure via nonchildren’s TV, characters and other product
providing subsidies along the entire chain from production packaging, billboards and social media. The Chilean
government has instituted the most comprehensive child 30% of all school food must be purchased from local
marketing control on 35–45% of processed foods and bev- farmers and other incentives related to reducing ultra-
erages, aiming at foods and beverages high in added sugar, processed foods (229). This law is being implemented
sodium or saturated fat. These guidelines increase, in year now, and no evaluation of the law exists. Most of the other
2 and year 4 of the law’s implementation, the strictness of countries in Latin America have school meal programmes.
the added nutrient and energy density to cover more prod- Only Chile bans marketing and junk food. The others have
ucts unless they were reformulated. A full layout of the not implemented major reforms on food quality to the ex-
law has not been published. Many countries are drafting tent desired, so this is an area open for improvements. How-
identical laws, but none has been implemented yet. Several ever, rigorous evaluations are needed to ensure that the
are in Latin America. Another Chilean law expands a ban changes are implemented and produce positive dietary
on marketing during selected TV programmes with audi- changes.
ences that are more than 20% children to a 6 AM to
10 PM total ban on unhealthy designate foods and warning Fast food chains
messages on all TV programmes in other hours. The regula- Clearly many changes can improve the quality of fast food
tions related to implementation of this new total marketing chains, ranging from shifting the temperature of cooking
ban law will be instituted in mid-2018. One of the major French fries to lower the fat content (230), calorie and so-
hopes is that if marketing controls are comprehensive, then dium labelling, and portion-size pricing. One of the most
larger-scale nutrition education to shift populations towards important is to require chains with six or more fast food res-
selecting truly healthier eating may be more effective. Re- taurants to label calories and require pricing such that each
moving or reducing intake of marketing of nonessential or calorie of a given food or beverage is charged the exact same
junk food and beverages alone will not create truly healthy amount. This will create incentives to reduce the excessive
eating. portion sizes of foods and beverages at fast food restau-
It is critical to add that to date evaluations are underway rants. Nevertheless, there is no research on ways to shift
in Chile, but we expect it to be 2–4 years before major die- purchases in the formal food service sector towards health-
tary shifts would be seen there, if at all. And other than the ier eating, another huge gap.
research in Chile, there is evidence only from other market-
ing control literatures like in the tobacco area to suggest
Informal food sector
marketing controls might shift behaviour. Real evidence
on purchasing and dietary intake shifts is lacking to date. This is the least regulated area and can range from carts,
There is a voluminous literature on the lack of impact of nu- trucks and other types of food vendors to small stands sell-
trition facts panels and dietary guidelines and other global ing packaged processed food in villages. It is an expensive
and local government initiatives in the education area we area to address. To date globally, only Singapore has tried
do not discuss here. to control this sector, improve the quality of its food and
provide proper sanitation and quality controls (231). Exper-
imentation is needed to generate some viable policy options.
Front-of-the-package profiling
In Latin America, Chile is a leader in creating the most com-
Policies impacting the supply side
prehensive front-of-the-package (FOP) system, which has
been described elsewhere (43). The system’s cut-offs are There are three categories of agents to consider – farmers,
identical to those of the marketing law and thereby rein- processors and retailers – and three key premises to keep
force it. Furthermore, these laws ban characters on un- in mind.
healthy food products and keep these foods out of schools. The first and most important premise is that these actors
Ecuador uses a variant of the UK traffic lights, and do not have an inherent stake, ideological position, prefer-
Mexico has a limited government voluntary FOP. PAHO ence or goal with respect to how they affect diets. Their goal
has a recommended system that would essentially ban most is sustaining and growing profitable businesses. If they can
ultra-processed food from marketing (228). Many countries do that selling healthy products or unhealthy products (we
are considering a Chilean-style or PAHO-style warning do not mean toxic products), it is essentially all the same
label, but none has implemented it. to the business. As has been observed in the USA,
Germany and Chile, when organic fruit brings a profit,
farmers shift to organic fruit. If the market requires inte-
Food and marketing at government-controlled
grated pest management to grow and sell fruit, farmers shift
institutions
to integrated pest management. If consumers want to buy
Brazil has been a leader in developing the most comprehen- multigrain bread, bakeries add lines of those products.
sive school meal law that includes, among other things, that The economics of the product’s attributes and technology
decide the choice. If farmers find it unprofitable to grow or- That leaves the demand side policy lever. We see that as
ganic fruit, they switch out of it. When the Chinese, Euro- the most practical way to influence processors. As noted
pean and Latin American markets wanted to buy massive earlier, 65% of what supermarkets sell and consumption
amounts of soybeans to feed chickens and fish (and beef cat- baskets in Latin America show are processed foods. What
tle), Brazilian and Argentine farmers quickly switched to they are and how they are processed are crucial. It makes
these products without subsidies or help. The markets and minimal economic sense to subsidize or tax medium-size
profits have dictated the main decisions in Latin American and large processors, as they are at ease with and adept at
agriculture, not subsidies. Processors can use the ensuing ingredient substitution. Rather, if their consumers prefer
mass of soy to produce miso, tofu or fish feed, all healthy less of this and more of that, the processors will quickly fol-
ends; or for cow feed or for milk for children, healthy ends; low. This is in fact the real reason the policies described ear-
or for feed for wagyu beef cattle in Japan, arguably a tasty lier work mainly in rich or upper-middle-class countries, as
but less healthy end (232). that is where consumers have become aware of the health
The second premise is that the retail, processing and even consequences of trans-fats, sugar, chemicals and other un-
farming sectors of Latin America are commercial businesses healthy ingredients and are willing to support taxes or other
and are concentrated or in the process of concentrating. regulations on consumption of them. The same happened
There are many small firms still, but as we have shown, with cigarettes. Once the profits favour whole grain pasta,
the great bulk of Latin American food is in the hands of brown rice and low trans-fat foods, processors will run to-
medium-size and large actors. The share of LAC food com- wards them, as has been demonstrated elsewhere. Where
ing from small farmers is small. Hence, governments cannot they see that the mass of consumers still want white bread
seek solutions that turn back the clock to fragmented food and snacks laden with highly processed fat, sugar and so-
systems (with high transaction costs, much risk and expen- dium, they will keep selling those. Demand decides the
sive food). The supply side is concentrated. However, the supply.
very concentration and formalization of food processing Retailers represent an area where innovation is poten-
and food retail have permitted government to apply regula- tially possible. They do not have a stake in selling healthy
tions to food safety, as implementation of such regulations versus unhealthy food, and many differentiate themselves
is difficult in a fragmented, traditional and informal food by trying to support healthier food purchases. In the LMICs
system. This in itself provides some hope that regulations of Latin America, this is an area where no major research or
constraining equivalently harmful excesses and formula- experimentation has been systematically carried out, and
tions can also be implemented in the nutritional realm. there is room for experimentation and innovation.
However, consider how much more the demand side is In summary, the LAC region faces a major diet-related
concentrated in Latin America. It is not a rural society but health problem accompanied by enormous economic and
one with 75% urbanization. The most important goal fac- social costs. Obesity and many nutrition-related NCDs are
ing policymakers is ensuring no food shortfall in the cities linked with both excessive intake of unhealthy ultra-
and that farmers, processors and even retailers are produc- processed food and excessive intake of unhealthy traditional
tive and efficient. Thus, it may not be politically or econom- foods, be they deep-fried items, highly refined white bread
ically practical to turn back the clock to traditional food or confectionaries made in traditional fashions. Most of
systems. In all industrializing and industrialized societies, the way to shift the food system, as we have noted, relates
one sees the push towards eating wholesome food, usually to shifting demand. When consumers demand healthier
from local farmers, among those with higher educations foods and beverages, we will begin to see these changes
and incomes. Rarely are attempts made to reach lower- for an array of fiscal and regulatory reasons. As noted, we
income populations, and those usually require extensive are seeing the beginning of such actions in Chile and
subsidies. There is a strong movement in many countries Mexico and Brazil, but the road ahead is very long and
among select farmers to serve the high-end food service sec- not simple to achieve.
tor, households and retailers, but this is a relatively small An essential contribution of this piece is to marry and in-
niche market. tegrate the nutrition transition literature with the literature
The third premise is that the policy goals for primary pro- on the economics of food system transformation. These
duction can be to lower risk and transaction costs to pro- two literatures and debates have been to date largely ‘two
duce more healthy foods, given the aforementioned two ships passing in the night’. On the one hand, the nutrition
points and the fact that there is already a massive amount transition debate has rightly, but somewhat narrowly, em-
of private investment and government support for the pro- phasized the health problems emerging from the nutrition
duction of healthy foods in Latin America. Supporting agri- transition that has included obesity. Many who write on
cultural diversification towards horticulture and fish, dairy this topic have largely regarded the food system as
and chicken production is already a goal of most LAC unrooted, malleable, superficial, easily changed and re-
governments. versed as merely a creature of choices and politics and
profits. On the other hand, the food system transformation thus become less profitable and drop off the food shelves.
literature has largely sidestepped issues of nutritional con- We showed that the food system transformation is not just
sequences and has instead focused mainly on distributional existential choices that can turn on a dime but a long strong
consequences (who is excluded from participating in new logic that of course creates its own challenges. But at the
markets), and on signalling the positive consequences of same time, we use the essence of the current nutrition debate
the transformation (cheaper food for the poor, food system to argue that it is important to redouble the regulatory and
employment for rural areas, more processed/convenient policy effort to address those challenges. We must be cogni-
food to liberate women from drudgery, less sharp seasonal- zant that ultimately the public consumers must be incentiv-
ity of food availability, safer food, feeding huge growing ized to market the components of healthy diets. But this
cities to an extent traditional food systems could not have). does not address portion sizing. We must also find ways to
This literature tends to see the food system as the opposite reduce norms of food consumption towards healthy out-
in nature to the vision from the nutrition debate: as rooted comes. Again, there are price policies that could help. The
in inevitable economic and social logic and trends of ur- challenge is to reach the subpopulations with lower educa-
banization, women working outside the home, of a world tions and incomes in addition to those with higher socioeco-
where transfer of goods, services and technology is increas- nomic status.
ingly unfettered, and of the growing ability of firms
enjoying economies of scale and scope and new technology
Conflict of interest statement
to deliver a vastly expanded and more efficient food
system. No conflict of interest was declared.
We have taken the position that these two broad litera-
tures can and should be integrated and reconciled. We feel
Acknowledgements
it will change both debates. To frame the debate in that ho-
listic way will help the nutrition/obesity debate in the longer We thank the Food and Agriculture Organization for par-
run, as it is clear that convenience/industrialization is here tially funding this review. FAO does not endorse the opin-
to stay and serves a key purpose demanded by consumers, ions or data in the document. Other financial support
including the poor (cheap food including protein and comes from the NIH grants CPC P2C HD050924 and
calories, convenient food to liberate women from time- R01DK108148. We also wish to thank Dr. Julio Berdegué
consuming food preparation at a time where their involve- (FAO) for his review and assistance throughout the process.
ment in the economic marketplace and their opportunity For exceptional research assistance, we thank Ms. Carolina
costs of time have risen greatly). The new food system has Vargas of MSU and Emily Busey from UNC, Ms. Denise
taken traditional food system luxury and dream foods Ammons for graphics and research support and Ms.
(e.g. churros) and made them plentiful and cheap, while do- Frances Burton for administrative assistance.
ing the same for many good foods. We conclude that the
food system transformation is driven by such basic con- Supporting information
sumer side demands (of the large majority of the popula-
Additional Supporting Information may be found online in
tions of emerging markets) and demographic logic
the supporting information tab for this article. https://doi.
(urbanization and women working outside the home and
org/10.1111/obr.12694
men and women commuting) that trying to correct the
health externalities by striving to turn back the clock and re- Supplemental Table 1. Sample size: number of households,
instate a traditional fragmented food system will be very dif- mean age for women, and GDP per capita (PPP) by country
ficult at a minimum and most likely will not happen, except Supplemental Table 2. children aged 0–4, sample size and
at the margins for unique subpopulations that can afford proportion wasted, stunted, or both by country and region
the time and money to return to traditional foods and food Supplemental Table 3. Overweight and obesity status by
preparation. Turning back to the traditional would then country and region for females (15-49), weight, not age
have its own negative externalities, women being pushed adjusted
to spend scarce time in food preparation, food more expen- Supplemental Table 4. Prevalence of double burden in the
sive for the poor and still the growing need to feed the household in Latin America and the Caribbean
majority of the population who are increasingly living in Supplemental Table 5. Macronutrient distributions over
urban areas. time for Central America, South America, and the
The nutrition debate and action will need to work – with Caribbean
– the transforming food system and with regulation and ed- Supplemental Table 6. Trends in total per capita daily
ucation manage as much as possible its path, including sugar-sweetened beverage sales by category, 2005–2017
making it more profitable, through demand increase, for Supplemental Table 7. Trends in per capita daily junk food1
the food industry to serve up health foods. Bad foods will sales by category, 2005–2017
Supplemental Table 8. Energy from sugar & sweeteners 13. Albrecht SS, Mayer-Davis E, Popkin BM. Secular and
available for consumption for selected countries, the race/ethnic trends in glycemic outcomes by BMI in US adults: the
role of waist circumference. Diabetes Metab Res 2017; 33: e2889.
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Nations Secretariat. The State of the World’s Indigenous Peoples.
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food and non-alcoholic beverage expenditures, 1995–2017 growth and relative weight gain during early life with adult health
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Figure 1. Latin America and the Caribbean: Prevalence and
annualized change of undernutrition and overweight burden
(percentage point prevalence change per year)
Children who are wasted 1.97
Children who are stunted 16.60
Children who are overweight or obese 6.62
Women who are overweight or obese 56.11
0.00 10.00 20.00 30.00 40.00 50.00 60.00
-0.22 Annualized change in wasted children
-0.79 Annualized change in stunted children
Annualized change in children

-0.15
who are overweight or obese
Annualized change in women

0.99
who are overweight or obese
-1.00 0.00 1.00 2.00
Figure 2. Latin America and the Caribbean: Double burden of
undernutrition and overweight and annualized change
(percentage point prevalence change per year)
Children who are both overweight

1.44
and stunted (in the same child)
Overweight woman and

9.71
wasted or stunted child
Overweight woman 9.14

and stunted child
Overweight woman
0.76
and wasted child
0.00 2.00 4.00 6.00 8.00 10.00
Annualized change in double burden of overweight

-0.12
and stunted (in the same child)

-0.089 and wasted or stunted

-0.053
and stunted

-0.054
and wasted
-0.200 -0.100 0.000

Figure 3. Change in macronutrient percentages of total daily per capita
kilocalorie food balance by source, 1961-2013
Central America Caribbean South America

100% 100% 100%
Vegetal Proteins Vegetal Proteins Vegetal Proteins
Animal Proteins Animal Proteins Animal Proteins
90% 90% 90%
Vegetal Fats Vegetal Fats Vegetal Fats
80% 80% 80%
percentage of total calories
Animal Fats Animal Fats Animal Fats

70% 70% 70%
60% 60% 60%
50% 50% 50%

Other Carbohydrates Other Carbohydrates Other Carbohydrates
40% 40% 40%
30% 30% 30%
20% 20% 20%
10% 10% 10%

Sugars Sugars
Sugars
0% 0% 0%
1961
1964
1967
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
2012
1961
1964
1967
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
2012
1961
1964
1967
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
2012
Source: FAOSTAT
Figure 4. Total daily per capita sales of sugar-sweetened
beverages in Latin America and select countries, 2016
Mexico 448
Chile 398
Latin America 257
Colombia 208
Brazil 207
0 100 200 300 400 500

ml per capita per day
Source: Euromonitor
Figure 5. Trends in daily per capita sugar-sweetened beverage
sales by category in Latin America and select countries, 2005–2016
500
450 Sports & Energy Drinks
400 Fruit Drinks
350 Caloric Soft Drinks

mL per capita per day
300
250
200
150
100
50
0
'05
'06
'07
'08
'09
'10
'11
'12
'13
'14
'15
'16
'05
'06
'07
'08
'09
'10
'11
'12
'13
'14
'15
'16
'05
'06
'07
'08
'09
'10
'11
'12
'13
'14
'15
'16
'05
'06
'07
'08
'09
'10
'11
'12
'13
'14
'15
'16
'05
'06
'07
'08
'09
'10
'11
'12
'13
'14
'15
'16
Mexico Chile Latin America Brazil Colombia
Source: Euromonitor
Figure 6. Total daily per capita junk food sales in
Latin America and select countries, 2016
Mexico 57
Chile 50
Latin America 33
Brazil 27
Colombia 17
0 10 20 30 40 50 60 70
Grams per capita per day
Source: Euromonitor
Figure 7. Trends in per capita daily junk food sales by category
in Latin American countries, 2005-2016
70
Chilled and Shelf Stable Desserts
Salty Snacks
60
Cakes
Confectionery
50
Pastries
Grams per capita per day
Sweet Biscuits, Snack Bars, & Fruit Snacks

40
30
20
10
0
'05
'06
'07
'08
'09
'10
'11
'12
'13
'14
'15
'16
'05
'06
'07
'08
'09
'10
'11
'12
'13
'14
'15
'16
'05
'06
'07
'08
'09
'10
'11
'12
'13
'14
'15
'16
'05
'06
'07
'08
'09
'10
'11
'12
'13
'14
'15
'16
'05
'06
'07
'08
'09
'10
'11
'12
'13
'14
'15
'16
Mexico Chile Latin America Brazil Colombia
Source: Euromonitor
Figure 8. Sugar and sweetener food
balance, 1990 and 2013
(kcal/capita/day)
Sugar & sweeteners food balance in
1990 and 2013
Kcal per capita per day

800
600
473 452 436
388 410
366
400
200
0
1990 2013
Sugar & sweeteners food balance in

1990 and 2013
800
611
565 557
600 500 502 466 503
458 471 458
417 378
400
200
0
Colombia Barbados Jamaica Mexico Brazil Chile
1990 2013
Source: FAOSTAT
Figure 9. Combined retail and food service
daily per capita sodium sales, 2010 and 2015
8000
7000
mg per capita per day
6000
5000
4000
3000
2000
1000
0
Latin America Mexico Chile Brazil Colombia
2010 2015
Source: Euromonitor
Figure 10. Trends in animal product food balance, 1961–2013

1400 1400 1400
Kcal per capita
1200 1200 1200

1000 1000 1000
per day
800 800 800

600 600 600
400 400 400
200 200 200
0 0 0
1961
1965
1969
1973
1977
1981
1985
1989
1993
1997
2001
2005
2009
2013
1961
1965
1969
1973
1977
1981
1985
1989
1993
1997
2001
2005
2009
2013
1961
1965
1969
1973
1977
1981
1985
1989
1993
1997
2001
2005
2009
2013
Jamaica Chile Colombia
Kcal per capita
1400 1400 1400

1200 1200 1200
per day
1000 1000 1000

800 800 800
600 600 600
400 400 400
200 200 200
0 0 0
Brazil Mexico Barbados

Kcal per capita
1400 1400 1400

1200 1200 1200
per day
1000 1000 1000

800 800 800
600 600 600
400 400 400
200 200 200
0 0 0
1961-2013
Source: FAOSTAT
Figure 11. Per capita away-from-home
food and nonalcoholic beverage yearly
expenditures, 1995-2016
500
US$ per capita, fixed 2016 exchange rates

Chile
450
Mexico
400
Brazil
350
Colombia
300
Latin America
250
200
150
100
50
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Source: FAOSTAT
Figure 12. Trends in bean, pea, and other legume
food balance, 1961–2012 (kcal/capita/day)

250 250 250
Kcal per capita
200 200 200

per day
150 150 150

100 100 100
50 50 50
0 0 0
1961
1965
1969
1973
1977
1981
1985
1989
1993
1997
2001
2005
2009
2013
1961
1965
1969
1973
1977
1981
1985
1989
1993
1997
2001
2005
2009
2013
1961
1965
1969
1973
1977
1981
1985
1989
1993
1997
2001
2005
2009
2013
Brazil Mexico Barbados
Kcal per capita
250 250 250

200 200 200
per day
150 150 150

100 100 100
50 50 50
0 0 0
Chile Colombia Jamaica

Kcal per capita
250 250 250

200 200 200
per day
150 150 150

100 100 100
50 50 50
0 0 0
1961-2012
Source: FAOSTAT
180
270
180
270
180
270
0
0
0
90
90
90
1961 1961 1961
1963 1963 1963
1965 1965 1965
1967 1967 1967
1969 1969 1969
1971 1971 1971
1973 1973 1973
1975 1975 1975
1977 1977 1977
1979 1979 1979
1981 1981 1981
1983 1983 1983
1985 1985 1985
1987 1987 1987
1989 1989 1989
1991 1991 1991
Caribbean
1993 1993 1993

1995 South America 1995 1995
Central America
1997 1997 1997

1999 1999 1999
2001 2001 2001
2003 2003 2003
2005 2005 2005
1961–2013 (kcal/capita/day)
2007 2007 2007

2009 2009 2009
2011 2011 2011
2013 2013 2013
balance in Latin America and the Caribbean,
Figure 13. Trends in fruit and vegetable food
Total
Fruits
Vegetables
Source: FAOSTAT
Figure 14. Trends in fruit and vegetable food balance
in select countries, 1961–2013 (kcal/capita/day)
270
180
90 Barbados
0
270
180
90 Chile
0
270
180
90 Jamaica
0
270
180
90 Colombia
0
270
180
90 Brazil
0
270
180
90 Mexico
0
Fruits Vegetables Total
Source: FAOSTAT
Figure 15. Daily per capita whole grain
consumption in select countries,
1900 and 2015 (kcal/capita/day)
1200
1000
800
600
400
200
0
Chile Jamaica Barbados Brazil Mexico Colombia
1990 2015
Source: Institute for Health Metrics and Evaluation

Supplemental Table 1. Sample size: number of households, mean age for women, and GDP per capita (PPP) by country
Supplemental Table 1. Sample populations for anthropometric analysis for Latin America and the Caribbean
Households N (#) earliest year Households N (#) lastest year

Housholds with Housholds with 2010
Earliest Households Households Mean Latest Households Households Mean
Country children (0–4) children (0–4) GDP
year with children with women age for year with children with women age for
and women and women (PPP
(0–4) (15–49) women (0–4) (15–49) women
(15–49) (15–49) units)
Bolivia 1994 2,547 2,273 2,149 28.64 2008 5,880 12,299 5,488 29.66 1978.85
Brazil 1996 3,189 3,122 2,911 28.21 2013 . 21,645 . 30.90 10992.9
Colombia 1995 3,347 3,173 3,055 28.33 2010 12,840 34,233 12,050 29.65 6186.02
Dominican Republic 1991 2,235 2,066 1,907 27.63 2013 2,581 6,685 2,421 30.24 5195.38
Guatemala 1995 5,370 4,771 4,631 28.90 2014 8,664 16,459 8,151 28.89 2873.08
Guyana 2009 1,272 3,438 1,174 30.65 2994.45
Haiti 1994 1,861 1,762 1,610 30.10 2012 2,986 5,923 2,834 28.17 663.91
Honduras 2005 6,940 13,335 6,492 28.71 2011 7,787 15,370 7,419 28.96 2018.75
Mexico 1988 5,157 9,786 4,647 28.60 2016 2,006 3,681 1,091 31.66 9128
Nicaragua 1998 4,797 8,536 4,486 28.50 2001 4,313 8,451 4,056 28.75 1455.84
Peru 1992 5,454 4,967 4,770 29.50 2012 7,531 17,314 7,242 30.79 5283.22
PPP is purchasing power parity measures of real purchasing power in GNP/caita by the World Bank.
Supplemental Table 2. children aged 0-4, sample size and proportion wasted, stunted, or both by country and region
Wasting Stunting Wasting and stunting Overweight or obese

Most Most Most Most
Earliest Earliest Earliest
recent Annualiz recent Annualiz Earliest recent Annualiz recent Annualiz
year year year
Latin America and the Caribbean year ed year ed year year ed year ed
prevalen prevalen prevalen
prevalen change prevalen change prevalence prevalen change prevalen change
ce ce ce
ce ce ce ce
Bolivia 6.82 2.24 -0.33 37.90 30.80 -0.51 41.68 32.16 -0.68 9.74 11.79 0.15
Colombia 2.44 1.24 -0.08 22.93 13.87 -0.60 24.38 14.79 -0.64 6.24 6.01 -0.02
Dominican Republic 3.60 2.97 -0.03 25.09 8.68 -0.75 27.21 11.14 -0.73 7.25 10.10 0.13
Guatemala 6.73 1.08 -0.30 63.06 49.67 -0.70 64.95 50.01 -0.79 10.11 6.82 -0.17
Guyana 7.54 25.09 31.06 13.43
Haiti 14.39 7.36 -0.39 47.33 24.65 -1.26 53.03 29.27 -1.32 7.79 5.28 -0.14
Honduras 2.26 1.75 -0.09 32.45 24.79 -1.28 34.04 25.81 -1.37 7.97 6.92 -0.17
Mexico 8.36 1.60 -0.28 30.03 13.79 -0.68 35.60 15.24 -0.85 14.33 9.13 -0.22
Nicaragua 5.10 3.36 -0.58 35.92 29.59 -2.11 38.91 31.61 -2.43 11.40 10.93 -0.15
Peru 3.12 0.84 -0.11 42.74 19.66 -1.15 44.34 20.15 -1.21 13.57 8.75 -0.24
Region total 6.27 1.97 -0.22 33.00 16.60 -0.79 36.75 18.10 -0.91 11.53 6.62 -0.15
Supplemental Table 3. Overweight and obesity status by country and region for females (15-49), weight, not age adjusted
Thinness prevalence Overweight prevalence

Latin America
and the Most recent Annualized Most recent Annualized
Caribbean Earliest year year change Earliest year year change
Country
Bolivia 2.38 2.03 -0.02 33.59 56.28 1.62
Brazil 7.29 3.95 -0.20 35.90 48.73 0.75
Colombia 3.88 5.58 0.11 45.63 53.42 0.52
Dominican Republic 8.21 7.91 -0.01 23.37 57.15 1.54
Guatemala 3.62 2.92 -0.04 34.28 62.26 1.47
Guyana 11.94 53.27
Haiti 22.01 13.87 -0.45 11.33 32.32 1.17
Honduras 4.35 4.91 0.09 54.78 60.25 0.91
Mexico 14.25 1.78 -0.52 36.24 69.71 1.39
Nicaragua 4.52 3.82 -0.24 52.99 57.89 1.63
Peru 1.34 1.98 0.03 40.05 60.22 1.01
Region total 8.39 3.70 -0.22 36.89 56.11 0.99
Supplemental Table 4. Prevalence of double burden in the household in Latin America and the Caribbean
Overweight woman & wasted child Overweight woman & stunted child Overweight woman & wasted and stunted child
Country Earliest Most recent Annualized Earliest Most recent Annualized Most recent Annualized
Earliest year
year year change year year change year change
Bolivia 2.23 1.19 -0.07 12.35 15.91 0.26 13.07 16.59 0.25
Colombia 0.87 0.33 -0.04 8.92 5.63 -0.22 9.28 5.90 -0.23
Dominican Republic 0.70 2.40 0.08 3.80 3.79 0.00 4.30 5.78 0.07
Guatemala 1.40 0.53 -0.05 19.04 24.34 0.28 19.64 24.35 0.25
Guyana 1.87 11.80 12.76
Haiti 1.43 1.49 0.00 3.77 5.05 0.07 4.38 6.11 0.10
Honduras 0.71 0.94 0.04 12.77 13.71 0.16 13.34 14.19 0.14
Mexico 2.27 0.81 -0.06 8.53 7.83 -0.03 10.48 8.51 -0.08
Nicaragua 2.97 1.10 -0.62 14.19 12.78 -0.47 16.34 13.44 -0.97
Peru 0.80 0.29 -0.03 14.88 11.24 -0.18 15.19 11.43 -0.19
Region total 1.66 0.76 -0.05 9.96 9.14 -0.05 11.15 9.71 -0.09
Supplemental Table 5. Macronutrient distribution for Central America, South America, and the Caribbean
Central America
Total kilocalories
Macronutrient Source 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
FAT Animal fats 178.29 174.96 173.97 170.10 168.21 177.93 182.61 180.81 183.51 186.39 186.84 206.19 214.29 224.46 234.45 247.05 260.37 266.94 273.87 282.24 289.17 289.62 293.40 294.30 288.72 275.76 271.71 278.64 257.13 258.93 267.57 273.06 276.39 282.78 275.76 270.00 280.44 290.70 302.40 314.28 323.19 329.49 332.01 342.45 343.35 347.13 351.63 351.18 358.29 353.43 346.41 347.85 360.27
Vegetal fats 255.96 258.48 256.86 265.68 267.48 270.81 264.87 263.97 269.73 280.26 276.21 272.43 277.74 288.36 294.12 286.47 297.63 316.53 319.05 333.18 360.63 396.54 409.32 360.45 382.68 403.11 376.47 389.43 384.57 362.16 389.25 385.11 391.23 389.34 385.83 405.63 399.42 393.39 373.23 373.05 381.69 392.58 386.82 393.48 408.78 398.07 409.05 407.88 389.34 400.05 424.80 411.30 416.25
CHO Other carbohydrates 1,259.23 1,246.08 1,263.53 1,289.86 1,301.63 1,316.61 1,339.59 1,357.14 1,357.27 1,348.51 1,362.07 1,352.66 1,355.73 1,356.66 1,372.27 1,350.40 1,370.24 1,370.61 1,385.92 1,448.14 1,528.28 1,490.59 1,484.88 1,453.25 1,486.65 1,454.74 1,420.82 1,448.21 1,426.50 1,411.39 1,414.98 1,416.43 1,411.46 1,416.08 1,400.97 1,401.17 1,385.37 1,380.23 1,382.93 1,400.19 1,421.72 1,420.76 1,421.13 1,403.47 1,389.19 1,396.95 1,397.99 1,382.94 1,367.89 1,367.16 1,358.99 1,369.58 1,382.52
Sugars 249.00 260.00 263.00 272.00 281.00 284.00 298.00 315.00 326.00 340.00 328.00 344.00 369.00 365.00 406.00 398.00 392.00 415.00 421.00 429.00 429.00 418.00 388.00 432.00 429.00 435.00 420.00 421.00 446.00 473.00 446.00 450.00 457.00 449.00 444.00 446.00 424.00 437.00 441.00 451.00 461.00 468.00 475.00 468.00 447.00 459.00 463.00 461.00 471.00 461.00 457.00 465.00 452.00
PRO Animal proteins 63.16 64.28 65.24 64.80 63.92 68.24 70.44 69.64 70.52 71.88 72.08 77.60 78.48 82.16 84.24 89.04 92.60 96.12 97.36 108.36 108.88 106.00 104.68 103.60 106.96 106.48 104.80 105.04 100.64 103.84 104.36 110.64 113.76 115.40 111.36 111.00 116.64 120.52 125.44 131.16 135.96 138.92 136.68 137.64 141.48 143.72 146.20 147.12 145.92 145.24 144.12 143.64 145.68
Vegetal proteins 174.36 170.20 171.40 178.56 178.76 179.32 181.36 183.44 182.84 181.96 183.76 180.12 180.80 179.36 180.92 175.00 177.16 178.80 177.80 197.08 212.04 202.16 199.68 187.36 196.08 193.00 187.20 190.68 184.16 186.68 189.84 185.72 184.16 184.40 186.08 186.20 185.04 184.12 184.00 186.28 188.44 188.16 188.36 186.96 183.20 185.04 185.04 182.88 180.56 182.12 178.68 182.72 184.28
Total kilocalories 2,180.00 2,174.00 2,194.00 2,241.00 2,261.00 2,296.91 2,336.87 2,370.00 2,389.87 2,409.00 2,408.96 2,433.00 2,476.04 2,496.00 2,572.00 2,545.96 2,590.00 2,644.00 2,675.00 2,798.00 2,928.00 2,902.91 2,879.96 2,830.96 2,890.09 2,868.09 2,781.00 2,833.00 2,799.00 2,796.00 2,812.00 2,820.96 2,834.00 2,837.00 2,804.00 2,820.00 2,790.91 2,805.96 2,809.00 2,855.96 2,912.00 2,937.91 2,940.00 2,932.00 2,913.00 2,929.91 2,952.91 2,933.00 2,913.00 2,909.00 2,910.00 2,920.09 2,941.00
% of kilocalories
FAT Animal fats 0.08 0.08 0.08 0.08 0.07 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.09 0.09 0.09 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.09 0.09 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.11 0.11 0.11 0.11 0.11 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12
Vegetal fats 0.12 0.12 0.12 0.12 0.12 0.12 0.11 0.11 0.11 0.12 0.11 0.11 0.11 0.12 0.11 0.11 0.11 0.12 0.12 0.12 0.12 0.14 0.14 0.13 0.13 0.14 0.14 0.14 0.14 0.13 0.14 0.14 0.14 0.14 0.14 0.14 0.14 0.14 0.13 0.13 0.13 0.13 0.13 0.13 0.14 0.14 0.14 0.14 0.13 0.14 0.15 0.14 0.14
CHO Other carbohydrates 0.58 0.57 0.58 0.58 0.58 0.57 0.57 0.57 0.57 0.56 0.57 0.56 0.55 0.54 0.53 0.53 0.53 0.52 0.52 0.52 0.52 0.51 0.52 0.51 0.51 0.51 0.51 0.51 0.51 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.49 0.49 0.49 0.49 0.48 0.48 0.48 0.48 0.48 0.47 0.47 0.47 0.47 0.47 0.47 0.47
Sugars 0.11 0.12 0.12 0.12 0.12 0.12 0.13 0.13 0.14 0.14 0.14 0.14 0.15 0.15 0.16 0.16 0.15 0.16 0.16 0.15 0.15 0.14 0.13 0.15 0.15 0.15 0.15 0.15 0.16 0.17 0.16 0.16 0.16 0.16 0.16 0.16 0.15 0.16 0.16 0.16 0.16 0.16 0.16 0.16 0.15 0.16 0.16 0.16 0.16 0.16 0.16 0.16 0.15
South America
Total kilocalories
FAT Animal fats 263.25 263.97 259.65 254.25 257.31 265.77 260.82 270.09 269.82 268.11 259.56 254.61 254.97 266.13 276.30 278.19 275.85 279.09 287.28 302.04 296.37 283.14 273.51 274.14 282.69 291.51 298.80 293.67 300.33 296.46 311.94 314.73 320.58 331.56 353.07 353.97 360.45 364.86 376.47 383.94 376.02 373.59 373.50 380.16 370.53 386.91 398.16 415.62 413.37 425.16 438.66 441.81 450.09
Vegetal fats 176.76 193.32 190.35 199.80 204.21 219.42 219.51 231.75 231.84 227.61 228.51 236.16 237.24 266.76 259.20 256.41 285.75 306.54 310.86 315.45 318.78 317.88 322.83 322.38 327.42 334.98 346.23 369.09 361.89 360.45 373.41 375.30 368.46 362.88 353.61 357.30 362.97 365.67 405.81 418.59 422.10 416.34 426.69 433.89 430.83 435.87 441.27 455.40 448.02 452.97 455.67 460.35 461.34
CHO Other carbohydrates 1,249.47 1,257.11 1,253.00 1,303.11 1,306.40 1,290.21 1,314.19 1,324.00 1,330.50 1,323.36 1,329.40 1,279.51 1,264.67 1,283.47 1,282.34 1,304.41 1,300.88 1,287.77 1,310.10 1,300.71 1,289.85 1,300.50 1,277.78 1,276.44 1,284.38 1,259.87 1,273.49 1,268.20 1,258.22 1,245.45 1,269.85 1,267.53 1,270.73 1,285.08 1,271.56 1,282.60 1,282.05 1,270.47 1,286.32 1,288.07 1,296.96 1,284.63 1,340.65 1,336.39 1,354.52 1,349.30 1,347.37 1,361.93 1,360.05 1,374.03 1,384.12 1,360.59 1,361.21
Sugars 388.00 391.00 365.00 373.00 380.00 359.00 362.00 377.00 386.00 389.00 393.00 412.00 401.00 430.00 444.00 451.00 439.00 455.00 480.00 479.00 452.00 445.00 444.00 445.00 439.00 458.00 456.00 442.00 437.00 436.00 433.00 452.00 449.00 458.00 461.00 449.00 444.00 442.00 395.00 395.00 395.00 391.00 401.00 407.00 409.00 407.00 407.00 410.00 407.00 403.00 406.00 408.00 410.00
Total kilocalories 2,329.00 2,357.00 2,320.00 2,383.00 2,403.96 2,390.00 2,416.00 2,466.00 2,479.00 2,467.00 2,467.91 2,433.00 2,407.00 2,501.04 2,520.00 2,548.09 2,560.00 2,588.00 2,654.00 2,666.00 2,624.00 2,610.00 2,576.00 2,578.00 2,595.09 2,607.00 2,640.00 2,636.00 2,621.00 2,599.00 2,658.00 2,683.00 2,687.09 2,724.00 2,731.04 2,744.91 2,748.95 2,742.00 2,768.00 2,792.00 2,797.00 2,769.00 2,853.00 2,866.00 2,875.04 2,895.00 2,914.00 2,972.95 2,956.00 2,990.04 3,027.13 3,011.91 3,027.00
% of kilocalories
FAT Animal fats 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.10 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.12 0.12 0.12 0.12 0.13 0.13 0.13 0.13 0.14 0.14 0.13 0.13 0.13 0.13 0.13 0.13 0.14 0.14 0.14 0.14 0.14 0.15 0.15
Vegetal fats 0.08 0.08 0.08 0.08 0.08 0.09 0.09 0.09 0.09 0.09 0.09 0.10 0.10 0.11 0.10 0.10 0.11 0.12 0.12 0.12 0.12 0.12 0.13 0.13 0.13 0.13 0.13 0.14 0.14 0.14 0.14 0.14 0.14 0.13 0.13 0.13 0.13 0.13 0.15 0.15 0.15 0.15 0.15 0.15 0.15 0.15 0.15 0.15 0.15 0.15 0.15 0.15 0.15
Sugars 0.17 0.17 0.16 0.16 0.16 0.15 0.15 0.15 0.16 0.16 0.16 0.17 0.17 0.17 0.18 0.18 0.17 0.18 0.18 0.18 0.17 0.17 0.17 0.17 0.17 0.18 0.17 0.17 0.17 0.17 0.16 0.17 0.17 0.17 0.17 0.16 0.16 0.16 0.14 0.14 0.14 0.14 0.14 0.14 0.14 0.14 0.14 0.14 0.14 0.13 0.13 0.14 0.14
Caribbean
Total kilocalories
FAT Animal fats 182 191 208 218 209 216 223 240 244 254 261 266 264 270 276 272 283 288 276 290 291 291 290 274 279 257 258 259 262 257 224 190 188 185 177 181 179 186 194 195 194 195 189 190 195 211 222 236 238 240 231 225 235
Vegetal fats 193 194 191 197 206 218 223 227 229 225 230 229 229 229 227 242 247 242 250 266 279 281 276 300 290 328 310 298 300 328 313 284 293 303 285 283 310 320 331 358 344 351 334 373 362 362 361 343 354 378 406 412 407
CHO Other carbohydrates 1073 1109 1164 1131 1143 1094 1104 1111 1143 1195 1256 1227 1221 1289 1239 1264 1244 1267 1250 1295 1293 1270 1280 1292 1310 1288 1268 1255 1246 1189 1171 1154 1106 1125 1139 1157 1156 1189 1237 1282 1303 1344 1361 1352 1367 1389 1389 1348 1361 1396 1409 1429 1457
Sugars 356 380 381 380 378 384 383 396 396 384 390 394 399 418 402 414 409 423 409 423 416 448 464 464 455 451 451 404 414 388 406 406 410 397 411 426 439 426 449 438 441 422 404 426 404 385 383 370 400 386 378 374 366
PRO Animal proteins 66 71 76 79 74 79 84 93 92 97 96 94 93 92 92 95 95 95 95 101 102 102 102 102 102 101 101 98 99 97 91 80 80 80 80 81 81 85 84 86 85 86 82 85 88 93 97 104 106 104 100 99 103
Vegetal proteins 122 123 129 123 126 122 125 122 126 130 136 134 134 141 134 137 134 137 136 143 142 141 142 145 147 143 144 142 140 132 131 130 123 129 128 128 130 134 142 145 148 147 155 152 159 161 162 163 160 159 163 166 170
Total kilocalories 1992 2069 2150 2128 2137 2113 2142 2188 2229 2285 2368 2344 2339 2440 2369 2425 2412 2453 2416 2517 2523 2533 2554 2576 2584 2569 2533 2456 2460 2390 2336 2245 2201 2218 2220 2256 2295 2341 2437 2503 2515 2545 2526 2579 2575 2601 2614 2564 2620 2664 2688 2706 2738
% of kilocalories
FAT Animal fats 0.09 0.09 0.10 0.10 0.10 0.10 0.10 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.12 0.11 0.12 0.12 0.11 0.12 0.12 0.11 0.11 0.11 0.11 0.10 0.10 0.11 0.11 0.11 0.10 0.08 0.09 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.07 0.08 0.08 0.09 0.09 0.09 0.09 0.09 0.08 0.09
Vegetal fats 0.10 0.09 0.09 0.09 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.09 0.10 0.10 0.10 0.10 0.10 0.11 0.11 0.11 0.11 0.12 0.11 0.13 0.12 0.12 0.12 0.14 0.13 0.13 0.13 0.14 0.13 0.13 0.14 0.14 0.14 0.14 0.14 0.14 0.13 0.14 0.14 0.14 0.14 0.13 0.14 0.14 0.15 0.15 0.15
Sugars 0.18 0.18 0.18 0.18 0.18 0.18 0.18 0.18 0.18 0.17 0.16 0.17 0.17 0.17 0.17 0.17 0.17 0.17 0.17 0.17 0.16 0.18 0.18 0.18 0.18 0.18 0.18 0.16 0.17 0.16 0.17 0.18 0.19 0.18 0.19 0.19 0.19 0.18 0.18 0.17 0.18 0.17 0.16 0.17 0.16 0.15 0.15 0.14 0.15 0.14 0.14 0.14 0.13
Supplemental Table 7. Trends in per capita daily junk food sales by category, 2005–16
Grams per capita per day total sales volume

Sweet biscuits, Chilled and
snack bars, & Confectione shelf-stable
Region Year fruit snacks Pastries ries Cakes Salty snacks desserts
2005 12.05 26.58 7.67 6.03 6.30 0.82
2006 12.33 27.12 8.22 6.30 6.30 0.82
2007 12.60 26.85 8.49 6.30 6.58 0.82
2008 12.60 26.30 8.49 6.30 6.85 0.82
2009 12.33 25.48 8.22 6.30 6.30 0.82
2010 12.88 24.38 8.49 6.30 6.30 0.82
Mexico
2011 12.88 26.03 8.49 6.30 6.58 0.82
2012 12.88 26.03 8.22 6.30 6.58 0.82
2013 12.88 26.30 7.95 6.03 6.58 0.82
2014 12.60 24.11 7.40 5.75 6.30 0.82
2015 12.60 23.84 7.40 5.48 6.58 0.82
2016 12.88 24.11 7.12 5.48 6.85 0.82
2005 9.04 4.11 8.49 8.22 4.66 3.01
2006 10.14 4.11 9.04 8.77 5.21 3.01
2007 10.96 4.11 9.32 8.77 5.48 3.29
2008 11.51 4.11 9.04 8.49 5.75 3.29
2009 11.78 4.11 9.04 8.49 5.48 3.56
2010 12.05 4.11 9.32 9.04 5.48 3.56
Chile
2011 12.60 4.38 9.59 9.04 5.75 3.84
2012 13.15 4.38 9.59 9.04 6.03 3.84
2013 13.70 4.38 10.14 9.59 6.30 4.11
2014 14.25 4.38 10.41 9.32 6.85 4.11
2015 14.79 4.38 10.41 9.59 6.85 4.11
2016 14.52 4.38 9.86 9.59 7.12 4.11
2005 9.59 8.22 6.30 4.11 2.47 0.82
2006 9.86 8.49 6.30 4.38 2.74 0.82
2007 10.14 8.49 6.58 4.38 2.74 0.82
2008 10.41 8.22 6.85 4.38 3.01 0.82
2009 10.14 8.22 6.85 4.38 2.74 0.82
2010 10.41 7.95 7.12 4.38 3.01 0.82
Latin America
2011 10.68 8.22 7.12 4.66 3.01 0.82
2012 10.68 8.22 7.12 4.66 3.01 0.82
2013 10.68 8.22 7.12 4.38 3.29 0.82
2014 10.68 7.95 6.85 4.38 3.29 0.82
2015 10.68 7.95 6.58 4.38 3.29 0.82
2016 10.41 7.95 6.30 4.38 3.29 0.82
2005 12.88 0.82 7.40 3.01 1.10 0.55
2006 12.88 0.82 7.40 3.01 1.37 0.55
2007 12.88 0.82 7.95 3.29 1.37 0.55
2008 12.60 0.82 8.22 3.29 1.37 0.55
2009 12.88 0.82 8.49 3.29 1.64 0.55
2010 12.88 0.82 9.04 3.56 1.64 0.55
Brazil
2011 12.60 0.82 9.32 3.56 1.92 0.55
2012 12.60 0.82 9.04 3.56 1.92 0.55
2013 12.60 0.82 9.04 3.84 2.19 0.55
2014 12.33 0.82 9.04 3.84 2.19 0.55
2015 12.33 0.82 8.49 3.84 2.19 0.55
2016 12.05 0.82 7.67 3.56 2.19 0.55
2005 3.56 1.64 3.29 2.47 2.47 0.27
2006 3.56 1.64 3.56 2.47 2.74 0.27
2007 3.84 1.64 3.56 2.47 3.01 0.27
2008 4.11 1.64 3.56 2.47 3.29 0.27
2009 3.84 1.37 3.56 2.47 3.29 0.27
2010 4.11 1.37 3.56 2.47 3.29 0.27
Colombia
2011 4.38 1.37 3.56 2.47 3.29 0.27
2012 4.66 1.37 3.56 2.47 3.56 0.27
2013 4.66 1.37 3.84 2.47 3.84 0.27
2014 4.66 1.64 3.84 2.47 4.11 0.27
2015 4.93 1.37 3.56 2.47 4.38 0.27
2016 4.93 1.37 3.56 2.47 4.38 0.27
Supplemental Table 6. Trends in per capita daily sugar-sweetened beverage sales by category, 2005–16
ML per capita per day total

sales volume
Sports & Caloric
Fruit
energy soft
drinks
Region Year drinks drinks
2005 6.85 60.27 356.16
2006 6.85 62.74 377.53
2007 7.12 63.01 379.18
2008 6.85 77.53 359.45
2009 6.85 80.27 358.36
2010 7.67 83.56 354.52
Mexico
2011 8.22 86.85 360.27
2012 8.49 90.96 363.84
2013 8.77 92.88 361.92
2014 9.59 92.05 346.58
2015 10.41 92.05 343.29
2016 11.23 92.60 344.38
2005 0.27 23.01 287.12
2006 0.55 27.67 302.74
2007 1.10 35.07 319.18
2008 1.37 37.53 330.41
2009 1.64 42.74 323.84
2010 2.47 46.85 329.59
Chile
2011 3.56 53.97 336.16
2012 5.21 60.27 341.92
2013 7.12 63.56 345.75
2014 8.77 67.67 328.77
2015 10.96 66.03 318.63
2016 12.88 70.14 314.52
2005 3.29 23.01 213.15
2006 3.56 24.66 221.10
2007 3.84 26.30 224.38
2008 4.11 30.14 222.47
2009 4.38 31.78 221.92
2010 4.93 33.97 224.11
Latin America
2011 5.48 35.62 224.93
2012 6.03 37.53 229.59
2013 6.30 38.63 227.67
2014 6.58 39.45 222.74
2015 6.85 39.73 214.79
2016 7.40 40.00 209.59
2005 1.10 12.88 176.71
2006 1.37 14.25 181.64
2007 1.37 15.07 186.03
2008 1.37 15.89 189.86
2009 1.92 16.71 195.62
2010 2.19 17.81 209.04
Brazil
2011 2.74 18.90 209.59
2012 3.01 20.55 217.53
2013 3.29 22.74 210.41
2014 3.56 24.93 206.03
2015 3.29 24.66 190.14
2016 3.01 24.66 179.45
2005 2.47 8.77 151.51
2006 3.01 9.59 154.79
2007 3.56 10.41 156.99
2008 4.38 12.88 161.10
2009 4.38 17.26 164.11
2010 4.93 22.74 166.30
Colombia
2011 5.21 23.84 167.95
2012 5.75 24.93 169.04
2013 6.30 24.66 169.04
2014 6.85 24.66 171.51
2015 7.40 25.75 172.33
2016 7.67 27.67 172.33
Supplemental Table 8. Sugar & sweeteners available for consumption for selected countries, the Caribbean, and Central and South America
Food supply (kcal/capita/day)

Country 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Barbados 507 510 513 513 511 513 510 507 490 506 568 505 553 576 585 584 595 605 623 629 667 615 654 574 556 558 540 575 528 500 435 480 442 483 482 554 564 516 528 522 526 521 523 517 525 524 533 557 555 556 553 555 557
Brazil 408 411 393 374 401 359 369 405 402 402 398 419 423 449 469 467 453 462 510 520 476 483 458 469 451 480 472 461 471 471 464 488 492 506 514 501 493 486 382 390 387 385 406 409 410 409 407 412 410 415 414 416 417
Chile 269 343 351 315 292 280 298 292 366 358 381 394 315 316 297 336 353 370 370 373 366 342 329 353 326 351 368 359 377 378 379 422 420 425 434 442 449 456 464 446 433 440 413 423 423 421 457 461 460 468 468 464 458
Colombia 563 559 511 500 469 459 436 418 458 426 455 482 490 530 597 639 630 672 647 664 618 649 665 648 660 648 707 639 638 611 630 648 633 628 629 601 609 612 631 608 619 607 612 615 598 589 593 591 580 528 533 549 565
Jamaica 385 392 392 415 424 444 460 478 512 448 482 494 487 483 504 518 539 534 478 546 460 424 433 433 418 439 473 495 550 502 502 493 514 509 388 498 462 485 472 542 536 528 527 463 495 451 448 518 474 475 490 495 466
Mexico 245 258 260 272 277 285 302 321 336 354 334 351 379 375 425 409 398 427 438 443 442 426 391 449 442 449 431 433 466 503 470 473 479 465 460 464 433 447 452 466 482 486 492 485 450 467 467 471 478 469 459 476 458
Region 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Central America 249 260 263 272 281 284 298 315 326 340 328 344 369 365 406 398 392 415 421 429 429 418 388 432 429 435 420 421 446 473 446 450 457 449 444 446 424 437 441 451 461 468 475 468 447 459 463 461 471 461 457 465 452
Caribbean 356 380 381 380 378 384 383 396 396 384 390 394 399 418 402 414 409 423 409 423 416 448 464 464 455 451 451 404 414 388 406 406 410 397 411 426 439 426 449 438 441 422 404 426 404 385 383 370 400 386 378 374 366
South America 388 391 365 373 380 359 362 377 386 389 393 412 401 430 444 451 439 455 480 479 452 445 444 445 439 458 456 442 437 436 433 452 449 458 461 449 444 442 395 395 395 391 401 407 409 407 407 410 407 403 406 408 410
Country 1990 2013

Colombia 611 565
Barbados 500 557
Jamaica 502 466
Mexico 503 458
Brazil 471 417
Chile 378 458
Region 1990 2013

Central America 473 452
Caribbean 388 366
South America 436 410
Supplemental Table 9. Salt from retail and food service establishments (mg/capita/day)
Retail + Food Service Sales Volumes (mg/capita/day)

Country Volumes 2009 2010 2011 2012 2013 2014 2015
Retail 3,450 3,170 3,280 3,160 3,270 3,350 3,420
Brazil Food service 720 700 740 740 780 820 860
Total 4,170 3,870 4,020 3,900 4,050 4,170 4,280
Retail 4,660 4,940 5,050 5,050 5,010 5,140 5,360
Chile Food service 810 860 890 920 960 990 1,230
Total 5,470 5,800 5,940 5,970 5,970 6,130 6,590
Retail 1,730 1,720 1,820 1,830 1,850 1,820 1,800
Colombia Food service 340 350 380 390 400 400 390
Total 2,070 2,070 2,200 2,220 2,250 2,220 2,190
Retail 5,730 5,590 5,470 5,460 5,450 5,430 5,450
Mexico Food service 1,440 1,390 1,360 1,360 1,360 1,360 1,360
Total 7,170 6,980 6,830 6,820 6,810 6,790 6,810
Retail 3,690 3,560 3,590 3,540 3,580 3,600 3,640
Latin America Food service 830 820 830 840 860 870 900
Total 4,520 4,380 4,420 4,380 4,440 4,470 4,540
Total Volumes
Country 2010 2015
Brazil 3,870 4,280
Chile 5,800 6,590
Colombia 2,070 2,190
Mexico 6,980 6,810
Latin America 4,380 4,540
Supplemental Table 10. Animal source food products available for consumption for selected countries, the Caribbean, and Central and South America
(Meat, fish, eggs, cream, butter, poultry, etc.)
Country 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Barbados 560 572 641 641 687 646 653 676 766 801 916 870 886 895 744 804 776 829 788 807 815 797 806 824 800 808 847 820 891 873 833 751 736 736 731 712 712 700 713 656 638 639 645 642 696 662 709 681 686 699 679 684 687
Brazil 287 293 290 304 312 312 307 321 314 319 312 316 324 335 352 360 349 355 374 405 384 374 369 362 370 427 427 413 450 454 481 480 483 509 576 584 596 604 629 643 629 655 661 680 648 674 687 724 738 771 803 810 826
Chile 413 422 434 393 413 437 435 461 453 468 438 438 379 469 388 365 371 387 404 425 449 430 411 391 384 379 402 421 451 470 470 503 542 555 591 603 612 623 601 624 626 626 660 651 667 706 714 138 139 139 142 144 140
Colombia 353 360 361 353 351 331 333 328 323 326 338 327 313 313 326 354 354 334 339 340 356 351 344 356 355 358 356 382 398 417 419 403 416 436 465 462 460 463 447 462 463 464 462 459 469 495 493 813 772 751 789 781 776
Jamaica 277 304 318 342 318 335 362 389 387 428 425 456 387 444 440 458 398 451 382 379 372 383 372 391 357 395 432 389 390 481 490 474 505 452 476 514 529 517 509 515 526 540 552 559 545 527 550 528 492 520 489 515 512
Mexico 282 281 278 274 268 295 306 300 305 312 312 353 366 388 397 420 445 460 474 518 523 516 514 512 513 490 478 488 453 462 467 486 499 503 485 475 495 514 535 559 576 585 585 602 605 610 618 1,328 1,301 1,308 1,310 1,304 1,314
Region 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Central America 269 268 268 264 259 279 288 285 290 296 298 328 337 356 364 384 404 415 425 455 456 449 447 447 450 433 424 430 404 411 415 432 441 447 434 428 446 461 480 499 514 523 524 535 541 546 555 1,274 1,257 1,264 1,268 1,263 1,270
Caribbean 290 306 334 351 337 349 368 401 401 426 430 426 423 430 430 435 444 447 437 458 462 462 459 442 448 423 425 419 422 412 372 317 315 311 304 307 306 319 323 324 322 325 312 316 323 347 362 927 910 931 942 963 968
South America 414 417 413 404 409 421 414 429 428 426 409 403 406 425 441 446 443 446 458 481 470 451 437 441 452 470 479 469 481 474 497 502 511 530 567 573 579 583 598 608 596 591 591 598 591 616 631 964 968 966 966 960 967
Country 1990 2013

Mexico 462 1,314
Barbados 873 687
Brazil 454 826
Colombia 417 776
Jamaica 481 512
Chile 470 140
Region 1990 2013

Central America 411 1,270
Caribbean 412 968
South America 474 967
Supplemental Table 11. Out-of-home vs. in-home food spending on food in USD/capita/year
Passport variables:
In-home: "Consumer expenditure on food and non-acoholic beverages"
Out-of-home: "Consumer expenditure on catering"
Spending (USD per capita | current prices | fixed 2016 exchange rates)
Country Spending 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Home 362.00 397.90 440.10 472.20 466.20 497.80 512.40 524.50 540.70 560.10 613.60 658.50 743.30 849.70 865.60 921.20 1,026.60 1,095.20 1,153.80 1,272.50 1,348.30 1,402.40
Chile
Away 75.70 87.70 103.70 109.50 111.40 118.10 122.40 123.40 129.80 144.80 159.00 165.40 182.80 208.40 211.30 233.20 269.40 299.80 328.60 363.20 389.60 414.20
Home 167.80 234.10 273.20 332.70 391.80 451.80 493.20 523.00 570.00 629.70 679.70 702.40 773.60 842.10 876.60 928.60 1,013.50 1,090.80 1,150.20 1,201.70 1,255.30 1,331.20
Mexico
Away 28.80 36.20 43.70 55.50 64.20 77.90 84.70 86.70 89.50 94.60 97.70 100.40 103.30 103.50 97.00 98.90 103.00 109.90 112.20 115.80 119.90 125.10
Home 189.30 220.20 243.00 262.90 277.70 299.20 317.70 334.70 362.80 391.70 420.80 448.60 495.20 554.20 577.80 627.40 695.40 757.10 833.00 911.10 975.10 1,069.80
Latin America
Away 49.50 56.50 63.00 68.20 72.00 78.70 84.70 89.70 98.40 107.70 116.60 126.80 139.10 157.50 168.60 186.90 208.00 228.10 252.10 278.80 296.80 320.90
Home 129.20 157.40 172.70 175.50 188.80 203.30 217.70 232.20 263.00 284.10 307.40 330.80 362.70 405.20 441.40 490.40 543.90 600.20 697.20 765.70 802.60 833.40
Brazil
Away 49.70 60.90 67.30 69.00 74.90 81.40 88.70 95.90 110.50 122.10 135.00 147.80 165.20 195.70 225.90 259.70 294.40 327.70 373.80 421.40 446.60 468.30
Home 125.90 144.80 168.50 197.90 204.90 228.90 248.90 268.90 283.40 301.10 318.50 343.00 378.00 429.40 445.00 456.30 493.00 517.80 523.80 559.50 599.10 645.50
Colombia
Away 68.40 74.10 85.30 100.50 100.20 110.00 117.00 124.40 136.40 153.50 166.80 186.20 210.10 236.10 246.50 260.60 283.80 303.80 326.30 350.60 383.80 416.20
Definitions:
Consumer expenditure on food and non-alcoholic beverages: food products and non-alcoholic beverages purchased for consumption at home. Excludes: food products and non-alcoholic beverages sold for immediate consumption away from the home by hotels, restaurants, cafés, bars, kiosks, street vendors, automatic vending machines, etc. (consumer
expenditure on catering services); cooked dishes prepared by restaurants for consumption off their premises (consumer expenditure on catering services); cooked dishes prepared by catering contractors whether collected by the customer or delivered to the customer's home (consumer expenditure on catering services); and products sold specifically as pet
foods (consumer expenditure on other recreational items and equipment, gardens and pets).
Consumer expenditure on catering: restaurants, cafes and the like: catering services (meals, snacks, drinks and refreshments) provided by restaurants, cafés, buffets, bars, tearooms, etc., including those provided: in places providing recreational, cultural, sporting or entertainment services: theatres, cinemas, sports stadiums, swimming pools, sports
complexes, museums, art galleries, nightclubs, dancing establishments, etc.; on public transport (coaches, trains, boats, aeroplanes, etc.) when priced separately; also included are: the sale of food products and beverages for immediate consumption by kiosks, street vendors and the like, including food products and beverages dispensed ready for
consumption by automatic vending machines; the sale of cooked dishes by restaurants for consumption off their premises; the sale of cooked dishes by catering contractors whether collected by the customer or delivered to the customers home; tips. Canteens: catering services of works canteens, office canteens and canteens in schools, universities and
other educational establishments; university refectories, military messes and wardrooms. Excludes: tobacco purchases (consumer expenditure on tobacco); telephone calls (consumer expenditure on telecommunications services), food and drink provided to hospital in-patients (consumer expenditure on hospital services).
Supplemental Table 12. Pulses/legumes available for consumption in kcal/capita/day for selected countries, the Caribbean, and Central and South America
(Beans, peas, chickpeas, lentils, lupins, other pulses)
Country 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Barbados 68 69 66 75 66 68 69 80 76 88 87 81 73 70 75 77 84 74 74 72 78 75 76 68 74 74 76 67 80 69 67 65 64 67 62 63 70 78 66 67 69 67 69 69 73 73 61 68 61 64 66 65 61
Brazil 200 191 211 203 235 215 251 228 203 197 238 235 187 181 177 144 153 154 152 147 150 156 156 154 145 137 135 133 133 127 144 147 157 163 125 180 141 144 145 155 155 150 161 143 144 153 153 155 154 154 155 145 152
Chile 56 59 56 47 49 61 64 61 59 60 63 72 58 59 43 54 56 46 54 54 58 58 53 59 50 35 32 27 24 25 32 34 31 28 32 39 33 32 33 37 37 40 41 44 43 45 35 33 28 36 32 33 39
Colombia 48 46 43 45 41 38 40 40 40 41 42 44 43 44 49 43 42 44 47 53 51 56 56 57 56 52 60 57 54 65 63 72 62 64 61 66 68 64 67 70 72 70 69 62 69 62 61 60 63 63 62 65 60
Jamaica 23 29 27 32 23 22 31 35 38 34 32 37 29 28 31 23 23 39 33 30 33 26 27 30 28 30 33 27 27 27 25 29 30 30 28 25 25 16 27 19 27 19 19 35 27 36 35 30 31 29 39 30 31
Mexico 169 147 139 183 170 166 165 161 150 154 165 149 152 150 147 123 129 123 120 214 252 193 184 118 156 157 136 118 90 129 142 123 116 116 143 137 147 129 115 120 114 118 122 119 112 115 115 110 110 116 88 111 119
Region 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Central America 151 135 130 162 154 151 151 148 139 141 148 135 138 136 133 115 119 114 112 182 215 167 161 113 144 142 125 116 94 125 135 119 113 111 131 124 132 120 111 115 111 116 118 115 110 115 114 111 113 118 98 117 122
Caribbean 110 93 105 100 102 103 105 96 102 105 103 106 106 109 94 98 96 102 94 99 99 103 98 105 106 94 114 104 111 101 105 117 96 113 101 97 100 104 126 108 122 97 129 124 130 130 143 141 137 129 139 136 148
South America 126 120 131 127 142 132 151 138 125 123 142 140 114 112 110 93 99 98 98 97 100 103 102 101 96 90 90 89 86 84 94 97 100 103 84 113 93 95 95 100 100 97 104 93 94 98 99 99 99 99 99 95 98
Country 1990 2013

Brazil 127 152
Mexico 129 119
Barbados 69 61
Colombia 65 60
Chile 25 39
Jamaica 27 31
Region 1990 2013

Central America 125 122
Caribbean 101 148
South America 84 98
Supplemental Table 14. Whole grains available for consumption for selected countries in the Caribbean and Central and South America
Consumption (kcal/capita/day)
Country 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Barbados 497.49 488.19 479.36 479.20 488.93 504.46 521.63 536.31 548.02 558.18 565.76 567.85 563.95 558.73 553.90 547.38 541.50 540.38 544.29 551.40 558.68 561.61 557.14 544.99 528.55 514.74 510.65 517.43 532.97 552.14 570.77 584.58 593.37 599.38 604.51 609.94
Brazil 342.43 346.21 349.40 351.89 353.08 352.21 349.18 344.83 340.17 336.40 334.43 334.26 335.16 336.96 339.52 341.57 342.50 343.30 345.12 348.64 354.50 362.98 373.07 383.20 391.82 398.10 401.82 403.62 404.57 405.42 406.99 409.31 412.33 415.80 419.45 423.09
Chile 1,090.19 1,084.61 1,073.27 1,061.42 1,054.43 1,055.50 1,060.86 1,059.17 1,050.86 1,046.81 1,047.73 1,044.82 1,031.51 1,010.51 988.37 967.62 948.54 933.65 927.50 929.37 937.10 946.75 952.47 951.74 945.88 932.80 911.90 890.77 879.84 880.44 887.35 891.63 888.89 881.05 871.09 860.79
Colombia 144.38 151.79 161.30 171.30 179.56 184.29 185.25 183.33 180.57 179.80 183.22 190.57 199.90 208.67 215.79 221.04 224.02 225.55 226.57 227.83 230.13 233.15 235.57 236.88 237.20 237.05 237.06 237.47 238.71 240.82 243.99 247.18 248.89 249.32 249.15 248.83
Jamaica 594.08 593.22 591.77 587.32 579.96 570.34 558.71 546.11 533.81 523.35 516.92 515.29 516.37 517.54 514.75 507.40 501.79 506.72 517.02 525.33 529.82 531.92 533.40 537.63 545.09 553.23 560.58 567.21 573.36 578.72 583.60 588.39 593.36 598.57 603.96 609.47
Mexico 305.65 317.01 324.40 326.93 324.32 316.29 306.30 299.47 297.74 300.10 304.97 311.21 317.15 319.36 315.35 305.32 294.59 287.11 284.06 284.83 287.78 290.88 293.22 294.25 293.47 290.29 283.99 274.81 264.71 256.66 251.78 248.12 243.70 238.40 232.69 226.91
Country 1990 2015

Chile 1,047.73 860.79
Jamaica 516.92 609.47
Barbados 565.76 609.94
Brazil 334.43 423.09
Mexico 304.97 226.91
Colombia 183.22 248.83
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Supplemental Table 13. Fruits & vegetables available for consumption for selected countries, the Caribbean, and Central and South America
Variables: "Vegetables" and "Fruits — excluding wine"

COUNTRY Item 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Vegetables 11 10 11 12 13 13 15 18 18 21 26 26 25 24 23 24 25 31 34 39 38 39 42 35 28 32 34 37 36 35 38 33 39 35 56 56 51 44 61 51 66 63 70 60 72 69 74 65 68 63 64 62 60
Barbados Fruits 42 43 39 42 41 41 40 40 42 44 41 46 38 35 40 41 41 44 45 47 51 46 46 49 57 66 70 75 68 62 79 69 69 77 84 75 81 68 95 86 104 106 111 98 108 109 113 114 116 116 111 106 103
Total 53 53 50 54 54 54 55 58 60 65 67 72 63 59 63 65 66 75 79 86 89 85 88 84 85 98 104 112 104 97 117 102 108 112 140 131 132 112 156 137 170 169 181 158 180 178 187 179 184 179 175 168 163
Vegetables 12 11 13 16 17 16 15 13 12 14 21 21 21 22 21 26 24 28 28 28 31 28 31 36 30 27 29 23 29 31 27 35 43 51 53 56 47 46 52 47 54 41 50 44 46 49 46 45 51 49 64 63 66
Jamaica Fruits 149 156 152 155 141 135 145 128 123 129 148 158 142 142 131 128 145 154 162 170 183 196 190 191 187 176 173 169 161 135 123 125 133 154 153 163 156 150 162 151 157 156 163 170 140 136 138 111 134 130 130 129 117
Total 161 167 165 171 158 151 160 141 135 143 169 179 163 164 152 154 169 182 190 198 214 224 221 227 217 203 202 192 190 166 150 160 176 205 206 219 203 196 214 198 211 197 213 214 186 185 184 156 185 179 194 192 183
Vegetables 16 17 16 17 16 17 17 17 17 17 17 17 17 18 17 18 19 20 21 21 21 22 21 22 21 21 23 23 22 24 24 23 25 27 27 26 27 26 28 27 27 31 32 30 30 31 32 33 35 37 38 35 36
Brazil Fruits 88 93 99 98 101 101 108 112 118 122 119 130 93 103 99 113 108 100 102 108 93 104 96 86 120 96 107 116 125 109 116 116 102 99 122 117 130 115 125 120 103 123 115 119 115 125 125 128 130 140 148 124 113
Total 104 110 115 115 117 118 125 129 135 139 136 147 110 121 116 131 127 120 123 129 114 126 117 108 141 117 130 139 147 133 140 139 127 126 149 143 157 141 153 147 130 154 147 149 145 156 157 161 165 177 186 159 149
Vegetables 86 83 88 84 87 88 80 75 76 76 73 74 71 71 75 71 69 94 104 97 102 97 96 94 70 70 72 80 83 75 80 77 88 92 92 96 71 74 74 78 76 79 83 81 81 80 62 64 64 57 57 63 62
Chile Fruits 47 49 49 49 50 53 58 60 67 61 62 58 52 58 51 41 43 45 55 48 54 59 55 53 53 46 46 46 58 59 51 59 75 75 74 83 68 65 67 69 57 72 65 69 68 70 73 75 78 84 68 74 82
Total 133 132 137 133 137 141 138 135 143 137 135 132 123 129 126 112 112 139 159 145 156 156 151 147 123 116 118 126 141 134 131 136 163 167 166 179 139 139 141 147 133 151 148 150 149 150 135 139 142 141 125 137 144
Vegetables 17 18 19 20 20 23 24 24 25 26 26 26 26 26 28 34 33 33 32 32 32 28 27 28 33 36 31 32 29 30 20 17 18 19 25 31 37 33 30 34 28 28 32 29 30 26 28 30 31 31 30 32 33
Colombia Fruits 200 199 195 195 193 191 206 196 202 207 190 192 201 194 203 200 195 208 208 209 206 173 190 171 172 178 186 184 185 161 166 199 189 178 202 174 178 158 170 190 198 200 196 201 196 213 212 215 196 211 203 216 237
Total 217 217 214 215 213 214 230 220 227 233 216 218 227 220 231 234 228 241 240 241 238 201 217 199 205 214 217 216 214 191 186 216 207 197 227 205 215 191 200 224 226 228 228 230 226 239 240 245 227 242 233 248 270
Vegetables 13 14 15 14 16 15 17 16 15 15 20 23 21 22 17 17 19 23 26 27 23 28 30 31 30 31 28 31 32 33 34 35 29 27 26 30 36 39 46 40 45 45 45 44 44 44 45 43 39 40 38 42 40
Mexico Fruits 62 68 76 74 87 89 85 82 72 77 91 85 85 81 86 87 85 90 85 95 101 109 102 113 107 104 104 105 96 96 94 101 99 106 101 107 99 87 95 104 113 111 111 114 111 112 107 110 106 98 102 97 105
Total 75 82 91 88 103 104 102 98 87 92 111 108 106 103 103 104 104 113 111 122 124 137 132 144 137 135 132 136 128 129 128 136 128 133 127 137 135 126 141 144 158 156 156 158 155 156 152 153 145 138 140 139 145
REGION Item 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Central Vegetables 14 14 15 14 15 15 16 16 15 16 19 22 20 20 17 16 18 21 23 24 21 25 26 27 27 28 25 28 29 30 31 32 27 25 25 27 33 35 41 36 40 41 42 40 41 42 43 42 38 39 38 40 39
America Fruits 70 73 79 78 87 89 87 85 78 81 91 87 87 84 87 88 87 90 86 92 97 104 97 105 101 99 98 99 94 95 92 99 97 103 97 102 97 86 92 98 104 103 102 104 103 105 100 102 101 94 97 94 99
Total 84 87 94 92 102 104 103 101 93 97 110 109 107 104 104 104 105 111 109 116 118 129 123 132 128 127 123 127 123 125 123 131 124 128 122 129 130 121 133 134 144 144 144 144 144 147 143 144 139 133 135 134 138
Vegetables 19 19 20 21 19 21 21 19 16 17 19 18 21 26 24 25 23 23 23 27 29 28 27 28 29 28 28 29 26 24 24 26 23 22 24 29 29 32 42 48 50 48 55 52 55 52 51 50 52 45 49 47 50
Caribbean Fruits 153 152 154 155 152 151 142 143 151 148 152 158 156 155 149 156 156 163 156 164 167 166 170 172 168 172 170 168 164 137 138 145 137 131 132 142 139 137 139 155 172 161 190 184 161 172 180 147 164 177 185 192 189
Total 172 171 174 176 171 172 163 162 167 165 171 176 177 181 173 181 179 186 179 191 196 194 197 200 197 200 198 197 190 161 162 171 160 153 156 171 168 169 181 203 222 209 245 236 216 224 231 197 216 222 234 239 239
South Vegetables 28 29 29 30 29 30 30 29 29 29 29 29 28 29 30 30 30 31 32 31 30 30 29 29 29 29 30 30 29 29 29 29 30 31 33 34 34 34 36 36 35 37 37 36 36 36 36 37 39 40 41 39 39
America Fruits 117 119 122 122 127 130 134 135 142 145 141 144 123 133 127 131 133 127 128 128 118 118 113 106 126 111 120 125 127 114 120 124 117 119 129 125 134 121 130 133 126 131 126 127 124 129 128 132 131 139 143 133 128
Total 145 148 151 152 156 160 164 164 171 174 170 173 151 162 157 161 163 158 160 159 148 148 142 135 155 140 150 155 156 143 149 153 147 150 162 159 168 155 166 169 161 168 163 163 160 165 164 169 170 179 184 172 167

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Obesity and the food system transformation in Latin America

Article in Obesity Reviews · December 2017

The user has requested enhancement of the downloaded file.

Obesity and the food system transformation in

B. M. Popkin1 and T. Reardon2

Keywords: Food service, food system, obesity, retailers.

Introduction and a greater vulnerability to diabetes and hypertension at

The proportion of kcal per day from macronutrients

Figure 4 Total daily per capita sales of sugar-sweetened beverages in

reflect only a proportion of the sodium consumed. They

expenditures on away-from-home food and nonalcoholic

Reductions in healthier food options

Figure 10 Trends in animal product food balance, 1961–2013. Source FAOSTAT.

Midstream and downstream food system

Meta-conditioners of food system change

enterprises (SMEs) developed rapidly, stepped into the void

Compound Compound Compound Compound Compound Compound

Compound Real GDP Compound Real GDP Compound Real GDP

2008 2011 2014 2016

Waves Sales Outlets Sales Outlets Sales Outlets Sales Outlets

Policies impacting consumer demand Marketing controls

Children who are wasted 1.97

Children who are stunted 16.60

Children who are overweight or obese 6.62

Women who are overweight or obese 56.11

0.00 10.00 20.00 30.00 40.00 50.00 60.00

-0.22 Annualized change in wasted children

-0.79 Annualized change in stunted children

Annualized change in children

Annualized change in women

Children who are both overweight

Overweight woman and

Overweight woman 9.14

0.00 2.00 4.00 6.00 8.00 10.00

Annualized change in double burden of overweight

Annualized change in double burden of overweight

Annualized change in double burden of overweight

Annualized change in double burden of overweight

-0.200 -0.100 0.000

Central America Caribbean South America

Animal Fats Animal Fats Animal Fats

60% 60% 60%

50% 50% 50%

30% 30% 30%

20% 20% 20%

10% 10% 10%

Latin America 257

0 100 200 300 400 500

450 Sports & Energy Drinks

400 Fruit Drinks

350 Caloric Soft Drinks

Sweet Biscuits, Snack Bars, & Fruit Snacks

Kcal per capita per day

Sugar & sweeteners food balance in

Central America Caribbean South America

1200 1200 1200

800 800 800

1400 1400 1400

1000 1000 1000

Brazil Mexico Barbados

1400 1400 1400

1000 1000 1000

US$ per capita, fixed 2016 exchange rates