#16 food & farming
Carlos A. Monteiro

Resist the “Snack Attack”

Carlos A. Monteiro, one of the creators of Brazil’s Food Guide, warns of the dangers of ultra-processed foods, noting that our personal and social well-being is at risk.

In 2014, in collaboration with the University of São Paulo, Brazil’s Ministry of Health released advisory guidelines that recommend returning to more traditional dietary patterns and resisting ultra-processed food and drink products and their aggressive marketing for the sake of our happiness and health. DDD had the opportunity to interview one of its conceptual contributors, Professor Carlos A. Monteiro. As former paediatrician fighting child undernutrition, he shared with us his distinguished view on the consumption of food that promotes obesity, its effects on individuals and society as well as the causes of its rise in popularity in developed and emerging markets.

DDD: You advocate a holistic concept of nutrition that considers the body and the planet as well as the soul. Northern public health debates often focus on individual dietary and lifestyle changes to prevent diseases and risks. Why should we pay more attention to the impact of food on well-being?

Eating is more than the intake of nutrients and health goes beyond disease prevention and involves a state of physical, mental and social well-being.

Carlos A. Monteiro: One of our recommendations is to dedicate more time and attention to eating, eat in company as often as possible, and eat in pleasant and clean places. Eating is more than the intake of nutrients and health goes beyond disease prevention and involves a state of physical, mental and social well-being. It is important to acknowledge that social and cultural dimensions are also part of eating. The right modes of eating will not necessarily prevent diseases, of course, but they always promote well-being, so people can enjoy themselves more and strengthen their ties to family and friends. Often people think that health and pleasure are opposite outcomes when it comes to diet: either you go for health or you go for pleasure. We need to make them compatible. So, the main aim of the food guide is to promote health, directly by preventing diseases, directly by improving well-being, and indirectly by promoting a food system intended to have a positive impact on the environment and on society as a whole.

DDD: These days slogans and packages for most food products claim to bring us this “well-being“ in the form of joy, energy and happiness. Your research indicates that the opposite is true. What is the “snack attack” and why do we have to tackle it?

To summarize the dietary transition that has been happening around the world since the late 90s: We have observed the replacement of foods, true foods produced by nature, at different rates of speed. Foods and methods of preparation vary from culture to culture. But everywhere, traditional diets are made of naturally ready-to-eat foods like fruits, milk and nuts, plus foods like grains, roots and tubers, vegetables, meat and eggs that are prepared, cooked and seasoned. This is what the basic human diet consists of. The world over, traditional dietary patterns are by definition appropriate because they were the ones that allowed us to become who we are as humans today.
But in recent years, traditional dietary patterns have been threatened by ultra-processed food and drink products (UPPs). In the U.S. about 60% of all calories come from such products. In Brazil it is still only 25%. But all over the world, these products are becoming more and more important. And that is bad because natural and minimally processed foods offer many advantages for our health and our well-being and they help to promote a more sustainable food system. Why should we eat UPPs? They hurt us and the planet, so there is no reason.

I use the term “snack attack” in order to clarify that something is being attacked: the traditional dietary patterns.

In general food processing is not problematic, but ultra-processed food which sets out to destroy the food matrix is a serious issue: The natural food ingredients are separated and re-engineered to create a new product. Added to this is the fact that UPPs are then ready to consume without requiring any preparation. This means you can eat these products anytime, anywhere, alone, and while doing other things. They induce a type of eating that is not healthy and not good for your well-being, even if people find it very convenient. I use the term “snack attack” to clarify that something is being attacked: the traditional dietary patterns. Marketing is probably the main weapon welded in this attack and food guides are a very important counter weapon in this battle for the world’s stomachs.

DDD: Following the WHO’s Global Strategy on Diet, Physical Activity, and Health, Brazil released its revised national food guide last year. First of all, why do we need national food guides?

In the past food guides were not so necessary because people essentially knew how to eat. People learned from or simply imitated their parents, their grandparents. Actually, traditional dietary patterns are an important cultural asset. The problem we have now is that this transmission of knowledge is being interrupted by marketing and publicity from high-revenue transnational companies. Most food advertising is about UPPs; you almost don’t see advertisements for other kinds of foods. Today food guides are very important for providing people with correct information about food and it is equally important to reduce people’s exposure to wrong and misleading information, that is so common in food advertising.

Marketing in the year 2015 is very aggressive, very misleading.

One of our ten recommendations is directed at marketing: “The purpose of marketing is to sell products, not to inform, much less to educate people.” It seems very obvious, but we considered it very important to emphasize this point. Marketing in the year 2015 is very aggressive, very misleading. It is important to regulate marketing, but we will only push such regulations through if society backs them in the first place. Food guides have become very important to convince society how important the right kind of food is.

DDD: Could you explain Brazil’s innovative approach and the guide’s “golden rule”?

Our food guide was done at the behest of the Ministry of Health in Brazil, so the main focus was initially the promotion of health. Although we are dealing with very complex issues, we try to make the message really simple. This is why we created a golden rule that could be summarized as: “Eat a variety of real foods, prepare dishes and meals with these foods, and avoid ultra-processed foods.” In order to illustrate how different types of food can be part of healthy and delicious dishes and meals, we took real examples of a recent national dietary survey instead of making abstract or theoretical recommendations. From this survey, we took the 20% of Brazilians whose diets were close to being based on our golden rule. The nutrient profile of these diets was very close to WHO/FAO nutrient recommendations, but we did not start from these recommendations. We started with real, existing dietary patterns. The big advantage of this approach is that our recommendations have been tested; they are part of our food culture.

In the food guide, people can recognize meals their parents used to eat, but which sometimes they no longer do.

We took pictures of real breakfasts, lunches and dinners to illustrate the recommendations. People liked it because we used examples from different regions. Brazil is a big country with many different food cultures. In the food guide, people can recognize meals their parents used to eat, but which sometimes they no longer do.

DDD: Your research suggests that an increase in obesity among the poor goes hand in hand with economic growth and development in many countries. Today, 21.4% of the Brazilian population still lives below the poverty line. If economic development and public health are in opposition in this respect, what means, other than the food guide, does the state have to protect public health?

In countries where obesity is very prevalent among rich and poor people, the whole environment is problematic.

The relationship between obesity and poverty is very complex and not always well acknowledged. First of all, it is true that if we look at the distribution of obesity related to income and other socio-economic indicators, it is growing faster among the poor. In very poor countries, the poor are still protected from obesity in a sense because obesity is a disease that comes with consumption. And extremely poor people don’t have the resources to consume UPPs when they are more expensive than natural foods, such as in African countries and even in Brazil. But this is changing very fast and this is why the consumption of UPPs in Brazil is increasing. Obesity is increasing at a faster rate among the poor than the rich. The poor are becoming as obese as the rich and in some countries even more obese. This does not mean that rich people are not obese, however. If you look at the U.S. statistics on obesity, you see that all income groups are affected by huge prevalences. In countries where obesity is very prevalent among rich and poor people, the whole environment is problematic. People are not obese because they are poor, since rich people are obese as well. If you leave out this fact, you might think it is enough to increase income and then we resolve the problem of obesity. But that won’t work.

Taking a national perspective, what can programs like “Fome Zero” and “Bolsa Família” initiated in Brazil over 10 years ago achieve? What do they teach us about the role of state intervention to protect and improve personal and public health?

Income-transfer programs like Bolsa Família and Fome Zero were very important in reducing and almost eliminating undernutrition. I actually started my career working on undernutrition in Brazil. We studied its decline and were able to demonstrate that in addition to education, sanitation, water supply etc., increasing income for Brazilian families was one of the most important factors in explaining our success in fighting undernutrition. Obesity is a disease of excessive consumption; undernutrition is a disease of under-consumption, of food, education, water supply, etc. So thanks to such social policies, we now have less inequality in terms of income and much less undernutrition. Actually I’d say undernutrition is no longer a public health problem in most parts of Brazil.

…we have almost two million new cases of obesity per year.

What was the impact of income redistribution on obesity? None. Or at least nothing positive. Having income, buying things, having access to sanitation or a water supply does not help fight obesity. And this is a big challenge for Brazil. The statistics are shocking: From 2006 to 2014, the prevalence of obesity in the country has increased by almost one percentage point per year. This means we have almost two million new cases of obesity per year. The obesity situation is kind of tragic because all the efforts we put into income redistribution did not affect obesity in a positive way.

If economic growth and health stand in opposition, what means and strategies do governments have for protecting public health?

We need policies to counteract this ideal scenario for food industries in emerging countries.

Ideally, we should combine more protection with economic growth. Sales of UPPs are actually stagnating or declining in high-income countries. Markets in economically undeveloped countries aren’t very interesting for these companies. But income for the poor is rising with economic growth in moderate-income countries. International producers of UPPs are trying to enter these emerging markets and adapting their products and marketing strategies. We need policies to counteract this ideal scenario for food industries in emerging countries. These policies should essentially make true foods and freshly prepared dishes more attractive, accessible and affordable and UPPs less competitive. We need a combination of good and sound information for people and we need regulations. Just like we saw a great deal of resistance from the food industry towards the food guide, there will be even more blowback against any policy that touches on taxation or marketing of their products. We hope that our food guide raises awareness of this problem, thus garnering more social support that will allow us to counteract the power of the food industry, the marketing agencies, the newspapers and all these vehicles that get money from food advertising. There is awareness in Brazil, but we have not yet been able to move fully in the right direction.

In 2010 Nestlé adapted its marketing for the Brazilian market by launching its first floating supermarket in Amazonia to target remote and low-income populations. Despite such developments, and unlike most high-income countries, Brazil still retains its traditional food systems to a large extent, as you have mentioned. What can be learned from your country’s way of eating?

If you look at Latin America as whole, Brazil has stayed closer to traditional dietary patterns than Mexico or Chile, for example. There are a few reasons for this: Mexico has a very strong food culture, but it is also very close to the US. The markets are linked through commercial agreements and Mexicans are very exposed to U.S. food culture. The same is more or less true for Chile.

… the cultural dimension of eating is as important as health, the prevention of disease, and environmental concerns.

The food culture determines a specific country’s situation. France and Italy have a diet that involves consuming even fewer UPPs than in Brazil whereas Germany is closer to UK and the U.S. where 60% of the calories come from these products. This shows that food culture is really important and this is why the cultural dimension of eating is as important as health, the prevention of disease, and environmental concerns.

In closing do you have any recommendations on what to eat for dinner tonight?

This brings us back to the only apparent contradiction between pleasure and health. I would say that if tonight is a normal sort of evening for you, eating something simple, fresh and made with care is enough. But sometimes an evening is special, and then the pleasure and cultural aspects are more important. When you look at traditional dietary patterns, you will see that most people do not eat what we would call a balanced diet when they celebrate. Rice and beans are eaten almost daily in Brazil, but on some days people like to enjoy a “feijoada”, meaning a lot of salty and fatty pork meat. This is perfectly okay sometimes because it is part of our culture and we will compensate the excess of salt and fat in the following meals. When people say “let’s have a light feijoada” though – that is ridiculous! When you have a feijoada, you have to have a real feijoada! Because the culture and the pleasure are just as important! Some days you emphasize your pleasure, tradition and culture more, on other days you emphasize your health more. The important thing is that on the whole you don’t depart very much from the food and the way your parents and their grandparents used to eat.

Interview: Prisca L. Watko

Photo: “Snacks!” by Sara B.
2011 - licenced under Creative Commons Attribution (2.0)

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