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Symposium: Obesity in Developing Countries:

Biological and Ecological Factors

Obesity Trends in Latin America: Transiting from Under- to Overweight 1

Ricardo Uauy, 2 Cecilia Albala and Juliana Kain

Instituto de Nutricion y Tecnologia de los Alimentos (INTA), Universidad de Chile, Santiago, Chile

ABSTRACT Latin America is undergoing a rapid demographic and nutritional transition. A recent WHO/PAHO

survey on obesity in the region revealed an increasing trend in obesity as countries emerge from poverty, especially

in urban areas. In contrast, in middle income countries, obesity tends to decline as income increases; this is

especially so in women. Dietary changes and increasing inactivity are considered the crucial contributory factors

that explain this rise. The end result is a progressive rise in overweight and obesity, especially in low income groups

who improve their income and buy high fat/high carbohydrate energy-dense foods. Intake of these foods increases

to the detriment of grains, fruits and vegetables. Most aboriginal populations of the Americas have changed their

diet and physical activity patterns to fit an industrialized country model. They now derive most of their diet from

Western foods and live sedentary and physically inactive lives. Under these circumstances they develop high rates

of obesity, insulin resistance and type 2 diabetes. Supplementary feeding programs are common in the region; the

number of beneficiaries significantly exceeds the malnourished. Weight-for-age definition of undernutrition without

assessment of length will overestimate the dimension of malnutrition and neglect the identification of stunted

overweight children. Providing food to low income stunted populations may be beneficial for some, although it may

be detrimental for others, inducing obesity especially in urban areas. Defining the right combination of foods/

nutrients, education and lifestyle interventions that are required to optimize nutrition and health is a present

imperative. J. Nutr. 131: 893S–899S, 2001.

KEY WORDS: ● obesity ● Latin America ● aboriginal population ● diabetes

● supplementary feeding programs

OBESITY TRENDS IN LATIN AMERICA

Latin America is undergoing a rapid demographic and

nutritional transition. Significant changes in the causes of

death have occurred over a relatively short period of time. As

an example of this, Figure 1 illustrates the trends in causes of

death by disease categories in Guatemala, Mexico, Chile and

Uruguay (1). These data give a clear indication of how death

from infections is on the decline while death from noncommunicable

chronic disease is on the rise. Guatemala has recently

initiated the transition while Mexico is clearly in the

midst of the process. Chile has recently finished the period of

rapid change while Uruguay can be considered to be in the

posttransition phase. In the absence of systematically collected

data on distribution of causes of death, these categories serve

1 Presented as part of the symposium “Obesity in Developing Countries:

Biological and Ecological Factors” given at the Experimental Biology 2000 meeting

held in San Diego, CA on April 15–19, 2000. This symposium was sponsored

by the American Society for Nutritional Sciences and was supported in part by an

educational grant from Monsanto Company. Symposium proceedings are published

as a supplement to The Journal of Nutrition. Guest editors for the symposium

publication were Benjamin Caballero, Center for Human Nutrition, Johns

Hopkins University, Baltimore, MD and Najat Mokhtar, Ibn Tofaïl University,

Kenitra, Morocco.

2 To whom correspondence and reprint requests should be addressed at

Universidad de Chile, Instituto de Nutricion y Tecnologia de los Alimentos (INTA),

Casilla 138-11, Santiago, Chile. E-mail: uauy@uchile.cl.

as a proxy indicator of type of malnutrition present at the

population level. As obesity rises, deaths from cardiovascular

disease and cancer also increase; conversely, if death from

infection predominates, malnutrition tends to be high and

obesity low.

Information on obesity trends in Latin America is limited

to specific country data for selected countries and to data of

women of reproductive age and children under 5yofage

obtained from the Demographic and Health Surveys Institute

for Resource Development (DHS/IRD). Martorell et al. (2)

reviewed DHS surveys conducted since 1982 and evaluated

the prevalence of obesity in women and children. The mean

value for obesity in women for the eight countries evaluated

was 8–10%. Table 1 summarizes results for five countries using

a BMI cutoff of 30 kg/m 2 according to WHO or a BMI index

of 27.3 following USA Hanes I (3). The lowest prevalence

was found in Honduras while the highest is found in Bolivia

and Peru, depending on cutoff point defined. In the case of

children under 5yofageaweight-for-height 1 SD was

considered as overweight, and 2 SD as obesity. The lowest

figures are found in Bolivia while the highest are found in the

Dominican Republic. An increasing prevalence of obesity in

women was found in countries with higher per capita income

and in those with lower rates of stunting in children. A recent

PAHO/WHO publication on obesity in Latin America (4)

revealed an increasing trend for obesity as countries emerge

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0022-3166/01 $3.00 © 2001 American Society for Nutritional Sciences.

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FIGURE 1 Trends in relative contribution

of cause of death in four Latin

American countries from 1970 to 1995.

Guatemala preepidemiologic transition,

Mexico undergoing rapid change, Chile

early posttransition and Uruguay posttransition.

(Data from Ref. 1.)

from poverty, especially in urban areas. In contrast, in middle

income countries, obesity tends to decline as income increases;

this is especially so in women.

Selected country data demonstrate increasing rates for obesity

in adults (BMI 30) over the past two decades for Brazil

and the past decade in Chile; this is depicted in Figure 2A,

and B for women and men (5,6). Similar trends are observed

for Costa Rica, Barbados and other Caribbean countries. A

study by Sichieri et al. (7) using a BMI 30 found 4. 8%

obesity for men and 11.7% in Brazilian adult women. In Costa

Rica the prevalence of overweight in 1996 was 45.9% using a

BMI 25 (8). Atalah (9) in Santiago, Chile, reports a

prevalence of 20.5% in men and 30% in women in 1993 using

a BMI of 27 as a cutoff limit. Sinha (10) from Barbados reports

a prevalence of obesity of 16% in men and 38% in women in

1981 using a BMI 27, indicating that for the Caribbean,

obesity rates in 1995 were 7–20% for men and 22–48% for

women.

In this current issue Monteiro reports regional data within

Brazil, which demonstrates the interaction between educational

level, urban/rural residence and socioeconomic level in

defining obesity trends over the past two decades. In Mexico

Country (year)

TABLE 1

Prevalence of obesity in women and children

in Latin America1

% Children

weight-for-height

% Women BMI

1 SD 2 SD 27.3 30

Bolivia (1994) 13.1 2.1 16.8 7.6

Colombia (1995) 21.6 9.2 12.2 1.8

Peru (1996) 22.8 9.4 23.9 4.7

Honduras (1996) 18.7 7.8 3.7 1.4

Dominican Republic (1996) 23.3 12.1 15.3 4.6

1 From Ref. 2 [Martorell et al. (1998)].

Lerman Garber et al. (11) demonstrate in a cross-sectional

study of adults older than 35 y of age a higher prevalence in

urban areas relative to rural areas. Trends demonstrate a progressive

rise in obesity rates, especially in urban women; rates

of increase are highly variable between and within countries

(12). In general as income increases so does the prevalence of

obesity; dietary changes and progressive inactivity are considered

the crucial contributory factors that explain this rise.

OLD AND NEW CONDITIONING FACTORS

FOR OBESITY

Lifestyle changes in the general population

The nutrition transition brings about significant dietary

changes as presented by Popkin et al. in this same issue.

Increases in total fat, animal protein and fat consumption are

the most prominent. As income increases in transitional countries,

so does the consumption of high fat foods, including

industrially processed hydrogenated fats. Processed foods are

usually more expensive in the rural areas, whereas the converse

is true for natural foods such as grains, fruits and vegetables.

Progressive urbanization and the mass media may contribute

to the shift in diet of rural migrants who abandon their

staple plant food–based diets, favoring processed foods and

animal food products. These factors affect children and adolescents

as well. If the change in diet is accompanied by a

sedentary lifestyle and physical inactivity, the combination is

perfect to trigger increasing adiposity. Energy balance and fat

stores strictly follow the laws of thermodynamics, whether

people are urban or rural, rich or poor. The end result is a

progressive rise in overweight and obesity, especially in low

income groups who improve their income and buy high fat/

high carbohydrate energy-dense foods. Sweet and salty high fat

foods show marked consumer preference in the urban supermarket;

intake of these foods increases to the detriment of

grains, fruits and vegetables. On a positive note, recent trends

demonstrate that high income countries are reducing the

consumption of fat, possibly in response to the existence of

public health–based dietary guidelines.

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OBESITY IN LATIN AMERICA

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drinks. A study on food consumption carried out in Santiago

in 1995 demonstrated that 70% of adults consumed less than

two fruits and 59% consumed less than two portions of vegetables

per day (18). On the other hand, sedentarism is high in

Chile and has increased with the progress of urbanization. In

1970 three quarters of the population lived in urban areas; for

1997 this figure is 87%. The number of cars increased from

363,150 in 1970 to 1,969,128 in 1997. TV sets numbered

12,170 in 1970, increasing to 2 million in 1997 (19). A

recent study carried out in Santiago demonstrated that 90% of

school-age children watch television during weekdays, and of

these 20% watch for more than 3 h daily (5). For Metropolitan

Santiago in 1988, 55% of men and 77.4% of women performed

less than two 15-min periods of exercise per week, while in

1992 these figures increased to 57.8% in men and to 80.1% in

women (20). In Valparaiso for 1997, 90% of adult women

were inactive during their leisure time, which for the low

socioeconomic group was 97% (16).

FIGURE 2 Change in the prevalence of obesity (BMI 30 kg/m 2 )

in Brazil (A) and Chile (B) for adult women and men. (Data from Refs. 2

and 5.)

Recent data from several urban centers including data

obtained in Santiago, Chile, demonstrate that television viewing

and a child’s preference for certain TV commercials has a

direct relationship with snack food consumption and other

food purchased by children at school (13). The relative contribution

of dietary change vs. physical inactivity in determining

the increasing rates of obesity in children in transitional

societies cannot be quantified in a precise manner. Furthermore,

attempting to do this would be futile, because preventive

strategies should address both. Recommendations to prevent

obesity are presently integrating dietary advice,

increasing physical activity and weight monitoring. The challenge

of preventing obesity is yet to be tackled effectively in

urban societies.

Although Chile has no national system to monitor the

nutritional status in adults, there are data representative of the

city of Santiago, where 40% of the population lives. In two

surveys on risk factors for chronic diseases carried out in the

population over 15 y of age, obesity increased from 6% to 11%

and from 14% to 24% in men and women, respectively, over

a 4-y period (14,15). Obesity increased with age, was more

prevalent in women than in men and was higher in women of

low socioeconomic level. In another study carried out in a

representative sample in urban Valparaiso, Chile (25–64 y of

age) in 1997, obesity prevalence was also high and had a

similar distribution to that found in Santiago (16). Changes in

the diet and sedentarism are the most probable causes of the

increasing trend of obesity in Chile.

Dietary patterns in Chile have changed rapidly, becoming

closer to the “Western diet,” high in saturated fat with decreased

consumption of grains and other fiber-rich foods (5). A

recent analysis of a National Household Survey on Food

Expenditure (17) demonstrated that the principal components

of food expenditure among the poor are bread, meat and soft

Lifestyle changes of aboriginal populations and obesity

Obesity has a complex etiology, resulting from the combined

effects of genes, environment, lifestyle and their interactions.

Although the genetic background is crucial to explain

the susceptibility to most chronic diseases, the modernization

and urbanization process affecting aboriginal populations has

brought about major changes that are most likely contributing

to the high prevalence of obesity and diabetes reported (21).

Most aboriginal populations today have changed their diet and

physical activity patterns to fit an industrialized country

model. They now derive their diet completely or in large part

from Western foods and live sedentary and physically inactive

lives. Under these circumstances they develop high rates of

obesity, insulin resistance and type 2 diabetes (22,23).

The Chilean population is formed by a mixture of Amerindian

native groups and descendants of several European

migrants. The Mapuche population, the major aboriginal

group in Chile, are descendants of Asian migrations that

settled in the southern part of the central valley of Chile and

extended to Patagonia, both sides of the Andes. A self-assessment

questionnaire on ethnicity included in the 1992 Chilean

census among people older than 14 y (24) indicated that close

to 10% of Chileans identify themselves as “Mapuche.” Economic

and social changes have forced a great number of

Mapuche to migrate from their original rural conditions in the

South of Chile to large urban centers, such as Santiago and its

surroundings. Nowadays, nearly one third of the Mapuche live

in urban centers (24). In 1985 a high prevalence of obesity,

close to 40% in the rural Mapuche population was found.

However, this ethnic group had a very low prevalence of type

2 diabetes, 1% (25). The prevalence of risk factors for

chronic diseases has increased dramatically in Chile over the

past three decades, in that lifestyle changes and rapid urbanization

have occurred. In fact, 15% of adult Chilean men and

23% of women are now obese (14). Considering these

changes, we explored whether Mapuche living in large cities

like Santiago had also experienced a rise in the metabolic

complications of obesity.

Our studies over the past 5 y have examined the effect of

genetic differences on the prevalence of obesity, glucose intolerance

and leptin levels in groups with different ethnic

backgrounds. Mapuche of rural areas preserving ethnical and

cultural distinctive characteristics were compared to Caucasian

subjects (Spanish heritage) from the general population of

Santiago (26). We found that BMI, gender and insulin were

independently associated to leptin levels in Caucasians,

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whereas for the Mapuche group, only BMI was associated to

leptin after controlling for gender and insulin. The comparison

of plasma leptin levels adjusted for BMI, gender and age

showed significant ethnic differences. Mean concentration of

plasma leptin in Caucasian individuals was approximately

twofold higher compared to that of Mapuche subjects. Fasting

insulin levels adjusted for age, gender and BMI, indicative of

glucose sensitivity, were also significantly higher in Caucasians.

Only 4.1% of rural Mapuche were classified as diabetics,

compared to 9.8% observed in urban Mapuche and 5.3% in

the Caucasian population of Santiago. Glucose intolerance

was identified in 3.4% of the rural and in 6.1% of the urban

Mapuche. Our study also revealed a higher prevalence of

obesity (P 0.05) in urban Mapuche compared to that in

rural natives. Moreover, these data suggest that the change in

environment may increase disease susceptibility beyond that

observed in Caucasian populations. The early report of a low

prevalence of diabetes in the presence of high rates of obesity

in the Mapuche was not upheld by our recent studies, suggesting

that aboriginal populations lose their protection from the

metabolic complications of obesity as they undergo urbanization

and lifestyle, including dietary changes (27). Table 2

summarizes these findings.

In contrast to the Mapuche, the Aymara living isolated in

the north of Chile, in the Bolivian and Peruvian highlands,

have mostly preserved their nomadic primitive agricultural

and cultural traditions. They speak their native language and

are dependent on subsistence agriculture for most of their

survival. They consume a traditional diet composed of indigenous

crops such as potatoes, quinoa (a local legume) and

some barley. Animal husbandry (domesticated llamas, alpacas

and sheep) is their main economic activity (28,29). Moreover,

the Aymara rural population has not experienced a massive

shift from their traditional ways of living to a modern Western

lifestyle. According to the self-identification questionnaire of

the 1992 census only 0.5% of Chileans older than 14 y were

Aymara (24). Studies conducted in the early 1970s revealed

an absence of clinically recognizable diabetes in a large sample

of rural Aymara subjects living in their natural ecosystem. Our

most recent study of the Aymara conducted in 1997, in a

sample of 78 men and 118 women older than 19 y of age,

found a prevalence of diabetes of only 1.0%, adjusted for age,

and 3.5% glucose intolerance. The low prevalence estimated

in the present study is concordant with previous observations

(30).

The difference in prevalence of obesity and diabetes between

Aymara and Mapuche populations or other indigenous

population of the Americas is difficult to interpret. Multiple

dietary factors and gene/environment interactions may determine

a potential epigenetic effect. However, the low prevalence

of type 2 diabetes in Aymara and rural Mapuche subjects

(30) is in sharp contrast to the high prevalence of this condition

in most aboriginal groups in North America, including

the Pima from Arizona and Mexican-American minorities in

the United States (21,32). Although the distribution of BMI

observed in the Aymara is similar to that in the general

population of urban Santiago, mean values of insulin resistance,

determined by HOMA, indicate improved glucose tolerance

in the Aymara subjects (30). Low mean values of

HOMA-IR and insulin levels in Aymara subjects could be in

part a consequence of their high level of physical activity and

their traditional high complex carbohydrate diet. The prevalence

of diabetes in the rural Aymara population who live in

high altitudes in the north of Chile is lower than the prevalence

in the urban Caucasian population of Santiago, Chile,

and much lower than the prevalence in other Amerindian

groups from North America. Prevalence of diabetes in this

Aymara population is similar to, or slightly lower than, the

prevalence reported for the rural Mapuche population. Both

populations have preserved a rural physically active lifestyle

and have maintained their traditional diet (30).

Nutrition interventions programs: from stunting and

underweight to overweight and obesity

Supplementary feeding programs are a fact of life for most

countries in the region. A recent Food and Agriculture Organization

survey with data from 19 Latin American countries

found that over 20% of the population—or approximately 83

million people out of an estimated 414 million in these countries—receive

some level of food assistance benefits from nutrition-related

programs (33). In contrast, the number of malnourished

in the study countries was 10 million, that is, 12%

of total beneficiaries. The explanation for this phenomenon is

that nutrition programs have evolved beyond the immediate

needs of the malnourished and have become part of social

economic benefit demanded by populations living under poverty.

Despite the obvious benefits (namely the significant

reductions in underweight and wasting that have occurred in

most countries), these programs have the potential to affect

the trends in obesity rates. Also, stunting remains a problem in

this region. In this setting providing food supplements may be

beneficial for some, although it may be detrimental for others.

Careful selection of beneficiaries of food assistance programs

and determining the right combination of nutrients/foods,

education and lifestyle interventions, required to optimize

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TABLE 2

Obesity and metabolic complications in aboriginal and Caucasian populations in Chile according

to gender and rural/urban condition

Rural Aymara 11 Rural Mapuche 22 Urban Mapuche 22 Urban Caucasian 33

Men Women Men Women Men Women Men Women

BMI 25 53 43.1 34 24.7 17.9 14.6 40 40

BMI 25–29.9 34 33.8 51 43.2 53.8 30.1 44 37

BMI 29.9 13 23.1 15 32.1 28.3 44.7 16 23

Diabetes 1.3 1.7 3.2 4.5 9.8 6.0 4 3.8

Impaired glucose tolerance 2.6 4.3 4.2 3.1 7.3 4.8 — —

1 From Ref. 30.

2 From Ref. 31.

3 From Ref. 16.


OBESITY IN LATIN AMERICA

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TABLE 3

Distribution of weight-for-length Z scores of infants receiving

the enhanced complementary feeding program for 12 mo1

Weight for length

on entry

Weight for length after 12 months in the

program

1 1 to0 0to 1 1 Total

1 2 65 23 3 93

1 to 0 4 259 209 26 498

0to 1 1 151 318 88 558

1 0 0 0 0 0

Total 7 475 550 117 1149

1 From Ref. 35 [Kain et al. (1994)].

nutrition and health at each stage of the life cycle, is a problem

that cannot be avoided (33).

Chile is often presented as a paradigm of the success of

supplementary feeding programs. Indeed, the association between

the presence of these massive interventions and the

decline in malnutrition in all age groups is there. Unfortunately,

these programs may be also contributing to the rising

prevalence in obesity (34). Specific examples will be given in

an effort to show the impact that these assistance programs

may have on the prevalence in obesity and to signal the road

ahead for other countries undergoing the rapid nutrition transition.

The Chilean supplementary feeding program or “Programa

Nacional de Alimentación Complementaria” (PNAC) began

in the 1920s as a public milk distribution program for working

mothers. It was built into the workers’ social security legislation

in 1937 as part of preventive health to protect working

class families. The PNAC was significantly strengthened in

the 1950s with the creation of the National Health Service

(NHS), which provides universal health protection and health

services for insured workers and the indigent population. The

existence of the PNAC is secured by law and financed by

direct contribution of private and public employees and employers.

In terms of beneficiaries it has the largest coverage,

presently approximately 1.2 million children under 6yand

200,000 pregnant women. This corresponds to approximately

80% of the national population of infants under 2 y and 70%

of preschool children, pregnant and nursing mothers.

The main objectives of the PNAC are: to promote normal

growth and development in children from conception through

6 y of age by providing food supplements to the mother during

pregnancy and lactation, and to the child from birth to 6yof

age; to protect mother’s health during pregnancy and lactation;

to promote breast feeding by providing supplements to

mothers during pregnancy and lactation; to prevent low birth

weight related to maternal malnutrition; to prevent infant and

childhood malnutrition among the beneficiaries of the NHS;

and to improve coverage of primary health care activities, thus

providing an incentive for beneficiaries to attend regular

check-ups (35). Within the activities of the PNAC the enhanced

program was specifically designed for the early control

of undernutrition. The calorie contribution provided by this

program varies from 100% of the requirement for infants of 5

mo old to 30% for children between 2 and 6yofage. The

protein contribution is considerably higher, 180 and 58%,

respectively.

Table 3 provides the results of a controlled evaluation

conducted by Kain et al. (35) in a group of 1149 infants in

which weight-for-length Z-score categorization on entry into

the program was compared to the corresponding Z-score upon

discharge, 12 mo later. As noted from the data on admission,

93 of 1149 infants had a weight for length below 1 Z, while

at the end of a year of receiving the benefit, only 7 remained

in that condition. On the other hand, the number of infants

who exceeded 1 Z increased from 0 to 117. Those who were

within 1 Z remained basically unchanged, that is, went from

1056 to 1025. The changes observed in the group in terms of

length-for-age are depicted in Figure 3; a control group was

obtained from nonparticipants in the enhanced PNAC program

matched for age and growth indices (36). The data from

participants and control infants were analyzed according to

stunted (below 1 Z length for age) or nonstunted (lengthfor-age

1 Z). As noted, both control and enhanced PNAC

stunted groups experienced a small nonsignificant gain in

length-for-age. Infants who were not stunted exhibited no

change in length Z-score during the year-long evaluation. In

summary, the benefit of improving mild underweight in 86

infants was offset by increasing the number of overweight

infants by 117. The evidence from length-for-age Z-score

suggests that even the stunted exhibited no gain from the

program as compared to a control group that did not receive

the benefit. Moreover, presently the significance of being

mildly underweight should be reassessed in light of the emergence

of a new paradigm of growth, in which more is not

necessarily better. What is clear from this evaluation is that, if

stunted or normal children are provided additional food, they

will gain weight to exceed the median reference value.

A separate example is drawn from the National Nursery

Schools Council Program (JUNJI). It was created in 1971

under the Ministry of Education and provides child care as

well as supplementary food for toddlers and preschoolers;

coverage is close to 50% of those in need. It also provides

social assistance to the family when required. In 1998

approximately 100,000 children under 5 y attended JUNJI.

Of those, 95% were preschoolers from 2 to 5yofage, and

the rest, infants under 2 y old. The food distributed covers

either 58% or 75% of the children’s daily caloric needs,

depending on whether they attend for half or full day. The

calorie contribution is divided by age groups as follows:

under 12 mo, 800 kcal; 12 to 24 mo, 950 kcal; 2 to 3 y, 1000

kcal; 3 to 5 y, 1150 kcal. If a nutritional deficit is detected,

a reinforcement of 150 kcal/d is provided (37). As demonstrated

in Figure 4A and B this program has contributed

most likely to the notable decrease in stunting observed in

FIGURE 3 Change in length for age Z score on entry and after 12

mo of participation in enhanced supplementary feeding program in

stunted and nonstunted infants. A group matched by growth indices on

entry who did not receive the program served as controls. (Data from

Ref. 36.)

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TABLE 4

Distribution of weight-for-height Z scores of children

beneficiaries of JUNJI on entry and after 3yofprogram1

Weight for height

on entry

Weight for height after 3yofprogram

1 1to 2 2 Total

1 67.8% 24.1% 8.1% 6238

1to 2 23.7% 42.5% 33.8% 1440

2 14.5% 26.0% 59.6% 408

Total 4715 2160 1211 8086

1 From Ref. 38 [Rojas and Uauy (1999)].

FIGURE 4 (A) Change in percentage prevalence of nutritional deficit

( 1 SD; 39) in height for age, weight for age and weight for height

of preschool children during 1988 to 1996 in Chile; data derived from

census of children attending day care centers. (B). Change in mean Z

score weight for age (WHO reference) of 6-y-old children from 1987 to

1996 in Chile; data derived from census of children entering first grade.

the preschool population during the past decade. The percentage

of children below 1 SD in terms of weight-for-age

and height-for-age has dropped significantly, while those

with mild under weight are 5% of the total. Concomitantly

over the same period (Fig. 4B), we observe that mean

weight for age has increased progressively for 6-y-olds entering

primary schools, more in girls than in boys. We also

evaluated the change in percentage of children over 2 Z in

weight-for-length between March (school entrance) and

November (final month of school year) for each age group

under JUNJI’s program. We observed, as shown in Figure 5,

a rise in obesity rates during the school year, progressively

higher with each age cohort. Finally, we obtained retrospective

data from 8086 children who had been measured

every year under standardized conditions to evaluate this

cohort, mimicking a longitudinal follow-up (38). This is

summarized in Table 4, demonstrating that at the time of

entry into the program a total of 408 exceeded 2 Z in

terms of weight-for-height, whereas 3 y later 1211 exceeded

that limit. That is a threefold increase in the number of

obese children over a 3-y period. During this same period,

the number of overweight children (over 1 Z) went from

1440 to 2160, that is, a 50% increase. On a more positive

note the program is presently adapting the food provided to

the current nutritional profile of the preschool population.

Currently, sugar and saturated fat content of the ration

have been lowered, skimmed milk is being provided and

additional fresh fruits and vegetables have been added,

favoring the supply of calcium, micronutrients (iron and

zinc) and fiber (39).

We conclude that Latin America is undergoing a rapid

nutritional transition with a progressive increase in the prevalence

of obesity. The trends are most prominent among urban

poor women, although they affect both genders. The responsible

factors are changes in lifestyle and diet, which are similar

to those observed in industrialized societies. In addition the

protective environment of rural aboriginal populations has

been lost, demonstrating that these groups are possibly more

sensitive to the metabolic derangement associated with obesity.

Finally, we consider that nutrition intervention programs,

especially in stunted populations, have the potential for aggravating

the obesity epidemic. Weight-for-age definition of

undernutrition in children without assessment of length will

overestimate the dimension of malnutrition and neglect the

identification of stunted overweight children. As malnutrition

rates fall, the need to prevent overweight and obesity should

be considered of equal importance to the eradication of undernutrition.

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LITERATURE CITED

FIGURE 5 Change in percentage prevalence of obesity, weightfor-height

2 SD (39) of preschool children during school year. March

is time of entrance and November is right before vacation. Data derived

from census of children attending day care centers.

1. Albala, C., Vio, F. & Yañez, M. (1997) Epidemiological transition in

Latin America: a comparison of four countries. Rev. Med. Chil. 125: 719–727.

2. Martorell, R., Khan, L. K., Hughes, M. L. & Grummer-Strawn, L. M.

(1998) Obesity in Latin American women and children. J. Nutr. 128: 1464–1473.

3. Kuczmarski, R. J., Flegal, K. M., Campbell, S. M. & Johnson, C. L. (1994)

Increasing prevalence of overweight among US adults: The National Health and

Nutrition Examination Surveys, 1960 to 1991. JAMA 272: 205–211.


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4. PAHO/WHO. (2000) Obesity and Poverty: A New Public Health Challenge

(Peña, M. & Bacallao, J., eds.), PAHO Scientific Publication 576, Pan

American Health Organization, Washington D.C.

5. Vio, F. & Albala, C. (2000) Nutrition policy in the Chilean transition.

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