Addressing The Growing Epidemic: A Policy Framework to Combat Obesity in Rural Areas of Brazil

By Stella Ribeiro, Brown University

Grocery store shelves of junk food. Credit: Contributors to Wikimedia, Wikimedia Commons, 29 Oct. 2024.

The Global Rise of Obesity

Obesity has become a global epidemic, surging in low and middle-income countries that just a decade ago struggled with hunger and malnutrition. Over the last two decades, Brazil has witnessed a 90% increase in the prevalence of obesity, rising from 11.8% to 24.3% in 2023. The increased incidence of obesity in rural areas, where increased access to affordable and widespread Western-style processed foods, facilitated by globalization, has significantly contributed to the transformation of the food system, is particularly disconcerting. While the growing availability of packaged foods has aided in alleviating hunger, their prevalence is inextricably linked to the growing incidence of obesity in rural regions of Brazil. Therefore, policy frameworks geared toward decreasing the availability of ultra-processed foods while increasing access to fresh and minimally processed foods are urgently needed to improve the Brazilian food system and reduce the disease burden.

The Escalation of Obesity in Brazil

Obesity is a chronic disease characterized by an excessive accumulation of body fat, classified using the body mass index relating weight to height. At present, more than half of the adult population (60.3%) in Brazil is within the overweight or obese range; among these, one in four are obese—corresponding to 41 million adults. In rural areas, obesity has reached 14.8% in men and 51.5% in women. Such prevalence presents considerable health threats since overweight and obesity increase the risk of developing various noncommunicable diseases (NCDs), including cardiovascular disease, hypertension, Type 2 diabetes, and cancer, which currently represents 74% of all deaths in Brazil. The growing incidence has placed a heavy burden on society, with the Brazilian Health System incurring an extra $670 million per year in costs related to obesity and an additional $7.4 billion annually from associated NCDs. If left unaddressed, 68% of the Brazilian population will be overweight, and 26% will be obese by 2030, positioning it as the fourth largest country by obesity prevalence, behind only the United States, China, and India. 

Underlying Causes of Rural Obesity in Brazil

The development of obesity in rural regions of Brazil reflects a global trend: obesity rates are rising more rapidly within rural populations than in urban settings. In Brazil, this phenomenon can be explained primarily by the lack of access to nutrition education and financial constraints that have led to a disproportionate increase in the consumption of ultra-processed foods, which now comprise 24% of the calories consumed by Brazilians compared to 10% in 1990. Just a decade ago, Brazilian rural areas identified hunger and malnutrition as the primary risk factor driving the most deaths and disability in the country. 

Nevertheless, multinational companies like Nestlé, which have sponsored river barges and initiated 'door-to-door' delivery programs, have made ultra-processed foods more accessible in rural Brazil. Originally designed to combat hunger by bringing affordable packaged foods directly to rural households, these initiatives have inadvertently contributed to the exact opposite nutritional issue. By making high-calorie, low-nutrient foods like chocolate pudding, cookies, and sugary cereals readily available, they shifted dietary patterns away from traditional diets and increased the consumption of ultra-processed foods. This ultimately contributed to a new form of malnutrition: obesity—the present-day leading risk factor of death and disability in Brazil.

Another factor contributing to soaring obesity rates are increasing prices of fresh and minimally processed organic foods. The cost of ultra-processed foods remains low, and therefore accessible. In 2017, 62% of existing organic food buyers blamed product prices for their decreased consumption. By 2021, this percentage rose to 67%. Among non-buyers, 59% cited price as the reason for not consuming organic products. Studies found that organic foods are, on average, 30% more expensive than conventional ones. Thus, the root of the epidemic stems from the reality that processed foods are convenient, widely available, and cost less than a piece of fruit.  

Policy Framework for Reducing Obesity

A policy framework geared towards decreasing the attractiveness of ultra-processed foods while increasing that of minimally processed foods lies at the forefront of addressing and reversing the burden of obesity in rural regions of Brazil. To achieve this, Brazilian policymakers should pursue a three-tiered approach. 

Firstly, a Pigouvian tax should be levied on the sale of ultra-processed products high in salt, sugar, and saturated fat. A Pigouvian tax, unlike a standard commodity tax, specifically targets products with negative externalities by taxing them at a rate that reflects their social costs. This policy framework has been proven successful in countries such as Chile, which, following the first year of its sugar tax implementation, saw a significant 22% decrease in the sale of sugary beverages. This, alongside already implemented policies requiring front-of-package warning labels on ultra-processed foods, creates informational and financial incentives for consumers to avoid these products. Additionally, the government should impose a restriction on the types of products sold and distributed by multinational food companies, accomplished by placing cap amounts (in grams) of salt and sugar allowed and banning the sale of those that exceed the set amount. This encourages companies to introduce healthier alternatives to the market. 

However, to counter the regressive effects of increased food prices from the Pigouvian tax, the government must concurrently implement a micro food distribution system in rural regions of the country with a similar model to the successful distribution system launched by Nestlé in 2012. This system’s success lies in its personal, adaptable model: it recruits local individuals as micro-distributors who deliver goods directly to households, bridging the gap created by limited access to traditional retail outlets. The model’s strength compared to traditional distribution methods is its ability to reach isolated communities by building strong customer relationships and offering credit options, allowing customers up to a full month to pay for their purchases, making products more accessible and affordable for low-income consumers. 

To replicate this success, the government must seek partnerships and directly subsidize Brazilian food companies. Examples include Camilo, known for providing Brazilian staple foods including rice and beans, Jasmine, which specializes in organic, minimally processed packaged foods, and small-scale farmers to provide organic produce. The subsidies will ensure that these products can be available at a more affordable price, and accessibility will be increased through a door-to-door system. Furthermore, mobilizing locally recruited distributors within each community will have spillover benefits. Funding for this project could be directly aided by government revenue collected through the imposed Pigouvian tax, allowing the government to balance the economic burden while increasing access to healthier food options and supporting community distributors.

Ultra-processed foods are convenient and highly addictive. Their consumption has altered the Brazilian food system, resulting in a significant surge of overweight and obesity and 57,000 premature deaths. Studies have found that decreasing the proportion of ultra-processed foods ingested by merely 10% would reduce these attributed deaths by 20%. Therefore, the three-tiered policy framework centered on decreasing consumption of ultra-processed foods lies presents a possible avenue of tangibly reducing the burden of such foods and reversing Brazil’s growing obesity epidemic.