Changing Times Feed Obesity in Costa Rica
On any given day, the line at the McDonald’s alongside downtown San José’s Plaza de la Cultura is 10- to 15-people long. The tables are piled high with Big Mac containers, supersized sodas and pockets of fries. On the busiest days, when the seats are all full, many eat outside the plaza.
The traditional “Soda” around the corner is empty in comparison. Apart from a lone man sipping coffee and a few college students huddled over some Imperial beers and a half-eaten casado, the place is quiet.
In what has become a growing trend, Costa Ricans are forfeiting their typical intake of rice, beans and local vegetables in favor of an imported fast food diet. And, as far as their waistlines are concerned, it’s beginning to show.
Today, 60 percent of women between the ages of 24 and 45 are overweight, as compared to only 2 percent in 1982. Their mothers – those between 45 and 64 – suffer an incidence of obesity 128 times greater than in 1982, according to the Costa Rican Health Ministry.
Yet, the greatest concern for nutrition experts is the weight increase among children.
Twenty-one percent of kids aged 5 to 12 are overweight now as opposed to 15 percent in 1996.
“The fact that children are showing a tendency of gaining weight is a serious issue,” said Xinia Fernández, associate professor at the University of Costa Rica’s School of Nutrition. “With more Costa Ricans gaining weight at young ages, it means that when they are adults, they will have serious problems with their health such as hypertension or high blood pressure, among other illnesses.”
And, because Costa Rica has a universal healthcare system, the weight problem not only taxes the overall health of the country, but also government finances.
“Obesity will cost Costa Rica a lot of money,” Fernández said. “These groups represent a significant cost in medical attention.
We don’t have millions of dollars to throw at this problem like the United States. But it’s an issue that we are beginning to work on.”
Like most problems in Costa Rica, obesity is being blamed on outside factors. Processed food, including those sugary cereals and bags of chips that typically enter Costa Rica in shipping containers, are one part of the equation. Add to that the booming fast food business, which is seeing the opening of 26 establishments this year alone, according to a study by the Costa Rican daily La República. Such food has become almost a status symbol in the country.
“The casado is now considered food for low-income people,’” Fernández said. “People don’t want to be seen with rice and beans. They want McDonald’s or Kentucky (as Kentucky Fried Chicken is referred to here), especially at younger ages.”
But the weight gain is also a result of an increasing sedentary lifestyle in which people have forgone work in the fields in favor of office jobs. More than 60 percent of the country’s population lives in the traffic-logged-metropolitan area, where there are limited places to walk. Relatively few have the time, money or motivation to work out in gyms.
“For us, obesity has been a big challenge,” said Luis Tacsan, director of science and technology development within the Health Ministry. “Our past efforts haven’t been enough. And that has been very concerning.”
The problem of weight gain isn’t just Costa Rican – it’s found its way into the farthest corners of the world and into some of the poorest countries.
According to the World Health Organization, there are one billion obese people worldwide, 30 percent of whom are clinically obese; defined as those that have a Body Mass Index of 30 kg/m2 or greater.
In the Pacific island of Samoa, 93.5 percent of the country is overweight, followed by its neighbor Kiribati at 81.5 percent. The United States comes in third with 66.7 percent of the country experiencing a weight problem. Germany and Egypt trail closely on its heels.
Enrique Jacoby of the Pan American Health Organization said obesity has the potential to bankrupt Latin America.
“Obesity carries serious threats for Latin American countries,” he said. “Their governments don’t have the resources to treat the high cost of the resulting chronic diseases.”
Someone who is 55 pounds over their weight at age 18 is five times as likely as a trim person to develop hypertension, and those who are 24 to 44 points overweight are five times more likely to develop Type 2 diabetes, according to studies published by the Obesity Society (www.obesity.com).
And while developed countries have money to spend on their weight problem, developing countries neither have the funds for prevention or treatment.
The United States spends $14,000 per person on medical care, Latin American countries put out a mere $200 or $300, Jacoby said. “When we talk about the problem of obesity and the amount of money that is required to treat the effects, we are talking about big bucks.”
Obesity is not an attractive topic, said Fernández. It doesn’t make the covers of social issue magazines and it’s hard to get leaders to adopt it as a priority for their agenda.
“An overweight child doesn’t receive as much attention as one who is skinny,” she said, indicating that when international organizations come to Costa Rica looking to do reports, they gravitate to photos of a stick-thin boy eating from a trash can and not the overweight child eating at McDonald’s.
But obesity is just as big of a problem, if not more so, she said.
Despite the abundance of cheap fruits and vegetables, poorer families will often rely on starches because they provide greater sustenance. They are also easier to prepare, which is a luxury for parents working 10-12 hour days.
Yet, it’s their children who end up suffering, as food choice can set them up for a lifestyle of overeating and chubbiness.
In the past, Costa Rica has fought obesity through nutrition education, ad campaigns, exercise- programs and by monitoring school children’s diets, but it’s been frustrating for policy makers who haven’t seen many results.
“People are conscious of their diets,” said Ana Eduviges, in the Health Ministry’s development department. “So they know the serious impact overeating can have on their body. But many people are looking for a quick way to lose weight like taking a pill or going a few weeks without eating. “It doesn’t work like that,” she added. “What needs to change are lifestyles.”
Fernández suggests zeroing in on children and pregnant mothers as early prevention and the establishment of good eating habits can curb weight gain in the future. She said physical education needs to be improved, as today’s students are offered a mere two or three months of physical education a year when at school.
“The game of obesity is a game of balance,” she said. “In children, physical exercise is very important. We should not only watch out for what a child eats but also, how often he or she moves.”
On an international level, Brazil is requiring all school meals contain 70 percent fruits and vegetables and that 30 percent of those meals be produced locally. In Mexico, the legislature recently approved a plan mandating that school children have daily exercise and restricting education centers from selling junk food. And in the United States, First Lady Michelle Obama unveiled the “Let’s Move” initiative, targeting childhood obesity through education and exercise.
How Costa Rica chooses to scale down the problem of weight gain is largely undefined, other than making programs on a micro or pilot level more prevalent across the board, Tacsan explained.
What is clear is that if the country doesn’t want to see a bulge in medical costs in coming year, it should focus on controlling the growing bulge at its waists.
Gallo pinto and coffee
A mix of rice and beans, which is sometimes accompanied by eggs.
Snack or merienda
Fruit or fruit juice
The traditional casado A plate of rice and beans complimented by a meat (could be chicken, fish or beef), tortilla, a vegetable picadillo and fried plantains, and served with natural fruit juice.
Coffee or café
Coffee with light side dish The light side dish might include bread or a dessert.
Olla de Carne
A nutritious blend of vegetables, beef and plantains, combined in a nourishing soup.
The traditional Costa Rican diet provides a balance of fruit, vegetables, proteins and carbohydrates. Food consumption is also timed throughout the day to provide the heavier meals earlier on, thus supplying energy when most needed. But rice and beans are increasingly being replaced with hamburgers, fries, pizzas and other fatty foods, and lifestyles are becoming more sedentary. According to Xinia Fernández, associate professor at the University of Costa Rica’s School of Nutrition, the change in diet and lack of exercise could lead to severe problems for the country in the future.
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