http://dx.doi.org/10.15446/revfacmed.v62n3sup.43143

Editorial

Does NAFTA represent a new nutritional transition? How will it influence Colombian people’s weight?

Jhon Jairo Bejarano Roncancio PhD¹, Diana Parra-Pérez PhD²

¹ Departamento de Nutrición Humana, Universidad Nacional de Colombia. Bogotá, Colombia.
jjbejaranor@unal.edu.co
² Program in Physical Therapy, School of Medicine,
Washington University in St. Louis. St. Louis, MO, USA MPH, Centre for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.

Nutritional transition refers to a series of changes regarding the type and quality of diet, thereby affecting an individual’s bodily composition. According to Barry Popkin, the third stage of nutritional transition is characterised by increased obesogenic bodily weight, which is accompanied by patterns of leading a sedentary life and consuming food rich in sugar, fat and salt (1). Such nutritional transition is accompanied by demographic transition determined by population fertility/mortality and an epidemiological transition characterised by a high prevalence of chronic and degenerative diseases associated with life-style (2). The many states of malnutrition represent one of the manifestations of such transition, whether due to lack or excess, often coexisting in the same population, family and even individuals (known as the double burden of malnutrition).

Most Latin-American countries are in the same stage of nutritional transition, except for Mexico which has undergone an accelerated transition. Since the North-American Free Trade Agreement (NAFTA) came into effect in 1994 Mexico has undergone a profound nutritional and social transformation which has led to epidemiological evidence being debated.

Obesity in Mexican women has risen from 34% to 73% during the last two decades whist chronic malnutrition in children under five years old has reached 13.6% when this should be less than 2.5%. One of the most significant phenomena has been the industrialisation of breastfeeding, as 22% of women used to breastfeed their children whilst now this figure is just 14%. Likewise, the consumption of soft drinks sweetened with high fructose corn syrup has risen by 37% during this period. One of the most worrying consequences of such changes has been that 40% of overweight, obese children now suffer from high blood pressure or alterations regarding the metabolism of carbohydrates and hypertriglyceridemia (3).

Increased obesity and all the information regarding breastfeeding, malnutrition and the type of food most consumed in the Mexican diet have been documented in national surveys. Mexico occupies first place worldwide regarding infant obesity and second place concerning obesity in adults, preceded only by the USA. This problem is present during infancy and adolescence as well as in the preschool population (4). Data from the National Health and Nutrition Survey (ENSANUT) has indicated that one out of every three 12- to 19-year-old adolescents is overweight and/or obese. The combined prevalence of schoolchildren being overweight and obese has risen by an average of 26% for both genders, representing more than 4.1 million schoolchildren living with this problem (5).

All the aforementioned health-related data regarding food practice and consumption led to guidelines for labelling the front of pre-packaged food and non-alcoholic soft drinks being issued in 2004 to provide consumers with product information as well as nutritional criteria and characteristics for obtaining and using products (6).

Regulation of Sanitary Control of Products and Services was based on the National Development Plan 2013-2018 which warned about the very high levels of being overweight, obese and suffering diabetes and high blood pressure in all groups of the population and the urgency of protecting Mexican children, particularly school-aged ones at risk of developing chronic non-communicable diseases (NCD). Such regulation was aimed at reducing children’s exposure to products having very high caloric density, including sugary drinks (5), bearing in mind that Mexico is the main consumer of such products worldwide (7).

Colombia is no stranger to the situation experienced by México; regardless of the FTA coming into force, the figures regarding obesity, being overweight and their co-morbidities have increased dramatically in Colombia during the last few decades. According to the latest survey of the nutritional situation (ENSIN 2010), 5% of children aged less than five years-old were suffering from obesity and 20% were overweight; 20% of fertile-aged women were obese, 35% overweight and 62% had abdominal obesity whilst 9% of pregnant women were obese and 24% were overweight. Every day, 22.1% of the 5 to 64 year-old population (i.e. one in five people) drinks sugary soft drinks or soda and one in seven eats package food (8).

Taking Mexican experience as an example, Colombia now faces a new challenge regarding nutritional transition as hundreds of ultra-processed products will now enter Colombia through NAFTA. This situation raises alarm that Colombia’s nutritional problems could become increased, especially considering that, although labelling and information concerning products’ nutritional content has been regulated, consumers’ reading and knowledge about this subject is not pedagogical, it is poor.

Other aspects worth considering concern these products being easily accessible and having very competitive prices on the market, often being cheaper than many vegetables and fruit. These products are also known for their far-ranging scope and advertising impact in the mass media, thereby competing with fresh food which is nutritionally more beneficial.

Due to the above, and many other reasons not listed here, introducing public health policy (or re-evaluating existing policy) and providing information aimed at protecting consumers and guaranteeing food and nutritional safety has become an urgent priority in complying with the right to healthy eating and drinking habits, all based on scientific evidence.

There is no certainty concerning how NAFTA might affect Colombians’ body weight, but it is worth considering Mexican experience when taking decisions and action regarding public nutrition. Going beyond problems related to increased weight and the appearance of other chronic diseases, one of the main menaces regarding the entry of ultra-processed products via the FTA is the loss of agricultural and cultural traditions associated with the production and consumption of minimally processed regional food which is nutritionally more balanced. Such changes could imply profound transformation regarding the traditional Colombian family basket which would increase the obesogenic environment in which we are becoming immersed (added to the population’s lack of knowledge and confusion related to identifying nutritional labelling and the type of ingredients in ultra-processed products, as well as a lack of control and follow-up regarding their marketing and traceability).

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