Celine Da Silva and her daughter, Sabrina, delivering Nestlé products door-to-door credit William Daniels for The New York TimesPhoto by: credit William Daniels for The New York Times
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- September 16th, 2017
FORTALEZA, Brazil - The echo of the children's screams in the wet morning air as a woman pushed a gleaming white cart along dilapidated, garbage-strewn streets. He was delivering to some of the poorest households in this coastal city; he carried puddings, cookies, and other packaged foods on his sales route.
Celene da Silva, 29, is one of thousands of door-to-door sellers at Nestlé; thus helping the world's largest packaged food conglomerates expand their reach to a quarter of a million homes in Brazil's innermost corners.
While delivering packages with different flavors of Chandelle pudding, Kit Kat chocolates and Mucilon cereal for children, there was something surprising about their customers: it was evident that many were overweight, even young children.
He pointed to a house on its route and shook his head, remembering how his patriarch, a man with morbid obesity, died the previous week. "He ate a slice of cake and died while he slept," he said.
Da Silva, who weighs about 100 kilos, recently discovered that he had hypertension, a condition he recognizes is perhaps related to his taste for fried chicken and Coca-Cola that he drinks at every meal, including breakfast.
Da Silva and other vendors like her make regular deliveries to Nestlé to a quarter of a million homes in Brazil. Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
Nestlé's direct sales army in Brazil is part of a broader transformation of the food system that is delivering processed foods and Western-style sugary beverages to the most isolated corners of Latin America, Africa and Asia.
As growth slows in the more affluent countries, multinational food companies like Nestlé, PepsiCo and General Mills have been expanding their presence vigorously in developing countries through huge marketing campaigns that are drastically modifying the diets countries such as Brazil, India or Ghana.
An analysis of corporate records, epidemiological studies and government reports conducted by The New York Times-as well as interviews with numerous nutritionists and health experts around the world-reveals a huge transformation in the way food is produced, distributed, and advertised in much of the planet.
This is a change that, according to many public health experts, is contributing to a new epidemic of diabetes and heart disease, chronic diseases that increase due to the very high rates of obesity in places that were affected by hunger and malnutrition just a generation ago .
The new reality is exemplified by a single fact: in the world, there are more obese people than underweight.
At the same time, scientists say, the increasing availability of high-calorie, low-nutrient foods is creating a new type of malnutrition, one in which increasing numbers of people are both overweight and malnourished.
"The prevalent story is that this is the best of all possible worlds: cheap food, available everywhere. If you do not think about it a lot, it makes sense, "said Anthony Winson, who studies the political economics of nutrition at the University of Guelph in Ontario. However, a more thorough analysis reveals a very different story, he said. "To put it clearly: that diet is killing us."
Even critics of processed foods recognize that there are multiple factors in increasing obesity, including genetic, urbanization, higher wages and more sedentary lives.
Nestlé executives say their products have helped alleviate hunger, provided crucial nutrients and the company has lowered salt, fat and sugar from thousands of items to make them healthier.
However, Sean Westcott, Research and Development manager for the Nestlé Food Business Unit, agreed that obesity has been an unexpected side effect of expanding the availability of cheap processed foods.
"We did not expect what the impact would be," he said.
Part of the problem, he added, is a natural tendency for people to overeat because they can afford more food. Nestlé, he said, struggles to educate consumers about proper portion sizes, as well as to manufacture and market foods that balance "pleasure and nutrition."
There are now over 700 million obese people worldwide, 108 million of whom are children, according to research published recently in The New England Journal of Medicine.
The proportion of people suffering from obesity to the total population has doubled in 73 countries since 1980, contributing to the premature death of four million people, the study found.
Obesity in the world
The United States, the South Pacific and the Persian Gulf have the highest obesity rates in the world: one in four Americans is obese.
However, in the last 35 years there has been an increase in obesity - understood as having a body mass index greater than 30 - in Latin America, Africa and Asia.
Percentage of
the obese population
the obese population
USA
10%
10%
Brazil
7%
7%
China
0.7%
0.7%
Mali
0,7%
0,7%
1980
USA
27%
27%
Brazil
18%
18%
China
5%
5%
Mali
11%
11%
2015
Change in
obesity rate since 1980
obesity rate since 1980
USA
+ 154%
+ 154%
Brazil
+ 153%
+ 153%
China
+ 674%
+ 674%
Mali
+ 28%
+ 28%
By Audrey Carlsen | Source: Institute for Health Metrics and Evaluation. There is no information available on French Guiana and Western Sahara.
History is about both economy and nutrition. As multinational corporations move deeper into the developing world, they are transforming local agriculture, forcing peasants to abandon subsistence crops in favor of cash-in-hand raw materials such as sugar cane, corn and soybeans: the essential products of many industrial food products.
It is an economic ecosystem that absorbs both neighborhood stores and department stores, food distributors and manufacturers and local vendors such as Da Silva.
In places like China, South Africa and Colombia, the growing influence of large food companies translates into political power, hampering public health officials seeking to levy taxes on soft drinks or legislation with the aim of curbing the impact on health which have processed foods.
For a growing number of nutritionists, the obesity epidemic is intrinsically linked to the sale of packaged food, which grew 25 percent globally between 2011 and 2016, in contrast to ten percent in the United States, according to Euromonitor, a market research firm.
An even more obvious change occurred with carbonated beverages: sales in Latin America doubled since 2000 and exceeded sales in North America in 2013, the World Health Organizationreported .
The same trends are reflected in fast food, which grew by 30 percent across the world from 2011 to 2016, compared with 21 percent in the United States, according to Euromonitor.
Take Domino's Pizza, which in 2016 added 1281 stores - one "every seven hours," its annual report said - and virtually all but 171 of them abroad.
"At a time when some of the growth is more subdued in established economies, I think the strong position of emerging markets will be a winning position," Nestlé chief executive Mark Schneider told investors recently. Developing markets now provide the company with 42 percent of its sales.
For some companies, that may mean targeting young people, as Ahmet Bozer, president of Coca-Cola International, described to investors in 2014. "Half of the world's population has not drunk a Coke in the past 30 days, "he said. "There are 600 million teenagers who have not had one in the past week. So the opportunity here is huge. "
Advocates of the industry say that processed foods are essential to feed a growing and urbanized world of people, many with rising salaries that demand practicality.
"We are not going to get rid of all the factories and return to growing only grains. That makes no sense. It will not work, "said Mike Gibney, an emeritus professor of Food and Health at Dublin University College and a Nestlé consultant.
"If I ask a hundred Brazilian families to stop eating processed foods, I must ask myself: 'What will they eat? Who will feed them? How much will it cost?'".
In many ways, Brazil is a microcosm of how rising wages and government policies have led to better and longer lives and have eradicated hunger on a large scale.
However, the country is now facing a new and serious challenge of nutrition: over the past decade, the country's obesity ratio has almost doubled to 20 percent and the number of overweight people has almost tripled to reach 58 percent.
Each year, 300,000 people are diagnosed with type II diabetes, a disease strongly linked to obesity.
In Brazil, the political skill of the food industry also stands out. In 2010, a coalition of Brazilian food and beverage companies ended a series of measures that had been planned over the years and sought to limit junk food advertising to children.
The latest challenge has come from the country's president, Michel Temer, a business-minded centrist whose conservative allies in Congress want to scuttle the handful of regulations and laws aimed at promoting healthy eating.
"What we have is a war between two food systems, a traditional diet of real food ever produced by the peasants around you, and the producers of ultraprocessed foods designed to overeat and in some cases addictive," said Carlos A. Monteiro, a professor of Nutrition and Public Health at the University of São Paulo.
"It's a war," he said, "but one food system has, disproportionately, more power than the other."
Door-to-Door Deliveries
Da Silva reaches the customers of the poor neighborhoods of Fortaleza, who do not have easy access to a supermarket. He believes strongly in the products he sells and enthusiastically points out the nutritional information of the labels that presume to contain added vitamins and minerals.
"Everyone here knows that Nestlé products are good for you," he said, and pointed to Mucilon's cans, a small-aged baby porridge labeled "full of calcium and niacin," but also Nescau 2.0, which is a chocolate powder with lots of sugar.
Da Silva with some of his children and a cousin in his home in Fortaleza Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
She became a Nestlé saleswoman two years ago, when her family of five people had trouble getting by.
Although her husband is still unemployed, things are getting better.
With the $ 185 a month he earns from selling Nestlé products, he was able to buy a new refrigerator, television, and gas stove for the family's three-room house on the edge of a foul-smelling marsh.
The door-to-door sales program of the company complies with a concept that Nestlé articulated in its 1976 annual report of shareholders, which noted that "integration with the host country is a core objective of our company."
The program began a decade ago in Brazil and sells to 700,000 "low-income consumers every month," according to its website .
Despite the country's continuing economic crisis, the program has been growing at ten percent per year, according to Felipe Barbosa, a company supervisor.
He said that the low incomes of poor Brazilians or working class people had been a boost to direct sales.
That's because, unlike most food vendors, Nestlé gives its customers a whole month to pay for their purchases.
It also helps that sellers - the program employs exclusively women - know when their clients receive the Bolsa Família , a monthly government subsidy for low-income households.
"The essence of our program is reaching the poor," Barbosa said. "What makes it work is the personal connection between the seller and the customer."
Nestlé increasingly seeks to present itself as a leader in its commitment to community and health. Two decades ago, it was described as "a company of nutritional well-being and health".
Over the years, the company says, it has reformulated nearly 9,000 products to reduce salt, sugar and fat, and has delivered billions of fortified portions with vitamins and minerals.
The company emphasizes food safety and food waste reduction. It works with nearly 400,000 peasants worldwide to promote sustainable agriculture.
In an interview at Nestlé's new $ 50 million campus in the suburbs of Cleveland, Sean Westcott, R & D manager of the Nestlé Food Business Unit, said the door sales program in doorway reflected another of the slogans of the company: "Creating shared values".
"We create shared value by generating micro-entrepreneurs: people who can establish their own businesses," he said. A company like Nestle can boost the well-being of entire communities by "sending positive messages around nutrition," he said.
Nestlé's range of foods is vast and different from that of some snack companies, which do not go out of their way to offer healthy products. They include Nesfit, a whole-grain cereal; low-fat yogurts such as Molico, which contain a relatively small amount of sugar (six grams), and a range of baby cereals, served with milk or water, which are fortified with vitamins, iron and probiotics.
Some of the Nestlé products for sale at a store near Muaná Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
Gibney, a nutritionist who works as a consultant for Nestlé, said the company deserved credit for doing laudable work by reformulating healthier products.
However, of the 800 products that Nestlé says are available through its vendors, Da Silva says that its customers are only interested in about two dozen of them; almost all sugary products like Kit Kat; Nestlé Greek Red Berry, a 100-gram glass of yogurt with 17 grams of sugar, and Chandelle Pacoca, a peanut-flavored pudding in a container the same size as yogurt but having 20 grams of sugar - more than half of the recommended daily intake.
Until recently, Nestlé sponsored a floating vessel carrying tens of thousands of cartons of milk powder, yogurt, chocolate pudding, biscuits and sweets to isolated communities in the Amazon basin. Since the boat was out of service in July, private boat owners have taken on the task of meeting the demand.
"On the one hand, Nestlé is a world leader in water, infant formulas and many dairy products," said Barry Popkin, a professor of nutrition at the University of Northern California.
"On the other hand, they go to the marginalized areas of Brazil and sell them candy."
Popkin believes door-to-door sales are emblematic of a new and insidious era in which companies leave no options intact in an effort to grow and become fundamental in Third World communities.
"They do not leave a single inch of the country free," he explained.
Public health advocates have criticized the company on previous occasions.
In the 1970s, Nestlé was the target of a boycott in the United States for having heavily publicized infant formulas in developing countries, which, according to nutritionists, undermined healthy breastfeeding.
In 1978, Nestlé Brazil's then-President Oswaldo Ballarin was called to testify in highly publicized hearings of the United States Senate on the subject and stated that criticism of infant formula was a product of church activity, which was aimed at "undermining the system of free enterprise".
In the streets of Fortaleza, where Nestlé is admired for its Swiss lineage and perceived as high quality, you rarely hear negative feelings about the company.
The 53-year-old Joana D'Arc's house in Vasconcellos, another saleswoman, is full of Nestlé stuffed animals and engraved certificates that she won in nutrition classes sponsored by Nestlé.
In his room, the framed photographs of his children occupy a special place at the age of two; each posed in front of a pyramid of empty cans of Nestlé infant formula.
As her son and daughter grew up, she switched to other Nestlé products made for children: Nest Kinder, a milk powder for small children; Chocapic, a chocolate-flavored cereal, and the Nescau chocolate powder.
"When I was a baby, my son did not like to eat, until I started giving him Nestlé products," he said proudly.
Joana D'arc de Vasconcellos with photos of her daughter, Vittoria, and Nestlé Credit products William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
De Vasconcellos, on the right, has diabetes and hypertension. Vittoria, 17, has hypertension and weighs almost 136 kilos. Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
De Vasconcellos has diabetes and hypertension. His 17-year-old daughter, who weighs more than 110 kilos, has hypertension and polycystic ovary, a hormonal disorder strongly associated with obesity.
Most of their relatives suffer from one or more diseases associated with deficient diets: their mother and two sisters, diabetes and hypertension; her husband, hypertension. His father died three years ago, after his feet were amputated because of gangrene, a complication of diabetes.
"Every time I go to the public health clinic, the line for diabetics reaches the entrance," he said. "It would be very difficult to find a family here that does not suffer."
De Vasconcellos previously tried to sell Tupperware and Avon products door-to-door, but many customers did not pay. Six years ago, after a friend told her about Nestlé's direct sales program, De Vasconcellos did not hesitate to seize the opportunity.
He says his clients have never stopped paying him.
"People should eat," he explained.
The industry takes action
In May 2000, Denise Coitinho, then Director of Nutrition at the Ministry of Health, was at a Mother's Day party at her children's school when her cell phone rang.
He was the Director of Government Relations for Nestlé. "He was very upset," recalled Coitinho.
Nestlé was concerned about a new policy that Brazil had adopted and was promoting in the World Health Organization.
If adopted there, the policy would have recommended that children around the world breastfeed for six months instead of the previous recommendation of four to six months, Coitinho said.
"It may not look like much for two months, but it's a lot of income. It's a lot of sales, "said Coitinho, who resigned her position in 2004 and is now an independent nutrition consultant for the United Nations, among others.
In the end, infant food companies succeeded in curbing the policy for a year, said Coitinho.
Nestlé said in response to Coitinho's anecdote that "he believes that breast milk is the ideal nutrition for babies" and that he supports and promotes WHO guidelines.
It is difficult to overestimate the economic power and political access enjoyed by the food and beverage conglomerates in Brazil, who account for ten percent of the country's economic output and employ 1.6 million people.
In 2014, food companies donated $ 158 million to members of Brazil's National Congress, a three-fold increase compared to 2010, according to Transparency International Brazil.
A study released by the organization last year revealed that more than half of Brazil's current federal legislators had been elected with donations from the food industry - before the Federal Supreme Court banned corporate contributions in 2015.
The largest donor of the congressional candidates was Brazilian meat giant JBS , a company that gave the candidates $ 112 million in 2014; Coca-Cola gave 6.5 million in campaign contributions that year, and McDonald's donated $ 561,000.
A woman disguised as Wonder Woman welcomes customers at a McDonald's in São Paulo. The company gave $ 561,000 to congressional candidates in 2014. Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
The scenario was set for a major political battle when, in 2006, the government tried to pass strict regulations to the food industry to combat obesity and disease.
Measures taken from the previous breastfeeding policy included advertising warnings to inform consumers about foods high in sugar, salt and saturated fats, as well as advertising restrictions to lessen the attractiveness of highly processed foods and sugary drinks, specifically those that are aimed at children.
Taking the successful government initiative to reduce tobacco-related marketing as an example, the new regulations would have barred brands such as Pepsi and KFC from sponsoring sporting and cultural events.
"We believed that Brazilcould be a model for the rest of the world, a country that puts the welfare of its citizens above all else," said Dirceu Raposo de Mello, then director of the National Agency for Health Surveillance , widely known through the acronym in Portuguese Anvisa.
"Unfortunately, the food industry did not think the same thing."
Loading a boat in Belém, Brazil, with Nestlé products destined for Muaná Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
Sweets and chocolate bars in a small store in São Paulo, Brazil Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
Ana Cláudia Caranha and her son, Gabriel, returning from a store in Muaná, where they bought food for the week, including several products from Nestlé Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
Food companies took a low profile and met at the Brazilian Association of Food Industries , a lobbying group whose board of vice presidents included Nestlé executives ; American meat giant Cargill and Unilever , the European food conglomerate with brands such as Hellmann's , Mazola oil and Ben & Jerry's.
The association declined to comment for this article.
During the first days of public hearings, the industry appeared to be negotiating goodwill regulations, but privately, health activists say corporate lawyers and lobbyists were involved in a multi-angle bout to derail the process.
Industry-funded academics began appearing on television to outlaw the rules of being financially disastrous.
Other experts wrote editorials in the newspapers suggesting that exercise and stricter parenting might be more effective than regulations aimed at combating childhood obesity.
The most effective slogan of the industry, analysts say, was its shrill report that the proposed advertising restrictions were censorship.
The accusation had a particular resonance given the almost two decades of military dictatorship in Brazil that ended in 1985.
At a meeting, a food industry official accused Anvisa of attempting to subvert parental authority by saying that mothers had the right to decide what to feed their children, said Vanessa Schottz, a nutrition advocate.
In another meeting, he said, a representative of the toy industry denounced the proposed advertising rules and said they would take Brazilian toys out of toys that sometimes accompanied fast food.
"He said we were putting an end to the children's dreams," Schottz recalled. "We were perplexed."
Pursued by criticism, Anvisa withdrew the restrictions at the end of 2010; the only thing that remained was a proposal calling for the advertising to include a warning about unhealthy food and drinks.
Then came the demands.
Over several months, an unequal group of industrial groups filed eleven lawsuits against Anvisa.
The complainants included the Brazilian Association of Cookie Manufacturers, the pressure group of maize producers and an alliance of chocolate, cocoa and candy companies. Some of the lawsuits alleged that the regulations violated constitutional protections around freedom of expression, while others said the agency did not have the authority to regulate the food and advertising industries.
Buying Nestlé Cereal at a Supermarket in São Paulo Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
Although health advocates say the litigation was not entirely unexpected, they were blinded by the response of the federal government's top lawyer, Attorney General Luis Inacio Adams, who was appointed by the presidency.
Shortly after the proposed rules were officially published in June 2010, Adams took the side of the industry .
A few weeks later, a federal court suspended the regulations and cited Adams's written opinion, which suggested that Anvisa does not have the authority to regulate the food and advertising industries. Adams declined to comment for this article.
Raposo de Mello, former president of Anvisa, says he was surprised by the change in opinion of Adams, given the enduring support that the attorney general had given Anvisa.
Seven years later, with most of the eleven lawsuits still unresolved, regulations are still frozen.
"The industry carried out an evasion maneuver against the system," said Raposo de Mello.
Meanwhile, the food and beverage industry became more aggressive as it sought to neutralize Anvisa, which it considered as its biggest adversary.
In 2010, in the midst of the battle against the regulations proposed by the agency, a group of 156 business executives expressed their concerns to the campaign of Dilma Rousseff, who contended for the position of president.
Marcello Fragano Baird, a political scientist in São Paulo who has studied the food industry's lobbying campaign against nutrition regulations, said Rousseff assured executives that he would reform Anvisa. "He promised that he would 'clean the house' if he was elected," he said, adding that he learned of the meeting through interviews with participants.
Rouseff won and shortly after his protest, he replaced Raposo de Mello with Jaime César de Moura Oliveira, who had long been his political ally and a former lawyer for Unilever Brasil, the local subsidiary of the giant multinational food company .
A spokeswoman for Rousseff declined to make contact with her for an interview.
Credit From left: Adriano Machado / Reuters; Agência Brasil; Marcelo Camargo / Agência Brasil; Apu Gomes / Agence France-Presse - Getty Images; Fabio Rodrigues Pozzebom / Agência Brasil
In 2012, Anvisa organized a walking exhibition to combat obesity that made stops at other government buildings across the country.
Under the title Lose Weight Brazil , the exhibition praised exercise and moderation as the keys to attacking obesity, but ruled out prevailing scientific evidence about the dangers of eating too much sugar, soft drinks, and processed foods.
Who was the sponsor of the exhibition? Coca Cola.
Irresistible Foods, Fats with Many Fats
More than 1,600 kilometers south of Fortaleza, the effects of changing eating habits are evident in a brightly colored community center in the center of São Paulo, the largest city in Brazil. Every day, more than a hundred children fill the nursery classrooms, sing the alphabet, play games and take group naps.
The program, led by a Brazilian non-profit organization, had a clear mission when it began in the early 1990s: to end hunger among children in some of the city's most impoverished neighborhoods.
Many of those attending school today are considerably chubby, and nutritionists at the campus indicate that some are disturbingly small in height for their age; is the result of diets abundant in salt, fat and sugar, but lacking the nutrition necessary for a healthy development.
The program, operated by the Center for Nutrition Education and Recovery, includes 10-year-old prediabetic children with dangerous fatty livers, adolescents with hypertension, and children who are malnourished and have trouble walking.
"They are reaching babies, which is something that we have never seen before," said Giuliano Giovanetti, who is responsible for the dissemination and communication of the center. "It is a crisis for our society because we are producing a generation of children with damaged cognitive skills that will not reach their full potential."
Nearly nine percent of Brazilian children were obese by 2015, an increase of more than 270 percent since 1980, according to a recent study by the Institute for Metrics and Health Assessment at the University of Washington. That puts the country at a dramatic distance from the United States, where 12.7 percent of children were obese by 2015.
The figures are even more alarming in the communities served by the center: in some neighborhoods, 30 percent of children are obese and another 30 percent are malnourished, according to data from the organization, which found that 6 percent of obese children were also malnourished.
Some children at the Center for Nutrition Education and Recovery with signs that say "Yum" after eating a fruit cake Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
Rising obesity rates are strongly associated with improvements in the economy, as higher-income families adopt the practicality, status, and flavors of packaged foods.
Busy parents fill their children with instant soups and frozen chicken nuggets , foods that are often accompanied by sugary drinks.
Rice, beans, salad and grilled meats - essential parts of the traditional Brazilian diet - are losing ground, according to what studies have discovered.
The problem is exacerbated by unbridled street violence, which keeps small children locked up in their homes.
"It's just too dangerous to let my kids play in the street, so they spend all their free time sitting on the couch playing video games and watching TV," said Elaine Pereira dos Santos, 35, the mother of two children. 9 and 4 years old, both overweight.
Isaac, 9, weighs 63 kilos and can only wear clothes made for teenagers. Dos Santos, who works in a hospital pharmacy, trimmed the legs of his pants to fit his son.
Like many Brazilian mothers, she was glad to see that Isaac began to gain weight when he was younger shortly after he tasted his first McDonald's French fries.
"I always thought that when it comes to babies, the fatter the better," he said. Fortunately, he met his eating habits, which included frequent visits to fast food places and virtually no fruit or vegetables.
However, when he began to have problems running and complained of pains in his knees, Dos Santos knew that something was wrong.
"The hard part is the teasing of the other kids," he said. "When we go shopping, even adults point out and observe it " or call gordinho (chubby).
Isaac Pereira dos Santos, 9, weighs 63 kilos and can only wear clothing made for adolescents. Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
Isaac eating salad at home. His mother, Elaine Pereira dos Santos, now prepares healthier meals for her. Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
At the São Paulo day care center, health care workers keep records about the physical and cognitive development of children, while nutritionists teach parents how to prepare healthy and cheap meals. For some children, the center's test kitchen provides their first contact with cabbage, plums and mangoes.
"I always thought that when it comes to babies, the fatter the better."
ELAINE PEREIRA DOS SANTOS, MOTHER OF TWO CHILDREN WITH OVERWEIGHT
One of the key challenges is convincing parents that their children are sick.
"Unlike cancer or other diseases, this is a disability that is not seen," said Juliana Dellare Calia, 42, a nutritionist working with the organization.
Although staff members say the program has made significant changes in the way families feed, many children in any way will face a lifelong battle with obesity.
That's because a growing body of research suggests that childhood malnutrition can lead to permanent metabolic changes, reprogramming the body so that excess calories can more easily become body fat.
"It is the body's response to what it perceives as starvation," said Dellare Calia.
Money sends
While nutrition experts lament the growing obesity crisis - and potential long-term medical costs - one aspect of the processed food revolution is undeniable: the expansion of industry provides a short-term economic benefit to people across the globe socioeconomic spectrum.
Nestlé, which claims to employ 21,000 people in Brazil, started a two-year internship program that has trained 7,000 people under the age of 30.
Near the bottom of the food chain is Da Silva, the saleswoman from Fortaleza, who is optimistic about the future despite growing concerns about her health.
Life has been a struggle since she quit school at age 14, when she became pregnant with her first child.
Now he talks about fixing his missing teeth and affecting his smile, as well as buying a suitable house, one that does not drip during heavy rains.
All thanks to your work with Nestlé.
"For the first time in my life, I feel hope and independence," he said.
A few Nestlé products for sale from door to door in Fortaleza Credit William Daniels for The New York TimesPhoto by: William Daniels for The New York Times
He is aware of the connection between his diet and his persistent health problems, but insists that his children are well nourished and points out Nestlé products in his room.
Being a Nestlé salesperson has another advantage: cookies, chocolate and puddings that often support your family are purchased wholesale.
With a growing customer base, Da Silva has set the sights on a new goal, one that, according to her, will increase the business even more.
"I want to buy a bigger refrigerator."
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