For 30 years now, nutrition transition has been changing the pattern of chronic diseases’ prevalence in Latin American countries. Three factors contribute for this change: 1) increasing urbanization; 2) reduced physical activity; 3) changes in nutritional patterns. This article intends to study the current status of obesity and diabetes in the Mercosur¹ (Brazil, Argentina, Paraguay and Uruguay), and look for a better understanding of this condition and its future perspectives.

The increase of the consumption of processed and ultra-processed foods, which are high in fat, sodium and sugar, is a major cause of metabolic diseases. The consequent decrease on the consumption of traditional foods that compound the original latinamerican diet, which includes rice and beans, fruits and vegetables, contributes for the current situation. Especially in the last decade, overweight and obesity increased in all population groups of this region in South America.

Keeping a healthy diet and regular physical activity is associated with lower levels of chronic diseases, as well as cardiac and cerebrovascular events. The growing prevalence of cardiovascular risk factors such as diabetes, obesity, hypertension, dyslipidemia and a sedentary lifestyle explains a big part of the morbidity and mortality, turning them into a major public health problem in the Mercosur [1] .

The effects of globalization and urbanization on food patterns have influenced dietary choices and lifestyle of the world’s population in general [2] .

According to Popkin, Sichieri (2003), the “Nutritional Transition” phenomenon refers to changes in the diet structure, associated with economic, social and demographic changes and their impact on populational health [3] . The stage and the speed of this transition differ according to the regions where it develops. The basic feature that has been observed in developing countries, including Mercosur countries, is the increased consumption of saturated fatty acids, sugars and soft drinks at the expense of reduced consumption of complex carbohydrates, fruits and vegetables [4] .

Although cereals and grains, beans, rice and leguminous are still the main source of calories in the Mercosur countries, plants, for example, show a clear decrease in their consumption in recent years, along with an increase in the consumption of animal protein (eggs, milk, meat). The calorie intake (kcal/day) showed a slight increase in most of these countries to reach around 3000 kcal/day in Brazil and Argentina, for instance.

One of the factors that contribute to this change in habits is the increased consumption of food outside home. In Brazil, a research found out that this consumption varies from 13% among the elderly in the South to 51% of young people in the southeast region of the country (the most developed region), and found that the higher the family income, the more frequent is this consumption outside home. The food groups with the highest percentage of consumption outside home were beverages, fried snacks and baked goods, pizza, soft drinks and sandwiches, both in rural and urban areas [4] .

The characteristics and stages of development in the nutritional transition differ among the various Latin American countries [5] . Paraguay, for example, is the only Mercosur member that presents, according to a study of the IEA (Institute of Agricultural Economics), a decrease in the total calorie intake among the four members [6] .

In the last 20 years Latin American countries have undergone a fast demographic, epidemiological and nutritional transition; a shift from malnutrition to obesity. Many regional governments still do not understand this change, and keep fighting undernourishment as a priority.

Dietary factors are a leading cause of death in Latin American countries. Increased intake of fats, especially saturated fat in general, is the important and directly related to the increased prevalence of cardiovascular disease and other chronic diseases [5] .

A sedentary lifestyle, favored by modern life, is a risk factor as important as improper diet in the etiology of obesity [4] and has a direct relationship with the increasing incidence of type 2 diabetes in adults.

Chronic non-communicable diseases (NCDs) are a major public health problem in the world today, with a high morbidity and mortality. Among these diseases, there are the circulatory system, cancer, diabetes and chronic respiratory disease. Obesity is a major risk factor for these diseases, as well as smoking, unhealthy diets, physical inactivity and alcohol consumption [7] .

Overweight and obesity have a significant impact on physical and psychosocial health and are closely related to eating habits, among many other key aspects of overweight. Especially hypertension and diabetes make up the group of non-transmissible chronic diseases, both as a disease and a risk factor for other diseases. All of them have had an increase in their prevalences in recent decades. For these reasons, among others, nutrition has become one of the most modifiable determinants of chronic diseases, occupying the place that recently would belong to smoking [8] -[10] .

More than half of all adults in the Mercosur are overweight. Approximately 15% are obese.

In Brazil, NCDs accounted for 72% of total mortality in the country in 2007 [11] . It is estimated that overweight and obesity are responsible for 2.8 million deaths each year [12] . In Argentina, only 26% of the population has a normal body mass index (BMI). The rest of the population is divided into overweight (49%) and obese (25%) [9] . These data show that developing countries have experienced a problem of malnutrition / malnourishment for overweight and obesity epidemic [12] .

The prevalence of obesity has increased markedly in the world, especially during the last 10 to 15 years, becoming a public health problem [6] . Overweight is related to serious health problems, including breast and colon cancer and especially diabetes and heart disease [13] , thus influencing the morbidity and mortality of these populations profile.

The studies confirm the growing magnitude of the obesity problem in children, adolescents, adults and childbearing-age women. As determinants, they identify sedentary lifestyle and consumption of inadequate diets. Above all, they issue a call for a greater diversity of interventions and government support with the implementation of clear measures for preventing and combating obesity. Obesity today is no longer a problem only for the so-called developed countries; rather, it increasingly affects growing portions of the most underprivileged population strata [8] .

According to the study “Trends in prevalence of overweight and obesity in adults in 26 Brazilian state capitals and the Federal District from 2006 to 2012”, the prevalence of overweight in adults in the 27 cities monitored by VIGITEL (Surveillance System of Risk and Protective Factors for Chronic Non-Communicable Diseases through Telephone Interviews) increased from 43.2% (2006) to 51.0% (2012), with an annual increase rate of 1.37%. Prevalence of obesity increased from 11.6% to 17.4%, with an annual increase rate of 0.89%. The perspectives of disease’s prevalence for next years: increase and epidemic.

Knowing the perspective of the overweight’s prevalence (overweight plus obesity) associated or not with diabetes mellitus, as well as the trend of prevalence of this, it is vitally important for the development of public policies to face that.

In this context, within MERCOSUR, Brazil has had a prominent position in fighting excess weight epidemic in the region. Using surveillance actions, with data collected annually from Brazilian Health Ministry by VIGITEL (the Portuguese acronym for Risk and Protective Factors Surveillance for Chronic Diseases by Telephone Interviews), a methodological and scientific system sampling done annually by phone calls, although not the best way, to be subject to multiple biases, shows a satisfactory estimate of the prevalence in the population to so-called risk factors since the year 2006 [14] . The survey reveals that being overweight affects 52.5% of the adult population in the country, significant growth compared with the 2006 data, when the index was 43%, with an increase of 23% over the last nine years. Excess weight tends to increase with age. Among young people is 38% and among people 45 - 64 years old, 61%. The result also indicated the presence of obesity in 17.9% of the study population, with an increase in prevalence since 2006. However, demonstrating for the past three years, no significant increases.

However, one point stands out, namely the marked increase in the prevalence of obesity in the various population sub-groups in nearly all Latin American countries. Within this context, obesity has taken hold as a nutritional problem associated with a high incidence of cardiovascular diseases, cancer and diabetes, thereby influencing the morbidity and mortality profile of populations [8] .

In recent years, despite the accumulation of a certain amount of knowledge concerning the determination and distribution patterns of obesity within the context of the nutritional transition, much remains to be done, especially in the field of prevention and population intervention [8] .

In the economically emerging countries such as in Mercosur, the prevalence of diabetes increased rapidly in the last 30 years [15] . As a result, government vigilance actions and health promotion were built to confront these circumstances, reinforced by the WHO recommendations in this same direction. The complexity of determining factors involved in metabolic diseases is a hindrance towards an effective approach. It takes a collective and multisectorial initiatives, in many spheres of society, to understand and to find effective measures towards diabetes control and prevention.

According to the International Diabetes Federation (IDF), there are around 387 million people in the world with diabetes. Eighty percent of these patients live in developing countries [16] . The growing trend of diabetes is associated with irregular lifestyle habits, such as inadequate diets and an increased sedentary lifestyle. Excess weight is a major risk factor for the development of diabetes [17] . Another contributing factor for this epidemiological information is that populations are living longer, and diabetes is prevalent in elderly people, following a higher life expectancy in the Mercosur populations [3] .

In the time span analyzed, approximately 19 million patients with type 2 diabetes in the countries that compose the Mercosur. Brazil has the highest number of diabetic patients, corresponding to 11.6 million, followed by Colombia (2.1 million), Argentina (1.6 million) and Chile (1.6 million). Regarding the prevalence within the age group 20 - 79 years (adults), Argentina has the highest percentage (12.3%), while Brazil, Colombia and Uruguay stands out with 8.7%, 7.2% and 6.6%, respectively (Table 1).

Is it important to outline that the prevalence of diabetes increases with advancing age, as Figure 1 shows, and over the fifth decade of life diabetes represents an important health issue among South American populations.

A quantitative analysis regarding recent juridical decisions on obesity and diabetes, in the higher courts of Brazil and Argentina, shows a similar pattern of increasing demands on these issues, an important reason for concern.

The uniterm “obesity” was found in 37 decisions of the higher court of Brazil, in 12 decisions of the higher Argentinean Court, and in 36 decisions of various levels of courts in Uruguay (which allows no consultation to decisions regarding only the higher court) [18] -[20] . Paraguay does not have such an online research system available [21] .

Regarding “diabetes”, 38 decisions were found in Brazilian Higher Court, 30 decisions in Argentinean Higher Court, and 85 decisions in various court levels in Uruguay.

These results clearly indicate the presence and relevance of these diseases on the juridical system, and a major influence on lawsuits within the Mercosur. When each case is analysed, a trend is found in most decisions regarding demands towards the “Right to Health” in these Mercosur countries, possibly explained because of the historical pattern of negligence towards public health care in Latin America. Most of the claimants request access to medications to treat their health condition, or the right to undergo bariatric surgery or other health procedures. Medical treatments have become increasingly expensive, and therefore individuals seek economic sup-

port from governments, according to the universal “Right to Health” that states in their Constitutions and in international treaties [22] .

Governments face a complex challenge in the control and prevention of diabetes and obesity. Some causal factors associated with NCDs are in part behavioral and depend on individual choices, such as food and drink consumption, thus making government’s intervention a complex and arguable task [23] .

There are several debates under way regarding who should define an individual’s health threshold. Governments decide which are the limits of health and disease, in order to build public health policies and define approaches towards chronic diseases. These (bio) political decisions usually do not take into account the personal right to decide what is best for each citizen and each person [24] . They focus, instead, in planning health prevention and producing health costs’ reduction. Public policies regarding obesity and diabetes as very important for nations’s public budgets nowadays, because the costs of health are increasing in all countries, and pose a special challenge to Latin American countries, whose budget is extremely limited, along with social and economic priorities [25] .

A historical analysis of health reforms lead by governments in the recent decades point out to a pattern of public intervention in the private sphere, regarding health habits, physical activity and food pattern changes. The seven trigger points that justified these initiatives were: social disapproval, medical and scientific discoveries, self-help, blaming those associated with users of these risk factors (e.g. tobacco, alcohol, trans fat), “demonization” of the industry, popular movements and group actions [23] .

It is to expect that “biopolitics”, regarded as the control of health by the State, are going to be the next frontier of this huge health debate [26] . What are the limits of governments to decide what is healthy of unhealthy, and should an individual follow strict guidelines in order to prevent diseases, leaving own choices with a minor function? Who should decide what is best for a person: a public policy or self-determination? Or should the government “nudge” the people to make healthier choices [27] [28] ?

Decisions are yet to be reached, and the limits for action will surely be defined. The search for fair answers is under way; not only in Latin America, but all around the world.

Efforts to educate populations about the importance of a healthy diet and the establishment of policies for assessing the quality of the food and its nutrients, as well as guidelines and a diversity of actions for access to healthy food, might help to reduce the alarming increase of obesity and chronic diseases, such as diabetes, in the Mercosur.

NCDs pose a major challenge for the populations of the Mercosur nowadays, because of their high prevalence and associated comorbidities. Obesity and diabetes are health conditions that affect individuals, governments and influence many aspects of health and life.

In public health, evidences suggest that public policies are essential to control obesity, diabetes and associated disorders. However, habit changes resulting from population policies are rarely effective, and the results depend on many variables. The campaign against smoking, which also involved public agencies and other sectors of society, through incentives, could be an example to be followed.

Several studies showed that healthy dietary interventions focusing in children, since pre-school, may significantly increase the consumption of fruit and vegetables, as well as add knowledge related to good nutrition, which become lifelong tools for better food choices. Children nowadays learn about food in schools, and receive excess information through the media and communication channels, which might be a benefit or a risk.

There are several points that must be analyzed on an approach towards a better health of individuals. Public health policies should focus in achieving adequate results, whilst preserving an individual’s autonomy and still looking for effective measures to control these both epidemics. These goals have not been reached so far.

We live in a time of food awareness, in which joint actions between states and citizens should be stimulated. Public and private health initiatives, especially those aimed at children, could be able to improve the current scenario in the near future.

We would like to thank CAPES for supporting clinical research in Brazil.

We thank the PPGBIOS Post graduate research Group, FIOCRUZ, Professor Dr. Murilo Mariano Villaça and Professor Dr. Maria Clara Marques Dias for their continuous feedback, guidance and comprehension regarding research initiatives in Latin America and elsewhere.

The authors show no conflicts of interest.

Tatiane AndreazzaLucchese,Amanda MaiaBreis,KarineRucker,Vagner RosaBizarro,Lis Marina MesquitaAraújo,AlessandreGomes,Mikele TorinoPaletti,Ana Luísa Conceiçãode Jesus,Marcella GarcezDuarte,Denise Rosso Tenório WanderleyRocha,Alberto KrayyemArbex,11, (2016) Diabetes, Obesity and the Nutrition Transition in the Mercosur. Open Journal of Endocrine and Metabolic Diseases,06,28-37. doi: 10.4236/ojemd.2016.61005