VERA PERINO

Brazil,

Although Brazil struggled with issues of severe malnutrition in the past, since the 1990s obesity among children has become an increasingly alarming but unreported problem. Vera Perino is transforming the way Brazilian society perceives and addresses obesity by looking at both its causes and symptoms, while sparking deep behavior change and offering alternative lifestyle opportunities to low-income children and their families.

This profile below was prepared when Vera Perino was elected to the Ashoka Fellowship in 2010.

INTRODUCTION

Although Brazil struggled with issues of severe malnutrition in the past, since the 1990s obesity among children has become an increasingly alarming but unreported problem. Vera Perino is transforming the way Brazilian society perceives and addresses obesity by looking at both its causes and symptoms, while sparking deep behavior change and offering alternative lifestyle opportunities to low-income children and their families.




THE NEW IDEA

Brazilians have been slow to acknowledge the emergence of obesity as a serious problem to grapple with because of their country’s traumatizing past with malnutrition. Various medical doctors have begun addressing the physical symptoms of the disease under the assumption that it can be quickly treated with drugs; but they usually fail to recognize the psychological, behavioral, and socioeconomic factors that lead to obesity. Vera is leading the way in addressing this issue among low-income overweight children and youth. She is dismantling the restrictive approach of diets and medical treatment, and replacing it with a methodology that positively incentivizes lasting behavior change. Vera is bringing psychologists, physiotherapists, nutritionists, physical education teachers, and endocrinologists together to address the various facets of the issue through fun and participative activities.

Vera began implementing her approach in 2004 when she founded the Movere Institute, which offers free treatment to low-income children and spreads awareness about this problem to health professionals, schools, governments, and Brazilian families. By working with both children and their families, Vera is having a lasting impact on their lives. The results could not be more tangible: Improved eating habits; reduction of body weight and fat; increased fitness levels; improved self-esteem; and disease prevention. Constant monitoring and evaluation have allowed Vera to improve her methodology and to become a leading expert in this field.

Vera operates by the motto: “Small changes. Great results.” She has worked with more than 1,400 families, hundreds of schools and citizen organizations (COs), chefs throughout Brazil, and several recognized researchers in the field. Vera is on her way to changing the manner in which Brazilian society perceives and addresses obesity. In order to ensure the institute’s sustainability, Vera is diversifying Movere’s organizational structure. She is getting ready to open a new facility to offer her services, free of charge, to low income communities closer to their homes. This facility’s operations will be “subsidized” by for-profit gyms that will focus on providing preventative health care services to the base of the pyramid. Movere is also developing a partnership with the Ministry of Health which will allow Vera to spread her approach throughout the country.




THE PROBLEM

Within the last 20 years, Brazil’s rates of obesity among children have skyrocketed by 240 percent. Today, an alarming 10 percent of children and 17 percent of adolescents are overweight, regardless of socioeconomic status. This drastic increase can be traced back to a few critical social and economic factors, such as rapid urbanization and globalization, a historical culture of scarcity, and a reactive and restrictive medical culture.

Brazil’s rapid economic growth and urbanization coupled with intense processes of globalization have caused several important changes, such as the emergence of a fast food culture; a dramatic increase in the number of women as heads of the family; and the largest poverty reduction effort in the past 14 years. As a result of these cultural and economic transformations, the Brazilian family’s eating habits have changed drastically. However, unlike the U.S., Brazilian cities do not have structures and public spaces that promote physical education.

These problems are exacerbated by Brazil’s recent history with prevalent malnutrition. The pervasive culture of scarcity this has engendered means that most Brazilians have a hard time worrying about eating too much. A significant number of adults, many of whom come from rural areas, have experienced hunger firsthand. Their traumatic personal experiences often make it difficult for them to impose seemingly unnecessary limitations on their children. Meanwhile, richer families tend to be embarrassed by the issue and therefore decide to ignore it. In addition, obese children and teenagers are discriminated against and often suffer from psychological and physical health problems. The psychological aspects of obesity often exacerbate its physical symptoms and degenerate into much graver health problem such as heart disease.

As a result of these historical and cultural factors, obesity has become an important public health problem in Brazil. It currently costs the state approximately R$1.5B a year (US$807M) to address this medical issue, representing 12 percent of the general health care budget. According to the Ministry of Health, the number of stomach reduction surgeries augmented by 542 percent between 2001 and 2009. This highlights Brazil’s myopic emphasis on addressing the symptoms of obesity, as opposed to its causes. It is now common practice to treat overweight people by medicating them, thus ignoring the emotional and psychological causes of the disease as well as the need to change habits and behaviors through a cross-disciplinary approach.

In 2004, the World Health Organization published a study emphasizing the need to focus on the prevention of obesity among low-income populations in Brazil. Very few individuals, such as Vera, are acting on this recommendation. It is exactly because of the complexity of this problem that children and adolescents are particularly vulnerable: An obese child is 30 percent more likely than anyone else to remain obese into adulthood. This risk increases 50 percent for overweight adolescents. Dealing with this issue in Brazil entails coming to terms with many preconceived notions about hunger, poverty, and well-being.




THE STRATEGY

Throughout her professional life, Vera began to understand the complex correlations between obesity, poverty, education, and culture. She also noticed the disconnect between socioeconomic factors and the current treatment options offered to obese children in teaching hospitals. It became clear to her that their restrictive approach would never efficiently address the causes of this multi-pronged problem. She understood that she could attain sustainable impact by bringing together a multidisciplinary team of psychologists, physiotherapists, nutritionists, physical education teachers, and endocrinologists to simultaneously address the psychological and physical causes and symptoms of obesity. This eclectic group of professionals develops activities that serve as opportunities to change behaviors and bring families together.

Vera founded the Movere Institute in 2004 to provide an unprecedented alternative to children and families struggling with weight problems. She has developed a methodology where low-income, obese youth are given fun incentives to change their habits. They are taught to proactively enhance their own well-being through non-prescriptive measures: They write plays, share healthy recipes with their colleagues, suggest topics to discuss with the psychologist, and monitor their own achievements on a monthly basis. Thus, the children become subjects and leaders of change; they learn how to overcome challenges and begin to make conscious choices to become healthier and happier individuals. They decide what and how much to eat, how long to spend in front of the television, what physical activities to engage in, whether to take the bus or walk. As a result, not only do they begin to develop better lifestyles, lose weight, and avoid developing other health problems, they also gain confidence in their abilities to surmount challenges, learn how to work in teams, and reduce their propensity to become self-conscious, depressed, and anxious.

At Movere, low-income children between the ages of six and seventeen come together three to five times a week to participate in experimental cooking classes and physical activities. Vera and her team choose participants by evaluating the children’s clinical states and by engaging with their families from the very first day to determine whether there is an overall commitment to change. Ensuring that the whole family adheres to lessons learned at the Movere Institute has been crucial to the approach’s effectiveness. This process of experiential education leads to significant behavior change and promotes conscious choices cross-generationally. Children learn about teamwork and discipline and become comfortable talking about their passions and preoccupations, while families get involved by participating in monthly meetings and field trips to the supermarket, clubs, museums, and sport tournaments. They also learn how to prepare affordable but healthy meals while minimizing waste.

Although Movere began its work by focusing on re-educating youth and their families to adopt healthy behaviors, Vera has since expanded her organization’s vision to share the Movere approach with cooks, school caretakers, and COs through delivering trainings. In addition, Movere implements in-depth courses targeting health professionals to disseminate the institute’s methodology and transform the way they understand the complex factors that cause obesity. Finally, since Vera is concerned with transforming the way Brazilian’s view this issue, she is also spreading awareness to key players and society as a whole.

This evolution in Vera’s strategy began with the establishment of a partnership with PepsiCo that began in 2006 and lasted three years. She decided it was time to bring her approach to the public school system, thus benefitting approximately 1,000 children that year. Vera trained teachers to incorporate her methodology in their classrooms and physical education teachers received textbooks containing more than 100 lessons. All of the students benefitted from their interactions with her curriculum and Vera used this first experience to systematize her learnings through her Ph.D. thesis and the publication of a book entitled, The Prevention of Obesity during Childhood and Teenage-hood: Exercise, Nutrition and Psychology. This book positioned her as a leader in this field and spread awareness nationwide about the issue of obesity.

By establishing partnerships with PepsiCo, Novartis, Brazil Foundation, and Eletropaulo, among others, Movere has worked with more than 1,400 families (approximately 7,000 individuals). Practically all participants have drastically changed their eating habits and improved their health. These results are monitored scientifically through physical and written exams, body language, and surveys. Most recently, Movere has partnered with Nestlé and Sao Paulo’s Secretariat of Social Assistance, to train more than 300 schools and COs in seven states to become Movere cooks and educators. As a result of the program’s success, Vera was invited by the secretariat of another principality to provide courses to local schools and government bodies.

Although these initiatives have been quite successful, Vera noticed early on that health professionals were still uncomfortable with the idea of cooperating across disciplines. She has therefore created an in-depth course to entrench her cross-disciplinary approach and disseminate it through lectures. Vera has been offering this course for four consecutive semesters and has provided training to 400 professionals at Brazil’s most influential clinical laboratories: Fleury and Mars. The Santa Casa Medical School, where Vera did her Ph.D., is now planning to offer the institute’s curriculum as a professional specialization course.

With a good initial track record, Vera is now thinking strategically about the institute’s sustainability. She has all the elements in place to develop a revenue generating initiative. The strategy includes: Establishing the Movere Institute’s Headquarters and Research Center on the east side of Sao Paulo (the poorest and most populated region) to offer free treatment to low-income communities; implementing fee-for service, in-depth courses targeting professionals—Movere has already conducted a feasibility study to launch these courses; and operating gyms as social businesses that offer low-cost health activities to the bottom of the pyramid, thus subsidizing Movere’s free activities.

By affecting three generations at the same time (i.e. children, parents, and their future families), this multi-pronged approach has the potential to reduce the health care cost related to obesity by at least 8 percent nationally. Thus, Vera is pursuing partnership opportunities with the Ministry of Health. Her ultimate goal is to re-establish a healthy link between human beings, the earth, and nourishment.




THE PERSON

Vera was strongly influenced as a child by her father’s social commitment. He frequently took her and her siblings to different areas of the city to give them a true appreciation of different socioeconomic realities and to elicit a desire to become active citizens. He was an Attorney General and a community leader.

In high school, Vera became recognized as a leader as a result of proactively defending children who were being bullied, publishing newspaper articles in the 1970s (i.e. during the dictatorship) and by spearheading charitable activities. At the age of 17, Vera decided to become a mother, even though everyone encouraged her to remain an “independent woman.” She confronted her parents, and society, and left with her boyfriend to raise her children. They became her priority and she decided that above all else, she would bring them up in a rich learning environment.

Nine years later, Vera realized that she needed a new challenge and she opened the region’s first natural product store with her brother. She also decided to pursue postsecondary studies. Vera enrolled in university preparatory courses, and at the age of 33, she began her university degree. She originally thought of pursuing pharmaceutical studies, until she realized that physical education would provide her with exactly what she was looking for: A renewed connection between body and mind to promote better health. Driven by sheer determination (while she was still taking care of her children and the store) Vera became involved with community initiatives at the university. It was during her specialization that she first became aware of the issue of obesity and became passionate about it immediately.

Although Vera began her professional life relatively late her experience as a mother was crucial to developing Movere’s methodology. As a mother she could understand the complex factors that led to obesity, pursuing her studies in a teaching hospital, Vera had the opportunity to attend to patients by creating an interdisciplinary connection with various professionals and specialists. She realized how important it was to adapt treatment to each patient, and encouraging lifestyle changes was equally important.

Initially, one of Vera’s challenges was to find support for her approach among medical professionals. After 14 years of work and studies in the field of childhood obesity, she created the Movere Institute of Community Actions: An unprecedented initiative in Brazil that brings interdisciplinary care to overweight children from low-income backgrounds. Thanks to greater access to information about obesity and lifestyle changes, Vera hopes that one day obesity will cease to be such a prominent problem and attention will shift to prevention rather than treating its symptoms.