An Extra Helping Hand: Changing Behavior to Fight Adult Obesity

Suparna Ferreira is the Founder and CEO of Bienestar, a US-based non-profit whose mission is to promote effective, empowering, affordable, culturally appropriate, fun lifestyle/behavior change to manage weight, for life. Bienestar’s story is inextricably linked with Suparna’s story of losing 40 pounds and dropping cholesterol by 50 points. Suparna has 20 years of management, consulting, and performance improvement experience in healthcare and financial services. Suparna has an MBA in Finance from India, and a Masters in Health Sciences from Johns Hopkins University, Bloomberg School of Public Health. 

Around the world, especially in North America, adult and childhood obesity rates are increasing as consumers embrace diets heavy in saturated fats and low in fruits and vegetables. Mexico recently surpassed the United States as the country with the highest obesity rates in the world for a populous country, a public health crisis that has translated into increased spending for chronic diseases. Policy makers are struggling to respond to the staggering human and economic cost of high obesity rates with initiatives such as First Lady Michelle Obama’s nationally focused Let’s Move! campaign and community-based urban gardens. Into this escalating public health problem steps Suparna Ferreri’s Bienestar, with a mission to help Mexico’s adults manage a healthy and sustainable weight.

Why is the mission of Bienestar specifically focused on adults? Mexico’s children have some of the highest obesity rates in the world, so why target adults instead of focusing on healthy eating and activities with children?

Well, this comes back to also the fact that this is a social entrepreneurship. It is not purely a charity program, for which I think childhood obesity is a very good candidate. The reason why adult obesity makes more sense for social entrepreneurship is because it is a business-to-consumer model in the sense that I am requesting that people pay. It is a sliding scale, but you still get people to pay for the service. Part of the hypothesis that I am testing is that actually with obesity, and with any lifestyle change issue that requires a lot of effort from the person who is engaging in it, part of engagement, at least up front, is the monetary part of it. So what is the behavioral economics of a free model versus a model in which you pay?

The other important thing is that if you look at obesity in the adult population, it is truly a lifestyle issue in the sense that these are choices that adults have made throughout their lives and so it is a learned behavior. With a lot of children, to some extent, they are the victims of the circumstances that they have. So if you are really looking at lifestyle changes focused on individual empowerment, and the human being and the individual changing their own circumstances, it makes more sense to focus on adults.

The third thing that I am experimenting with is actually where do habits come from? Where do we learn? We learn from our families and grandparents and our parents. So part of the hypothesis that I am testing is also what happens to the rest of the family when you help the adult improve their circumstances, and does that translate to the improved health of the child or not. So part of the outcomes that we measure is the weight of the child when the parent starts the program and six months, a year, and 18 months later. We fully expect to find that in households which did have obese children, that without having done the intervention with the child, that they will show an impact as well as the adult. So that is the overall view.

What national systems are in place for combatting this public health issue? What are the challenges to your message, government support, or coalition building?

Actually in Mexico, they have universal coverage with the three different insurance systems that they run. They definitely are interested in implementing preventive care programs because a large portion of their overall budget is going towards chronic care and hospitalization. We quickly realized that you get a lot more bang for your buck if you spend on preventative care.

The other thing is that a lot of states in Mexico and the federal government are interested in public-private partnerships. So I would probably leverage both the federal insurance systems as well as this idea of public-private partnerships, both at the state and federal level. I was meeting Salomon (Chertorivsky) just now, the last health minister for Mexico, and he was also talking about the fact that Mexico is not only interested in public-private partnerships, but also interested in alternative models of business. So the idea of social entrepreneurship in the social sector where you are not only taking a policy approach or you are not only taking a capitalistic approach to a problem, but are trying to blend the best of a lot of these models and build a community-based approach to something like this.

A lot of what they are doing today with obesity is being addressed through the government healthcare system, which is run by the doctors. They have a program called 5 Pasos or 5 Steps: drink more water, eat more vegetables, exercise, that kind of thing. But again, they find that is having a limited impact for many reasons.

Another part of what Bienestar is experimenting with is what happens when we take everything back to the idea of community medicine. If you look at your grandmother’s generation and your mother’s generation, there was a lot of common sense in what we did. There was a lot of us helping each other versus running to the doctor because you sneezed this morning. So I am trying to bring back that basic sense of community, of people healing people.

I worked with a lot of medical appointments when I worked at Sutter Health, and one of the most powerful things that I saw was not what the counselor or the doctor or the nurse was telling people, but the dialogues that they would have within themselves, the thoughts that they shared with each other, or the emotional support that they would give each other to overcome a difficult issue. You know, this is a journey that you make in trying to overcome obesity for life, and is something where you avoid recidivism and it becomes a life-altering decision that is with you for the rest of your life.

One of the best things that you can do is actually connect with other people who are going through the same things themselves. Microfinance understands it; Alcoholics Anonymous understands it.

Mexico still struggles with food insecurity and it is a nutritional transition country with both problems of malnutrition and hunger. Do you find a tension when you discuss obesity in a country that still faces hunger issues?

Not at all. And I have seen this in India as well, which if anything, has even more chronic problems than Mexico with this issue. I think people are beginning to recognize that it took a lot of countries by surprise. If you just look at the trend in the last 15 years, 20 years, it has really come up on us within a generation.

There are lots of corner stores that sell basic fruits and vegetables – it is not as much the issue of food desserts as it is in some cities of the US. It may not be organic and all that fancy stuff, but it is still fresh fruits and vegetables. So it is not an availability problem. It may not have as much abundance, but it is an access problem from the perspective of cost – more of monetary cost than time. And that is really the biggest thing that I tried to deal with and understand is in the middle income and lower income communities is that time is added value to a lot of people.

So that is why I call it a life-altering experience. Because when you try to deal with this issue, it touches not just what you consume, but how you spend your time. How much time do you spend watching TV, and is there something better you can be doing for yourself. So it really becomes those issues and not just access issues of what kind of nutrition that is available to people.

This interview has been edited and condensed for clarity.

Feature Photo: cc/(Caillum Smith)