MEXICO CITY — When Maria Guadalupe Ramirez set up a snack stand a few years ago to help support her five daughters, they started eating most of their meals in the streets.
"I used to cook at home for the girls every day," she said, "but working at the stand makes that hard to do."
The girls have paid in extra pounds, fueled by a culture of street food awash in grease. The cheese tortillas Ramirez fries up for pedestrians are as ubiquitous across Mexico as the fried pork rinds known as chicharones that sprout from pushcarts. For the sweet tooth, there are churros -- twisted sticks of fried dough -- and oceans of soft drinks to wash it all down.
Throughout its history, Mexico has struggled against malnutrition. Now that it is making gains against that blight, the scales have tipped in the other direction. Profound shifts in the country's diet, lifestyles and employment patterns over the last generation have made Mexico one of the fattest nations on Earth, close behind the U.S.
As more women leave the kitchen to enter the workforce, household spending on fruits and vegetables is dropping. Fried-snack vendors obstruct the bike lanes in Chapultepec Park, where the Ramirez family snacked during a recent outing. Guzzling an orange soda, 15-year-old Sofia, the eldest of the five overweight Ramirez children, described her favorite meal: tacos campechanos, an artery-clogging steak-and-sausage combo.
Mexican officials have identified obesity as the country's fastest-growing health problem. And unlike Mexico's chubby northern neighbor, this country's anemic public health system is proving far less capable of bearing the weight.
The first alarm sounded when a 1999 government study showed that obesity rates among Mexican women had tripled over the previous 11 years. The nutritionist who oversaw the nationwide survey was so astonished that he asked an independent panel to review the data before publication.
Mexico's numbers -- based on an international scale called the body mass index, which measures weight relative to height -- have continued to grow. The latest show that 64% of women and 60% of men are overweight. Twenty-four percent of the overall population is classified as obese, second only to the United States in last year's survey of 27 industrialized nations of the Organization for Economic Cooperation and Development. The survey listed 31% of Americans as obese.
Another alarm rang two years ago, when endocrinologist Sara Arellano Montano noticed parents bringing their children to the Obesity Clinic, which she runs at the General Hospital of Mexico. Of the clinic's 3,000 outpatients, who come in periodically for blood tests and guidance on diet and exercise, more than 400 are 18 or younger.
"For the first time in Mexico, we are seeing diabetes mellitus in children between 8 and 18," Arellano said, referring to the most common form of diabetes, in which sugar and starch are not properly absorbed from the blood. "Only part of the explanation is hereditary. It is mostly the way these kids are growing up -- sitting in front of the TV, the computer, the Nintendo, munching on fried snacks, gulping soft drinks."
Diseases associated with obesity claimed more than 300,000 lives in Mexico last year, government researchers say. Over the last two decades, as nutrition has improved for the rural poor, such ailments have become more widespread among adults than Mexico's traditional killers, the infectious and parasitical diseases that prey on the malnourished.
Among the school-age population, the rising number of overweight children has drawn even with the declining number of those who are malnourished.
"Obesity has reached epidemic proportions," said Juan Rivera Domarco, director of nutrition research at the National Institute of Public Health. "It is creating a health crisis with potentially catastrophic consequences."
Those consequences include more patients with diabetes and heart disease than Mexico's medicine supplies, clinics and specialists can treat. About one in 10 Mexicans has diabetes, but in each of the last five years the public health system has run out of some types of insulin, obliging patients who can afford the medicine to pay for it out of pocket.
The fattening of Mexico is part of a global pattern that this year prompted the World Health Organization to launch an international campaign against obesity. Rural migrants swell the cities, where advertisers persuade them to replace their traditional protein- and vitamin-rich diets with empty calories. Tractors, cars, public transportation, television and home computers make people more sedentary. Urban sprawl crowds out athletic fields.
Some researchers say the exodus of women from the kitchen has been the biggest factor in Mexico's spreading girth.
