Berkley Center

Background: As part of the Education and Social Justice Fellowship, in June 2014 undergraduate student Adam Barton interviewed Caroline Dalabona, a staff nutritionist working at the national headquarters for Pastoral da Criança in Curitiba, Paraná, Brazil. In this interview Dalabona discusses the role of nutritional education in Pastoral’s work in terms of shifting nutritional trends affecting today’s Brazilian youth, with particular attention paid to Brazil’s nationwide obesity epidemic. 

What, in your own words, is the mission of Pastoral da Criança?

I think that the major focus of Pastoral is a full life for all children, with us doing all that is possible for these children to develop in the fullest form possible, considering all aspects that development encompasses—health, citizenship, education—so that these children truly grow and develop in all of the abilities that are necessary for them to become healthy and successful adults, no matter the circumstances. That is what is going to make a difference in the world in the future.

With respect to nutrition, what do you think would be ideal result for a family or a community followed by Pastoral?

The ideal result, when we speak of nutrition, is a healthy diet in terms of both quantity and quality; a diet that manages to include all of the food groups that are necessary for the health of any human being, beginning at pregnancy. And the parameter that Pastoral uses to detect if this is occurring is nutritional monitoring: you measure the height and weight of a child and determine if these measurements coincide with the child’s age. With this parameter, we can say, "Look, this child has conditions suitable for healthy development." or, "No, this child does not have the conditions necessary for healthy development, so we need to somehow intervene." And that, in most cases, directly involves nourishment and nutrition.
 
Pastoral has to train leaders and trainers to be able to talk with families about nutrition. Could you talk to me about the methodology behind these trainings?

Pastoral da Criança has 3 actions that deal specifically with nutrition. First, we have the Leader's Guide—a piece of our training material that covers specifically the subject of nutrition, beginning with gestational nutrition and ending with dietary information for six-year-olds, the age at which a child leaves Pastoral’s care. The leaders are trained in the material found in the Leader’s Guide, and from there are able to perform their job of bringing nutritional and dietary information to the mothers that they follow.

Our second action, called "Nourishment and Home Gardening," has leaders working with mothers from the community on creating healthy diets by way of planting community gardens to encourage the consumption of healthy foods.

And the third would be our work in nutritional monitoring, which is relatively new in Pastoral and is due to the nutritional transition that occurred in Brazil, along with the vast majority of developing nations, in which the prevalence of malnutrition fell greatly while the prevalence of obesity skyrocketed. I do not know if this issue exists or existed in the USA, but, at the time, obesity in Brazil was seen as synonymous with healthiness, even though we know that that is not the case—there are serious consequences for an overweight child. Seeing this, Pastoral began a research project in 2011, which involved speaking with various experts in the field of nutrition to see how we would be able to introduce a new tracking system in relation to the childhood obesity epidemic, and from there what type of interventions we could put in place. In the new nutritional tracking system, which occurs every three months, we use height along with weight at each age—something that we had not done before—in order to detect childhood obesity.

With regard to interventions for childhood obesity, we created a computer program that analyzes the measurements taken from the child, supplies the leader with information on the nutritional state of that child—“Oh, he is overweight,” “He is malnourished,” “He is obese”—and then refers the leader to a nutritional orientation card. So, for each nutritional state there is a specific card that the leader should give to the mother detailing health risks and next steps for the family.

Thinking about the current situation of children in Brazil, what do you think are some of the most pressing problems facing families with respect to health and nutrition today?

Something that is much discussed in today’s healthcare reality is Barker’s theory called the “First 1000 Days,” meaning the first 1,000 days of a child’s life, beginning in the womb. So I think that this is the most urgent problem: making known that these first 1,000 days are truly the most important in a child’s life, as they will be what determines a whole series of factors in that child’s life. If this child will have high blood pressure, if he could be obese in the future, if he will grow to be a normal height, all of this depends on the diet of the pregnant mother, the child breastfeeding exclusively up to six months of age, and the nutrition of the child in the first two years of his life. In short, by caring for these first 1,000 days, you are caring for the health of an adult.    

What have you learned in your time working with Pastoral? 
 
I think that working with Pastoral allowed me to understand what it means to work “populationally,” that is, to work with populations, as there is no possible way to do an individual consultation with each child and each family. Rather, one must launch actions that can be disseminated to the most people who are in need. And I think that Pastoral has as a characteristic—due to its solid hierarchy and strong training system—the ability to ensure that information arrives to those who most need it. Pastoral’s work is of quality; it is something that functions. 

With regard to the question of faith: I think the fact that Pastoral is linked with a church, whether Catholic or any other, as something truly beautiful as it ends up involving people in a very spontaneous and real way, a way that is truly about caring for the other, and I think that this is something that is very necessary in today’s world. Working with those close to you, with your neighbors, with those who are most in need, that is a beautiful thing.

Is there anything else that you would like to share with me? 

Yes. In truth, we know that nowadays, here in Brazil at least, cases of extreme poverty are very rare—that is, people who have nothing to eat because they do not have access to food. So, in some way, all families have access to some type of nourishment. But the question is: to what type of nourishment do these families have access? What quality of food? From there we see the question of education becomes an important one in order to know what type of food should be given to your child. 
 
Sometimes, perhaps because they want to be accepted by their community, mothers also want to drink Coca-Cola and have that special stuffed cookie, just because they have the means to have these foods in their homes. This, however, does not necessarily mean that these are the best foods to give to your child.

So I think that this educational work, this work of raising the awareness of mothers and their families, is one of the most essential responsibilities of Pastoral. I think that it is the biggest issue that Pastoral must face, and I would say that it is one of the most difficult to confront, because changing another’s attitude is always one of the greatest challenges.