24 July 2018Cuba: More than old Buicks and the Buena Vista Social Club

Cuba is a country somewhere frozen in time before 1959, characterized by old Buicks and Chevrolets, rusty bicycles, and Spanish architecture painted in pastel colors. While studying the Cuban public health system this summer, I gained new insights into the age-old question of whether decreasing calories and increasing exercise really work to lose weight. It seems so simple; however, with so much misinformation about losing weight and a plethora of fad diets abounding on the internet, one begins to wonder what will truly work to lose weight. However, learning the history of Cuba and spending time among the Cuban people, showed clear support for this old remedy.

After the collapse of the Soviet Union in 1989, subsidies from the motherland for food and gas stopped abruptly, and the economy plummeted. During this crisis or "special period" as it is called, shortages of food occurred. The number of calories eaten each day per person decreased from about 2800 calories per day to about 1800 calories per day; consequently, there was an average decrease of 1000 calories per day. The prevalence of obesity (people with a body mass index of greater than 30) declined by 50% with an average loss of 10 pounds or 5.6% of body weight. Interestingly enough, the Dietary Guidelines for Americans, which all of the food labels are based on, recommends 2000 calories per person.

Due to food shortages, it was illegal to eat large whole pieces of meat, such as a steak or pork cutlet. Thus, the meat in meals were stretched by adding vegetables such as carrots and potatoes and a variety of locally grown root vegetables. Ironically, when I teach clients today how to modify recipes to make them healthier, we discuss ways to decrease the meat portion and increase vegetables in traditional recipes. This recommendation is to cause a reduction in the total calorie count of the meal with all other benefits of eating vegetables left unmentioned. For example, when making burritos, decrease the hamburger and add sautéed vegetables, such as chopped carrots, celery and onions in addition to increasing the beans. When making stews decrease the meat by half and double the vegetables by adding more carrots, celery, onions, turnips and parsnips. Similar to our stew, the Cuban national dish which was popular during this "special period" is called "Ropa Vieja" or old clothes and is still nostalgically served in restaurants today.

Shortages of fuel meant that there was not enough gasoline for public transportation such as buses as well as private cars. Thus, there was an increase in physical activity by adults from 30% to 67% because they were now walking and bicycling more as their means of transportation. A survey during this "special period" defined an "active" person as someone who participated in moderate or intense physical activity for at least 30 minutes at least 5 days a week. This physical activity guideline is exactly what the American College of Sports Medicine recommends for us today.

The combination of these two changes of reduced calories and increased physical activity not only helped to decrease weight, but also to decrease the prevalence of some chronic diseases. In most cultures, as the weight increases, so does the prevalence of type two diabetes. In Cuba, between the years of 1989 and 2000, as body weight and additionally the body mass index (BMI) decreased, deaths caused by type two diabetes decreased by 51% while deaths attributed to coronary heart disease decreased by 35%. Of course, we do not want to repeat this horrific time period for the Cuban people; however, one can truly see the correlation between weight and type two diabetes and heart disease on a population-wide scale.

In conclusion, if you ever wondered whether decreased calories intake and increased exercise work to decrease your risk of diabetes and cardiovascular disease, look at the population changes that occurred during the "special period" in Cuba between the years of 1989 and 2000. These two changes demonstrated that with simple steps such as increasing bicycling and walking in tandem with decreasing calories consumed will not only cause sustained weight loss, but also have the positive effect of decreasing the chronic diseases of type two diabetes and heart disease.

Martha M. Henze, MS, RDN. Traveling Taste Buds, LLC. While working on her master’s degree in global epidemiology from the Colorado School of Public Health in Denver on the Anschutz Medical Campus, Martha has enjoyed traveling to Cuba with her class and looking at how to make nutrition and public health changes using a community-based approach.
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Exercise/Health Weight Loss/Behavior

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