By ANDREW JACOBS and MATT RICHTEL
Few predicted when Mexico joined the free-trade deal that it would transform the country in a way that would saddle millions with diet-related illnesses.
SAN CRISTÓBAL DE LAS CASAS, Mexico — William Ruiz Sánchez spends his days grilling burgers and slathering fried hot dogs with pepperoni and cheese at his family’s restaurant. Refrigerators and fire-engine red tables provided by Coca-Cola feature the company’s logo in exchange for exclusive sale of its drinks.
Though members of the Ruiz family sometimes eat here, they more often grab dinner at Domino’s or McDonald’s. For midday snacks, they buy Doritos or Cheetos at Oxxo, a convenience store chain so ubiquitous here that nutritionists and health care advocates mockingly refer to the city as San Cristóbal de las Oxxos.
The family’s experience in food service began in the 1960s, when Mr. Ruiz’s grandmother sold tamales and home-cooked food made with produce from a nearby farm; those same ingredients sustained her boys with vegetable stews, beans, tortillas and eggs. Meat was a luxury.
Since then, the Ruizes have become both consumers and participants in an extraordinary transformation of the country’s food system, one that has saddled them and millions of other Mexicans with diet-related illnesses.
It is a seismic shift that some nutritionists say has an underappreciated cause: free trade.
Mexico began lifting tariffs and allowing more foreign investment in the 1980s, a transition to free trade given an exclamation point in 1994, when Mexico, the United States and Canada enacted the North American Free Trade Agreement. Opponents in Mexico warned that the country would lose its cultural and economic independence.
But few critics predicted it would transform the Mexican diet and food ecosystem to increasingly mirror those of the United States. In 1980, 7 percent of Mexicans were obese, a figure that tripled to 20.3 percent by 2016, according to the Institute for Health Metrics and Evaluation at the University of Washington. Diabetes is now Mexico’s top killer, claiming 80,000 lives a year, the World Health Organization has reported.
For many Mexicans, Nafta promised to make real “the fever dreams of joining the modern economy,” said Timothy A. Wise, a trade expert at the Small Planet Institute and Tufts University. “All former rural workers would be in new jobs in the burgeoning manufacturing industries of the post-Nafta world. That just hasn’t happened.”
“The only way that Mexico became a ‘first world’ country was in terms of diet.”
The phenomenon is not limited to Mexico. Research shows free trade is among the key factors that have accelerated the spread of low-nutrient, highly processed foods from the West, “driving the obesity epidemic in China, India, and other developing countries worldwide,” according to the T.H. Chan School of Public Health at Harvard.
But Jaime Zabludovsky Kuper, Mexico’s deputy chief negotiator on the pact, said Nafta didn’t cause obesity. Instead, he said, it lowered food prices and reduced malnutrition. In 2012, 1.6 percent of Mexican children suffered from severe malnutrition, a sharp drop from 6.2 percent in 1988, according to government data.
Mr. Zabludovsky said that Mexicans had long been enticed by American food, and that high tariffs used to make it expensive, not unavailable. The economy is now more stable, he said, and Mexicans are living longer — which is partly why more people are dying from noncommunicable diseases like diabetes and heart disease. “It’s a symptom of relative prosperity,” he said.
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The broader pros and cons of Nafta have come under increasing scrutiny given President Trump’s threats to dismantle it. Among its chief champions are American farm and food-retailing interests whose fortunes have benefited tremendously from the open market. Mexican exports to the United States have surged, and a more stable economic structure has evolved in Mexico. The country’s unemployment rate has stayed mostly constant, but average wageshave fallen to $15,311 in 2016 from $16,008 in 1994, according to the Organization for Economic Cooperation and Development.
Critics of Nafta acknowledge the complex causes of obesity, but argue free trade intensified the problem by opening Mexico’s largely isolated economy.
In addition to dramatically lowering cross-border tariffs, Nafta let billions of dollars in direct foreign investment into Mexico, fueled the growth of American fast food restaurants and convenience stores, and opened the floodgates to cheap corn, meat, high-fructose corn syrup and processed foods.
The surge in agricultural investment from the north modernized Mexican farming practices but it also displaced nearly five million people who worked on family farms. Many migrated to cities, adding to the ranks of those who rely on Western, processed food.
The top two grocery chains and most of the top food service outlets in Mexico are American backed or partners with companies like Walmart, Subway and Pizza Hut. Oxxo, the convenience store chain, is owned by Femsa, a Mexican food and beverage conglomerate that received hundreds of millions of dollars in foreign investment, helping it grow to 16,000 stores from 400 in 1990.
The Ruiz family followed a characteristic narrative, migrating from family farms to cities and adopting the new American-style diet, not just as consumers but as middlemen. They buy ingredients for their restaurant, including cheese, mayonnaise and ground beef, from Sam’s Club, the members-only retail giant owned by Walmart.
“I like that a lot of their meat comes from American cows,” said Mr. Ruiz, 28. “It’s softer and fattier than meat from Mexican cows.”
Mr. Ruiz, at 275 pounds, and his older brother, Gabriel, at 300, are notably overweight. Their parents’ diets have also changed: Two years ago their father suffered a stroke brought on by hypertension, while their mother has diabetes.
Across the world, trade deals have made food more affordable and accessible. A major selling point for the World Trade Organization, founded in 1995, was that it would relax trade barriers so “food is cheaper” — though such deals can also influence diet for the worse.
In 2007, Samoa, the South Pacific republic, banned the import of turkey tails, a fatty, fried delicacy that nutritionists say has played an outsized role in the island’s roughly 30 percent obesity rate. But when Samoa joined the World Trade Organization in 2012, it was forced to lift its ban on turkey-tail imports.
Nafta’s impact has been far more pervasive. Direct United States investment into Mexican food and beverage companies soared to $10.2 billion in 2012 from $2.3 billion before Nafta, and the link to the trade deal is undisputed; the United States Department of Agriculture states, “Many of these investments were initiated following implementation of” Nafta.
The stark changes carried the Ruiz family along for the ride.
From Farm to Fast Food
During a lull one recent evening at the their restaurant, Dogo Express, the mother of William and Gabriel, Maricela Sánchez Espino, 62, reminisced about her childhood. Her parents raised corn, zucchini, mushrooms, pigeons and rabbit, and the family ate what they grew.
Her husband, Gabriel Ruiz Barbosa, 60, also grew up in rural Mexico. His father, a farmer and beekeeper, was murdered, and his mother made ends meet hawking homemade food.
Mr. Barbosa studied agricultural engineering, but Mexico was moving away from its reliance on small family farms.
Until the mid-1980s, Mexico had been a protectionist, inward-looking economy but a financial crisis in the early 1980s spurred talk of free trade to stabilize the country, attract foreign investment and spur growth.
In 1986, Mexico gained entry into the General Agreement on Tariffs and Trade — the precursor to the World Trade Organization — which lowered tariffs and relaxed rules on foreign ownership of companies.
To its supporters, Nafta would complete the transition. “It was a change in the economic model,” said Mr. Zabludovsky, the deputy chief negotiator. “We started to seek the advantage of the geographical proximity to the United States.”
The agreement removed hurdles to cross-border investment and fully eliminated Mexican restrictions on foreign majority ownership in Mexican companies. The United States, Canada and Mexico became an open trading bloc.
Mexican exports of fruits and vegetables to the United States soared; enormous quantities of the raw ingredients of processed foods flowed in the other direction.
Last year, more than half the agricultural products exported from Mexico to the United States were fruits, vegetables and juice, while these foods made up only 7 percent of what the United States exported to Mexico, according to the United States Department of Agriculture.
United States exports to Mexico have been dominated by meat, soybeans and corn. The average annual value of grains crossing into Mexico jumped to $4.7 billion in 2016 from $897 million before Nafta. Pork and beef exports also surged during the same period; exports of high-fructose corn syrup jumped to $345 million annually from $5 million.
After Nafta, Mexican farming became more efficient, but also contributed to a major shift in how the industry was structured. Overall paid employment of farm workers rose by 2.8 million but there was a displacement of 4.8 million people who left family farms, according to a study by the Woodrow Wilson Center that has been cited by some Mexican officials as evidence of Nafta’s imperfections.
Duncan Wood, director of the center’s Mexico Institute, said falling food prices, coupled with a stagnant economy, have left many Mexicans in a curious economic position. “People are able to indulge in more processed food, consuming more calories,” Mr. Wood said, “but not rich enough to have an affluent lifestyle where they are able to be healthier.”
So went the Ruiz family. As a boy, William Ruiz adored home-cooked meals like traditional thick stews with squash, carrots, potatoes and green beans. The family rarely ate out.
But when he was 11, the family moved to Villahermosa, the bustling, heat-scorched capital of Tabasco where American fast-food joints had become plentiful. The Ruizes became avid patrons of Domino’s and Burger King. McDonald’s was their favorite.
William savors the memory of his first Happy Meal — the crispy fries, chicken nuggets and toys nestled in the box. “It was like having something first-world on your uncivilized ranch,” he said, “It was beautiful.”
In 2012, after the bar they owned in Tabasco went out of business, the family moved to San Cristóbal and opened Dogo Express.
The sons began to put on considerable weight in their late teens but the elder Mr. Ruiz was not worried. In fact, it was a point of pride. “We were in a good financial position so we could offer them foods heavy in protein and also fast food,” he said. “We’d say to one another, ‘If they’re a little fat, it means they’re well fed.’”
Rise of the Chains
On a recent Sunday, the Ruiz brothers went to Sam’s Club to stock up for the restaurant. They like the expansive meat section with marbled beef that is often cheaper than the sinewy cuts sold by local butchers.
They are in good company. A study published in 2015 found that Mexicans bought, on average, 1,928 calories of packaged food and beverages a day, 380 more calories than in the United States and more than people in any other country tracked by Euromonitor International, a market research firm.
While the causes of obesity are complex — involving genetics, lifestyle changes and other factors — multiple studies have linked weight gain to consumption of processed foods high in salt, sugar and fat that are staples of retail giants.
In 1991, as negotiators hammered out Nafta’s details, Walmart made its first foreign investment by partnering with Mexico’s largest retailer, Cifra.
In 1997, Walmart paid $1.2 billion for a controlling stake in Cifra. Walmart is now Mexico’s largest food retailer.
Oxxo is second in grocery market share. It is also the largest convenience store chain, with a 75 percent market share, according to Euromonitor.
Although Oxxo is owned by Femsa, a Mexican company, it has significant outside investment. In 1993 Coca-Cola purchased one-third of Femsa’s soft-drink unit for $195 million, not long after PepsiCo had announced it would spend $635 million to expand in Mexico. Then, in 1994, the Canadian brewing company Labatt invested $510 million in Femsa’s beer business.
The money gave Femsa capital to buy down debt, helping it grow.
“Money flowed south. It’s one of the reasons the growth of these foods is so fast in these countries,” said Corinna Hawkes, director for the Centre for Food Policy at City University London and an expert on trade policy and nutrition. “Oxxo is exactly the kind of thing we’re talking about.”
Such products are core to Oxxo’s success. In its 2003 annual report, for example, Femsa boasted that Oxxo had become “the largest vendor of beer and soft drinks, as well as telephone cards, cigarettes and bottled water.”
Javier Astaburuaga, Femsa’s chief financial officer for 11 years, dismissed the role of free trade in the rise of obesity, saying unhealthy eating habits were taking hold before Nafta. He attributed Oxxo’s growth to its aggressive corporate strategy, not free trade, though he conceded that outside investment gave the company a stronger financial footing to grow all its divisions, including Oxxo.
In a twist, the trust that manages money for the Bill & Melinda Gates Foundation, one of the largest public health philanthropies, is the biggest outside investor in Coca-Cola Femsa, which is the largest Coke bottler outside the United States. Critics say the trust’s investment, currently valued around $470 million, is at odds with the foundation’s mission statement to “help all people lead healthy productive lives.”
Dr. Wise, from Tufts, said the investment sounded like “a classic paradox — give with one hand, take with the other.”
A spokesman for the Bill & Melinda Gates Foundation Trust declined to comment.
In 2012, Dr. Hawkes co-authored a paper on the impact of free trade on Mexico’s diet. The study, “Exporting Obesity,” found that the increased investment by United States companies had made soft drinks and processed food more accessible to the average Mexican.
She concluded that, at a minimum, Nafta had sped up Mexico’s dietary transition and the rise of obesity.
The impact is a variation on what was feared by Zapatista rebels who swept into San Cristóbal on New Year’s Day 1994, the day Nafta took effect, burning military barracks and occupying government buildings.
“They said it would be bad,” said Juan González Hernández, 64, a community leader in San Juan Chamula, a farming community near San Cristóbal, “but we didn’t believe them.”
These days, he said, diabetes touches most households, and locals seem more enamored by processed food and soda than the fruits and vegetables that grow all around them.
“American food and products dominate our lives,” said Mr. González, who is also diabetic. “Everyone is sad about the changes but, at the same time, we still go to Sam’s Club and McDonald’s.”
The Ruiz family shared his sentiments.
“I know this stuff is bad for me, but I can’t stop,” Gabriel Ruiz Barbosa said, glancing at a tray of McDonald’s sundaes his son was carrying into the restaurant. “My cardiologist says I should look after myself but I’m very stubborn.”
His son drinks Coke compulsively and suffers from high blood pressure and achy joints. “I’m afraid that one day I’m going to have a heart attack and die,” he said.
The family has mixed feelings about open trade. Their tenuous prosperity is built on selling food from the United States, and their diet is both sustenance and curse.
“Look at us,” the elder Mr. Ruiz said, as he sheepishly polished off the remains of a chocolate sundae. “We’re all educated people but we’re hooked.”
William Ruiz in San Cristóbal. Obesity has tripled in Mexico since the early 1980s, but malnutrition has decline sharply.
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