Anais Martinez is on the hunt in Mexico City's Merced Market, a sprawling covered bazaar brimming with delicacies. "So this is the deep-fried tamale!" she says with delight, as if she'd just found a fine mushroom specimen deep in a forest.
The prized tamales are wrapped in corn husks and piled next to a bubbling cauldron of oil.
"It's just like a corn dough patty mixed with lard, put in a corn husk or banana leaf, steamed and then deep fried," says Martinez of this traditional Mexican breakfast. "And then after you fry it, you can put it inside a bun and make a torta [sandwich] out of it. So it's just like carbs and carbs and fat and fat. But it's actually really good."
And it only costs 10 pesos — roughly 50 cents.
Martinez is a designer in Mexico City. She studied gastronomy here and now moonlights for a company called Eat Mexico giving street food tours.
Deeper in the market there's an area packed with taco stalls. Customers stand at the counters or sit on wobbly plastic stools. The young cooks fry, flip and chop various meats into tortillas. They pound strips of flank steak out on wooden cutting boards. Piles of red chorizo sausage simmer in shallow pools of oil. Yellow slabs of tripe hang from meat hooks.
We've just come to one of Martinez's favorite taco stands. Its specialty is pork tacos served with french fried potatoes piled on top.
"The pork is really thinly sliced, rubbed with chiles and spices and then they fry it," Martinez says as the meat sizzles on a long steel griddle in front of her. "Also, really good."
Rich, fatty street food like this is available all over Mexico — at bus stops, at schools and on street corners. And it's affordable to the masses. A heaping plate of Martinez's favorite pork tacos costs less than a dollar.
All that cheap food — in a country where incomes are rising — is contributing to Mexico's massive diabetes epidemic.
Diabetes is now the leading cause of death in Mexico according to the World Health Organization. The disease takes an estimated 80,000 lives each year. Nearly 14 percent of adults in this country of 120 million suffer from the disease — one of the highest rates of diabetes in the world. And it's all happened over the last few decades.
For roughly $2 a day, people in Mexico can now afford a diet heavy in carbohydrates, sugar and fat that delivers way more calories than the WHO's recommended daily intake of 2,000. A study in 2015 showed Mexico to be the leading consumer of junk food in Latin America, consuming 450 pounds of ultraprocessed foods and sugary beverages per person each year.
Until just recently Mexico was the largest per capita consumer of soda in the world, chugging down 36 gallons of sugary drinks per person per year. That dubious distinction now falls to Argentina, with the U.S. and Chile not far behind.
Excessive body fat is one of the main contributors to the onset of Type 2 diabetes. And obesity rates have been climbing steadily in Mexico. It's now one of the world's most overweight countries, coming in just behind the United States.
Mexican health officials are well aware of the crisis. Late last year, the health minister declared diabetes and obesity to be public health emergencies — the first time they'd made such a declaration that wasn't targeting an infectious disease.
"Diabetes is one of the biggest problems in the health system in Mexico," says Dr. Carlos Aguilar Salinas at the National Institute of Medical Sciences and Nutrition in Mexico City. "It's the first cause of death. It's the first cause of disability. It's the main cost for the health system."
Treating a patient with a severe case of diabetes in Mexico, he says, can cost upward of $40,000 a year. But the bigger problem, Aguilar says, is that the Mexican health system isn't prepared to treat the sheer number of diabetes patients with serious medical complications who show up in its clinics every day.
"The Mexican health system is very efficient to treat infectious disease," he says. But chronic disorders like diabetes, which require lifelong attention and medical monitoring, call for a different skill set from doctors. And Mexico's health system is still adjusting to this shift toward treating chronic disease.
Recognizing how daunting it is to treat diabetes, Mexican officials are trying to prevent it in the next generation. In 2014 the country slapped a controversial 5 cents per liter tax on soda. New rules bar advertisements for high calorie junk food aimed at children. Public service announcements encourage people to exercise more. And there's a major push to restrict the sale of soda and junk food in schools.
The head of the World Health Organization's office in Mexico, Dr. Gerry Eijkemans, says diabetes is a huge challenge to health care systems throughout Latin America.
"Diabetes used to be a disease of the rich," she says. "In Western Europe and the U.S., it was really the people who had the money who were obese, and now it's actually the opposite."
This is forcing already overstretched public health systems in Latin America to devote more resources to this complex disease.
"In order to prevent an infectious disease, you reduce the mosquitoes and basically you're done," Eijkemans says. "Not that it's easy, but it's much easier than changing a lifestyle, changing the way a society is basically organized [to encourage] people to consume unhealthy food with lots of fat and sugar."
An article earlier this year in the medical journal The Lancet warned: "Rising levels of increasingly severe obesity mean that, worldwide, populations are on the brink of a catastrophic epidemic of diabetes."
In Latin America, Mexico isn't on the brink of that epidemic, it's already there.
SCOTT SIMON, HOST:
Global diabetes rates have been increasing dramatically over the past 20 years. In Mexico, 14 percent of adults now suffer from diabetes. It is, in fact, the leading cause of death there, and it's having a huge impact on Mexico's health care system, as NPR's Jason Beaubien reports.
UNIDENTIFIED MAN: (Speaking Spanish).
JASON BEAUBIEN, BYLINE: Part of what's driving Mexico's diabetes problem is that it has an abundance of incredibly rich and inexpensive food.
ANAIS MARTINEZ: So this is the deep-fried tamale that I was telling you about.
BEAUBIEN: Anais Martinez is showing me a pyramid of tamales wrapped in corn husks next to a bubbling cauldron of oil.
MARTINEZ: And we are in Merced Market, which is the second-biggest market in the city, Mexico City.
BEAUBIEN: Martinez is a designer in the Mexican capital.
MARTINEZ: I was born here. I grew up here.
BEAUBIEN: She also studied gastronomy here and now moonlights giving street food tours. She's pointing out a bulging tamale sandwich that costs 10 pesos or roughly 50 cents.
MARTINEZ: So, you know, they're just like a corn dough patty mixed with lard, and then they put it inside the corn husk or the banana leaves, steamed and then after they've done all of that, they deep fry it.
BEAUBIEN: And when it comes out of the fryer, they stick it in a white bread bun to make a sandwich.
MARTINEZ: So it's just like carbs and carbs and fat and fat. But yeah, it's actually really good.
BEAUBIEN: Rich, fatty street food like this is available all over Mexico at bus stops, at schools, on street corners and is affordable to the masses. This is part of what's driving Mexico's burgeoning diabetes epidemic.
UNIDENTIFIED WOMAN: (Speaking Spanish).
BEAUBIEN: One of the country's top nutritionists says that for roughly two hours a day, Mexicans can afford a diet heavy in carbohydrates, sugar and fat that delivers way more than the U.N.'s recommended daily intake of 2,000 calories. A study in 2015 showed Mexico to be the leading consumer of junk food in Latin America. In addition to the rich tacos and kilos of processed food, Mexicans love to wash down their meals with a soda or an agua fresca, a sugary fruit drink ladled out of massive, five-gallon glass jars.
MARTINEZ: It’s not just the actual fruit. It’s fruit, water and lots of sugar because they have to compete with Coca-Cola in everyone’s taste buds.
BEAUBIEN: Until just recently, Mexico was the largest per capita consumer of soda in the world. That dubious distinction now falls to Argentina with the U.S. and Chile not far behind. Excessive body fat is one of the main contributors to the onset of Type 2 diabetes, and obesity rates have been climbing steadily in Mexico. Now the country is one of the most overweight nations in the world, coming in just behind the United States. Mexican health officials are well aware of the problem. Late last year, the health minister declared diabetes to be a public health emergency. It was the first time Mexico has ever made such a declaration that wasn't targeting an infectious disease.
CARLOS AGUILAR SALINAS: This new facility is focusing diabetes and metabolic disorders.
BEAUBIEN: At the National Institute of Medical Sciences and Nutrition in Mexico City, Dr. Carlos Aguilar Salinas is walking through a brand-new research and treatment complex for diabetes.
SALINAS: Diabetes is one of the biggest problems in the health system in Mexico. It's the first cause of death. It's the main cost for the health system.
BEAUBIEN: Treating a patient with a severe case of diabetes in Mexico, he says, can cost upwards of $40,000 a year. But the bigger problem, Aguilar says, is that the Mexican health system isn't prepared to treat the sheer number of complex diabetes patients that are showing up in its clinics every day.
SALINAS: The Mexican system, health system, is very efficient to treat infectious disease. However, for chronic disorders, which education, continuous care, it's much more complex than the infectious disease approach.
BEAUBIEN: Recognizing the huge task of treating diabetes, Mexican officials are putting much of their efforts into trying to prevent it. In 2014, the country slapped a controversial five-cents-per-liter tax on soda that started to put a dent in consumption. There were also new rules limiting advertisements for junk food. New public service announcements encourage people to exercise more. And there's a major push to restrict what foods are allowed to be sold in schools. The head of the World Health Organization's office in Mexico City, Dr. Gerry Eijkemans, says Type 2 diabetes didn't used to be much of a problem in the region.
GERRY EIJKEMANS: It used to be a disease of the rich, you know? In Western Europe and in the U.S., it was really the people who had the money who were obese and overweight, and now it’s actually the opposite.
BEAUBIEN: And now, public health officials in Latin America have to pivot to deal with this complex, chronic disease.
EIJKEMANS: In order to prevent an infectious disease, you, you know, eliminate or you reduce the mosquitoes, and you're basically done, you know, not that it's easy, but it's much easier than to change the way society is basically organized and encourages people to consume unhealthy, high-caloric food with lots of fats and sugars.
BEAUBIEN: An article earlier this year in the medical journal The Lancet warned rising levels of increasingly severe obesity mean that worldwide populations are on the brink of a catastrophic epidemic of diabetes. In Latin America, Mexico isn't on the brink of that epidemic. It's already there. Jason Beaubien, NPR News, Mexico City. Transcript provided by NPR, Copyright NPR.