After my posts on Jamie Oliver and McDonald's, a doctor I know asked me why so many of her young patients from lower income families are obese. "Many of these families struggle to provide three square meals a day," she said, "so where are the calories coming from?"
According to a 2010 Los Angeles Times article, which summarized a study from the journal Health Affairs, nearly one in three children currently has a body mass index above what is considered healthy. The study also found significant discrepancies between children of different racial groups, socioeconomic groups, and regions of the country. According to the article, these factors are not necessarily independent. For example, the article says, "In Alaska, poor children were only 1.2 times more likely to be overweight or obese than better-off children. But in Arizona, the difference in rates was 3.8. Why would it be different to be poor in Alaska than Arizona? That's basically what it amounts to - it's not the same being poor in one state as it is in another."
According to the Food and Research Action Center's (FRAC) page on poverty and obesity, "obesity rates increased ten percent for all U.S. Children ten to seventeen years old between 2003 and 2007, but by twenty-three percent during the same time period for low-income children."
One thing that is important to note is that the stereotype that virtually all low-income people are obese is not true. The Food and Research Action Center (FRAC) also shows that the link between income and obesity has actually been weakening over the past few decades. But the question still remains, why do the statistics show a link at all?
For answers, I turned to the FRAC page on food insecurity and obesity. Most of the information I am going to mention below is from this website, and the authors of the studies are specifically mentioned there. For me to put a citation after every sentence would make this post very long, so please refer to the FRAC food insecurity and obesity link for the authors of the studies and facts mentioned.
One of my friends, Sara, commented on my McDonald's post that many families live in "food deserts," which is actually one of the main points FRAC makes, as well. According to multiple studies, low-income neighborhoods often lack a full service grocery store where families can purchase fresh produce, whole grains, and low-fat dairy. Instead, many residents rely on small convenience stores, which do not carry the variety of healthy and low-fat options available in larger establishments. Low income communities, especially areas near schools, are also more likely to have fast food restaurants. Frequently eating fast food has been linked to high-calorie, low-nutrition diets, which may lead to weight gain.
According to other studies cited by FRAC, fruits and vegetables in low income neighborhoods are often of poorer quality, thus making it less likely that residents will be prone to purchase them. Furthermore, healthy food, such as fresh produce, whole grains, and low-fat options are often more expensive compared to more processed fats and sugars. Many families trying to stave off hunger look to purchase the maximum calories per dollar by buying energy-dense foods, which provide the calories a family needs, but not necessarily the other nutritional components of a healthy diet. "Feeling full" may be the priority for a family who is unsure when the next meal will be available, especially when it comes to preventing feelings of hunger in children. Carbonated beverages, such as soda, for example, will make a child "feel full," even if they do not provide any other nutritional value.
In addition, chronic ups and downs in the availability of food may encourage people to eat more when it is available. This can lead to general over-consumption or even metabolic changes that affect fat retention.
According to FRAC, the problem is not just about food consumption. Low income communities also have fewer resources for physical activity, such as parks and recreation centers. Even in communities that do have open space areas, they may be less attractive due to trash, noise, traffic, and criminal activity. It makes sense that parents would not want their children to play at the park in a particularly dirty or high-crime neighborhood. This puts children at a higher risk for staying indoors and living a sedentary lifestyle. According to other studies, lower income children are less likely to participate in organized sports or to have access to/participate in physical education classes and recess.
Additionally, the financial and emotional pressures of poverty may have a serious impact on both adults and children. Stress can contribute to unhealthful eating behaviors, hormonal/metabolic changes, and even chronic anxiety or depression, which have all been associated with adult and childhood obesity.
Many low income families also lack access to quality, affordable health care. Chronic illnesses that are related to obesity may not be diagnosed. Furthermore, families may not realize their child is overweight. For example, according to Strong4Life, an organization fighting childhood obesity in Georgia, 75% of parents of overweight or obese children in the state did not believe their child had a problem. I recently read an article saying that even among families who do have access to health care, less than 25% of parents of overweight or obese children recall a doctor telling them their child is overweight. If even medical professionals are unwilling to confront or acknowledge the issue, how can we expect households who have less access to health education and basic health care to recognize obesity and take action steps to prevent or correct it?
To me, the fact that obesity is inversely related to income is further support that the socioeconomic disparity in our society is not just a matter of money, but is linked to a complex set of dynamics that affect all aspects of life.
So what can be done to stave off the obesity epidemic in lower income communities in particular? I would suggest communities can start with the specific issues mentioned above, by bringing farmers markets to lower income neighborhoods, investing in community recreational centers and low/no-cost sports leagues, requiring schools to provide more hours of physical education, providing free health education for parents and kids, offering free classes on how to manage a tight food budget, focusing efforts on preventive health services (including attention given to decreasing stress), among other actions.
I have tried to lay out some of the reasons for the weight disparity, but I think it will take a lot of people with a lot of brain power to improve the health future of all our nation's children. If you have other ideas, please share!