The Power of Poverty on Obesity
By Evelyn Heun
American University
Obesity has been the subject of many conversations in the past decade, discussing the causes and how America is struggling today in combating obesity. To start it is important to understand the definition of obesity, which as described by the Obesity Medicine Association as, “a chronic, relapsing, multifactorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences”(Welcome, 2017). This definition is important to understand as a basis for discussing this issue and the prevalence today. The increasing rate of childhood obesity has been able to spark the conversation on how to find the root of the issue and what programs can combat the issue. To get an idea of the prevalence of this health outcome, a study utilized data from 1999-2016 from The National Health and Nutrition Examination Survey (NHANES), that found overall obesity increasing over the years. For example, “The prevalence of overweight and obesity increased with age, with 41.5% of 16- to 19-year-old adolescents having overweight or obesity” (Skinner et al., 2018). Many studies have been primarily focused on this growing rate among children and adolescents in America. In another study it found obesity and overweight among children in the United States to be one of the highest recorded in the world (Lobstein & Jackson‐Leach, 2007). Some would call this as an epidemic that could lead to many other health issues or even death. The severity of this issue cannot be ignored and with obesity increasing over the years in rate, which is difficult to counteract, we have to find the factors that lead to this health outcome.
One key risk that can be associated with obesity is family history. This includes genetics and the lifestyle of a family in some way that contributes to obesity. There are many genes that play a role in the outcome of an individual’s weight, as well as environmental factors that could trigger certain genetic predispositions. In a study on genetic epidemiology it found, “The risk of obesity (≥90thth BMI percentile) is two to three times higher for a person with a family history of obesity than for a person without such history. This risk increases as severity of family obesity increases”(Zlot et al., 2007). This is concrete evidence on the effects of genetics on obesity.
Another key risk is the price of healthy food in the U.S. today. It is important to have a healthy diet in order to maintain a healthy weight and receive all the necessary nutrients and vitamins. When we are younger we are taught the food pyramid to teach us what foods we should be eating on a weekly basis and to consume sweets in moderation. The pricing of food in the U.S. today poses as a key source for the obesity epidemic due to the low price for unhealthy food, making it an easy choice. People always try to get more food for less money and unfortunately the cheaper food is much unhealthy. In a study the reasoning for the price differences was explained as, “many decades of policies focused on producing inexpensive, high volume commodities have led to a complex network of farming, storage, transportation, processing, manufacturing and marketing capabilities that favour sales of highly processed food products for maximal industry profit”(Rao et al., 2013). This is just one piece of the puzzle to what is causing the increase of obesity in the United States today.
The last key risk that should be highlighted is food deserts , mainly in urban areas which, are all across the U.S. and negatively impacting many communities from the lack food options. A food desert can be defined as a lack of access to retail food in a certain area (Beaulac et al., 2009). It used to mean that healthy and affordable food is inaccessible, but today it is more studied as no access to any food. Some people have to drive more than ten miles to reach a grocery store and if there is no public transportation this can be significant hurdle to get any food within communities that have higher rates of poverty and do not have a motor vehicle, “As of 2009, about 2.3 million Americans did not own a car and lived over one mile from a supermarket”(Tulane University, 2018). This has a detrimental affect on an individual’s diet when combined with all these other key risks previously mentioned.
The combination of human genetics, the high price of healthy food options, and food deserts are all factors that contribute to the growing obesity epidemic that the United States is facing. With the increasing food deserts across the U.S. in conjunction with the more expensive price of healthy food once an individual gets to the store it creates an obstacle that many Americans can not overcome, resulting in higher consumption of highly processed food and sweets, which then leads to obesity. To add family history on top of this just creates a scenario where it becomes a situation that is almost insurmountable for some families to overcome.
One social context that needs to be considered when studying the epidemiology of obesity is poverty. Poverty as a social context creates the foundation for many issues that individuals encounter. When individual’s face having to feed their families and they are living from paycheck to paycheck, they are much more likely to get the cheapest food and possibly resorting to fast food. This high consumption of highly processed food due to lack of resources to buy healthy food leads to obesity. One study has shown that 55% of people that live in areas where healthy food availability is lowest are less likely to have a good-quality diet (Tulane University, 2018). This is a direct effect of the macrosystem, exosystem, and microsystem on the individual that produces negative health outcomes, such as obesity. The lack of social support on providing a healthy diet to individuals that are in poverty and only perpetuating the cycle to continue is one of the things that is adding to the insurmountable obstacle of fighting obesity with a healthy diet. On top of the food deserts, if the family history portrays some level of obesity in past generations, like mentioned before, individuals are much more likely to experience obesity themselves (Zlot et al., 2007). The risk factors that were mentioned are all highly probable in a poverty setting and creates the perfect storm for people in a lower socioeconomic status to be at a disadvantage to living a healthy lifestyle which leads to obesity, and also possibly leads to chronic diseases later in life, such as diabetes. There have been many studies done on the correlation between obesity and poverty that have produced this statistic, “Children of low socioeconomic status (SES) are 1.6 times more likely to be obese than high-SES children and have steeper rates of increase in obesity.”(Lee et al., 2014). This directly proves that being in a low SES correlates with health outcomes and particularly obesity. The social context in this situation is so powerful such that the obesity epidemic will continue to hurt low-SES individuals, unless something is put in place to help with educating the youth, increasing accessibility to healthy foods, and lowering the price of healthy foods.
The social context of poverty leading to obesity needs to be understood and addressed in order to create programs that will directly oppose the challenges that are faced. One program that is brought to mind is “Let’s Move” created by Michelle Obama, that works to improve the school meals, increase physical activity for children, and start a healthy habit that educate the children regarding what foods are more nutritious (Tanne, 2010). This is just one step to address obesity all together rather than just on the poverty level. Addressing children specifically is highly necessary because it is easier to fight youth obesity rather than adult obesity (Lee et al., 2014). To directly address food deserts, which are experienced primarily by individuals in poverty due to lack of transportation, there have been programs put in place like the Twin Cities Mobile Market that is a grocery store on wheels which attempts to increase access to affordable healthy food which is brought to directly to them (Tulane University, 2018). In order to combat obesity in the social context of poverty these programs are highly necessary and need financial support to continue. To fight this there needs to be an understanding of the main issues in the context of poverty, such as, lack of transportation in a food desert and lack of financial means to purchase healthy food. So, programs such as the non-profit mobile market which supplies farm to table foods needs to be replicated in cities around the nation in order to have the positive results we are looking for in decreasing obesity. Targeting children is also a specific way to combat this issue. A study showed that teaching people about nutrition led to a lower body mass index (BMI) and also increased physical activity, so instilling this knowledge at a young age is more likely to have a positive effect and lower the obesity rate (Brech, 2018). This would directly address children in poverty due to all children being required to attend school at a young age unless homeschooled. If public schools adopt a curriculum that teaches children more about the importance of a healthy diet, it would most likely address obesity in the social context of poverty as well. Overall, poverty has a very strong correlation with obesity with risk factors like family history, cost of healthy food, and food deserts, as aspects that only increase the likelihood of obesity; requiring educational programs and organizations that bring affordable healthy food to people who are in poverty.
References
Beaulac, J., Kristjansson, E., & Cummins, S. (2009). A Systematic Review of Food Deserts, 1966-2007. Preventing Chronic Disease, 6(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722409/
Brech, D. (2018). Childhood Obesity Prevention/Intervention Programs in Childcare, School, and Community Settings: A Narrative Review. Journal of the Academy of Nutrition and Dietetics, 118(10), A160. https://doi.org/10.1016/j.jand.2018.08.127
Lee, H., Andrew, M., Gebremariam, A., Lumeng, J. C., & Lee, J. M. (2014). Longitudinal Associations Between Poverty and Obesity From Birth Through Adolescence. American Journal of Public Health, 104(5), e70–e76.
Lobstein, T., & Jackson‐Leach, R. (2007). Child overweight and obesity in the USA: Prevalence rates according to IOTF definitions. International Journal of Pediatric Obesity, 2(1), 62–64. https://doi.org/10.1080/17477160601103948
Rao, M., Afshin, A., Singh, G., & Mozaffarian, D. (2013). Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open, 3(12). https://doi.org/10.1136/bmjopen-2013-004277
Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M., & Armstrong, S. C. (2018). Prevalence of Obesity and Severe Obesity in US Children, 1999–2016. 141(3), 11.
Tanne, J. H. (2010). Michelle Obama launches programme to combat US childhood obesity. BMJ : British Medical Journal (Online); London, 340. http://dx.doi.org.proxyau.wrlc.org/10.1136/bmj.c948
Tulane University. (2018, May 10). Food Deserts in America (Infographic). https://socialwork.tulane.edu/blog/food-deserts-in-america
Welcome, A. (2017, August 29). Definition of Obesity. Obesity Medicine Association. https://obesitymedicine.org/definition-of-obesity/
Zlot, A., Newell, A., Silvey, K., & Arail, K. (2007). Addressing the Obesity Epidemic: A Genomics Perspective. Preventing Chronic Disease, 4(2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1893129/