Poverty and Obesity – Not a paradox

“A lot of people think there is a yawning gap between hunger on the one end and obesity on the other. In fact, they’re neighbors…They are both signs of having insufficient funds to be able to buy the food that you need to stay healthy.” Raj Patel[1]

Tiffany[2] lives with her two young children in social housing in a low-income neighbourhood to the North of Washington DC. While the bureaucrats and consultants are dining out in the smart restaurants of the city, Tiffany is wondering what she is going to give her children for dinner. She works a low-wage job, and is not eligible for food stamps (SNAP – Supplemental Nutrition Assistance Program)[3], and barely makes enough money each week to pay the basic bills.

Tiffany’s neighbourhood used to have thriving mom and pop stores, but since the middle-classes left for the suburbs in the 1970s[4] , the shops have shut and no full-service supermarkets have taken their places (these are all out of town), so only a few convenience stores exist in the neighbourhood.

In Washington, DC, the city’s lowest income wards (Wards 7 and 8) have one supermarket for every 70,000 people while two of the three highest-income wards (Wards 2 and 3) have one for every 11,881 people. One in five of the city’s food stamp recipients lives in a neighborhood without a  grocery store: http://policylink.org/sites/default/files/FINALGroceryGap.pdf

“We have stores in Jonestown. We have about three grocery stores, but it’s hard to get some things. Like when you want fruit, no stores sell fruit. Maybe one store will have a few bananas. They have vegetables, but in the can. And so that’s why I go to Clarksdale sometime for grocery shopping…about a 45 minute drive. Those that don’t have transportation, it’s hard.” Ree Harris[5]

These stores stock only a small range of foods, the majority of which are packaged and processed, highly calorific and not healthy. It is difficult to look at the shelves and work out how to make a meal from scratch from what is available. Thus Tiffany selects what she thinks will provide the biggest calorie bang for her buck and keep the children feeling full for longer.

Tonight, an ordinary week night, dinner is going to be macaroni cheese from a box, in itself, not a bad choice, but there is no salad or fresh green vegetable to buy that could accompany the meal. The family has been eating processed foods and few fresh fruit and vegetables for months, in fact, ever since Tiffany lost her second job. Tiffany prepares the meal but there is barely enough for the three of them, and she eats only a small amount preferring to make sure that her children get as much food as they want[6]. She goes to bed hungry and the following morning loads up on a sweet variety of breakfast cereal before heading out to work.

Tiffany is not unusual, for a rich country like America, it is extraordinary to find out that there are 50 million people living with food insecurity. This means they are poor, they may be paying for food with food stamps, they have difficulty accessing food because their neighbourhoods are food deserts, and to cap it all, a large number of these people are obese.

Indeed Tiffany is overweight, it started gradually, she hardly noticed the change, and she can’t understand it. She doesn’t overeat, she doesn’t often have the opportunity to. It would seem that Tiffany’s maternal instincts to make sure her children don’t go hungry, but she does, is what is causing her to retain weight[7]. Her body is in a feast and famine mode, her body will hold onto calories when she has access to them because it is stocking up for the times when little food is available. It does this by slowing the metabolism down [8]. On top of this she has no time to exercise in between working and taking care of her family and of course the foods she buys are highly calorific.

Tiffany doesn’t know that another reason why she is getting fatter is because of two key ingredients in the processed food she is eating regularly. These are palm oil and high fructose corn syrup (HFCS).

The link between obesity and poverty is well documented[9], the richest are no longer the fattest (in rich countries), though the gap is closing. As the rich become less physically active and in spite of their ability to purchase nutritious healthy food, are tempted by the taste and abundance of processed foods, their waistlines expand.

Processed foods pack calories in and are unbelievably attractive and delicious” Susan Jebb[10]

The risk for Tiffany’s children is that they will grow up to be obese and at risk of the associated diseases (diabetes and heart disease). Children who have experience food deprivation are more likely to become obese as adults because they will do their utmost to avoid situations of food insecurity, they will overeat and use food as a reward[11].

What can be done…where to begin…poverty and associated food insecurity are multi-factorial problems. Raising awareness of eating habits, educating children and adults on the contents of their foods and bringing affordable healthy food back to the poorer neighbourhoods are all steps in the right direction.

***

[1] Patel, Raj. 2008. Stuffed and Starved: The hidden battle for the world food system. Melville House Publishing

[2] Tiffany is fictional, she is a composite based on real people interviewed in a number of locations by Activevoice (www.activevoice.net)

[3] http://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snap
[4] There are many reasons why the predominantly white middle class left the cities for the suburbs post-war, these include many racially motivated reasons such as the desegregation of schools, the migration of blacks from rural south to the cities in search of work, the decrease in investment by municipalities and businesses in the city with the change in ethnic composition, and the development of post-war interstate highway system to transport suburban workers into the city,
[5] Active Voice. 2013. Community action guide: A Place at the Table. http://www.Activevoice.net

[6] McIntyre, L., Glanville N., Raine, K., Dayle J., Anderson, B., and Battaglia, N. 2003. Do low-income lone mothers compromise their nutrition to feed their children ? Canadian Medical Association Journal 168, 686-691

[7] Olson CM, Bove CF, Miller EO. 2007. Growing up poor: long-term implications for eating patterns and body weight. Appetite. 2007 Jul;49(1):198-207.
[8] Montminy, M. et al. 2010. The CREB Coactivator CRTC3 Links Catecholamine Signaling to Energy Balance. Nature. 2010 December 16; 468(7326): 933–939
[9] http://frac.org/pdf/frac_brief_understanding_the_connections.pdf
[10] http://www.express.co.uk/life-style/diets/456134/Sugar-vs-fat-Twin-brothers-take-radical-steps-to-show-the-real-impact-of-our-fad-diets (accessed 12/6/2014)
[11] Olson CM, Bove CF, Miller EO. 2007. Growing up poor: long-term implications for eating patterns and body weight. Appetite. 2007 Jul;49(1):198-207.

Author: Dr. Marina Curran, Professor at BSL
Dr-Marina-Curran

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