Obesity - Socioeconomic Status

A hundred years ago in the United States, obesity was a mark of wealth and leisure. People who could afford to eat what they wanted and manage to pay others to work for them were the ones that put on the extra pounds. The economics of obesity have changed significantly since then, with the burden of weight and obesity falling disproportionately on the poor. There is a powerful inverse relation between obesity and socioeconomic status in the developed world, especially among African-Americans.

So, what is responsible for this association? There are at least two possibilities: obesity influences socioeconomic status or socioeconomic status influences obesity. But there is strong evidence supporting the latter as highlighted by the causal pathway between being poor and being at higher risk for obesity.

Recent studies reinforce this notion in suggesting that the direct causes of obesity have their roots in systemic social and economic factors that are not easily overcome by "eating less and not sitting around." Such socioeconomic factors that influence obesity have been documented in three areas: education, health care, and employment. These three elements inevitably tie racial elements to health outcomes such as obesity in the U.S.

For example, low income and low education is found to be strongly associated with both obesity and obesity comorbidities in etiological studies. Researchers found that weight gain over time in developed countries was associated with lower education levels and "blue-collar" occupations. Moreover, it is also found that the prevalence of obesity tends to shift toward lower socioeconomic groups as the country's gross national product rises (Drewnowski et al., 2005).

African-Americans in poor, urban environments reinforce the validity of these statistics. A 34-year study found that weight gain among African-Americans in the study was associated with low overall SES (socioeconomic status) calculated over three decades. Among white teenagers, the prevalence of being overweight decreases with increasing socioeconomic status. Among black teenagers, on the other hand, the prevalence of being overweight remains the same or increases with increasing socioeconomic status, according to the national survey data (Drewnowski et al., 2005).

Reasons for the prevalence of obesity in low socioeconomic classes includes neighborhood effects: lack of safety, lack of convenient grocery stores, less leisure time, and tight food budgets. Such low-and middle-income neighborhoods have significantly fewer resources for physical activity such as parks, fitness and community centers, and walking trails than high-income areas. Moreover, children are less likely to be physically active in low-income neighborhoods due to being deemed unsafe by the residents.

This reinforces the view that obesity in the U.S. is, to a large extent, an economic issue. In other words, the poor simply may be getting fat from the kinds of foods they can afford. This results in a less nutritious selection involving energy-dense foods rather than energy-poor foods. Energy-dense foods, higher in fats, refined grains, and added sugars, pack an excessive amount of calories into a small serving of food. Energy-poor foods, on the other hand, contain fewer calories per unit. As a result, a person would need to eat several bushels of energy-poor carrots to equal the calories contained in a doughnut. Energy-dense foods also tend to taste good, are more convenient to purchase, cook, and are much cheaper than energy-poor foods (Sutton, 2005). Fast food distributors, such as McDonalds and Burger King, provides this type of conveniency. Furthermore, people living on low income may have no choice but to choose energy-dense foods to satisfy their families' appetites while still remaining within budget.

Such a poor diet leads to high blood pressure, high cholesterol, & excess weight. It is also leads to diseases such as diabetes, hypertension, and heart disease. Additional evidence of the trend between socioeconomic status and obesity is illustrated through a poll that found black men and women with higher incomes and higher education levels ate more fruit daily than those with lower incomes and education (Drewnowski et al., 2005).

Lifestyle issues would prevent people of low socioeconomic class to lead such a nutritious standard of living. It would not be feasible for a person of low income to follow a professional nutritionist's guidelines. For instance, a nutritionist would recommend eating five to seven smaller meals a day every two to three hours (in order to prevent the drop in glycogen levels which would force the body to store fat during the next intake of nutrients). These meals would also have to be protein-oriented in that the diet must center on lean meat, eggs, etc. This meal plan costs money and time, neither of which a person of low socioeconomic status can manage to afford. Not only would the economics of poverty prevent such a nutritious lifestyle, but the limited, if not absent, access to proper nutritional education in low-income communities would also present another block (Sutton, 2005).

Resources for physical activity such as fitness and community center in low-income areas are also limited due to lack of public and private funding. Local gyms are modern-day luxuries because of inflating prices and costly one year-minimum contracts. Though there is a widespread perception that "blue collar" work provides more physical activity than that of the deskbound "white collar" occupations, a national survey of 9,621 people found that education predicted whether people got most of their exercise from work or leisure-related activities (Drewnowski et al., 2005). In addition, diet drugs and supplements such as Hydroxycut and pyruvates are proven to effective in treating obesity, yet, could only be afforded by people of middle to upper class due to the high expense.

A person of low socioeconomic standing may also be vulnerable to psychological effects such as depression and social effects such as economic hardship and isolation. This in turn leads to fatal health outcomes like heart disease. Consequences of such isolation or social withdrawal contribute to the worsening of obesity through psychological vulnerabilities that increase the likelihood of sedentary activity and over-eating (Puhl et al., 2003).

These psychological factors being said, many healthcare analysts attempted to assess whether or not obesity is a disease in the first place. Opponents to those who classify obesity as a disease argue that obesity is a product of confusion and misinformation. In other words, it is just a risk factor, not a disease. They dispute that an individual controls all the calories ingested and of the time spent exercising.