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With Less Access to Nutrition and Recreation, Poor at Greater Risk for Obesity

With less money to buy nutritious food, and less access to recreation, the poor are at greater risk for obesity.

"I keep reading about the obesity epidemic. Of course people are getting fatter - look at what they eat, and how little they exercise. But what puzzles me is why obesity rates are highest among the poor. Why does poverty increase a person's risk of obesity?"

Many experts have remarked that people in developed countries, and in urban areas of developing countries, live in an environment that promotes obesity: too much food, especially the wrong kinds of food, and a sedentary lifestyle. For many people, staying lean requires swimming upstream in a culture that discourages a healthful lifestyle. Here are some of the reasons that people of lower socioeconomic status (SES) may have an especially hard time cultivating a healthful lifestyle and preventing obesity.

A healthful diet costs more

A healthful diet delivers several servings of fruits and vegetables each day, as well as low-fat dairy, lean meat and fish, and whole grains. These foods tend to be more expensive than food products with a stable shelf life that don't require refrigeration.

Researchers have found that there is an inverse relationship between a food's energy density (calories per unit weight) and cost; that is, cheaper foods tend to have more calories per unit of volume. For example, cookies and potato chips supply about 1,200 calories per dollar, while fresh carrots provide only 250 calories per dollar.1 If dollars are in short supply, and you have a family to feed, it makes sense that economic pressures will affect your shopping choices.

The cost of food has risen sharply over the past year, with increased demand for food from developing countries, and the diversion of crops for the manufacture of biofuels.4 If food prices push consumers to choose filling but less-nutritious foods, the rising costs of food may mean that more people than ever will find it difficult to avoid obesity.

Food is an affordable pleasure

People enjoy food, and parents providing meals want to please their families. When access to food is limited, people preparing meals want to be sure no one feels hungry at the end of a meal.1 Filling bellies and satisfying those at the table comes ahead of nutrition recommendations.

Food is also used as a reward in many families.2 Most people, especially children, enjoy the taste of foods high in fat and sugar. Food product manufacturers have invested time and money to devise products that please the palate and can be sold at an affordable price. The U.S. diet contains about 50 percent of its calories from added sugars and fat.1 Taste is generally valued more highly than health and nutrition by people purchasing food.1 When financial pressures reduce spending power, vegetables may not make it into the shopping cart.

Poverty is stressful

People may respond to chronic stress with fatigue. Disorganized households have less energy to put toward long-term planning and shopping. For many people, eating reduces feelings of stress. Such people may eat more comfort foods to cope with stress.2 Some researchers have suggested that stress may alter metabolic pathways, and lead to obesity, increasing obesity-related health problems.1

Poor neighborhoods offer less access to physical activity

Poor neighborhoods tend to have fewer supermarkets, and more convenience stores and fast food establishments.3 It's expensive to be poor - food costs more when purchased at convenience stores rather than large supermarkets. And, while people in poor areas may walk more for transportation, other options for physical activity are generally more limited, with less access to parks, recreation centers and swimming pools. People who fear neighborhood crime restrict outdoor time for themselves and family members.

References
1. Drewnowski, A., and S.E. Specter. Poverty and Obesity: The role of energy density and energy costs. American Journal of Clinical Nutrition 79: 6-16, 2004.
2. Olson, C.M., C.F. Bove and E.O. Miller. Growing up Poor: Long-term implications for eating patterns and body weight. Appetite 49: 198-207, 2007.
3. Stafford, M., S. Cummins, A. Ellaway, et al. Pathways to Obesity: Identifying local, modifiable determinants of physical activity and diet. Social Science and Medicine 65: 1882-1897, 2007.
4. Tightening belts. The Economist 4/1/2008, pp.71-72.
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