Monday, September 28, 2009

Does poverty make people obese?

Does poverty make people obese, or is it the other way around?
As a matter of public health, it might be more important to help poor people than fat people. According to epidemiologist Peter Muennig, the relative risk of mortality for being obese is between 1 and 2. That means that, controlling for other factors, someone who's really fat is up to twice as likely to die early as someone whose body mass index is in the normal range. But if you compare people from the top and bottom of the wage scale (with everything else held constant), the risk ratio goes up to about 3.5. In other words, it's much better for your health to be rich and fat than poor and thin.

Those in greatest need, furthermore, tend to be both poor and fat. We know, for instance, that the lower your income, the more likely you are to inhabit an "obesogenic" environment. Food options in poor neighborhoods are severely limited: It's a lot easier to find quarter waters and pork rinds on the corner than fresh fruit and vegetables. Low-income workers may also have less time to cook their own meals, less money to join sports clubs, and less opportunity to exercise outdoors.

If poverty can be fattening, so, too, can fat be impoverishing. Paul Ernsberger, a professor of nutrition at Case Western Reserve University, lays out this argument in an essay from The Fat Studies Reader, due out in November. Women who are two standard deviations overweight (that's 64 pounds above normal) make 9 percent less money (PDF), which equates to having 1.5 fewer years of education or three fewer years of work experience. Obese women are also half as likely to attend college as their peers (PDF) and 20 percent less likely to get married. (Marriage seems to help alleviate poverty.)

When it comes to public health, the relationship between poverty and obesity gets more convoluted. Being fat can make you poor, and being poor can make you sick, which means that being fat can make you sick irrespective of any weight-related diseases. Fatness (or the lifestyle associated with obesity) also creates its own health problems, regardless of how much money you have—and health problems tend to make people poor, through hospital bills and missed days of work. So fat can be impoverishing irrespective of any weight-related discrimination.

The point here is that sickness, poverty, and obesity are spun together in a dense web of reciprocal causality


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