Health

Poverty causes obesity. Low-income families need to be better off to eat well


Boris Johnson has made obesity a political issue. The prime minister accepts that one of the reasons he nearly died from Covid-19 was that he was carrying too many pounds.

Johnson is not the first prime minister to “declare war” on obesity. In recent decades there have been plenty of campaigns designed to make people exercise more and eat more healthily. There have been exhortations to eat five a day, sugar taxes, bans on the advertising of junk food, but none of them have made a difference. Obesity levels in England have doubled in the past quarter of a century.

In theory, Johnson ought to have a greater chance of succeeding, because his initiative has been launched during a global pandemic when the potential dangers are glaringly apparent. A report from Public Health England in June found that being obese or excessively overweight increased the chances of death or serious illness from Covid-19. Hospitals have been treating plenty of people in a similar condition to the prime minister’s.

Johnson is overweight but doesn’t have to count the pennies. It is far more common for people who are obese – in developed countries, at least – to be poor. Obesity is an economic issue, as a recent academic study published by the magazine Nature shows.

The paper, by Alexander Bentley, Paul Ormerod and Damian Ruck, looks at how obesity evolved in the US between 1990 and 2015. It is a pretty dense, academic tract but worth a read because the findings are significant.

For a start, the rise in obesity – people with a body mass index of more than 30 – in the US mirrors that of the UK. In 1990, about 11% of a typical US state’s population was classified as obese and no state had an adult obesity rate of more than 15%. By 2015, there were several states – such as Mississippi, Alabama and West Virginia – where the obesity rate was over 35% and no state had an obesity rate of less than 20%. “In one generation, the change has been so dramatic that the obesity rate in any US state in 2015 would have been an extreme outlier in the US in 1990,” the paper notes.

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Mississippi, Alabama and West Virginia are all among the poorer US states, so the paper also explored whether there was a link between income and obesity. It found that while there was no such correlation in 1990, there certainly was by 2015. In states where the median income was below $45,000 (£34,500) a year, obesity levels were more than 35%, whereas in states where median income was above $65,000 a year obesity levels were less than 25%, such as Colorado, California and Massachusetts.

This is a developed-country phenomenon. In the developing world, calorific intake and obesity levels tend to be higher among the better off. It is also a recent phenomenon. Industrially processed foods, with their high sugar and fat content, have been available for more than a century but it is only in the past three decades that the link between income and obesity has become so marked.

The paper explores a number of reasons for the trend. One is that poor people have plenty of other things that worry them more than being overweight. A second is that many low-income families live in food deserts and have to travel relatively long distances, often on foot, to shops that sell nutritious food. More than 50 million people in the US – getting on for a fifth of the population – live in low-income districts where there is no convenient access to a supermarket.

A third is that an increasing number of low-income Americans have become hooked on processed foods with a high sugar content, and in particular soft drinks containing high-fructose corn syrup (HFCS). Americans have been consuming refined sugar in food and drink since the 19th century but it has only been since 1970 that it has been in the form of HFCS, which increased from virtually zero per capita to 60lb per capita in the three decades from 1970 to 2000. HFCS became the main sweetener in soft drinks and by 2016 sweetened beverages made up 9% of the household expenditure of low-income households in the US. “The obesity and diabetes epidemics could be driven by the commercial oversupply and widespread marketing of inexpensive high-sugar foods, especially HFCS–sweetened beverages,” according to the paper.

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All of which suggests that an anti-obesity strategy based around trying to ensure children don’t view junk food ads, exhorting the overweight to take up jogging and advising that it would be a good idea to ditch the fizzy drink for a glass of carrot juice is bound to fail. That approach often comes across as downright condescending and misses the point. If obesity is linked to poverty – which is what the evidence suggests – then the way to reduce obesity is to reduce poverty.

Unfortunately, the economic shock imparted by Covid-19 looks likely to push more people below the poverty line. That’s because the most vulnerable sectors – hospitality, retailing and leisure – are those that employ low-income workers and offer entry-level jobs for those who are not working.

If governments are serious about tackling obesity, they need to ensure special attention is paid to low-income families. They need to use the tax system so that employers have the incentive to hire rather than fire; they should be more generous with tax credits to top up the incomes of the working poor; and they should resist pressure to reduce budget deficits by cutting benefits. The message for the politicians is clear. There will be less obesity when people can afford to eat better – and more expensive – food. To do that they need to be better off.



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