Today, professors Brownell and Campos look at how culture and class affect the debate over obesity. Yesterday, they discussed the biggest obesity myths; Wednesday it was the best public policies for reducing national weight; Tuesday, it was the government's rationale for intervening on the issue, and on Monday, they attempted to define the parameters of the problem. Saturday, they'll end with a discussion about the cultural components of the debate.

Why poverty leads to obesity


It is a mistake to think that obesity is a problem only in certain social or racial groups. It is rampant in all races, in both genders, and across all ages. It would be mistake as well to believe that race and social class do not matter. The prevalence of significant obesity (body mass index over 30) in the U.S. population is 29% for Caucasians, 34% for Hispanics and 40% for African Americans. Fully 78% of African American females are overweight or obese.

Social class is also a big deal. The likelihood of being overweight in the poorest 25% of the population is twice that of people in the highest quarter of economic class. With obesity comes a wide array of serious diseases, including some, such as hypertension, that strike particularly hard at some ethnic groups. Children born into poverty will have illnesses far in excess of what confronts others, both in their childhood and later in life.

These stark effects of race and poverty on diet, activity and obesity might seem counterintuitive -- poverty should lead to food deprivation, plus poorer people are more likely to be engaged in hard physical labor.

Toss away intuition. People living in poverty find it hard to be physically active. Leisure time is rare and concerns with neighborhood safety keep both children and adults indoors. Poor individuals are less likely to work for companies with fitness facilities, and there is no discretionary income to join health clubs, have personal trainers, etc. Poor schools have worse facilities and fewer organized sports, and safety issues prevent children from walking or biking to school.

Food is a major issue as well. Studies have shown that poor individuals have limited access to healthy foods and considerable exposure to high-calorie, nutrient-poor foods. Declining numbers of supermarkets in inner cities is part of the reason. In 1963, there were 34 full-service supermarkets in inner-city Los Angeles; that number had dropped to 14 in 1991. By 2002, there were only 5. If one does not own a car, a trip to a supermarket might require several transfers on a bus and then the task of carrying groceries on the return trip.

Poverty not only complicates access to stores with healthier foods, but drives people toward cheap foods. This encourages purchase of packaged snack foods, sugared drinks and fast foods, and discourages purchase of the more expensive fruits and vegetables.

The reality stares us in the face - poverty discourages physical activity and encourages excess calorie consumption. Anything but sky-high rates of obesity, diabetes and other diseases would be surprising. So what does one do with this information? Blaming the victims for making bad choices is common, but more helpful would be an honest assessment of the conditions that create the problems, and solutions based on the causes.

Zoning laws and tax-incentive programs can encourage supermarkets to open in poor neighborhoods. Food stamps might be changed to allow bonus money for the purchase of fruits and vegetables. Safer neighborhoods would help encourage activity. Better funding of schools makes them less susceptible to deals with soft-drink and snack-food companies. Another step would be to reduce advertising for calorie-dense, low-nutrition foods, shown in studies to be directed disproportionately at minority populations.

Bold action is necessary. The nation will make progress only by recognizing that real change requires real change.

Kelly D. Brownell is a professor of psychology, epidemiology and public health at Yale University, where he serves as director of the Rudd Center for Food Policy and Obesity.

Inflicting white neuroses on nonwhite women

Americans are obsessed with fat because fatness has become a symbol for poverty, downward mobility, nonwhiteness and socially marginal status in general. Fear and hatred of fat has very little to do with the health risks associated with being "overweight" and "obese" (which are wholly imaginary and highly exaggerated, respectively), and everything to do with the symbolic meanings that thin and fat bodies have in this culture.