Higher prices, wider waistlines

The Times recently ran a story on the latest obesity survey by the Centers for Disease Control and Prevention -- a survey that did not make the connection between obesity and the price of food.

U.S. obesity levels have again risen to record levels, according to the center's study, which found the Southern states had the dubious distinction of topping the list. While some may blame the deep-fat frying of "Southern cooking," it is no coincidence that the states with the highest obesity levels also have the highest proportions of families in poverty.

The link between poverty and obesity may be counterintuitive, but it is well documented. Hunger and obesity are not at opposite ends of the continuum from poverty to wealth; rather, they are opposite sides of the same coin of malnutrition. As food prices continue to inflate, so will waistlines. And increasing rates of diabetes, heart disease, stroke and a host of other chronic disease will likely follow.

In many parts of the world, the huge jumps in food prices have added to the millions who go hungry. Even in the U.S., food price increases have driven many more to seek out food banks and pantries that are already being squeezed by higher costs and greater demand. Although one might think that higher food prices would decrease obesity by decreasing food consumption, the reality is that one can expect higher food prices to increase rather than decrease obesity.

Obesity isn't simply about too much food. It's about the type of food, how it's prepared and the balance of calorie intake with physical activity. Stress and social conditions can also play a role. For decades, nutrition counselors, diabetes educators and other health professionals have been informing the public that fresh fruits and vegetables, whole grains, fish, lean meats and low-fat dairy are preferable to sweetened drinks, processed foods loaded with fats and sugars, and fast food heavy with oils and "fillers."

In recent years, this public health message has been starting to take root. School cafeterias upgraded their menus; natural foods stores and green markets expanded, and even fast-food chains introduced some healthier alternatives. However, the cost per calorie of healthier food is higher because of the economics of industrialized food production and distribution. As food prices climb, people with lower incomes will be pressured to choose cheaper, processed, calorie-dense foods -- increasing the likelihood of obesity.

A part of the food price crisis is being driven by the diversion of worldwide corn and sugar crops to biofuels. In the past, the relative low cost of these mass-produced commodities was considered a factor in the obesity epidemic. Now, the amount of these crops available for food has gone down and the prices have risen proportionately faster. Nonetheless, calorie-dense foods, including those made with corn syrup sweeteners, will still be cheaper on a per-calorie basis. Already some school cafeterias have switched back to the old, high-calorie processed fare as a cost-cutting measure. Cheaper, high-fat, processed meats are also experiencing a boost in sales. In addition, as the price of fuel climbs higher, biofuels become even more attractive crops for smaller-scale farmers who are already switching away from fruit and vegetables or selling their land to the biofuel giants. High fuel prices also make food more expensive by raising transportation costs, which in turn make bulkier, less-calorie-dense whole foods even more expensive.

Using biofuels to address the energy crisis is turning out to be a cure that may be worse than the disease. Burning food in gas tanks while hundreds of millions around the world face starvation is a horrific prospect. But it's not just a problem for poor countries. The inevitable increases in obesity from high prices of food and fuel will be costly in human suffering and healthcare dollars here as well. Along with hunger, rising obesity, diabetes and heart disease will take their toll on the poor and middle-income -- while agribusiness literally makes a killing.

Dr. Hillel W. Cohen, an epidemiologist and biostatistician, conducts research in the areas of heart disease and diabetes. Dr. Judith Wylie-Rosett, a nutritionist and health educator, conducts research on the role of nutrition in chronic disease prevention and control. Both are professors in the department of epidemiology and population health at the Albert Einstein College of Medicine.

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