Poverty and Obesity: Where Does the Problem Start?
It’s become a bit of a cliché. Poverty and obesity seem to travel together. Though obesity rates are rising among all social and economic groups, populations under the most pressure suffer disproportionately. But that begs a question. How does the relationship between poverty and obesity work?
Reversing the Usual Assumption
The typical assumption is that poverty puts people at risk for obesity. But a recent analysis in BMJ Open concludes that evidence is stronger for a reverse effect. In other words, it seems a bit more likely that obesity causes a low income. Evidence for a low income causing obesity is not as strong.
To reach this conclusion, Tae Jun Kim and Olaf von dem Knesebeck conducted a systematic review and meta-analysis of all of the research they could find on this subject through early 2017. Altogether, 21 studies made it into their meta-analysis. They did find an association of lower income with the subsequent development of obesity. But when they adjusted for publication bias, the significance of that finding disappeared.
On the other hand, they found more consistent evidence favoring reverse causality. This relationship held up even after taking publication bias into account.
Defying Typical Patterns of Disparities
The relationship between obesity and income is a vexing one. Just today, the Commonwealth Fund issued its 2108 Scorecard on State Health System Performance. Of course, high obesity rates present key problems. And when you dig into the details about disparities in obesity, you will find the biggest disparities in some unlikely places.
For example, Minnesota is among a handful of states with the overall lowest health disparities. But when it comes to obesity, disparities in Minnesota are among the highest. On the other hand, Missouri ranks near the bottom in health disparities overall. But for obesity, the disparities are relatively low.
Without a doubt, measuring disparities – and for that matter, measuring obesity rates – is a tricky business. But these data serve as a sharp reminder. Strategies that work for privileged populations might not work for disadvantaged populations. And obesity itself might be a cause for economic disadvantages.
Click here for the study in BMJ Open and here for the Commonwealth Fund report. For perspective on obesity disparities in Minnesota, click here.
Childless Millionaire and the Poor with Children, painting by Niko Pirosmani / WikiArt
Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.
May 3, 2018
May 14, 2018 at 3:52 pm, Valerie said:
The basis of those commentaries on obesity and poverty is that obesity is more prevalent in poor people than in rich people.
What data do you have to support that idea?
I remember having this kind of discussion before. Here, I found it. It is in the comment section. I am Valerie over there too.
https://eathropology.com/2016/01/07/low-fat-high-maintenance-how-money-buys-lean-and-healthy-plus-an-alternative-path-to-both/
Seems to me that the idea that poverty and obesity are correlated is simply false (overall).
Show me the data!
May 14, 2018 at 3:59 pm, Ted said:
I recommend that you read the study, along with some of the references if you would like to find answers to the questions you’re raising, Valerie. http://bmjopen.bmj.com/content/8/1/e019862
May 14, 2018 at 7:03 pm, Valerie said:
The study contains 3 references regarding the link between obesity and poverty.
From the first reference:
“We find that in low-income countries or in countries with low human development index (HDI), the association between SES and obesity appears to be positive for both men and women: the more affluent and/or those with higher educational attainment tend to be more likely to be obese. However, in middle-income countries or in countries with medium HDI, the association becomes largely mixed for men and mainly negative for women. This particular shift appears to occur at an even lower level of per capita income than suggested by an influential earlier review. By contrast, obesity in children appears to be predominantly a problem of the rich in low- and middle-income countries.”
From the second reference:
“The overall pattern of results, for both men and women, was of an increasing proportion of positive associations and a decreasing proportion of negative associations as one moved from countries with high levels of socioeconomic development to countries with medium and low levels of development. Findings varied by SES indicator; for example, negative associations (lower SES associated with larger body size) for women in highly developed countries were most common with education and occupation, while positive associations for women in medium- and low-development countries were most common with income and material possessions.”
From the third reference:
“… reveals a strong inverse relationship among women in developed societies. The relationship is inconsistent for men and children in developed societies. In developing societies, however, a strong direct relationship exists between SES and obesity among men, women, and children.”
None of the references show an overall positive association between obesity and poverty. The best they can find is an association between obesity and poverty for women in affluent countries. Not men. Not developping countries.
From other sources (I don’t know the references from the top of my head, but I had taken the time to find them in the discussion I refered you to earlier), there seems to not even be an association for black or latino women in affluent countries. Only white women. For black men, the association was inverse, and for all other groups, there was no association.
How can you jump to the conclusion that poverty is associated with obesity (in general)?
May 15, 2018 at 3:59 am, Ted said:
Thanks, Valerie, for pointing out that the relationship between poverty and obesity is complex and fluid.