Widening Disparities May Frustrate Obesity Policies
A new study has us thinking that widening disparities may get in the way of efforts to reverse the the excess of obesity that has developed over the last three decades. Tiffany Powell-Wiley and colleagues conducted a longitudinal study of subjects in the Dallas Heart Study and found that moving to socially and economically deprived neighborhoods is associated with significant weight gain. The authors commented:
This study is among the first to evaluate the role of moving to higher-NDI areas on weight gain and demonstrate the impact of cumulative exposure to neighborhood deprivation on this relationship. These findings are consistent with longitudinal analyses comparing weight gain among non-movers in the DHS, which linked greater duration of residence in higher-NDI neighborhood to a greater likelihood of weight gain. Changes in biomarkers, including cortisol and c-reactive protein, associated with living in disadvantaged neighborhoods suggest that sympathetic activation or alterations to the typical hypothalamic-pituitary-adrenal axis may contribute to a biological pathway by which exposure to neighborhood deprivation promotes weight gain.
To their credit, Powell-Wiley et al have been careful to note that these results simply demonstrate an association that provides the basis for hypotheses and further research.
But this research adds perspective to prior observations that social and economic disparities are linked in some fashion to rising rates of obesity. It also provides food for thought about well-intended efforts to address obesity — like farmers markets and the Healthy Food Financing Initiative — that have done little to move the needle.
Simply dropping supermarkets and farmers markets into economically stressed neighborhoods does little to address the underlying economic and social stresses that may be a key factor in obesity. Economic disparities have been growing on a parallel path with the obesity epidemic since the 1980s.
Right now, we have more questions than answers. Digging for the answers with scientific integrity is the only way to make progress.
Click here to read more about the study and here to read the study itself. Click here for further perspective on disparities in obesity just published in Preventing Chronic Disease.
Poor Folk, book illustration by Aubrey Beardsley from WikiArt
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May 13, 2015 at 8:59 am, Amy Habeck, MS, RDN said:
I agree that social and economic stressors are a key factor in obesity. I see it in my practice all the time.
Is it also possible that being surrounded by people who are of larger body size creates a “new norm” in body size? Just as those who watch high calorie high fat foods being prepared on television shows adjust their own perception of acceptable levels of fat and calories in foods, perhaps people adjust their thinking of what is “normal” body size based on the size of the bodies surrounding them.
As usual with complex biological, social and emotional beings, it is likely more than one factor that contributes to any outcome.
May 13, 2015 at 7:00 pm, Ted said:
Amy, I agree with you completely about the complexity of multiple factors that have bearing on the prevalence of obesity.
I’m not so clear about the impact of social acceptance of larger body sizes. There’s not much evidence that feeling bad about your own body image leads to better health. In fact, shame and guilt about body image has been shown to lead people to avoid healthcare, adopt unhealthy behaviors, and progress to more severe stages of obesity.
I think (just my opinion) that social norms have a more powerful influence by the default choices they present than by creating a perception that obesity is normal. Food at your fingertips all the time, jobs and classrooms that keep you sedentary, and communities that prevent people from walking are all examples of these norms.