Poverty Pocket Sugar House

Neglecting Social Rank in Obesity Prevention Strategies

By any objective measure, our current obesity prevention strategies are failing. Former CDC Director Tom Frieden said it bluntly in JAMA this week. “There has been no progress in reducing childhood obesity.” The latest obesity statistics in Mexico show the problem is still growing. That’s true even though Mexico passed a tax on sugary drinks and highly caloric foods in 2013.

It might be that nutrition policies alone will never solve a problem being fed by social disparities.

In Lancet this week, Silvia Stringhini and colleagues published a massive analysis of social rank as a cause of premature death. In their analysis, they found that low social status has a three-fold greater effect on life expectancy than obesity itself. The analysis is tricky because low social status and obesity are clearly related. Obesity can lead to low social status and vice versa.

But the authors provide compelling reasons to think. We might never reduce obesity prevalence without addressing social and economic disparities. In a companion commentary, Martin Tobias says:

The strength of evidence for the effect of social rank on mortality, as exemplified by the study by Stringhini and colleagues, is now impossible to ignore.

In yet another paper, published in Food Policy, Mabel Gracia-Arnaiz reflects on the problem in Spain. “Spanish health policy has had little effect on obesity rate, particularly among lower classes.” She says an excessive focus on individual lifestyles and nutrition might be responsible. She describes a critical need for greater attention to economic and social factors that drive increased obesity for people with low social status.

In JAMA, Frieden is pretty clear in pointing out why we haven’t made progress against obesity. He says we lack definitive evidence for what is causing it. And we lack effective large-scale models for prevention and control.

Perhaps taxing bad foods and disparaging people with obesity will never get us there. Can even the smartest nutrition policies reduce obesity rates if we continue to neglect widening social disparities?

Click here for Frieden’s commentary in JAMA, here for the analysis by Stringhini et al, here for the commentary by Tobias, and here for the paper by Gracia-Arnaiz.

Poverty Pocket Sugar House, photograph © Professor Bop / flickr

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February 4, 2017