It used to be that rich and fat were terms associated with people, not dessert. A portly shape, in fact, signaled the good life. If you ever saw the musical Oliver!, you may recall the number, "Food, Glorious Food," in which a stage full of scrawny orphans pine for the gluttony that money can buy: "Rich gentlemen have it boys, In-di-gestion!" Today, however, we often see the reverse scenario: the leaner your wallet, the fatter you are.
"You have this coexistence of obesity and food insecurity in America," says Susan Blumenthal, former U.S. assistant surgeon general, clinical professor at Georgetown and Tufts University medical schools, and director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress. Finding, and affording, healthy food along with safe places to exercise, are among the challenges that low-income populations face.
So perhaps it's not surprising that the statistics released Monday by the Centers for Disease Control and Prevention (CDC) showed that Mississippi, the poorest state in America, has the nation's highest obesity rate, at 34.9 percent. States in the South and Midwest, which, in some cases, represent the poorest parts of the country, showed the highest incidences of obesity. While financial health has a bearing on physical health, the correlation is a complicated one. Culture, gender, education, biology, and even politics, play a role. America's so-called "red" states tend to have higher rates of obesity, experts note. Plus, the prevalence of cheap, processed foods, the layout of our neighborhoods, and access to parks and public transportation also factor into one's risk for obesity and, consequently, disease. And while poor Americans may find it especially challenging to access the ingredients of a healthy lifestyle, obesity is clearly not limited to the province of the poor. More than one-third of the nation is obese, according to some data sets, and that cuts across all income levels.
[See the Most and Least Obese U.S. States.]
"There is no single, simple answer to explain the obesity patterns" in America, says Walter Willett, who chairs the department of nutrition at the Harvard School of Public Health. "Part of this is due to lower incomes and education, which result in purchases of cheap foods that are high in refined starch and sugar. More deeply, this also reflects lower public investment in education, public transportation, and recreational facilities," he says. The bottom line: cheap, unhealthy foods mixed with a sedentary lifestyle has made obesity the new normal in America. And that makes it even harder to change, Willett says.
In 1990, not one U.S. state had an obesity rate greater than 14 percent, according to the CDC. Ten years later, 23 states reported an obesity rate between 20 to 24 percent. And in 2010, 36 states had an obesity rate of at least 25 percent, with 12 states reporting an obesity rate beyond 30 percent. (The CDC notes that it used a new methodology for its 2011 survey, rendering comparisons with past years rather rough.)
"We now see that life expectancy is for the first time decreasing in many parts of the South and Southeast," says Willett.
Obesity puts people at risk for heart disease, stroke, diabetes, and cancer. These illnesses, of course, exact a financial toll too. In 2008, this country spent approximately $147 billion on medical costs, the CDC says. If every American were to lose an average of 10 pounds, the United States would save roughly $29 billion a year within five years, says Jeffrey Levi, executive director of the Trust for America's Health, a nonprofit organization promoting national health. "If you really want to bend the cost curves, it isn't doing things at the margins" that counts, he says, but "taking on the fundamental challenge of preventing and reversing chronic disease."
But the CDC's state-by-state picture of America's obesity epidemic may not be the best way to understand, let alone tackle, the issue.
Obesity is tied not to states, per se, but to certain populations who reside in those states, says Barbara Ormond, senior research associate at the Health Policy Center of the Urban Institute, a Washington, D.C.-based think tank. Each of these populations grapple with specific problems, she explains. "Take, for example, comfort food, she says, which varies by culture and nutritional quality.
According to the CDC, non-Hispanic blacks have the highest rates of obesity, followed by Mexican Americans, all Hispanics, and non-Hispanic whites. When it comes to socioeconomic status, the data differ by gender. For example, college-educated women and women who earn higher incomes are less likely to be obese than women who didn't graduate high school or earn lower salaries. However, such correlations don't exist among men, for whom obesity is roughly the same across income levels. In fact, higher incomes were associated with increased obesity rates among non-Hispanic black and Mexican-American men, the CDC reports.
Such complexities explain Ormond's caveat against labeling obesity a poverty problem. It's a "shorthand way of looking at it" that reduces it almost to something that's hard to do anything about, she says. "You can't make everybody not poor, but you could give them good schools, or you could make sure the school lunch you're serving is nutritious."
Fixing this problem is going to take a proverbial village, public health experts say.
"We need to mobilize all sectors of society," Blumenthal says, calling for policies that will create more places to walk and exercise, as well as physical and health education in schools and healthier choices in vending machines, for example. But communities can begin the intervention, she says, noting the Affordable Care Act's Prevention and Public Health Fund, which can seed local efforts. Neighborhoods might come together to organize a health fair, coordinate a race to motivate community weight loss, or plant community gardens, she advises.
And beyond that, those working to fight obesity in this country ought to be patient and persistent, Ormond says. "It took us many, many years to get as fat as we are as a nation, and it's going to take us a similar number of years, or certainly a lot of effort to reverse that trend."
- www.snaptohealth.org, which provides a forum on food stamps and nutrition, and features healthy recipes for the budget-constrained.
- www.cdc.gov/obesity/strategies, which provides "strategies to combat obesity" for individuals, families, and communities.