Over the past decade, the American obesity epidemic has provoked a wide range of possible solutions, from soda-pop bans in elementary schools to salad bars in high school cafeterias. Some cities have begun retooling their recreation infrastructure, making playgrounds and public sports fields safer and more accessible.
The jury is still out on such measures, but there remain two fundamental truths. One: Obesity, especially childhood obesity, is real and getting worse. Two: Obesity eludes simple, popular fixes.
Come now two new studies that explode a key and popular belief--that the absence of access to healthy food in poor neighborhoods is a significant determinant of childhood obesity. It is a notion largely hatched and groomed by California activists over the last ten years, and so it is devastatingly on point that the research is based on California food and obesity data. The studies, one in the American Journal of Preventive Medicine, the other from Social Science and Medicine, show that when you do detailed demographic and socio-economic analysis, you find little difference in the number of food outlets between poor neighborhoods and more affluent neighborhoods. In fact, in many poor neighborhoods there is greater access to food.
The studies also showed that obesity rates and the kind of food sold in such stores were unrelated. There was no correlation between the proximity of food sources to where the participants lived, their diets and their weights.
All of this will give great comfort and ammo for the guardians of liberty on the right--the talking heads who routinely--and misleadingly--castigate the First Lady’s efforts to reduce childhood obesity as yet another intrusion of a mythical American “nanny” state.
Yet obesity undisputedly remains a special problem of the poor. The obesity rate in LA’s affluent beach community of Manhattan Beach is 4 percent. The obesity rate twenty miles way, in Bell Gardens, in 34 percent.
But why? The answer is ultimately simple but troubling: poor kids get fat for different reasons than rich kids, and they suffer from it more.
Poor kids get fat for different reasons than rich ones, but the common focus of blame isn't valid. Photo: Shutterstock
Consider three notable observations, one from developmental pediatrics, one from sociology, and one from the world of nutrition and evolutionary science.
Mommyhood makes metabolism
Over the past 20 years, scientists who study human development--how we grow--have documented a close link between maternal health during pregnancy and the ability of infants to efficiently process sugars.
Much of the data derives from the so-called “in utero programming theory,” first proposed by British scientists who documented a close link between heart disease and infants born during the Dutch famine of 1944. Their finding: A mother whose pregnancy was punctuated by under-nutrition or interrupted nutrition is more likely to give birth to a child that gets hypertension, high cholesterol and obesity and diabetes.
More recent research shows almost any trauma during pregnancy--illness, stress, infection, exposure to pollution, and, on point, over-nutrition--makes it much more likely that a newborn will develop organs that are not up to the task of dealing with a food environment of abundant sugars and fats.
Money, not “access”, drives food choices
Poor people don’t simply have inadequate income, they have episodic income. In fact, they have episodic lives, full of stressful uncertainty, from trauma to family fragmentation. All of this leads to an eat-as-much-as-you-can-now mentality that goes a long way to explaining why poor people are so fat.
More: Episodic poverty drives bad food choices, regardless of the presence of healthy alternatives. You can see this at any local food pantry. Not only do the lines get longer as the month goes on--as income from social service agencies gets spent on other priorities--but their food choices get increasingly starchy: people take more bread and potatoes to stretch their food dollar and fill empty stomachs.
Excess starches and sugars make for excess weight, higher rates of obesity and type 2 diabetes.
The tyranny of liquid calories
The new studies showed that obesity rates and the proximity of stores were unrelated, but what about the kind of food purchased and taken home? A recent study in Pediatric Dentistry showed that “Low SES children consistently had significantly greater consumption of soda pop than high socioeconomic families.” Why do poor parents buy more soda pop? Because it is cheap, omnipresent, and tasty.
It may also be the single most destructive element in the human diet. Barry Popkin, the current dean of obesity studies, has even argued that because humans evolved without liquid calories (except for breast milk) they are uniquely unsuited to metabolize them. “High-sugar drinks didn't even exist until 150 years ago, and they weren't consumed in significant amounts until the past 50 years,” he has noted. “This is just a blip on our evolutionary timeline." Liquid calories don’t make us feel full. We eat too much. We get fat.
Supermarket Clinics?
Building new supermarkets or farmer’s markets addresses none of these core causes, but building other kinds of institutions would. To get at the root of the problem, we need more maternal services in the inner city, from pre natal care to nutrition education and early childhood monitoring of growth rates. Traditionally such clinics derive funding from universities and city governments, but what if we required big food sellers--the kind who reap huge profits by selling soft drinks--to underwrite such basic services as part of their business license fees? Think of the tobacco industry’s forced underwriting of smoking cessation programs.
Supermarkets, a huge real estate power in most communities, might also provide space for clinics, perhaps in the waiting areas of their jumbo pharmacies. Already some neighborhood pharmacies provide basic diabetes counseling; they should be recognized and encouraged to share their experience with the big boys.
Native Solutions
In the quest for giant supermarkets, did we overlook the kinds of native, off-the-official grid innovations that immigrants have themselves cooked up in recent years? Look around in surrounding residential areas in most big cities (and some small), starting around 4 pm, and you will likely see a parade of rickety old commercial vans selling fruit and veggies; they also sell all kinds of salty fatty sugary snacks, which is likely why they’ve been ignored by food activists. But why not focus on what the vans do right, and make it easier for them to operate and expand? More: an agile public health school might find ways to connect the van to childhood health, perhaps via a once a month blood-glucose demo--a simple, fast, cheap way to educate customers about metabolic health.
That's the issue. And that's way the poor can make up their own minds about what to buy.
Taco Truck Clinics?
Mommy clinics don’t have to be fancy, technology-driven affairs either; they should be bare- bones operations focused exclusively on mothers and infants. We could take inspiration from one of Los Angeles’ most recent innovations: food trucks. Clinics on wheels make sense in ever-sprawling, car-dependent cities as well. Today UCLA and USC have mobile asthma and allergy clinics; the concept should be extended to basic diabetes care and obesity prevention.
The success of retail pop-up stores also suggests another tack: use vacant stores--many these days!-- for clinics. Diabetes giants like LA’s Medtronics Inc. might even develop a simple, portable kit to quickly transform small spaces into clinics. The company is, as it constantly reminds us, “the world leader in medical technology and pioneering therapies.” Let’s see some.
A Food Stamp App?
Lastly, there is episodic poverty, perhaps the most vexing ingredient of the modern obesity brew. So far, there’s been limited innovation. True, there are restrictions on using food stamps for beer and a some other items, but there are few incentives or rewards to spend them wisely and healthfully.
So: Can we develop a food stamp app that scans and reports healthy purchases to the USDA and then immediately rewards the healthy spender with extra stamps? Alright, that would likely be a minefield of bureaucratic, legislative and cultural battles. It would not be easy.
Then again, the easy stuff is not working.
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