Why Do Poor People Have Higher Obesity Rates?

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Some of my columns are generated by suggestions from readers. Most recently, I received one from a woman with whom I share a class at The Ridge. She is a cashier at a Bozeman grocery store that nearly all know and love. She suggested a column on obesity, poverty, and proposed health care reform.

As a grocery store cashier, she and her colleagues noticed a correlation between people and their purchases. Based on her years of experience, she is convinced that many folks with food stamps tend to spend more on "junk food," like chips, donuts, and pop, items high in salt, sugar, and fat. And, she says, their physical appearances often reflect what they buy. Her observations linking poverty with being overweight are backed by data, such as NYU researcher Jennifer Black's study connecting poverty and obesity. This surely doesn't apply to all. No doubt there are many people with low incomes who are serious about nutrition and health, perhaps even some who tackle the notoriously difficult Bridger Ridge Run, or Montana "fun hogs" performing equally demanding athletic feats.

Nonetheless, the grocery checker's observation deserves consideration. She went on to predict what will likely happen if the federal government picks up even more of the medical costs of the poor and underclass.

She believes the dietary choices of many food stamp users will raise health care costs. One way or another, she and other taxpayers will pay for the irresponsible, unhealthy behavior of others. As a working person, she feels abused when her taxes subsidize poor food choices and resultant ill health.

Reasons for poor health choices are numerous. Low-income families tend to maximize caloric intake per dollar and minimize food preparation time. Further, food selection is one feature of their lives over which they have substantial control. Quite understandably, they may choose comfort foods that are low in cost and taste great, but which are high in salt, sugar, and fat. These individuals ignore long term consequences of their dietary decision-making until it's too late for preventative care.

Hence, chips, cakes, and candy are purchased instead of broccoli, beets, and Brussels sprouts. When such purchases are the family norm, children grow up without a proper understanding of good nutrition. Perhaps it's time to reintroduce required family and consumer science curricula in schools. These could include courses on nutrition, child development, and consumer economics.

Current dietary trends will cost Americans under the Obama administration's proposed health care system. Under the new plan, the financial incentive to make smart personal health care choices will be essentially eliminated. Free, universal health care will make people less conscious of unhealthy decisions. According to Stanford University Hospital, obesity in America already costs over 100 billion dollars and 300,000 premature deaths per year from weight induced high blood pressure, diabetes, heart disease, joint problems, sleep apnea, cancer, and related conditions. This sorry situation will worsen as incentives to be healthy decrease. Under proposed reforms, consumers would be insulated from the consequences of their behavior with taxpayers picking up the tab.

As Cass Sunstein and Richard Thaler write, humans often make healthier decisions when they are "nudged" to do so. "A any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options of significantly changing their economic incentives. To count as a mere nudge, the intervention must be easy and cheap to avoid. Nudges are not mandates." Obviously, banning junk food isn't a nudge, but rather an elimination of options. Thaler and Sunstein write that subtle encouragement includes tray-less cafeterias to minimize over-consumption and rearranging supermarket displays to place healthier options at eye level.

Smoking now bears the social stigma of bad behavior. Might obesity follow as the costs it imposes strike the half of American families who pay income taxes? Successful and comprehensive reform must address the links among obesity, poverty, and poor health.