Obesity in Low-Income Populations

To: Howard Zucker, Commissioner, NY Department of Health

From: Leora Tuchman

Date: January 21, 2018

Re: Interventions for Obesity

Statement of Issue

Obesity is one of America’s most prevalent health problems, affecting 36.5% of U.S. adults. Obesity increases a patient’s risk of developing life-threatening illnesses that could otherwise be prevented, such as type 2 diabetes, hypertension, cardiovascular disease, arthritis, cholecystitis, dementia, and a host of mental health issues.  In addition, obesity and its associated health complications burden the health care system, costing the U.S. between $147 and $210 billion a year.  Over the past decade, many initiatives have been taken to educate individuals on healthy eating and physical activity recommendations, however, a disparity of healthful eating habits continues to exist in different socioeconomic groups.  This is largely due to the higher cost of more nutritious foods.  It is important to not only educate individuals on healthy lifestyles, but to also make these diets accessible to them.

• Obesity is a modifiable risk factor, causing chronic illnesses that contribute to America’s overwhelming health expenditure. More than 80% of people with diabetes are overweight and obese.  Diabetes is the seventh leading cause of death in the US and costs around $245 billion in medical costs and lost productivity each year.  Approximately 30% of cases of hypertension are attributable to obesity.  People who are overweight are more likely to have high blood pressure, high levels of blood fats and high LDL, all of which are risk factors for heart disease and stroke.  Around 40% of some forms of cancer and attributable to cancer.  Studies show a strong association between anxiety and obesity in both men and women.  They are also more likely to have depression, anxiety and other mental health conditions.
• Those with lower levels of education and income were disproportionately more obese. 33% of adults who did not graduate high school were obese, compared to 21% of those who graduated from college or technical college.  More than 33% of adults who learn less than $15,000 per year are obese compared with the 24.6% who earn at least $50,000 per year.  In addition, children living below the federal household poverty level have an obesity rate 2.7 times higher than children living in households exceeding 400% of the federal poverty line.
• One of the biggest contributing factors of obesity is the high cost of nutrient rich food, as well as lack of access to healthy options. Studies show that people with lower education attainment had diet costs $1.09 per day lower than those of the highest education attainment.  Those with the highest educational attainment and income had higher nutrient density in their diets.  Nearly 30 million Americans still live in low income areas with limited access to supermarkets. Research has should that people who live in neighborhoods with better access to healthy food also have better nutrition and health.
• Sedentary lifestyle has become status quo for most Americans. Only one in three children are physically active every day. Less than 5% of adults participate in 30 minutes of physical activity every day; only one in three adults receive the recommended amount of physical activity each week.

Policy Options

• Government subsidized supermarkets with more healthful options open in low-income communities. These supermarkets will be accessible to only people of a lower income bracket.
  • Advantages: This program addresses a number of issues that are faced by low income communities that lead to the prevalence of obesity. It will increase the access to healthy food options which is limited in many low-income areas as well as making it affordable. In addition, the
  • Disadvantages: Requires a lot of funding. Requires monitoring the shoppers to ensure the patrons are in need of reduced rates.  Access to healthy food does not necessarily ensure a change in eating habits, community needs to be educated about healthy eating in order for these options to be effective.
• Mandates on popular fast food chains to provide more healthful options at comparable prices. These food items will have to follow a set parameter of nutritional value in order to be deemed acceptable, there must also be an equal number of healthy and unhealthy options.
  • Advantages: Makes healthy food more accessible and affordable to people. Will reduce the consumption of unhealthy food in fast food chains if there are healthy options.
  • Disadvantages: Requires monitoring of these restaurants. Will possibly be effective on patrons of specific restaurants, not on the general population.
• Required nutrition and fitness classes given in public schools in low income communities addressing healthy eating habits, introducing new foods and emphasizing the importance of physical health. Parents will be invited to attend these classes.
  • Advantages: Better education regarding healthy eating can lead to better food choices. Study done by The Food and Nutrition Service in 2013 showed that children participating in nutrition education programs increased their daily fruit and vegetable consumption at home by a quarter to a third of a cup and were more likely to choose low-fat and fat-free milk.
  • Disadvantages: Requires a lot of man power to implement. Education does not equal access to healthful options. Hard to measure results of such interventions.

Policy Recommendation:  Obesity among low-income communities continues to be prevalent.  The high rates of obesity can be attributed not only to poor access to healthful options but the lack of nutrition awareness.  Policies must improve access to such foods as well as implement education about healthful eating.  These should include government subsidized supermarkets in low income neighborhoods as well as strong nutrition education in these communities.  Although these interventions will have considerable costs, they will lower the healthcare expenditure caused by obesity in the United States.

https://stateofobesity.org/policy/health-healthcare-and-obesity/introduction

https://www.fns.usda.gov/pressrelease/2013/fns-001313

https://stateofobesity.org/socioeconomics-obesity/

http://www.washington.edu/news/2011/01/25/higher-costs-of-more-nutritious-diets-contribute-to-socio-economic-disparities-in-health/

https://www.huffingtonpost.com/don-hinklebrown/access-to-healthy-food_b_4822735.html

https://www.hhs.gov/fitness/resource-center/facts-and-statistics/index.html