Posted by: Joseph Dixon | May 27, 2014

Unintended Consequences; Ancel Keys, Cholesterol, and the Transition to an Obese Society; Part XIII, The Start of Obesity, Part 3, The Role of Income Inequality

In a world full of ironies, a very sad yet interesting irony of our current obesity crisis is that poverty and food insecurity breeds obesity. It does this in several major ways.

1. Lack of funds to purchase nutritious foods and general food insecurity leads families to rely on nutrient poor, energy dense foods, especially during the last week of the food stamp cycle.

2. Obese girls grow up to be obese mothers, who give birth to very heavy babies, who are at increased risk for becoming obese children, and the cycle of obesity is set up to continue.

3. Mothers or care givers in poor neighborhoods prefer to keep their children safe by keeping them in the house or apartment rather then allowing them to play outside where they may be exposed to violence as a result of drug abuse and gang activities.   Since the children get bored staying inside watching television, mothers try to make their children content by buying them cheap, tasty, calorie dense snack foods.

Income Inequality is Real in the US

Income Inequality is real 2011 Atlantic Mag

1.Lack of funds to purchase nutritious foods and general food insecurity…..

Anderson (1990) stated that food insecurity occurs, “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain.”

Anderson SA. Core indicators of nutritional state for difficult-to-sample populations. J Nutr. 1990;120:1559–1560

The USDA reported that in households with children, 17% experienced food insecurity without hunger while less than 1% experienced hunger in the children. In households without children, 8% experienced food insecurity without hunger and 4% reported hunger (USDA Economic Research Report # 11, 2004). The low amounts of hunger in households with children probably is a result of the WIC program, which supplements other aid programs when families have children.

Dinour and colleagues carried out a review of the effects of food insecurity on obesity in the literature published between 1996 and 2006. In their article they present and discuss each study that they considered large enough and that included well described methods. They found a relationship between food insecurity and body weight in women but not in men. This makes sense as men spend a large amount of time out of the home.

Dinour and co-authors also found no association between children being overweight and food insecurity. This last observation is also thought to be the result of extra nutrition provided by the WIC program and because mothers and caregivers often protect their children by giving them available food. However, an important wrinkle to this relationship occurs if the mothers are obese, as will be discussed directly below.

Dinour LM, Bergen D, Yeh MC; The food insecurity-obesity paradox: a review of the literature and the role food stamps may play. J Am Diet Assoc. 2007 Nov;107(11):1952-61.

2.Obese girls grow up to be obese mothers….

An explanation for obesity that applies specifically to infants and very young children is that, now that we have been in the obesity epidemic for at least 20 – 25 years, obese mothers are now giving birth to very large babies that have a high probability of growing up obese. In fact, an article by Gorman’s group (see below) indicated that, in the 28,000 children (2 to 5 years old) in the Massachusetts WIC program, the strongest association with obesity observed was the birth weight of the infant.

The conclusions of this study were:

“The results of this study point to a significant association between persistent household food insecurity without hunger, young children’s weight status, and risk of childhood obesity. It is noteworthy, however, that the associations depend on maternal weight status. Given that results imply that specific groups of children are particularly vulnerable to adverse effects of household food insecurity, targeting these groups might be necessary.”

But this study was amazing in another straight-forward way.  And that was the fact that there were, in the first place, 28000 children who qualified for WIC in Massachusetts alone. This is absolutely amazing to me. How is it that in a highly developed country there can be 28000 children who require nutrition assistance in only one of fifty states?

Metallinos-Katsaras E, Must A, Gorman K. A longitudinal study of food insecurity on obesity in preschool children.
J Acad Nutr Diet. 2012 Dec;112(12):1949-58.

(You will need to obtain the full article through Rutgers Libraries)

3.Mothers or care givers in poor neighborhoods prefer to keep their children safe….

……by keeping them in the house or apartment rather then allowing them to play outside where they may be exposed to violence as a result of drug abuse and gang activities.   Since the children get bored staying inside watching television, mothers try to make their children content by buying them cheap, tasty, calorie dense snack foods.

The above was presented to my Obesity class in a lecture by Dr. Debra Palmer.

The Fight Against Obesity is Carried out by Amazing, Awe-inspiring Individuals

Dr. Palmer is an amazing health professional whose life’s work is to help lower income people have better health through improved nutrition. But even more interesting is Dr. Palmer’s own life story and educational path to become a Professor at Rutgers University.

Dr. Debra Palmer grew up in the inner city of Cincinnati, Ohio. She realized that she needed to go to college in order to break out of the cycle of poverty and, as a single mother, to give her son a better life and insurance (he was asthmatic).  Dr. Palmer went to college for aerospace engineering. During this time she needed food stamps to supplement her and her son’s diets. After obtaining her undergraduate degree, Debra taught physics and chemistry in high school in inner city schools. During this time, Dr. Palmer came to the conclusion that most inner city children had no idea how to successfully navigate modern society and she decided to change her educational goals to specifically help the children of the inner city.

Dr. Palmer obtained 2 Master degrees, one in Education and the other in Nutrition. And later she went on to obtain a Ph.D. degree in Nutrition from Penn State University. During her Ph.D. studies, Dr. Palmer became familiar with government programs that were designed to help prevent hunger in the poor. One of them was Supplemental Nutrition Assistance Program – Education (SNAP-Ed, this was the education portion of the program formerly known as the food stamp nutrition education program (FSNE)). The other program was the Expanded Food and Nutrition Education Program (EFNEP). This program was specifically designed to help provide nutrition education to families with children.

After Dr. Palmer graduated with her Ph.D. and moved to New Jersey for a faculty position in Nutrition, she set about using her knowledge to bring SNAP-Ed to New Jersey, and to make these government educations programs efficient and helpful to the populations in New Jersey they were meant to serve. Having grown up in the inner city and having received food stamps while she was in college, Dr. Palmer was aware of the special problems that face poor people in urban areas.

Her strategy included three major operational tracts:
1) She studied the Federal laws so that the State of New Jersey could obtain the maximal amount of funds for nutrition education from the different legislation bills passed by Congress.

2) Dr. Palmer used her knowledge of the difficulties of urban city living to develop effective educational tools and plans. This has even progressed to the the production of educational videos that promote healthy practices, such as exercising at home. See

3) Finally, Dr. Palmer hired and trained an army of people from the different communities all over the state (people with high school diplomas (but not bachelor degrees)) and trained them to teach in the community, and along the way, to become successful Rutgers University employees, who were eligible to take college classes in order to work toward college degrees. Over the last 10 years she estimates she has obtained a 66% success rate in hiring competent and loyal community workers for her programs.

Income Inequality Certainly Involves the Physical Environment that Poor People Live In

The Physical Environment is defined as our current structured environment where people (adults and children) live, eat, play, shop, work, and attend school. Therefore, the Physical Environment includes the Neighborhood food environment, Neighborhood parks and playgrounds, Neighborhood walkability, Neighborhood public transportation, and Neighborhood safety. The Physical Environment, in most cases, cannot be altered unless the individual and family move to a new location.

In a review of studies by Booth and co-authors (2005), there was strong evidence that:  “…….research presented in this review clearly demonstrate strong preliminary evidence of a relationship between built environment features and the prevalence of obesity. Lower SES neighborhoods are a primary concern, as residents in these areas may have less access to recreational facilities or food stores with healthful, affordable options, …….”

Booth KM, Pinkston MM, Poston WS. Obesity and the Built Environment;  J Am Diet Assoc. 2005;105:S110-S117.

The impact of safe playgrounds on obesity was studied by Dr. Yanjong Jin of Rutgers University (2013).  Dr. Jin used the 2007 National Survey of Children’s Health (NSCH) to determine what effects the presence of a neighborhood park had on the obesity rate of children. Dr. Jin and her co-author found that the effects of a park/playground on childhood obesity was dependent upon the gender, age, race, household income level, neighborhood safety, and other neighborhood amenities. Of high importance was the safety of the neighborhood.

The following received more benefit from a safe neighborhood park:

1. The benefit was greater in girls than boys

2. The benefit was greater in the age 10 – 13 group

3. Non-Hispanic white youth benefited more than other groups

4. Children in unsafe neighborhoods benefited more

The take home message from Dr. Jin’s study was that we need to consider the environment people live in when strategies to combat the obesity epidemic are developed. However, if mothers are afraid to allow their children to play outside, it doesn’t matter what physical environment is available outside their houses.

Maoyong Fan and Yanhong Jin; Do Neighborhood Parks and Playgrounds Reduce Childhood Obesity? Am. J. Agr. Econ. (2013) doi: 10.1093/ajae/aat047 First published online: August 6, 2013

Published article can be found at:


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