Poverty and obesity: the role of energy density and energy costs.

Center for Public Health Nutrition, Department of Epidemiology, University of Washington, Seattle, WA 98195, USA.
American Journal of Clinical Nutrition (Impact Factor: 6.92). 02/2004; 79(1):6-16.
Source: PubMed

ABSTRACT Many health disparities in the United States are linked to inequalities in education and income. This review focuses on the relation between obesity and diet quality, dietary energy density, and energy costs. Evidence is provided to support the following points. First, the highest rates of obesity occur among population groups with the highest poverty rates and the least education. Second, there is an inverse relation between energy density (MJ/kg) and energy cost (US dollars/MJ), such that energy-dense foods composed of refined grains, added sugars, or fats may represent the lowest-cost option to the consumer. Third, the high energy density and palatability of sweets and fats are associated with higher energy intakes, at least in clinical and laboratory studies. Fourth, poverty and food insecurity are associated with lower food expenditures, low fruit and vegetable consumption, and lower-quality diets. A reduction in diet costs in linear programming models leads to high-fat, energy-dense diets that are similar in composition to those consumed by low-income groups. Such diets are more affordable than are prudent diets based on lean meats, fish, fresh vegetables, and fruit. The association between poverty and obesity may be mediated, in part, by the low cost of energy-dense foods and may be reinforced by the high palatability of sugar and fat. This economic framework provides an explanation for the observed links between socioeconomic variables and obesity when taste, dietary energy density, and diet costs are used as intervening variables. More and more Americans are becoming overweight and obese while consuming more added sugars and fats and spending a lower percentage of their disposable income on food.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine if employees with higher nutrition knowledge have better diet quality and lower prevalence of hypertension.
    12/2015; 2:105-113. DOI:10.1016/j.pmedr.2014.11.008
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: How have growing food-import dependency and intra-state inequalities impacted class diets under the neoliberal food regime? This study shows a deepening inequality between low-to-middle-income working classes, whose diet has become increasingly compromised nutritionally, and higher-income classes, who have gained increased access to healthful or “luxury” foods like fresh fruits and vegetables. We develop an index that measures the risk of exposure to what we call the “neoliberal diet” for low-to-middle-income working classes. Using this index, we compare the US and Canada with a group of countries including the BRICs (Brazil, Russia, India, and China) plus South Africa, Indonesia, Mexico, and Turkey. We conclude that food security for most people in these so-called emerging nations can hardly be achieved under the “comparative advantage” logic of the neoliberal food regime and its nutritionally compromised diet. A more promising, and democratic, alternative is a food-sovereignty program of agrarian reforms to promote peasant production and social empowerment, as well as rural–urban alliances.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dental caries is the most prevalent disease worldwide, with the majority of caries lesions being concentrated in few, often disadvantaged social groups. We aimed to systematically assess current evidence for the association between socioeconomic position (SEP) and caries. The study protocol was registered with PROSPERO (CRD42013005947). We included studies investigating the association between social position (determined by own or parental educational or occupational background, or income) and caries prevalence, experience or incidence. Risk of bias was assessed using the Newcastle-Ottawa-Scale for observational studies. Reported differences between the lowest and highest SEP were assessed, and data not missing at random imputed. Random-effects inverse-generic meta-analyses were performed, and subgroup and meta-regression analyses used to control for possible confounding. Publication bias was assessed via Funnel plot analysis and Egger test. From 5,539 screened records, 155 studies with mostly low or moderate quality evaluating a total of 329,798 individuals were included. Studies used various designs, SEP measures and outcome parameters. 83 studies found at least one measure of caries to be significantly higher in low-SEP compared with high-SEP individuals, whilst only three studies found the opposite. The odds of having any caries lesions or caries experience (DMFT/dmft>0) were significantly greater in those with low own or parental educational or occupational background or income (between OR [95% CI]=1.21 [1.03-1.41] and OR=1.48 [1.34-1.63]). The association between low educational background and having DMFT/dmft>0 was significantly increased in highly developed countries (R2=1.32 [0.53-2.13]). Publication bias was present but did not significantly affect our estimates. Due to risk of bias in included studies, the available evidence was graded as low or very low. Low SEP is associated with a higher risk of having caries lesions or experience. This association might be stronger in developed countries. Established diagnostic and treatment concepts might not account for the unequal distribution of caries.
    Journal of Dental Research 10/2014; DOI:10.1177/0022034514557546 · 4.14 Impact Factor


Available from