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: 6.77). 02/2004; 79(1):6-16.
Source: PubMed


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.

Full-text preview

Available from:
  • Source
    • "This study reinforces previous research that identifies cost as a major influence on family food purchases (Witall et al., 2009; Cason-Wilkerson, Goldberg, Albright, Allison, & Haemer, 2015; Sonneville, La Pelle, Taveras, Gillman, & Prosser, 2009; Styles, Meier, Sutherland, & Campbell, 2007; Hesketh, Waters, Green, Salmon, & Williams, 2005). Current data indicated that many parents make decisions to choose energy-dense, unhealthier foods instead of the more expensive, healthier foods consistent with previous findings in disadvantaged families (Giskes et al., 2002; Drewnowski & Spector, 2004). Despite comments that cost was a restriction to the purchase of healthier foods such as fruit, several participants reported to have fruit at home. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose The purpose of this qualitative study was to explore the perceptions and attitudes that underlie food choices, and, the impact of a school-based healthy eating intervention in mothers from an economically-disadvantaged community. The aim of the intervention was to educate children to act as ‘health messengers’ to their families. Method Sixteen semi-structured phone interviews were conducted with mothers with four receiving a second interview. Interviews were conducted following their child’s participation in a six-week after school healthy cooking intervention. Results Thematic content analysis revealed four main themes: Cost and budget influence on food choices, diversity in household rules controlling food, role of socialisation on diet, and improved cooking skills and confidence to make homemade meals. The interview findings demonstrated the positive influence of the after-school cooking intervention on children and their families in cooking skills, promoting healthier cooking methods and increasing confidence to prepare homemade meals. Conclusions The findings demonstrated the wider economic and social influences on food choices and eating practices. Socialisation into, and strong cultural norms around, eating habits were significant influences on family diet and on parental decisions underpinning food choices and attitudes towards the control of food within the family. The intervention was perceived to be successful in terms of improving nutritional knowledge, cooking skills and increasing confidence to make healthy and tasty homemade meals. The study demonstrates the importance of parental involvement in school-based interventions if improvements in healthy eating are to be evidenced at the family level and maintained.
    Eating Behaviors 01/2016; In press. DOI:10.1016/j.eatbeh.2015.11.001 · 1.58 Impact Factor
  • Source
    • "cakes, cookies) in the etiology of obesity have come under closer scrutiny (Brownell and Wadden, 1992; Fung et al., 2005; Kant, 2004; Lopez-Garcia et al., 2004; McNaughton et al., 2011; Nettleton et al., 2006; Schulze et al., 2005). While a general consensus is yet to emerge, it is becoming apparent that these products may contribute to the epidemic of overweight and obesity (Johnson et al., 2008) because of their low cost (Drewnowski and Specter, 2004), high energy content (Kant, 2000), poor satiety (Rolls, 2000), endocrine disruption properties (Prentice and Jebb, 2003) and hyperpromotion (Wilson et al., 2006). Consumers appear to be aware of some of these issues, reduced fat products in particular being in high demand (e.g. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: This study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. Methods: A national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. Results: Nutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. Conclusion: Communication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods.
    12/2015; 2:21-26. DOI:10.1016/j.pmedr.2014.11.006
  • Source
    • "Previous research has indicated that individuals with greater nutrition knowledge are more likely to consume healthier diets (Ball et al., 2006; Turrell and Kavanagh, 2006; Wardle et al., 2000). Yet, this suggested relationship between nutrition knowledge and diet quality is negated by research advocating that nutritional knowledge alone is not sufficient to influence healthy dietary behaviours (Darmon and Drewnowski, 2008; Worsley, 2002; Drewnowski and Specter, 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To examine if employees with higher nutrition knowledge have better diet quality and lower prevalence of hypertension. Method: Cross-sectional baseline data were obtained from the complex workplace dietary intervention trial, the Food Choice at Work Study. Participants included 828 randomly selected employees (18-64. years) recruited from four multinational manufacturing workplaces in Ireland, 2013. A validated questionnaire assessed nutrition knowledge. Food Frequency Questionnaires (FFQ) measured diet quality from which a DASH (Dietary Approaches to Stop Hypertension) score was constructed. Standardised digital blood pressure monitors measured hypertension. Results: Nutrition knowledge was positively associated with diet quality after adjustment for age, gender, health status, lifestyle and socio-demographic characteristics. The odds of having a high DASH score (better diet quality) were 6 times higher in the highest nutrition knowledge group compared to the lowest group (OR. =. 5.8, 95% CI 3.5 to 9.6). Employees in the highest nutrition knowledge group were 60% less likely to be hypertensive compared to the lowest group (OR. =. 0.4, 95% CI 0.2 to 0.87). However, multivariate analyses were not consistent with a mediation effect of the DASH score on the association between nutrition knowledge and blood pressure. Conclusion: Higher nutrition knowledge is associated with better diet quality and lower blood pressure but the inter-relationships between these variables are complex.
    12/2015; 2:105-113. DOI:10.1016/j.pmedr.2014.11.008
Show more