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.

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    • "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. "
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    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
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    • "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). "
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    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
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    • "Fresh fruits and vegetables and leaner proteins are far more expensive (Lee, 2011). Drewnowski and Specter's (2004) analysis of food energy and cost found an " inverse relation between energy density and energy cost … [suggesting] that 'obesity-promoting' foods are simply those that offer the most dietary energy at the lowest cost " (2004: 9). In general, " dry foods with a stable shelf life are generally less costly (per MJ [megajoule]) than perishable meats or fresh produce " (9). "
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    ABSTRACT: This paper discusses increasing differentiation of U.S. dietary components by socioeconomic strata and its health implications. While upper-income groups have had increasing access to higher-quality foods, lower-to-middle-income class diets are heavily focused on "energy-dense" fares. This neoliberal diet is clearly associated with the proliferation of obesity that disproportionately affects the poor. We provide a critical review of the debate about obesity from within the critical camp in food studies, between individual-focused and structural perspectives. Using official data, we show how the US diet has evolved since the 1960s to a much greater emphasis on refined carbohydrates and vegetable oils. Inequality is demonstrated by dividing the population into households-income quintiles and how they spend on food. We then introduce our Neoliberal Diet Risk Index (NDR), comprised of measures of food-import dependency, the Gini coefficient, rates of urbanization, female labor-force participation, and economic globalization. Our index serves to measure the risk of exposure to the neoliberal diet comparatively, across time and between nations. We conclude that only a societal actor like the state can redirect the food-production system by modifying its agricultural subsidy policies. Inequality-reducing policies will make the healthier food involved in such change widely available for all. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Social Science [?] Medicine 08/2015; 142:47-55. DOI:10.1016/j.socscimed.2015.08.005 · 2.89 Impact Factor
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