Article

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.

2 Followers
 · 
179 Views
  • 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: Background: Low-income black residents of Baltimore City have disproportionately higher rates of obesity and chronic disease than other Maryland residents. Increasing the availability and affordability of healthy food are key strategies to improve the food environment and can lead to healthier diets. This paper describes B'More Healthy: Retail Rewards (BHRR), an intervention that tests the effectiveness of performance-based pricing discounts and health communications, separately and combined, on healthy food purchasing and consumption among low-income small store customers. Methods/design: BHRR is 2x2 factorial design randomized controlled trial. Fifteen regular customers recruited from each of 24 participating corner stores in Baltimore City were enrolled. Food stores were randomized to 1) pricing intervention, 2) communications intervention, 3) combined intervention, or 4) control. Pricing stores were given a 10-30% price discount on selected healthier food items, such as fresh fruits, frozen vegetables, and baked chips, at the point of purchase from two food wholesale stores during the 6-month trial. Storeowners agreed to pass on the discount to the consumer to increase demand for healthy food. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests, and refrigerators. Primary outcome measures include consumer food purchasing and associated psychosocial variables. Secondary outcome measures include consumer food consumption, store sales, and associated storeowner psychosocial factors. Process evaluation was monitored throughout the trial at wholesaler, small store, and consumer levels. Discussion: This is the first study to test the impact of performance-based pricing and communications incentives in small food stores, an innovative strategy to encourage local wholesalers and storeowners to share responsibility in creating a healthier food supply by stocking, promoting, and reducing costs of healthier foods in their stores. Local food wholesalers were involved in a top-down, participatory approach to develop and implement an effective and sustainable program. This study will provide evidence on the effectiveness of price incentives and health communications, separately and combined, among a low-income urban U.S. population.
  • Source

Preview

Download
5 Downloads
Available from