Article

Poverty and Obesity: The Role of Energy Density and Energy Costs

University of California, Davis, Davis, California, United States
American Journal of Clinical Nutrition (Impact Factor: 6.77). 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.

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    • "Beliefs about the relative effects of fat taxes and thin subsidies on the poor relative to the non-poor are often premised on two assumptions. First is the assumption that the poor consume less healthful diets than the non-poor, perhaps due to the higher costs of more healthy diets (e.g.,Drewnowski and Specter, 2004). The second assumption is that price policies are more likely to benefit low income consumers because low income consumers have more room for improvement, and because of their financial situation, they are likely to be more responsive to price changes. "
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    • "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. "
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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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