Childhood obesity and will power

An article in the Journal of the American Medical Association reports that the rate at which obesity is increasing has slowed down and may actually have plateaued. Is this good news? It would be if obesity was descreasing for everyone, at both ends of the economic spectrum. But what if obesity is decreasing for those who can afford healthy food and still increasing for those who can’t?

Research presented at the recent International Congress on Obesity showed that childhood obesity has stabilized or decreased in many countries over the last ten years. Rates are up in China, Vietnam and Germany, but have decreased or stabilized in Australia, Denmark, England, France, Greece, Japan, the Netherlands, Norway, Russia, Scotland, Sweden, Switzerland, and the US. In India, rates have stabilized for boys, but are still rising for girls.

When you dig a little deeper into the numbers, however, there’s a difference between the children of the rich and the children of the poor. An English study, for example, found that obesity was decreasing for 5-to-10-year-olds from higher socioeconomic groups, but was still increasing in lower socioeconomic groups. When the two sets of data balance each other out, it creates the appearance of a plateau.

Studies in the US draw similar conclusions: Obesity rates are much higher among those who are economically disadvantaged or belong to certain ethnic groups.

The cost of healthy and junk food

The quality of the food you eat makes a huge difference when it comes to obesity and health. That’s why I was surprised to see Dr. George Lundberg, former editor of Medscape and JAMA, argue recently that gaining weight was simply a matter of failing to exert enough will power. In a video entitled “How to Prevent Obesity — Stop Eating” (transcript available at Medpage Today and KevinMD), he says:

If you are overweight (BMI 25 to 30), consider this a wake-up call and ACT NOW, before you become obese. STOP EATING. … [S]top eating fats and refined carbohydrates when you can eat fresh fruits and vegetables and complex carbohydrates.

Dr. Lundberg’s advice is probably quite appropriate for educated, comfortably middle-class adults who are currently employed. But consider these statistics from The New England Journal of Medicine (emphasis added):

[B]etween 1985 and 2000, the retail price of carbonated soft drinks rose by 20%, the prices of fats and oils by 35%, and those of sugars and sweets by 46%, as compared with a 118% increase in the retail price of fresh fruits and vegetables.

This widening cost differential, in combination with the global economic crisis, has profound implications in terms of increasing socioeconomic disparities in the incidence and management of obesity, hypertension, diabetes, and other diet-sensitive chronic diseases.

The focus of the NEJM article wasn’t even obesity. It was food insecurity in the US – the risk of going hungry due to an inability to afford food. In households with incomes below the federal poverty level, the rate of food insecurity is 42%. For all households, the rate increased 32% in 2008.

The obese don’t shop at Whole Foods

Commenting on a study that compared the obesity rates of shoppers at Whole Foods and low-cost grocery stores such as Albertsons, the study’s author pointed out the obvious. (emphasis added)

It’s not a matter of availability, Drewnowski said. All of the stores in his study stocked a wide range of nutritious food, including plenty of fruits and vegetables.

Instead, he contends it’s because healthy, low-calorie foods cost more money and take more effort to prepare than processed, high-calorie foods. In a separate study two years ago, Drewnowski estimated that a calorie-dense diet cost $3.52 a day compared with $36.32 a day for a low-calorie diet.

“If you have $3 to feed yourself, your choices gravitate toward foods which give you the most calories per dollar.”

Obesity rates are more than a question of will power. They’re an economic — and therefore a political — issue. When the time comes that we can fill up on fruits and vegetables as cheaply as on junk food, maybe the experts will stop telling us the obesity problem is simply a matter of will power.

Dr. George Lundberg: STOP EATING

Here’s Dr. Lundberg’s editorial.

Related posts:
Obesity: Moving beyond willpower vs. the food-industrial complex
The So-Called Obesity “Epidemic”
Sanjay Gupta, George Lundberg, and Obama’s Enneagram type
Sanjay Gupta a victim of obesity myths?
Do children really need chocolate baby formula?
Sin taxes: Financing health care with soda pop

Resources:

Image source: The Insurance Helpline, UK

Andy Coghlan, Rise in childhood obesity is slowing worldwide, New Scientist, August 7, 2010

Experts warn against being happy too early about child obesity stabilization in developed world, Xinhuanet News, July 15, 2010

E Stamatakis et al., Childhood obesity and overweight prevalence trends in England: evidence for growing socioeconomic disparities, International Journal of Obesity, November 3, 2009 (DOI: 10.1038/ijo.2009.217)

Katherine M. Flegal et al., Prevalence and Trends in Obesity Among US Adults, 1999-2008, Journal of the American Medical Association, January 20, 2010, Vol. 303 no. 3 (scroll down for complete article)

Pam Belluck, Obesity Rates Hit Plateau in U.S., Data Suggest, The New York Times, January 13, 2010

Success of Community Interventions for Childhood Obesity Varies Depending on the Target Age Group, Science Daily, July 13, 2010

George Lundberg, MD, Stop eating before you become obese, KevinMD,

George Lundberg, MD, How to Prevent Obesity — Stop Eating, Medscape Today, July 26, 2010

Hilary K. Seligman, M.D., and Dean Schillinger, M.D., Hunger and Socioeconomic Disparities in Chronic Disease, The New England Journal of Medicine, July 1, 2010

JoNel Aleccia, Pricey grocery stores attract skinniest shoppers, MSNBC, May 24, 2010

Adam Drewnowski and Nicole Darmon, The economics of obesity: dietary energy density and energy cost, The American Journal of Clinical Nutrition, July 2005