Who wants, can not: why obesity is preying on the poorest

“Eat cakes.” The phrase attributed to Marie Antoinette in the face of the shortage of bread during a period of famine clearly shows her distance and lack of consideration in the face of the difficulties of the commoners. Now, the pizzas are the new brioches, but served directly by the rulers. “Giving a child pizza is not a problem. For you it will be garbage, for those parents it is not garbage ”.

With statements like this, made during the strict confinement by the pandemic in 2020, the Community of Madrid justified the change of the school menus of the most vulnerable children, the recipients of the dining grant, for fast food. Whether the parents considered it garbage or it did not matter, because they had no other option to feed their children.

This was especially serious because excess weight and its associated problems prevail especially with the most disadvantaged classes. A worse employment situation, educational level, parental health status and family socioeconomic level are related to a greater risk of overweight or obesity in children, as stated in the latest Aladino Study of the Ministry of Consumer Affairs.

The false dichotomy: either this or nothing

Our economic status is manifested in the cell phone we carry, the car we drive —or not— or the neighborhood in which we live: there is not much Ibex35 executive living in Vallecas or Ciutat Meridiana. Material exhibitionism aside, our state of health also speaks of our financial situation: the lower the income, the more likely we are to suffer from obesity (among other diseases).

Without taking the crystal ball out, a glance at your income level can tell us if you are more likely to be overweight, as discussed in A systematic review of psychosocial explanations of the relationship between socioeconomic status and body mass index. If we go into detail and observe how that excess weight is distributed, outstanding scientific research confirms that, as a gift, your body composition will be worse – less muscle mass and more fat mass -, whether you are a child, an adult or an elderly person .

You can suffer from malnutrition, an acute or chronic state of undernutrition or overnutrition that leads to changes in body composition and decreased organ functions. “Well, it will be better to have something to eat than to eat nothing.” Scare or death, as if they were the only options: it is the fallacy of the false dichotomy. Of course, it is better to eat whatever it is than not to eat. In fact, in developing countries it is people with the most resources who have the highest body weight, because citizens with lower incomes live strenuous lives and do not have access to caloric and nutritionally dense foods, so the concern is not excess weight but pure access to food.

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But in the richest countries, raising this situation is a fallacy, because we have a wide availability of healthy foods that allow us to elaborate nutritious diets at a good price and the weight-status relationship is just the opposite, as established in this systematic review published in Appetite. For more data, Unicef ​​collects that in rich countries, children in social exclusion are those who have the highest risk of being overweight or obese. Something that, in addition, can affect your health throughout your life because it is one of the main determinants of obesity in adults: up to 70% of children who suffer from it will also suffer in their adult life. So it is not about “eating badly or not eating”, although this cynical idea serves as an excuse to implement policies that, far from helping the most vulnerable, deepen inequality.

Your health depends more on your zip code (and your income) than on your genetic code

The food environment has a determining impact on our choices, and we can get an idea of ​​what their influence capacity is being, knowing that in Spain 41.3% of minors and up to 54.5% of adults are overweight . Indeed: obesogenic environments predominate and it would be a mistake to conceive them as isolated aspects of our environment or lonely anecdotes in the form of an advertisement for pastries on a bus shelter or in the unhealthy products of the car machine. vending.

Having certain foods on hand, the supply, is one of the factors that companies do not miss to increase their sales, and vulnerable areas are a good market niche. In Madrid, educational centers located in lower-income neighborhoods have much closer shops where unhealthy food and beverages are sold than those in more favored areas, as shown in this study. You leave the institute in your working-class neighborhood and 100 meters away you can buy a chocolate palm tree, an energy drink and stay at the betting house for the afternoon. Deadline!

It is also more likely that you cannot walk to all the sites because some areas are not safe, or that there are fewer sports areas and you are doomed to a greater sedentary lifestyle. These are some of the reasons why even people who live in slums but have higher incomes are at higher risk of being overweight. However, in the opposite case the thing does not work the same: in Food deserts and the causes of nutritional inequality It is collected that low-income people who live in higher-income areas, with a better food supply, continue to have a worse diet. Having access to healthy food does not guarantee eating well.

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The obesogenic environment decides for you

The food environment has been defined in Obesity Reviews such as the physical environment (accessibility, quality, promotion), economic (cost), political (rules) and sociocultural (norms and beliefs), the conditions and opportunities that influence food choices and the nutritional status of the population. It affects four dimensions: availability, affordability, accessibility and acceptability, in such a way that it not only includes the offer that we have —although it is a parameter with an undeniable weight—, but also the factors that lead us to demand certain products.

Put yourself in situation: you go to a hypermarket where you have thousands of products at your fingertips, hundreds of them healthy options – fruits, vegetables, legumes, fresh, preserved or frozen fish and lean meats, eggs, roasted nuts without salt, olive oil— but a bar of chocolate, the packet of flavored yogurts, and a couple of pre-cooked dishes for dinner always drop in your car in case you get home late this week. It is not the offer that fails, but the conditions that make you choose unhealthy foods that end up in your pantry. Supply and demand determinants can create a dire food environment – that’s the obesogenic environment.

What are these factors when you live in a vulnerable neighborhood or have a low income?

Many things row against. If your job is precarious and with impossible hours, it will impact on your family organization, which is a potential risk factor for childhood obesity: if at six in the morning you are on the way to the subway, it is unlikely that you will be able to sit at the table in the style Family doctor. You are probably under stress and have poorer mental health, which, guess what? It also makes it harder to follow a good dietary pattern (1, 2).

It is not easy to get the complete picture of all the factors that determine diet and how they interrelate. Juan Revenga spoke about it in Why is it so difficult to control our weight?, and he mentioned an incredible infographic with which you can understand why “energy balance” is much more than that story of counting the calories that go in and those that go out. Using the same type of graphs, a model diagram has just been published that collects the elements that determine food intake specifically in people with lower income and from more vulnerable neighborhoods, using data from an umbrella review, which is a scientific investigation very robust and of quality.

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The idea is simple, the two basic concepts, supply and demand, are taken and they are shelled; in supply there are determinants such as food production, costs, trade and geographic access. Availability, perceived affordability, acceptability, family economy and resources, individual and sociocultural influences act on demand.

From this first scheme, sub-schemes (subsystems) are developed that go into detail, fragment those large systems and show by means of arrows how some parameters affect others and feed back. If, due to your personal circumstances, you can cook and you have culinary skills, you will be able to make a more health-focused purchase and there will be more healthy foods on hand and that counts in your favor. But your skills will be of little use if you don’t have time because you spend your life in public transport and you have to take care of two children, which is a negative factor. Thus, up to 60 different variables form a framework that includes all the obstacles that dynamite the possibility that you can eat healthily if you have financial difficulties.

You can now throw away the good roll that tells you that “whoever wants to, can”, because it is a cruel simplification that puts all the responsibility on the individual: if you are overweight it is not because you do not try hard enough or, by climbing a step in the scale of insensitivity, because your parents give in to all your whims and do not feed you well. It is not a question of individual will: the greatest benefits are not achieved with isolated interventions, but with comprehensive social policies that, in addition, entail a lower cost (3, 4). So giving pizzas, hamburgers and soft drinks as a menu to schoolchildren most at risk of exclusion is to row with all the will against their present and future health.


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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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