First Lady Michelle Obama has taken on childhood obesity as her signature issue, and today her task force released its report and recommendations. I have not had time to read it thoroughly, but from a quick scan, many of the recommendations seem pretty sensible: increase breastfeeding rates, encourage women who breastfeed to do so for a longer period of time (A+), improve the quality of school lunches, and get kids away from the TV set.
But I was struck by statistics on the relationship between obesity, race, income. Most people probably think that obesity is a problem of poverty and socioeconomic status. The reasoning goes that the cheapest foods are the least healthy foods, and so people on a budget are eating the worst quality foods. And the higher your education, the more you know about what’s healthy. This is all true, to an extent. But the report, to its credit, casts doubts that socioeconomic status is the primary driver of disparities in health outcomes.
In reviewing disparities in obesity rates, the report mentions race first:
"Childhood obesity is more common among certain racial and ethnic groups than others. Obesity rates are highest among non-Hispanic black girls and Hispanic boys. Obesity is particularly common among American Indian/Native Alaskan children. A study of four year-olds found that obesity was more than two times more common among American Indian/Native Alaskan children (31%) than among white (16%) or Asian (13%) children. This rate was higher than any other racial or ethnic group studied."
For anyone paying the slightest attention to obesity and diabetes, this should come as no surprise. Obesity and diabetes is most prevalent among races, like American Indians, that have had fewer generations to adapt to the agricultural revolution and modern foods. Yet it’s amazing how this plain as day finding doesn’t cause more people to take a longer historical perspective when evaluating the health benefits of grains or dairy, or whether eating meat and natural fats might actually be good for you.
The report continues on socioeconomic status (my emphasis):
"Among adults, obesity rates are sometimes associated with lower incomes, particularly among women.
The relationship between income and obesity in children is less consistent than among adult women, and sometimes even points in the opposite direction. Another study from the early 2000s found that only among white girls were higher incomes associated with lower BMI. Among African-American girls, the prevalence of obesity actually increased with higher socioeconomic status, suggesting that efforts to reduce ethnic disparities in obesity must target factors other than income and education, such as environmental, social, and cultural factors."
See page 62 for further discussion of "Is Poor Diet a Low Income Problem?" The answer?
"…the similarities are more striking than the differences…"
Income and poverty matter — see the section on food deserts, for example — but it’s not the whole story. Two key points:
1. Obesity is a national issue that is effecting everyone, rich and poor alike.
2. If we want to understand the underlying cause of obesity and diabetes (and heart disease and hypertension and, and, and), look where the genetic disparities point.
In general, foods that are new to the human diet are killing us. In general, foods that have been apart of the human diet for the longest time make us healthy and vital.