Thursday, January 24, 2013

Obesity among the poor


Theodore Dalrymple, whom we've met in these pages before, has written a very useful article in the Telegraph analyzing the root causes of the obesity epidemic among the poor.  His analysis is oriented towards Britain, but it applies pretty well (in my experience, at least) to inner-city America too.  Here's an excerpt.

... what we eat also has a social dimension. You can lead a man to a doughnut, but you can’t make him eat. What is the connection between poverty (relative, not absolute), and the obesity that is unprecedented in history?

. . .

It is ... in social changes that the explanation, or at least an important part of it, is to be sought.

With the decline of the family – wrought by the policies of successive governments – patterns of eating have changed. Meals in many households, especially those of the relatively poor, are no longer family or social occasions. It has been found that a fifth of children do not eat more than one meal a week with another member of their household; and in such households, which I used sometimes to visit as a doctor, the microwave oven was the entire batterie de cuisine, or at any rate the only cooking implement that was ever actually employed.

Moreover, there was no table at which a meal could have been eaten in common if anyone had thought of doing so. The result was that children became foragers or hunter-gatherers in their own homes, going to the fridge whenever they felt like it and grazing on prepared foods – high, of course, in the evil fructose. Not coincidentally, these households were also the least likely to have what would once have been considered the normal family structure.

Such households also tended to be in areas called “food deserts”, in which fresh produce is either not easily available or unavailable. But those who ascribe the dietary habits of the households I have just described to food desertification put the cart before the horse: for if heroin can reach these areas (and it can), surely the humble lettuce can do so?

. . .

... food desertification and the supposed cheapness of industrially prepared foods is a consequence, not a cause of, the food habits I have described. Food desertification is a symptom of the culinary ignorance, incompetence and indifference of a substantial minority of our population: ignorance, incompetence and indifference unopposed by any attempt of our educational system to counteract it, for example by teaching girls the elements of cookery. Fat is indeed a feminist issue, but not in the sense that Susie Orbach originally meant it.

Another contributory factor to the obesity epidemic is the control or authority now given to children over what they eat. Children are asked (and given) what they want by their solicitous mothers, not as a treat but as a matter of course; and what they choose is what is most immediately attractive to them.

This has the delightful short-term consequence of forestalling the struggle to get the children to eat what at first they do not want to touch; but it has the disastrous long-term consequence of restricting their repertoire and of keeping their tastes childish and undeveloped, that is to say likely to cause obesity.

. . .

It is not the combination of poverty and the easy availability of fattening food that has produced the epidemic of obesity: rather it is a sense in these circumstances of meaninglessness, that nothing much matters.

There's more at the link.  Insightful and authoritative - and deeply troubling.  Highly recommended.

Peter

6 comments:

Brigid said...

Maybe it's just that I'm bored as I stand in line but I tend to notice people, how they dress and act and what they are buying.

One young women, 20's, horrible acne and pasty pale, greasy skin, very overweight. Her cart had only Mountain Dew, processed lunch meat, chips, white bread, mayo and pop tarts, noodles and frozen Bubba burgers. When it was rung up, I thought, you could have had a week of real food for less than that.

Another man, slim, face worn with hardship and age, but full of health and vitality. Some meat, the bulk packaged type and just enough for a few servings a week, some generic tea bags, apples, oranges, dry beans,rice, some spices, flour, cornmeal, sugar, salt, milk, eggs, and a 1/2 pound of bacon. Food he would cook from scratch and enjoy, hopefully finding it lasting until hunger set in again.

As a Society, we've forgotten to cook, to prepare, to use bulk food stuffs and plan. The instant gratification of senses will be the death of many of us.

Anonymous said...

How sad. I guess I am a lucky man. My wife and I nearly always cook from scratch, and most of the time enjoy it. (there are the days when we are both so tired we wish take out would magically appear, but it is a 20 minute drive into town)

Peter B said...

Lustig is absolutely correct. In fact, fructose, despite not directly raising insulin levels as elevated levels of blood glucose do, is a major driver of insulin resistance via other mechanisms. Populations that consume less than 40 g/day of fructose are less likely to have diabetes and obesity (or, in the term popularized by Mark Hyman MD, diabesity) as health problems. Fructose also does not suppress hunger through the hormonal mechanisms that glucose does, but actually increases appetite.
The fat story is a bit more complicated. There are several critical pieces:
•The mistaken touting of polyunsaturated fat as "heart healthy,"
•The delayed appreciation of the importance and fragility of the omega -3 subcategory of unsaturated fats (the ratio of omega 3 to omega 6 ratios in our tissues is a much better predictor of cardiac risk than is total cholesterol, and is directly manipulable by diet and supplementation)
•The deleterious effects of the trans- isomers of unsaturated fatty acids, in which the fatty acids are altered by heat and/or industrial processing with catalysts

The story of the junk science that led to the fructose debacle is well told in Gary Taubes' Good Calories Bad Calories and his subsequent writing; another essential piece of the puzzle is detailed in Robert Johnson's The Fat Switch; the latter also contains some fascinating historical information about the history of sweeteners and obesity – and slavery.

trailbee said...

The one place to really see what poor people eat is in the first three food aisles of Walmart. The secret of 'overweight' lives in those aisles.
Yes, it is more complicated, but generally, we eat the most convenient way we can, as fast as possible.
We switched to vegan in August, and it is the most frustrating, labor intensive way to cook for us, and Americans. We really have to think about what we're doing.
I am not surprised at the content of the article.

tpmoney said...

Trailbee,

The first 3 aisles of food at the 3 local Walmarts are in order:

Baked goods / deli
Fresh fruits and vegetables
Frozen veggies

If the poor mostly ate from those aisles I imagine they would be a damn sight healthier than if they ate from the rest. To me, I think a large part of the problem comes from two things. First is this perpetual myth that fast food and crappy food is cheaper than real food. For any family size greater than 1 that just isn't true. The second is this perception that preparing real food is difficult, or "labor intensive." Many quality home meals can be made in 30 minutes or less and are very easy to make. The problem is in this country we've replaced our notion of healthy food with this image of organically free range hand carved snail penises prepared by master chefs. Combine with the usual admonishments to not eat red meat, salt, sugars, fats, starches, grains and to over cook everything in the name of safety and what we have is a perception that eating healthy is difficult, time consuming and tastes like cardboard.

Silver the Evil Chao said...

I picked up soymilk, butter, bread, a box of cereal, ingredients for egg salad (eggs, mayonnaise, mustard), and a slatted stirring spoon yesterday. You know what that cost me? $49. At Wal-Mart. Keep in mind that I was just buying for myself, not for myself and anyone else. And now also keep in mind that when I was working at a deli, that would've been half my paycheck.

With that in mind, is it any surprise that the poor are eating instant stuff? Instant food is way cheaper than fresh produce and meat, and takes less time to make, time that you generally won't have if both parents (or just one, if it's a single parent) have if they're constantly working, or heaven forbid, going to class after work (like my mom, who would go to massage therapy school directly after work and would come home at 11 PM).

It's so easy to sit on a high horse and go "oh those poor people, can't they just cook?", but if you've actually been there, you'd understand. Ever since I was ten, I've had to deal with it. So excuse me for getting a little defensive.