Popular perception holds that individual choices dictate a person’s weight: Those who eat well and prioritize fitness are healthy, and those who do not, are not. However, developing research on childhood obesity suggests that obesity levels are not caused by lifestyle choices — they are intimately linked to genetics and poverty rates.
The graphic below shows that states with the highest percentages of obese high school students have some of the highest poverty rates in the nation, while states with lower high school obesity rates have significantly lower poverty rates.
According to the Food Research and Action Center, a nonprofit working to eradicate hunger and malnutrition in the United States, the correlation — notably not a causation — between childhood obesity and poverty comes from a variety of factors such as lack of access to nutritious food, inability to safely exercise and high levels of stress.
The center points to several studies emphasizing the fact that poorer neighborhoods often lack supermarkets where fresh produce is readily available. Residents instead rely on small corner stores that stock processed, less-healthy food. Impoverished families may not have a car to go to a supermarket and transport nutritious items back in bulk. And while lack of access to nutritious foods is a factor, it is more than likely that impoverished families, especially those living off food stamps, would simply not be able to afford better foods due to high costs. When food budgets are low, families must opt for cheaper, nonperishable processed foods to keep their families fed at a low cost for longer periods of time.
Additionally, children in impoverished neighborhoods have less ability than their wealthier peers to regularly exercise. In areas where safety is an issue, public facilities such as parks and playgrounds can prove unfit for children’s use. While more structured physical activities like organized sports might skirt safety issues, their high costs often preclude children in poverty from participating.
Children in low-income communities also face high stress levels due to food and economic insecurity that can contribute to obesity. Poor mental health can lead to hormonal metabolic changes that wreak havoc on the body’s self-regulatory systems.
Evidence has long been amassing refuting the notion that obesity is the result of laziness and poor diet choices. There are plenty of medically healthy Americans with BMIs that would technically render them obese, and plenty of Americans with average BMIs who do not prioritize healthy living. The same research that shows that obesity levels among teens are intimately linked to high rates of poverty only further supports the notion that negative consequences of obesity are not about actual weight, but about nutrient deficiencies that can be present in people of all sizes. Labeling efforts to help malnourished children as “obesity initiatives” only serves to further stigmatize large body sizes, and it takes away from actual issues facing children like lack of nutrition, unsafe outdoor environments, and stressful living conditions.
Understanding these intricacies and fighting against stereotypes of obese people as poor decision-makers is vital for anyone working in public health — whether as a pediatrician, researcher or family nurse practitioner. It is critical to investigate obesity as a complex social issue interconnecting class, access to food and health care, and environmental stress levels. Public health leaders should focus their efforts on distinguishing between body size and health deficiencies — and then investigate to combat the social causes of illnesses of all impoverished children, rather than focusing on the numbers on a scale.