Why Low-Income and Food Insecure People are Vulnerable to Overweight and Obesity
- Limited resources
- Lack of access to healthy, affordable foods
- Fewer opportunities for physical activity
- Cycles of food deprivation and overeating
- High levels of stress
- Greater exposure to marketing of obesity-promoting products
- Limited access to health care
Due to the additional risk factors associated with poverty, food insecure and low-income people are especially vulnerable to obesity (see the section on the Relationship Between Hunger and Overweight or Obesity and the section on the Relationship Between Poverty and Overweight or Obesity). More specifically, obesity among food insecure people – as well as among low-income people – occurs in part because they are subject to the same influences as other Americans (e.g., more sedentary lifestyles, increased portion sizes), but also because they face unique challenges in adopting healthful behaviors, as described below. (For more information on the influences all Americans face, see the section on Factors Contributing to Overweight and Obesity.)
Limited resources and lack of access to healthy, affordable foods.
- Low-income neighborhoods frequently lack full-service grocery stores and farmers’ markets where residents can buy a variety of fruits, vegetables, whole grains, and low-fat dairy products (Beaulac et al., 2009; Larson et al., 2009). Instead, residents – especially those without reliable transportation – may be limited to shopping at small neighborhood convenience and corner stores, where fresh produce and low-fat items are limited, if available at all. One of the most comprehensive reviews of U.S. studies examining neighborhood disparities in food access found that neighborhood residents with better access to supermarkets and limited access to convenience stores tend to have healthier diets and reduced risk for obesity (Larson et al., 2009).
- When available, healthy food is often more expensive, whereas refined grains, added sugars, and fats are generally inexpensive and readily available in low-income communities (Drewnowski, 2010; Drewnowski et al., 2007; Drewnowski & Specter, 2004; Monsivais & Drewnowski, 2007; Monsivais & Drewnowski, 2009). Households with limited resources to buy enough food often try to stretch their food budgets by purchasing cheap, energy-dense foods that are filling – that is, they try to maximize their calories per dollar in order to stave off hunger (Basiotis & Lino, 2002; DiSantis et al., 2013; Drewnowski & Specter, 2004; Drewnowski, 2009). While less expensive, energy-dense foods typically have lower nutritional quality and, because of overconsumption of calories, have been linked to obesity (Hartline-Grafton et al., 2009; Howarth et al., 2006; Kant & Graubard, 2005).
- When available, healthy food – especially fresh produce – is often of poorer quality in lower income neighborhoods, which diminishes the appeal of these items to buyers (Andreyeva et al., 2008; Zenk et al., 2006).
- Low-income communities have greater availability of fast food restaurants, especially near schools (Fleischhacker et al., 2011; Larson et al., 2009; Simon et al., 2008). These restaurants serve many energy-dense, nutrient-poor foods at relatively low prices. Fast food consumption is associated with a diet high in calories and low in nutrients, and frequent consumption may lead to weight gain (Bowman & Vinyard, 2004; Pereira et al., 2005).
Fewer opportunities for physical activity.
- Lower income neighborhoods have fewer physical activity resources than higher income neighborhoods, including fewer parks, green spaces, bike paths, and recreational facilities, making it difficult to lead a physically active lifestyle (Estabrooks et al., 2003; Moore et al., 2008; Powell et al., 2004). Research shows that limited access to such resources is a risk factor for obesity (Gordon-Larsen et al., 2006; Sallis & Glanz, 2009; Singh et al., 2010b).
- When available, physical activity resources may not be attractive places to play or be physically active because poor neighborhoods often have fewer natural features (e.g., trees), more visible signs of trash and disrepair, and more noise (Neckerman et al., 2009).
- Crime, traffic, and unsafe playground equipment are common barriers to physical activity in low-income communities (Duke et al., 2003; Gordon-Larsen et al., 2004; Neckerman et al., 2009; Suecoff et al., 1999). Because of these and other safety concerns, children and adults alike are more likely to stay indoors and engage in sedentary activities, such as watching television or playing video games. Not surprisingly, those living in unsafe neighborhoods are at greater risk for obesity (Duncan et al., 2009; Lumeng et al., 2006; Singh et al., 2010b).
- Low-income children are less likely to participate in organized sports (Duke et al., 2003). This is consistent with reports by low-income parents that expense and transportation problems are barriers to their children’s participation in physical activities (Duke et al., 2003).
- Students in low-income schools spend less time being active during physical education classes and are less likely to have recess, both of which are of great concern given the already limited opportunities for physical activity in their communities (Barros et al., 2009; UCLA Center to Eliminate Health Disparities, 2009).
Cycles of food deprivation and overeating.
- Those who are eating less or skipping meals to stretch food budgets may overeat when food does become available, resulting in chronic ups and downs in food intake that can contribute to weight gain (Bruening et al., 2012; Dammann & Smith, 2010; Ma et al., 2003; Olson et al., 2007; Smith & Richards, 2008). Cycles of food restriction or deprivation also can lead to an unhealthy preoccupation with food and metabolic changes that promote fat storage – all the worse when in combination with overeating (Alaimo et al., 2001; Dietz, 1995; Finney Rutten et al., 2010; Polivy, 1996). Unfortunately, overconsumption is even easier given the availability of cheap, energy-dense foods in low-income communities (Drewnowski, 2009; Drewnowski & Specter, 2004).
- The “feast or famine” situation is especially a problem for low-income parents, particularly mothers, who often restrict their food intake and sacrifice their own nutrition in order to protect their children from hunger (Basiotis & Lino, 2002; Dammann & Smith, 2009; Dietz, 1995; Edin et al., 2013; McIntyre et al., 2003). Such a coping mechanism puts them at risk for obesity – and research shows that parental obesity, especially maternal obesity, is in turn a strong predictor of childhood obesity (Davis et al., 2008; Janjua et al., 2012; Whitaker, 2004).
High levels of stress.
- Low-income families, including children, may face high levels of stress due to the financial and emotional pressures of food insecurity, low-wage work, lack of access to health care, inadequate and long-distance transportation, poor housing, neighborhood violence, and other factors. Research has linked stress to obesity in youth and adults, including (for adults) stress from job-related demands and difficulty paying bills (Block et al., 2009; Gundersen et al., 2011; Lohman et al., 2009; Moore & Cunningham, 2012). Stress may lead to weight gain through stress-induced hormonal and metabolic changes as well as unhealthful eating behaviors (Adam & Epel, 2007; Torres & Nowson, 2007). Stress, particularly chronic stress, also may trigger anxiety and depression, which are both associated with child and adult obesity (Anderson et al., 2007; Simon et al., 2006).
Greater exposure to marketing of obesity-promoting products.
- Low-income youth and adults are exposed to disproportionately more marketing and advertising for obesity-promoting products that encourage the consumption of unhealthful foods and discourage physical activity (e.g., fast food, sugary beverages, television shows, video games) (Institute of Medicine, 2013; Kumanyika & Grier, 2006; Lewis et al., 2005; Yancey et al., 2009). Such advertising has a particularly strong influence on the preferences, diets, and purchases of children, who are the targets of many marketing efforts (Institute of Medicine, 2006; Institute of Medicine, 2013).
Limited access to health care.
- Many low-income people lack access to basic health care, or if health care is available, it is lower quality. This results in lack of diagnosis and treatment of emerging chronic health problems like obesity.