Spatial Analyses of Obesity and Poverty

Obesity in the United States is a socio-economic issue. Recent advances in geographic information system methodology can provide a better understanding of the impact of neighbourhood deprivation on access to healthy foods, diet quality and selected health outcomes. Whereas state-level Centers for Disease Control maps are still best known, newer approaches have mapped obesity at different levels of geographic aggregation: county, political district, zip code or census tract. This chapter examines data from the new Seattle Obesity Study, which permits the mapping of dietary behaviours and health outcomes at the property parcel tax level – the finest level of geographic resolution possible. Analysis suggests that food-consumption patterns also show a spatial distribution, broadly following the geographic distribution of wealth and social class.

Behavioural Biology and Obesity

While conventional wisdom holds that excessive body weight is the product of some combination of a high-calorie diet and a sedentary lifestyle, public health measures aimed at these factors have been met with only limited success. This chapter considers the possibility that obesity might be better understood in terms of the biologist's notion that humans and other animals evolved the ability to store body fat as an optimal response to the presence of starvation risk. Evidence from a broad array of disciplines is consistent with this view, including the neuroendocrinology of energy homeostasis, parallels between human and animal fattening behaviour, the effect of stress on dietary intake, population-level studies of the impact of economic insecurity on body weight and international variation in obesity rates.

Obesity: An Evolutionary Perspective

The brain consumes about 20 per cent of the total energy intake in human adults. Primates, and especially humans, have unusually large brains for body size compared with other vertebrates, and fuelling these is a significant drain on both time and energy. Larger-brained primates generally eat fruit-intense diets, but human brains are so large that a reduction in gut size is needed to free up sufficient resources to allow a larger brain to be evolved, placing further pressure on foraging. The early invention of cooking increased nutrient absorption by around 30 per cent over raw food. Increasing digestibility in this way perhaps inevitably leads to risk of obesity when food is super-abundant, as it is in post-industrial societies. However, obesity has clearly been around for a long time, as suggested by the late Palaeolithic Venus figures of Europe, so it is not a novel problem.

Introduction

Obesity, which is rising in affluent societies, is bad for health, expensive to treat and stigmatising. Its prevalence is higher in market-liberal societies than in those with a more extensive welfare state. This book explores the hypothesis that obesity is a response to stress, and that market-liberal societies are more stressful due to the greater intensity of economic and social competition, and to lower levels of social protection.

Income Inequality and Psychosocial Pathways to Obesity

Almost all health and social problems that have social gradients (more common further down the social ladder) are very much more common in societies with bigger income differences between rich and poor. Obesity is part of a very general picture to do with class, status and inequality that affects longevity, violence, mental health, teenage births, drug abuse and child well-being, among other outcomes. The causal pathways through which obesity might be affected by inequality are discussed in this chapter.

Obesity under Affluence Varies by Welfare Regimes

Among affluent countries, those with market-liberal regimes (which are also English-speaking) tend to have the highest prevalence of obesity. The impact of cheap, accessible high-energy food is often invoked in explanation. An alternative approach is that overeating is a response to stress, and that competition, uncertainty and inequality make market-liberal societies more stressful. This chapter reports an ecological regression meta-study that pools 96 surveys from 11 countries, using data collected in the years 1994 to 2004. The fast-food ‘shock’ impact is found to work most strongly in market-liberal countries. Economic insecurity, measured in several different ways, is almost twice as powerful, while the impact of inequality is weak.

The History of the Obesity Epidemic in Denmark

The prevailing interpretation of the global epidemic of obesity is that it is a consequence of changes in societies toward more so-called obesogenic environments, changes which involve the emergence of living conditions that promote persisting positive energy balance. A critical implication of this contention is that the development of the epidemic has followed the corresponding development of the obesogenic environment. This chapter focuses on the history of the obesity epidemic in Danish children and young adult men since the interwar period. Surprisingly, the epidemic has developed in sharply delineated phases closely linked to year of birth, a pattern that is not concordant with the presumed obesogenic changes, which are also problematic for other theoretical and empirical reasons. These findings suggest that the drivers of the epidemic are some changes in the perinatal environment, perhaps even before conception, increasing risk of obesity later in life. Identification of these drivers of the epidemic may offer strong preventive tools to combat obesity.

Subordination, Stress, and Obesity

The distribution of obesity in developed countries follows a social gradient. In developing countries, a similar pattern is emerging as national per capita income rises. The epidemiological evidence runs counter to the popular opinion that being overweight and obesity are matters solely of individual lifestyle choices or genetics. Both are important, but in themselves do not explain the social gradient in being overweight and obesity, to understand which, one needs to look at wider social influences. Evidence from studies including the Whitehall Study of British civil servants indicates that psychosocial factors, including stress, as well as material factors associated with position in the social hierarchy, contribute to the distribution of being overweight and obesity, particularly central adiposity, in the population.

Time Urgency, Sleep Loss, and Obesity

Advancing technology and global commerce have created a 24-hour society where the natural constraints on human activity of geography and distance are dissolving. The competitive challenge of this world offers excitement and opportunity, but also chronic stress, which is frequently experienced by individuals as anxiety and time urgency. Sleep deprivation is commonplace and often self-imposed. The cascade of physiological disruption so engendered has unintended health consequences including cardiovascular disease and obesity. In the latter, there is growing evidence that, together with reduced exercise, short sleep may help drive weight gain by disrupting the bi-directional communication among the body's autonomic, endocrine and immune systems and the brain. The homeostasis of the pro-inflammatory cytokines, and the appetite-modulating peptides, ghrelin and leptin, in each instance is disturbed by sleep debt. This biology is reviewed, together with a discussion of its implications within the broader social context.

Creative Destruction, Economic Insecurity, Stress, and Epidemic Obesity

The past three decades have witnessed a substantial increase in insecurity and stress as capitalism's creative destruction has become ever-more pervasive. A link between insecurity, stress and obesity is strongly suggested by the negative social gradient of obesity. This chapter begins with a survey of the dominant explanations of the obesity epidemic and their limitations. The second section surveys research that is supportive of a relationship between insecurity, stress and obesity. The third section provides evidence of the rise of insecurity and stress as creative destruction has gathered momentum over the past three decades. The fourth section examines the anomalously stable obesity rates between 1960 and 1980. The fifth section notes evidence of the worldwide relationship between rising insecurity and obesity. The chapter concludes with a reflection that, should the argument be correct, the obesity epidemic may be symptomatic of a social disorder in modern capitalist society.