The poor are most likely to be fat, but the more
affluent are closing the gap. Obesity is growing fastest
among Americans who make more than $60,000 a year,
researchers reported.
"This is a very surprising finding," said Dr.
Jennifer
Robinson of the University of Iowa, whose study
was presented at a meeting of the
American Heart Association.
But it "underlines the whole complexity" of the
obesity epidemic, she said.
For years doctors have known that the people most
likely to be overweight have the lowest incomes. Fresh
produce and other healthful fare can be expensive
as well as less accessible than fast food and other
high-fat options in low-income neighborhoods.
Just last week a report criticized the government
nutrition program that feeds millions of low-income
women and children for, among other things, providing
hardly any fresh produce and favoring high-calorie
juice over fruit.
But even as the nation's obesity rates have soared
since the 1970s, disposable income has, too, and Robinson
wondered what role the extra change was having on
waistlines.
She and graduate student Nidhi Maheshwari, who
presented the findings, culled decades of data from
the National Health and Nutrition Examination Surveys,
one of the government's prime health databases, to
compare obesity with family income.
In the early 1970s, 22.5 percent of people with
incomes below $25,000 were obese. By 2002, 32.5
percent of the poor were, they found.
Just 9.7 percent of people with incomes above $60,000
were obese in the 1970s a figure that jumped
to 26.8 percent in 2002.
For purposes of comparison, all the income figures
were adjusted to reflect year 2000 dollars.
Money for quality food aside, higher-income people
are thought to be better educated and to have better
access to health care, so why such a jump among them?
In an interview, Robinson said no one yet knows. But
she speculated that longer commutes, growing popularity
of restaurants and possibly longer work hours since
the 1970s are playing a role.
The poor still are the most likely to be fat, said
Dr. Adam Drewnowski of the University of Washington,
an expert on the problem. Moreover, since the '70s,
rates of extreme obesity being 90 to 100 pounds
or more overweight have ballooned among lower-income
groups, something the study doesn't address, he said.
Further complicating attempts to compare income
and obesity are cultural factors. Certain racial and
ethnic groups positively equate a man's girth with
wealth it's a sign of success, Drewnowski said.
"I would caution against any attempts to interpret
these data to say social differences have disappeared,"
he said. "It just shows that obesity is a general
problem and it's now affecting pretty much everybody.
... But it would be very shortsighted to stop paying
attention to the people who are most vulnerable."
Yet today, the obesity remedies most often recommended
for Americans in general eat fresh salads,
go ride a bike are impossible for many low-income
families, Drewnowski said
Exercise can be hard in inner cities, where the
streets may be too dangerous after working hours.
Many grocery stores in low-income neighborhoods don't
stock expensive fresh produce. And people who work
two or three jobs have little time to make home-cooked
meals.
Robinson agreed: "I don't want to take focus away
from the serious racial and ethnic disparities in
health."
But, she said, it's likely that different factors
play a role in spurring obesity among the middle class
than the poor. "We need to have a lot more research
... to tailor our interventions to specific populations."