What determines our behavior: ourselves, or our circumstances? It is true that we are more likely to be unhealthy when surrounded by unhealthy people. Still, we are individually responsible for what we decide to put in our mouth, and how much we decide to move. Experiences and culture play a tremendous role in health, which means that solutions must happen at the group level, as well as within the individual. Change on a broad scale requires that we honestly analyze and speak about causes and solutions.
Obesity worldwide has been on a steady rise, with the number of obese children in the U.S. tripling since 1970. According to a Harvard study, over 57% of today’s youth will be obese by the time they are 35.1 These trends are clearly a sign that something is going very wrong. Obesity has already reached epidemic proportions with crippling consequences.
Poverty and Obesity
From a global perspective, having more money makes us more likely to be obese. The richest nations are overwhelmingly the most overweight,2 and as nations increase their relative wealth, waistlines increase accordingly. At the national level, the reverse seems to be true: less money makes obesity more likely in developed nations. An analysis of individual U.S. states supports this. Four of the five poorest states are also in the top five for obesity, with Kentucky as the only exception.
Anecdotal evidence also supports this view. When driving through low-income neighborhoods, we tend to see a lot of fast food joints, and far fewer health-related businesses. While healthy foods might be available in grocery stores, the cheapest foods tend to have the most empty calories, thanks to corn subsidies that make high fructose corn syrup practically free.
One recent study showed that U.S. children who experienced poverty by age two were almost twice as likely to obese by the time they reach 15.5 years of age.3 This may be partially due to the increased likelihood that impoverished children will not be breastfed,4 which mounting evidence shows increases the likelihood of childhood obesity.5 As you’d expect, overweight or obese youth are significantly more likely to be overweight or obese adults.
Those in poverty are also the most likely to be malnourished, as many still struggle to eat consistently. Even obese people in poverty often fail to consume the necessary nutrients because of their food selection. Still, poverty is not the only predictor of obesity. Many other demographic factors seem to play an equal or greater role.
A More Complex Demographic Picture
When factoring in gender and race, the “poverty causes obesity” argument becomes less sound. For instance, lower income correlates with obesity in white women, but not black or Mexican-American. Higher incomes among black and Mexican-American men actually increased their likelihood of being overweight or obese. It is harder still to draw clear inferences between genders. According to the CDC, the number of overweight youths was highest among Mexican-American boys, non-Hispanic black girls, and all Native Americans.
Why are non-Hispanic black women more likely to be overweight, regardless of income? Why are Mexican-American men more likely to be overweight, particularly when they have more money, while Mexican-American women are generally unaffected by income? Why are wealthier white women far more likely to be at healthy weight ranges, while white men seem largely unaffected by income? Where is the disconnect between men and women in these sub-populations?
Clearly, culture is comprised of far more than socioeconomic status. There are equally relevant social norms among different genders in different cultures. It remains to be seen whether these demographic patterns will hold as cultures progressively integrate. Each of these statistical inferences look at broad categories that cannot tell the full story of any individual. Still, they indicate cultural patterns and expectations that might be useful to people, depending on their location and community.
The Key Statistic: Education
There is also a strong link between education and obesity. Over 30% of children whose parents did not graduate high school were obese, compared to just 9.5% of those whose parents both graduated college.6 This is a stronger correlation between familial educational level and obesity than poverty and other criteria.
This link would be even stronger if education featured a greater emphasis on physical literacy. Prior to the 20th century, physical and health education comprised a full third of the primary curricula. Currently it’s practically extinct. An education system that encouraged students to move and eat well would result in radically improved long-term health patterns, but the unintended consequence would be an even wider gap in physical health between those with a strong education and those without.
Empower the Individual to Reshape Society
If we take anything from these findings, it is that environment has a profound influence on health. We are intensely social creatures, sensitive to societal norms and with a deep need to belong. This reality influences why some people exercise and eat healthy, and others do not. The solutions to our obesity epidemic are as complex as the social factors that influence it.
According to clinical psychologist Jordan Peterson, the solution to societal issues is broadly emphasized individual interventions. This may seem paradoxical, but Peterson’s 2014 study7 demonstrates how it works. In it, individuals within an experimental group engaged in Peterson’s online future authoring program, which required them to vividly describe their ideal future, and then contrast that to an impulse-driven future they wanted to avoid. This group then created a specific plan of action. The academic performance of the experimental group as a whole improved by 20%. The gender performance gap decreased by 98% within a year, and the ethnic gap shrunk by 93% within two years.
It stands to reason that similar individual interventions, done broadly in the public school setting, may be the most successful way to address the growing problem of health and obesity.
Poverty, race, and gender are all elements of culture that correlate with our susceptibility to the norms of our environment. While we must concede the power of environment, we must also realize the danger of fatalism. The antidotes to an unhealthy environment are the ability to learn, and the inclination for persistence and personal responsibility. An individual’s interpretation of the world is malleable, and a powerful weapon against unhelpful circumstances. Regardless of what else we teach students, they must leave school with the perception and the tools to take steps to improve their health and wellbeing.
References:
1. Ward, Zachary J., Michael W. Long, Stephen C. Resch, Catherine M. Giles, Angie L. Cradock, and Steven L. Gortmaker. “Simulation of Growth Trajectories of Childhood Obesity into Adulthood“. New England Journal of Medicine 377, no. 22 (2017): 2145-2153.
2. Levine, James A. “Poverty and obesity in the US“. (2011): 2667-2668.
3. Lee, Hedwig, Megan Andrew, Achamyeleh Gebremariam, Julie C. Lumeng, and Joyce M. Lee. “Longitudinal associations between poverty and obesity from birth through adolescence“. American Journal of Public Health 104, no. 5 (2014): e70-e76.
4. Heck, Katherine E., Paula Braveman, Catherine Cubbin, Gilberto F. Chávez, and John L. Kiely. “Socioeconomic status and breastfeeding initiation among California mothers“. Public Health Reports 121, no. 1 (2006): 51-59.
5. Yan, Jing, Lin Liu, Yun Zhu, Guowei Huang, and Peizhong Peter Wang. “The association between breastfeeding and childhood obesity: a meta-analysis“. BMC Public Health 14, no. 1 (2014): 1267.
6. Singh, Gopal K., and Michael D. Kogan. Childhood obesity in the United States, 1976-2008: Trends and current racial/ethnic, socioeconomic, and geographic disparities. US Department of Health and Human Services, Health Resources and Services Administration, 2010.
7. Schippers, Michaéla C., Ad WA Scheepers, and Jordan B. Peterson. “A scalable goal-setting intervention closes both the gender and ethnic minority achievement gap“. Palgrave Communications 1 (2015): 15014.
