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From poverty to obesity: exploration of the food choice constraint model and the impact of an energy-dense food tax.

Article Excerpt
I: Introduction

Poverty and disease can participate in a vicious cycle wherein each one perpetuates the other. Deprived living conditions, malnutrition, and poor access to health care can advance the progression from poverty to disease. The resultant disease can lead to more poverty via the association of disease with limited employability, high health care expenses, and losses of skills and ability. This can become a tough cycle to break.

Obesity is one important chronic disease that could participate in this cycle. It is linked to about 30 serious medical conditions, including Type II diabetes mellitus and heart disease (American Obesity Association). Within the United States, obesity has grown to epidemic proportions with roughly one-third of Americans classified as obese (Flegal et al. 2002). It has been estimated that the direct health care costs of obesity in America exceed $ 100 billion, not to mention other indirect costs (American Obesity [Association.sub.b]). These alarming figures highlight the importance of the following questions. Does poverty influence the incidence of obesity and its related medical conditions? If so, how and what can be done about it? These questions address one of the two segments in the poverty-disease cycle: the segment from poverty to disease.

II: Literature Review

There is no doubt that poverty is associated with higher levels of obesity, as well as obesity-related disease, in the United States. The frequencies of obesity and type II diabetes follow an income gradient such that America's poor are overburdened with disease (US Department of Health and Human Services 2000). This relationship is displayed in Figure 1. The Centers for Disease Control and Prevention's analysis of the National Health Interview Survey dataset, comprised of information from 68,556 adults living in the United States, confirmed that the lowest income groups contain a disproportionately higher share of obese persons (Schoenborn, Adams, and Barnes 2002).

[FIGURE 1 OMITTED]

Although one cannot definitively infer cause and effect from these correlational studies, there is reason to believe that the relationship between poverty and obesity is causal. Drewnowki and Specter (2004) recently reviewed the relevant literature to present possible mechanisms by which poverty and obesity may be causally linked. The major mechanism presented describes an inverse relationship between the energy-density (MJ/kg) and energy-cost (US dollars/MJ) of foods. The authors provide evidence for the existence of this relationship in the United States. Based on food composition tables, the work of Rolls and Barnett (2000), and winter 2003 supermarket prices in Seat, Drewnowski and...

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