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Why Are So Many Low-Income People So Overweight?

Hint: It has a little to do with access to healthy food.
Farmers market in Los Angeles, California. (Photo: k lachshand/Flickr)

Farmers market in Los Angeles, California. (Photo: k lachshand/Flickr)

You’d think that only the surliest contrarian would challenge the premise that access to fresh food results in improved health. But the idea—which is embodied in the notion of a “food desert”—has come under friendly fire in the last couple of years. It appears that the evidence weakening the connection between food accessibility and personal health is frustratingly, annoyingly, peevishly convincing.

Back in 2012, in the New York Times, Gina Kolata wrote that “there is no relationship between the type of food being sold in a neighborhood and obesity among its children and adolescents.” She quotes Kelly Brownell, director of Yale’s Rudd Center for Food Policy and Obesity, as saying, “if you are looking for what you hope will change obesity, healthy food access is probably just wishful thinking.” More recently, in Slate, Heather Tirado Gilligan cites peer-reviewed research to conclude: “[M]ore fresh food closer to home likely does nothing for folks at the bottom of the socioeconomic ladder. Obesity levels don’t drop when low-income city neighborhoods have or get grocery stores.”

I hate this kind of news. But given that scores of expensive food-access initiatives, most of them following the lead of Michelle Obama, have been established to eradicate so-called food deserts, and given that many food reformers are working under the impression that “if you stock it they will eat it,” these relatively recent studies should inspire a more skeptical look at what seems to be the sensible move of making more fresh food available to obese, low-income consumers. Unfortunately, too much evidence indicates that the matter isn’t quite so simple. When it comes to food, nothing is.

It doesn’t take much imagination to hypothesize that, if your entire material existence teetered on the edge of loss—that is, if you were obsessed with scarcity because you had to be—that you’d likely blow your limited food budget on a bag of cookies and fried gizzards rather than a peck of apples and sweet potatoes.

That said, I worry about this counter-argument’s implications. If healthy food is available and affordable, and if obese, low-income consumers aren’t choosing it, it becomes very, very easy to blame the overweight victim in this scenario. In a country that places a big rhetorical premium on individual responsibility, we tend to not only do a lot of blaming the victim—we also seem to kind of enjoy it.

A recent piece by Tracie McMillan in National Geographic, entitled “The New Face of Hunger,” suggests how quickly (and viciously) blame can be leveled when it comes to personal food choices. In this lavishly illustrated piece we encounter families living in decent homes and owning nice appliances, Nike Airs, and cell phones—and they all eat terribly. They consume greasy chicken gizzards, hot dogs, chicken nuggets, and tater tots. Judging from the pictures and videos, most people profiled are overweight. With the exception of a family foraging for food, the eating scenes in this article are grim.

McMillan notes that one possible reason for ill-advised food choices involves the government’s failure to make the healthier options more affordable. This point has some merit—the federal government certainly subsidizes sodas and hot dogs far more than fresh fruits and vegetables. Still, I’m not thrilled by this argument. It only takes a quick scan of the June 2013 retail food prices—or taking a calculator to a chain grocery store—to see that for the cost of a pound of cookies and a pound of processed cheese you could buy a pound each of broccoli, tomatoes, oranges, bananas, potatoes, and rice. It’s thus difficult to accept, at least on the face of it, the “healthy food is too expensive” claim as a powerful determinant of pervasive obesity.

But does this mean we’re obligated to buck up, stop being so politically correct, and acknowledge that low-income people—folks whose primary source of calories comes from sodas, and sports and energy drinks—are willfully choosing their own diabetic fate? Should we simply go ahead and blame the obese for their obesity?

A perusal of the comments to McMillan’s piece reveals that many readers believe that’s exactly what we should do—and the more stridently we do it the better. Here’s a not atypical comment: “Seeing a family of extremely obese people complaining that they are hungry and don't have enough to eat while buying tatter tots, pre-made pancake batter and other industrial expensive pieces of shit is disgusting.... I'm not going to shed a tear for this fat-*ss family who are too dumb to figure out a way to live with a small income.”

What a sweetheart. Of course, such a response not only makes one sound like a jerk, but is tragically short-sighted. The recent rebuttal to the conventional wisdom that food access doesn’t necessarily equal healthier choices—in essence, that poor people could eat well but don’t—hardly gives us license to rant, as another commenter did, that “the fact they can't feed themselves is THEIR fault.” Instead, it suggests the need for a more nuanced way to think about why so many Americans end up trashing their bodies with corn dogs and cookies when other options are on hand. It’s an opportunity, in other words, to rethink the very nature of eating.

We might begin this process by trying to understand diet as a psycho-socioeconomic phenomenon rather than as a matter of food access. There’s a critically important aspect to McMillan’s story that’s essential to this shift in perspective: the people she profiles live lives defined by persistent scarcity—not necessarily food scarcity, but a generalized and even traumatizing kind of material instability. Absolutely nothing about their lives is secure.

Critics of McMillan’s piece complained about how the low-income cohort she profiled possessed houses, cell phones, decent clothing, and televisions. Nobody mentioned how precariously close these people were to losing those things, much less the anguish such anxiety entails. One unexpected medical bill, one glitch with the car, one minor brush with the law, one argument with your shift manager—all these events could have sent the entire edifice of material life crumbling. And that’s terrifying. The subjects pictured and videotaped in McMillan’s story are not just overweight. They’re scared out of their minds.

And being scared out of your mind affects how you eat. In their book Scarcity: Why Having Too Little Means So Much, Sendhil Mullainathan and Eldar Shafir write that “scarcity captures the mind.” Scarcity, they note, “has its own logic.” It doesn’t take much imagination to hypothesize that, if your entire material existence teetered on the edge of loss—that is, if you were obsessed with scarcity because you had to be—that you’d likely blow your limited food budget on a bag of cookies and fried gizzards rather than a peck of apples and sweet potatoes. Nobody’s saying such a choice would be advisable in terms of maximizing personal or public health. To the contrary, buying crap over carrots means that you are driven to eat by a scarcity-induced craving for the most immediate and gratifying satiation—the kind that sugar, salt, and fat excel at providing. But you remain, in fact, a victim.

Of what? Critics of the American diet frequently note that obesity rates have spiked over the last 30 years. They tend, as they should, to excoriate food companies churning out obesity-inducing processed junk. But do note: The problem is much bigger than our sinister food corporations. Consider the political economy of the United States in the 30 years before our waistline started to expand epidemically. Between 1945 and 1975, wages increased in proportion to worker productivity, the federal government maintained progressive taxes and expanded social service programs, and—while not all Americans had everything they wanted—a majority of us lived lives in the middle class, mercifully free from the distorting logic of scarcity.

Just as the availability of healthy food does not necessarily lead to healthy eating, the availability of unhealthy food need not lead to unhealthy eating. But for that to happen—for more Americans to choose healthier food—they must have a basic sense of security about their future. No matter how much fresh produce is imported into our food deserts, it will never compete with the junk when life is marked by scarcity.