Obesity and the environment

According to the Centers for Disease Control and Prevention (CDC), the obesity have been affecting some groups more than others. Hispanics 47.0% and non-Hispanic blacks 46.8% had the highest age-adjusted prevalence of obesity than the non-Hispanic whites 37.9% and non-Hispanic Asians 12.7%.[10] Many explanations exist to explain the disparity, among which include different behaviors among racial and ethnic groups, differing cultural norms in regards to body weight and size, and unequal access to healthy foods.[11]

Race and genetics are two other dimensions of obesity that have been extensively studied. Some researchers have found that genetics increase the likelihood of occurrence of obesity through higher levels of fat deposition and adipokine secretion.[12] Others think that race itself may affect the way obesity presents itself in individuals. In a recent study of 70,000 men and women of African ancestry, researchers found three new common genetic variants.[13] These single-nucleotide polymorphisms (SNPs) are connected to body mass index (BMI) and obesity. Therefore, individuals who carry these variants are more at risk of becoming obese. Researchers noted that these genetic variants are but a very small determination in most cases of obesity. It is generally agreed upon by many in the medical community that environmental factors and poor health and eating habits are still considered to be the strongest contributors to obesity.[14]

One study found that black men and women have a lower percentage of body fat than white men and women with the same body mass index (BMI).[15] A similar study concluded that obese black adolescents had significantly less dangerous visceral fat than obese white adolescents. Visceral fat is significant because it has been more strongly linked to the risk of disease as compared to fat stored in other parts of the body.[16]

A multitude of studies show that members of racial and ethnic minority communities are disproportionately obese. A recent study in the American Journal of Public Health found a strong correlation between community demographics and the likelihood of inhabitants being obese. In this study, non-Hispanic Blacks (36.1%) and Hispanics (28.7%) were shown to have higher percentages of obesity than non-Hispanic Whites (24.5%) and non-Hispanic Asians (7.1%).[17] Non-Hispanic Blacks and Hispanics inhabitants often have to rely on cheap calories with little nutritional value. Food deserts are also more likely to be located in these neighborhoods, which limits available food options. Additionally, these communities also tend to have less access to public goods (such as parks). While racial/ethnic minority communities are often impoverished, social standing alone does not explain the disparity between communities. A 2009 study in the Journal of Epidemiology and Community Health found that racial/ethnic minorities have a higher risk of being obese within each observed socioeconomic group.[18] This finding suggests that race may be a key indicator in determining disparities of obesity risk. The study also implies that structural racism may be causing certain racial/ethnic groups to experience a disproportionate risk, as class alone does not determine the likelihood of a person being obese.

Weight bias is an ongoing field of study that has garnered much more attention in the past few years. There are some studies that focus on obesity-related stigmatization. Multiple academics cite that people who are overweight and obese have been treated differently in almost all aspects of their life because due to the stereotypes commonly attributed to overweight. Laziness, incompetence, weakness of will, sloppiness, and untrustworthiness to name a few of them.[19][20]

In one study of 2,249 obese and overweight women, 54% reported experiencing weight stigma from their colleagues and 43% reported experiencing weight stigma from their superiors. Such weight stigma can be defined as derogatory comments, preferential treatment towards normal-weight colleagues, and denial of employment. In another study of 2,838 nationally representative adults aged 25–74, overweight respondents, obese respondents, and severely obese respondents were 12, 37, and 100 times more likely to report employment discrimination than normal-weight respondents, respectively. Studies show that wages can also be reduced. Data suggests that after controlling for other socioeconomic factors, limitations of health, and other household variables, obese men were expected to see a 0.7 to 3.4% wage depression and obese women were expected to see a wage depression between 2.3 and 6.1%.[21]

Studies have also been conducted showing that physicians are most likely to attribute lack of motivation as the primary cause of obesity, coupled with non-compliance and general laziness. In one United Kingdom study, physicians tended to follow a victim-blaming approach about the causes of obesity, while the obese patients themselves attributed their weight to specific medical causes or other socioeconomic factors, such as low income. Disparities in perceived causation have been seen in some circles as a major hindrance towards physicians and patients abilities to come up with a balanced obesity management plan.[21]

Educational weight bias also persists according to a range of studies conducted observing the effects of obesity and educational attainment. A study of over 700,000 Swedish men found that, after controlling for intelligence and parental socioeconomic levels, those who were obese at the age of 18 had a lower chance of going to college than their peers, who were of normal weight. Similarly, a study based on data gathered by the National Longitudinal Study of Adolescent Health concluded that obese women were 50% less likely to attend college than women who were not obese. It was also found in this study that female students who attended school where most of the females were obese had a relatively similar chance of attending college as non-obese women.[21]

Weight bias, fat stigma, and discrimination are factors that many academics say can contribute to hopelessness and depression that may encourage the same unhealthy habits that initially caused obesity[22]

One of the most critical lessons the scientific and healthcare communities have cultivated is that obesity and mental illness are directly related. Identifying and causing awareness of this complicated relation between these two diseases is necessary in developing progress and solutions that are not yet accessible. Because these two diseases are so closely related, it is crucial that patients being assessed for obesity be examined and assessed thoughtfully of their mental health status. Public health policies, according to the Charter, should itemize the prevention of mental illness and weight-concerned disorders, and recognize the relationship of both conditions to cultural, gender, socioeconomic, and other health elements. In order to create a type of cultural change, training as well as collaboration of health professionals, focusing on interventions, support, preventions, and collaboration with related specialties is crucial. Health Professionals need be more aware that anyone with one of these health issues, (obesity or mental illness), is automatically more susceptible to develop the other one.

Patients who are assessed for obesity are seen to have a chronic health condition. This is not just in a physical health sense, but extremities in mental health as well. A large variety of (extreme) psychological disorders or mental illnesses such as eating disorders (anorexia, bulimia, binge-eating disorder), Schizophrenia, bipolar disorder, and depression/anxiety, have all been shown to be associated with an increased risk of obesity, as well as other obesity-related illnesses such as diabetes and coronary heart disease. One recent study done to over 10,000 people suffering from schizophrenia, bipolar disorder or depression; showed that the 80% of these people were overweight or obese.[23] Other psychological issues which obesity has been shown to trigger are low self-esteem, distorted body image, and body shaming. People who are obese tend to have more increased rates of depression than those who are not overweight. Research done at the University of Wisconsin-Madison by Dr. David A. Kats and his colleagues shows that out of 2,931 patients who exhibit chronic health conditions, that clinical depression was highest in extreme obese patients (BMI over 35). Other research done by the Swedish Obese Subjects (SOS), have indicated that clinically significant depression is about three to four times higher in severely obese individuals than in those who are not obese. Professor Marianne Sullivan and her team from Sahlgrenska University Hospital noted from their findings and experience that people who are obese have exhibited depression scores just as bad as, or worse than those of patients with chronic (physical) pain. They state in a journal article that "Depression on a level indicating psychiatric morbidity was more often seen in the obese".[24][25]

In 2009, The U.S. Department of Agriculture conducted a "food desert" study to examine access to supermarkets. They found that 23.5 million people within the United States did not have access to a supermarket within a one-mile radius of their residences. More than 113 studies have been conducted to determine if healthy food and supermarkets are equally accessible to every socioeconomic class.[42] 97 of the 113 studies found that supermarkets and healthy food stores are unequally distributed between different socioeconomic groups, 14 of 113 found mixed results, and 2 of 113 found equal distribution. 85% of the studies resulted in the conclusion of unequal distribution between different socioeconomic classes.

Studies in which supermarkets were compared to other food outlets such as small grocery stores and convenience stores were also conducted; in this study supermarkets were used as a proxy for food access, for they provide the most reliable access to a wide variety of nutritious and affordable food. The study showed that low-income and minority communities had less supermarkets and more convenience and small grocery stores as compared to predominantly white and wealthy communities. 89 out of 98 national and local studies have found uneven geographic access to supermarkets in urban areas.

Nationwide studies have concluded that zip codes composed primarily of low-income households are 25% less likely to have a chain supermarket store but contain 1.3 times as many convenient stores when compared to zip codes composed of middle-income households. Zip codes composed of predominantly African-American households have about half the amount of chain supermarkets, as do zip codes composed of predominantly White households.[43] According to an assessment of 685 urban and rural census tracts spanning three states, low-income neighborhoods have approximately half as many supermarkets and four times as many small grocery stores when compared to high-income neighborhoods. The same study also found that predominantly white neighborhoods have four times as many supermarkets as predominantly African-American neighborhoods.[44] Also, a study of 10,763 residents in four states showed that the existence of supermarkets in the surveyed residential area was related with a 24% lower prevalence of obesity and a 9% lower prevalence of overweight.[45]

Studies done at the local level demonstrate similar trends to those done at the national level. There are 2.3 times as many supermarkets per household in low-poverty areas in Los Angeles, compared to high-poverty areas. Predominantly white regions have 1.7 times as many supermarkets as Latino regions, and 3.2 times as many as African-American regions.[46] Amongst affluent neighborhoods in Alaska, those composed of predominantly white residents have better access to grocery stores than those composed of predominantly African-American residents, indicating that race may be an element independent of income.[47] West Louisville, Kentucky, a low-income African-American community that suffers from high rates of diabetes, has one supermarket for every 25,000 residents, in comparison to the U.S. average of one supermarket for every 12,500 residents.[48] "In Washington, DC, the city's lowest income wards (Wards 7 and 8) have one supermarket for every 70,000 people while two of the three highest-income wards (Wards 2 and 3) have one for every 11,881 people. One in five of the city's food stamp recipients lives in a neighborhood without a grocery store."[49][50] Twenty-one studies have found that food stores in low-income communities are less likely to stock healthy or fresh food or snacks. These food stores are also more likely to offer lower quality items at higher prices, compared to food stores in predominantly white communities.[51][52][53][54]

Low income families are more vulnerable to becoming overweight and obese due to the low access of high quality, nutritious food in their neighborhoods. Neighborhoods that lack access to nutritious foods are considered to be food deserts.[55]

Low income neighborhoods and communities of color tend to lack full-service grocery stores. A report issued in 2002 by the Urban and Environmental Policy Institute at Occidental College found out that "middle- and upper-income neighborhoods in Los Angeles had 2.26 times as many supermarkets per capita than in low-income neighborhoods."[56] Due to the small amount of grocery stores, low-income residents rely on small corner stores for their food and produce. A study that was conducted in 21 of the nation's largest metropolitan areas found that there are fewer and smaller stores in low-income zip codes than in their wealthier counterparts.[57] Due to the minimal amount of supermarkets located in low-income neighborhoods, people that reside in these neighborhoods have less access to quality food and limited product selection as compared to the selections in wealthier neighborhoods. For example, corner markets in low-income neighborhoods are less likely to offer healthy selections such as whole-grain breads and lower-fat and dairy options.[58]

Low income neighborhoods are burdened with an abundance of fast food outlets. A 2005 study that was conducted in Chicago found that "African-American neighborhoods had 13.7 major fast food restaurants per 100,000 neighborhood residents, while white neighborhoods had 9.4 per 100,000 residents."[59] Fast food restaurants offer inexpensive, calorie-dense food, but that same food is also nutrient-poor and unhealthy, with high levels of sugar, fat, and sodium. According to the USDA recommendation for daily caloric intake, a McDonald's meal has more than half a day's worth of calories.[60][61] In the short term, the residents of these communities are making an economically rational decision when purchasing fast food as it is easily accessible and inexpensive. The alternative would be purchasing low quality groceries at a high cost.[57] In the long-term however, studies show that the consumption of fast food hurts overall health, raising the probability of becoming obese.[62]

Food desserts are described by the Department of Agriculture as neighborhoods without ready access to fresh, healthy, and affordable food. To combat this in the city of Chicago in 2015, then Mayor Emmanuel partnered with Growing Power, which transported affordable fresh fruits and vegetables to food desert areas.[63]  In 2004 Pennsylvania enacted a 100 million dollar economic stimulus package that subsidized grocery stores in food desert areas. Grocery stores could get a low-cost business loan from the Fresh Food Financing Initiative (FFFI) when they locate in a food desert.[63] In 2008 New York City, former Mayor Bloomberg introduced the Green Cart amendment which would allow pushcarts vendors to receive a low-cost permit only if they were willing to operate in underserved neighborhoods. The Green Carts program estimated that they would improve the health of 75,000 New Yorkers and save at least 50 lives a year over the long term.[63]

Obesity and School Nutrition Legislation

The National School Lunch Act and Child Nutrition Act of 2004 created the team nutrition network, this nutrition network was assembled to promote healthy eating and physical activity. These teams provided grants to states to create healthy eating programs as well as establish physical activity for children.[64] Along with this act CDC released its own guidelines to promote physical education and health education.[65] Schools should coordinate an approach to develop implement and evaluate healthy eating and physical activity policies and practices. They should create an environment that support both healthy eating and physical activity. School lunches should be healthy and provide appealing healthy food and drink choices outside the meal program. Schools should establish physical education programs as a cornerstone, as well as implement health education ensuring that students gain the proper knowledge necessary for healthy eating and physical activity.  Students should be provided with mental health and social services, as well as schools should partner with families and community members to develop and implement healthy eating and physical activities outside of school. Schools should employ qualified professionals and provide staff with professional development opportunities in areas such as physical education, health education, nutrition services, and mental health.

The 2010 Healthy Kids Act was part of Michelle Obama “Let’s Move” program.  This program authorized the USDA to regulate competitive foods, which references to any food that isn’t included in a school’s lunch program, such as fast food and vending machines. Under the Healthy Kids Act schools required more stringent nutritional standards for meals served in in cafeterias. The Healthy Kids Act requires the USDA's nutritional guidelines to be scientifically founded and in compliance with the published Dietary Guidelines for Americans.[66] With this schools began to replace food which were high in fat, sodium and any food that was lacking nutritional value, schools began to implement more fruits, whole grain, vegetables and low or nonfat milk.  As of 2014 kids were beginning to eat more fruits and vegetables, in a study conducted by Harvard it was found that kids age 16% more vegetables and 23% more fruit at lunch.[67] As of 2017 the Healthy Kids Act was still in place but on May 1, 2017 Secretary of Agriculture Sonny Perdue signed a proclamation to make nutrition requirements for school meals more flexible. This includes restoring local control of guidelines on whole grains, sodium and milk.[68]

The food justice movement works to address the obesity epidemic by promoting access to affordable and healthy food to communities. Underlying this discourse is the belief that healthy food is a right of every person regardless of race, ethnicity, socioeconomic status, or community. The New York-based non-profit organization Just Food defines food justice as "communities exercising their right to grow, sell, and eat healthy food."[78] As a potential remedy for obesity, food justice advocates are in favor of providing affordable, quality food through community supported agriculture and the slow food movement.[79] Proponents of the food justice discourse seek to empower historically disadvantaged communities and groups by advocating equal access to healthy food for all people. Some critics of this discourse commend the movement for making healthy food more accessible but are critical of the fact that it does not call into question the structural dynamics that make obesity a likely risk for many of people.[80] It offers alternative food as a solution to obesity but does not consider how food itself is produced and who is involved in production and consumption decisions.

The food sovereignty movement seeks to increase empowerment fostered by the food justice movement in addition to addressing structural issues of the food system by advocating for healthy food as a right and for the right of people and countries to actively participate in decisions of food production and consumption (i.e. the food system as a whole). It seeks to empower those most affected and at risk from the obesity epidemic by including them in the process of creating and implementing alternatives to the current food system. Leading food sovereignty organization Via Campesina defines food sovereignty as "the peoples', countries', or State Unions' right to define their agricultural and food policy..."[81] Adopting the food sovereignty discourse is one channel by which to lower the percentage of overweight and obese, particularly in countries that receive food aid and technology from industrialized nations in the form of grain and pesticides containing possible obesogens.