Not having enough food to eat may cause obesity, diabetes, high blood pressure, and heart disease. Most of us think the chronic disease epidemic is fueled by abundance, but it may be fueled as much by food scarcity and insecurity as it is by excess. And, right now, America is suffering from the highest levels of poverty and food insecurity that it has seen in more than a decade.
In 2008 49 million Americans--including 16.7 million children--lived in a home at risk of not having enough food on the table every day. After working in Haiti, the poorest country in the Western hemisphere, I learned that one in two Haitians wake up every day not knowing where their next meal will come from. But right here in the wealthiest nation in the world, one in five children live in poverty, one in four children live on food stamps, and one in 10 people don't know where their next meal will come from.
The Census Bureau recently reported that the nation's poverty rate increased to 14.3 percent in 2009--the highest level we've seen since 1994. 43.6 million Americans lived below the poverty line in 2009, earning less than $21,954 per year for a family of four or $10,956 for an individual. We now have the highest number of people living on the threshold of poverty in the history of government record keeping.
The poorest areas of the country are also the sickest and have the highest rates of obesity, diabetes, and premature death. These people are dying younger, and life expectancy is plummeting in the poorest states. These states also happen to be the fattest. For example, Mississippi--the poorest state in the union--has poverty rates over 20 percent, obesity rates over 33 percent, and extremely high childhood obesity rates. This is no coincidence.
How does not having enough to eat cause obesity, diabetes, heart disease, cancer, and early death? Let's investigate.
Food Insecurity: The Root of Obesity and Disease
The Life Sciences Research Office says food insecurity exists "whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways (e.g., without resorting to emergency food supplies, scavenging, stealing, or other coping strategies) is limited or uncertain." This may mean going hungry for some. But for a large portion of Americans floating on or sinking beneath the poverty line this means bingeing on cheap, sugary, starchy, fatty calories in order to avoid hunger.
Many poor people in this country are consuming an excess of nutritionally-depleted, cheap calories from sodas, processed foods, and junk food. These folks scarcely eat whole, fresh foods at all, and for good reason: We have made calories cheap, but real food expensive.
Almost $300 billion of government subsidies support an agriculture industry that focuses on quantity not quality, on producing cheap sugar and fats from corn and soy that fuel both hunger and obesity. These calorie-rich, sugary, processed foods are what most people buy if they don't have enough money. You can fill up on 1200 calories of cookies or potato chips for $1, but you'll only get 250 calories from carrots for that same $1. If you were hungry, what would you buy?
Processed foods have become cheaper as real food grows more expensive. The U.S. Department of Agriculture (USDA) reported that between 1985 and 2000 the retail price of carbonated soft drinks rose by 20 percent, fats and oils by 35 percent, and sugars and sweets by 46 percent. Compare that to the 118 percent increase in the retail price of fresh fruits and vegetables. In fifteen years the price of vegetables ballooned six times as fast as the cost of sugary, calorie-rich, nutrient-poor sodas.
This is further compounded by the fact that in some communities in America, the only place to buy food is a local convenience store where fruits, vegetables, or other whole, fresh, real foods cannot be found. Without a car in an urban setting you may have to walk miles to find anything resembling real food.
Social factors like these set the stage for the epidemics of obesity and disease we are facing. This in combination with the nature of human metabolism put our nation's poor in a trap from which it is very difficult to escape.
How the Biology of Starvation Contributes to Disease
What often happens in poverty-stricken families is a hunger-bingeing cycle that follows the economic conditions in the household. When resources come in, people buy cheap, abundant calories in the form of junk and processed foods that fill them up and stave off hunger. This leads to rapid fat storage--a common biological effect after a period of lower calorie intake or hunger. This is simply how human metabolism works.
When calories are scarce metabolism slows down and muscle is lost. As a result the blood sugar imbalances that drive the process of insulin resistance and lead to pre-diabetes and diabetes worsens, and soon people are caught in a recurrent pattern of bingeing on nutrient-poor calories once resources are again available.
Certainly people can learn to eat better for less as I pointed out in my recent blog on the topic, and doing so is an essential part of what needs to happen to break out of this cycle of poverty and disease as I will discuss more below. That said, breaking the hunger-binge cycle is easier said than done. Bingeing after food scarcity and the increased fat accumulation and insulin resistance that come along with it are hard-wired biological mechanisms to prevent us from starvation. Once you have diabetes, engaging in this cycle makes blood sugar control that much more difficult and leads to the swings of high and low sugar that drive health problems and their related costs.
Diabetics without access to adequate food have fives times as many doctor visits as diabetics who have enough to eat on a regular basis. The burden this creates in families already struggling to stay afloat is unspeakable. It's like they are caught in a Grecian hell--pushing the boulder of economic burden up a hill they will never see the top of, reaching for fruit that grows ever further from their reach.
We need to rethink how and what we feed our nation or the epidemics of disease and obesity will consume us. In Haiti, one in two people worry about where their next meal will come from. In America it is one in 10. In order to shift this we need a bold new vision and initiatives that can change our food culture and food availability.
Here are a few initiatives and ideas that may help shift this frightening tide of poverty and disease:
1. Stop or reduce subsidies of agriculture products that allow for the glut of cheap, high-calorie, nutrient-poor sugars and fats from corn and soy into the marketplace.
2. Consider taxing sugar and processed food to support national food programs and community projects, and help cover the hundreds of billions of dollars of health care costs from increasing obesity, diabetes, and heart disease.
3. Fund community-based initiatives to support healthy eating including community kitchens, gardens, and cooking classes that teach how to make good food cheaply. This is part of the new health care bill, and on the agenda of the new Council on Prevention, Health Promotion, and Public Health.
4. Make school lunches healthy by providing only real food and modeling healthy eating. Food can be both fun for you and good for you. Create national standards based on sound 21st century nutritional science and common sense. Most schools have only a microwave or deep fryer, hardly the tools needed to feed our children real, fresh food.
5. Expand the Supplemental Nutrition Assistance Program (formerly the Food Stamp Program). Increasing eligibility, helping those who are not aware they are eligible enroll, and creating new programs that support consumption of more healthful foods could shift the tide of the widening socioeconomic disparities in chronic disease. You should not be able to buy chips and soda with food stamps.
Everyone reading could also sign up for Jamie Oliver's Food Revolution and learn a recipe using inexpensive, fresh, whole food to create a delicious meal and teach that recipe to three people. They, in turn, could teach three more people. After just a few rounds of that, all of America would learn how to feed themselves again.
We need to reclaim our food supply and revive traditional ways of eating. As Michael Pollan says, "If 'food' was made in a plant, don't eat it. If it grows on a plant, then enjoy!"
To your good health,
Mark Hyman, MD
Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.
Follow Mark Hyman, MD on Twitter: www.twitter.com/markhymanmd
Stephen Barrie, ND: Your Fat Cells Control Your Brain
Nicole Skibola: Hunger, Obesity and Innovation in the Emergency Food System
Poverty Drains Nutrition From Family Diet - washingtonpost.com
Childhood nutrition and poverty
Poverty and nutrition policy analysis | International Food Policy ...
Food Security, Poverty and Nutrition Policy Analysis - Elsevier
Poverty may be an effect when you start out rich or middle-class, and make bad choices.
But poverty is a cause, when you are born poor, and live in a poor neighborhood - in that case, you have to make extremely good choices, and have a lot of luck against enormous odds, to get out of that situation. It is well documented that one of the challenges of the poor, is access to affordable, good quality food. If good food isn't available at an affordable price, there is little choice to be made.
Alcohol, drugs, tobacco, violent neighborhoods, poor education, poor housing, lack of transportation, lack of medical care, poor nutrition, and lack of good paying jobs, all conspire against the poor to reduce their chances to effectively improve their situation. It is possible to escape, but only with extraordinary effort and luck, given our current society.
This article does a good job of explaining the intersection of nutrition and poverty.
Perhaps one further recommendation to add to this article:
Encourage cities with poor neighborhoods to adopt zoning ordinances or tax levies to restrict alcohol, tobacco, and fast food stores, and encourage fresh food stores.
What all those people that you are talking about NEED is nourishment. Unfortunately, removing hunger with junk food does not address their need for nourishment, it just removes the body's natural alert system that malnutrition is imminent.
But I disagree that the poor eat badly because of cost or other social factors.
The poor are more likely to smoke tobacco, and that's certainly not because of cost.
Lack of ability to defer gratification leads both to poverty and obesity.
Many people are poor because of bad life choices, not vice versa.
Poverty is often effect, not cause.
Sometimes conservatives are right, this is one of them.
Here's why it won't happen: the corn farmers. Soft drinks, corn syrup (and oddly, also artificial sweeteners) are the main causes of obesity in America. You can't mess with the Dept of Agriculture and farmer's subsidies.
Bill Maher pointed out that it's all because the Iowa primary is first, so farmers get special political treatment, like subsidies for ethanol. He said "if Vermont held the first primary, we'd all be putting maple syrup in our tanks".
1. Stress--causes are many, poverty itself being a big one, but others as well
2. Infrastructural design of our communities--discourage walking, encourage driving or taking buses
3. Advertising--the Spanish word for it is "propaganda." Selling food with tempting images of fun, love and sex--food that is bad for you, like McD's, potato chips and cookies.
4. Ignorance--not knowing how to put together healthy meals with cheap food, like rice or corn with beans to make a whole protein
5. Junk food designed with lots of flavor enhancers like fats and sugars and salivary stimulants like salt to attract people away from the less-enhanced flavors of nutritious food.
Working with poor people, I have to say poverty is very expensive for the society as a whole. Obesity, diabetes, heart disease, strokes, kidney failure, circulatory problems leading to amputations, etc, all cost taxpayers a lot of money, and they are only a few of the problems related to poverty.
Here's the real comparison: Bag of spinach--$2. Cab ride to the supermarket--$4 (at least when I lived in Dallas 15 years ago). Bus is cheaper if it goes there, but it takes forever. If your hourly wage is $7, and you spend 2 hours riding back and forth to the 'burbs to get fresh veggies, then your food cost you $14 in transport costs. I found it was cheaper to take a taxi. I worked two jobs.
2 burgers--$2. no transportation cost.
What is a poor person going to buy, realistically?
So, yes, by any standard nutritious food is very expensive for the poor.
Is it that fast food is really cheaper or are low income people more likely to make poor choices? Lower fat 'select' beef is cheaper than higher fat 'choice' or 'prime'. Cheese isn't all that cheap at the supermarket but it's widely used in burgers and pizzas. I haven't compared the price difference between non-fat and whole milk but it would seem that whole milk is more expensive.
Something's not right here.
Then there's time. Many of the poor are working two or three jobs and odd shifts. Where's this assumption that they have time to be chasing around this kind of food? It shouldn't be a logistical challenge to get to fresh fruits and veggies but the reality is that it is. On the other hand, Coke is everywhere.
Hope that answers some of your question. The reliance of the poor on cheap sugary food is complex and rests on a constellation of factors. Don't assume, though, that they are making bad choices--they have limited choices. I've seen this myself.
(Note: If you are going to comment on prices, perhaps do some actual shopping first. Also, the federal nutritional program WIC (Women, Infant, Children) supports certain foods, like cheese, and not others, like broccoli.)
(Note: Chips are not a cheap food. They are cost more per pound than filet mignon. If you're going to comment, perhaps......................................................................)
Fast food is not a meal, it's a last resort. Candy is not a snack, it's a treat. Carbs are not the main course, they should be balanced with protein. Children would not need exercise time if we, as parents, shut down the video games and forced them outside to play tag, kick the can, basketball, baseball, or badminton.
The corporations have not created our obese nation. The parents and consumers have. If there is no market, there is no product. We need to take responsibility for our actions and stop being absentee parents. When we were young, our parents had didn't have an issue just saying, "No!"
I remember reading an article in the extraordinary St. Louis Post Dispatch in about 1947-1948 wherein a new policy had been enacted that provided cheap nutritious food filled with protean for a growing and developing population. I was a farmer's son. My Dad explained how Truman government policy kept farm prices down to provide an affordable, healthy diet for all Americans. Then I was impressed how government policy could be contructed for the public good.
If you read the history of the Truman Administration you are constantly amazed that his policies wisely took into consideration the entire humanity of citizens rather than simply the interests of the affluent and influential. He always reminded himself that he was President of 150,000,000 citizens of the greatest Republic in the history of the earth, that most of those citizens had no advocate other than the President.
Harry S. Truman stopped the financial interests from regaining deregulation. Their propaganda columnistsand others lost him the Congress in 1946 and almost lost him the election in 1948. But he never backed down to their incessant demands for going back to the "good old days" of the 1920s. This was most extraordinary prudent administratiivew victory that has never been recognized or acknowledged. Why? The present financial interests have written and rewritten the history books.
Grams (born 1898/died 1992) said people changed the way they ate after WW2--no more rationing and better pay- and they wanted to eat like rich folk (or what they thought they ate) Huge portions of meat-potatoes- veg. and dessert with Mom still home cooking. One problem was- it was farm, middle class "manners" to try to feed anyone who came to your house (hold over from Depression)so sometimes you ate several times a day and were still expected to eat a good dinner! Also labor was getting easier--even farmers use less energy with a modern tractor than a horse and plow! Store brought was modern- restraurant food was better (more upper class!) Then her grandaughters all got jobs!
Grams was "quaint" 'cause her grocery list consisted of- flour, salt ,sugar, coffee and tea, corn meal, oatmeal, baking soda, yeast, and a few spices---everything else came from her yard (yes-yard) vegs, chicken and eggs, fruit, medicine---and ham and bacon from her son's pigs. She could feed a family of six for two days with one chicken!