Obesity and the environment
Obesity and the environment aims to look at the different environmental factors that have been determined by researchers to cause and perpetuate obesity. In 1994 in the United States, the percentage of the adult population that was obese was much lower than it is today. In 1994 the percentage of the population in every state that was obese was less than 20%, but by 2008, only one state still had a percentage obese below 20%, six states had a percentage obese of more than 30% while the rest of the states ranged between 20% and 30%. In 2016, the number of obese people reached an all-time high of about 93 million, which was up 33 percent from 2008 according to the Center for Disease Control. This may be even more concerning for children and teens who have seen their rate of obesity go up to 18.5%, which is triple the rate in 1980. If current trends continue, as many as 57% of them will end up obese by the time, they reach the age of 35. This will put them at higher risk for other health conditions such as, Type 2 diabetes, heart disease, and cancer. In response, both federal and local officials have instituted policies to combat obesity as well as promote healthy eating, such as: The Farm Bill, National School Lunch Act and Child Nutrition Act, as well as The Healthy Kid Act.
Environmental obesogens
Studies have shown that obesity has become increasingly prevalent in both people and animals such as pets and laboratory animals. There have been no linkages found between this obesity trend and diet and exercise. According to Professor Robert H. Lustig from the University of California, San Francisco, "ven those at the lower end of the body mass index curve are gaining weight. Whatever is happening is happening to everyone, suggesting an environmental trigger."The theory of environmental obesogens proposes a different causal facet to obesity – that lifetime exposure to xenobiotic chemicals may change the body's metabolic system. Chemical obesogens are molecules that do not properly regulate lipid metabolism in the body and could therefore promote obesity. Data is scarce, but some in-vitro studies have found this model could be an accurate predictor of future obesity. A study suggested that smoking before and during pregnancy, for example, increases the risk of obesity twofold in children of school age.
Many chemicals that are known or suspected to be obesogens are endocrine disruptors. These obesogens are present in common-use products. In a University at Albany, State University of New York study, organotins were found in a designer handbag, vinyl blinds, wallpaper, tile, and vacuum cleaner dust collected from 20 houses. Phthalates, which have also been linked to obesity, are present in many PVC items in addition to scented items like fresheners, laundry products, and personal care products. Bisphenol A, is one known environmental obesogen that reduces overall number of fat cells, but makes remaining fat cells larger. Effects of obesogens in animals are the same effects researchers see later in life for low-birth weight babies – glucose intolerance and more abdominal fat. The study concludes that obesogens change an individual's metabolic set points for gaining weight.
What little research has been conducted on the relationship between chemical exposure and body mass index points to obesogens as a likely contributor to the obesity epidemic. Some endocrine disrupting chemicals belong to this class of compounds. Bruce Blumberg, a professor of developmental and cell biology at UC Irvine, has found compelling evidence that exposure to the chemical Tributyltin, a compound used in pesticides, can trigger fat cell creation. As several cases have confirmed, many farm workers in America have unwillingly or unknowingly worked in fields that had been recently sprayed with TBT and other dangerous chemicals. Among a wide variety of health risks, farm workers may bear a disproportionate risk of exposure to such obesogens. While legislation has been enacted to require a minimum amount of time to pass before workers enter sprayed fields, the lack of legal and political power of many farm workers combined with the fact that enforcing such laws can be difficult, makes exposure to obesogens a possible threat to the livelihood of many farm workers.
Race
Race and genetics
According to the Centers for Disease Control and Prevention, 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%. 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.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. 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. These single-nucleotide polymorphisms are connected to body mass index 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.
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. 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.
Race and the built environment
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 and Hispanics were shown to have higher percentages of obesity than non-Hispanic Whites and non-Hispanic Asians. 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. 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. 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.Social perspective
Weight bias and stigma
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.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%.
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.
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.
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
Relation to mental health
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,, 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 psychological disorders or mental illnesses such as eating disorders, 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. 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. Other research done by the Swedish Obese Subjects, 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 pain. They state in a journal article that "Depression on a level indicating psychiatric morbidity was more often seen in the obese".
Class-specific obligations
Familial obligations often prevent low-income youth from participating in after-school programs offered in their community. These obligations include, but are not limited to, chores, jobs, family assistance, and household management. A CCLC evaluation found that 50% of non-participating youth could not take part in their programs because of after school responsibilities. Another 28% stated that they could not participate because they were required to take care of their younger siblings after school while their parents were working. As highlighted in a recent brief by the Harvard Family Research Project, "In some evaluations of welfare-to-work programs, the only group of adolescents who experienced gains in participation in formal after school activities were those without younger siblings." Like sibling care, employment is another obstacle that prevents low-income youth from taking advantage of after school programs. Youth from less affluent homes are likely to work longer hours than youth from more affluent homes. According to television broadcast statistics, Hispanic and African-American teen and children are now more targeted by fast food restaurants, Spanish-language advertisement on TV has increased by 8%, and restaurants such as KFC and Burger King have increased their spending on Spanish advertisements from 35% to 41% while decreasing English-language advertising.Access to space
Between the years 1980 and 2000, obesity rates doubled among young children and tripled among teens. Many studies have been conducted to provide insight into whether genetics are to blame, or economic and environmental circumstances. According to the "thrifty gene hypothesis", a common genetic theory for rising obesity rates is that some people are genetically predisposed to more efficiently metabolize food than others. This is a result of years of human evolution. In times of scarcity, these genes were essential in ensuring survival, and in times of abundance, cause obesity. The thrifty genotype is one theory to explain obesity. The tendency to be sedentary and increasing rates of sugar and fat consumption are also linked to obesity prevalence.The propensity for children to be less active can be attributed to the accessibility to safe play areas and after school programs, which differ between different socioeconomic classes. Studies have shown that rates of participation in after school programs is similarly low across all socioeconomic groups. Current research shows that this may be due to external factors other than the willingness or need to participate. Research shows that children that come from high-socioeconomic households typically do not participate in after-school programs because they are already involved in a wide range of other activities not funded by the school. Children that come from low-socioeconomic households, however, typically do not participate because of a lack of ability to participate. Lack of transportation is another obstacle to utilizing play spaces and after-school programs. Parents of low-income and minority youth were less likely to report easy access to conveniently located after-school programs, as compared to high-income and white parents. The child's ability to participate in most after school programs is contingent on the parent's ability to drop them off or pick them up. It's very uncommon for after-school programs to have the resources to provide transportation.
Youth face similar problems as young children from disadvantaged families. Poor youth are less likely to have access to a car, and more likely to live in high crime neighborhoods, making it difficult to take public transportation or walk. The CCLC, an after-school program that targets low-income youth, conducted a survey in which 20% of youth reported that the reason they were not able to enroll was not due to lack of desire, but rather their inability to find adequate transportation.
Factors of the built environment may contribute to obesity, for example via the availability of unhealthy food or the absence of green spaces, defining the term "obesogenic environment".
Access to technology
Children of higher–class families have more access to technology tend to make less use of their provided 'environmental space' of their everyday life. With this, that use of technology takes away from youth outdoor interaction. This issue contradicts with the belief that children who come from high-income homes are less likely to become obese considering they usually have more access to be active in their surrounding 'environmental space'. Children now a day who have more access to technology tend to spend more time indoors behind a computer/television screen. With the ongoing advancement in technology, those who have access- especially children of wealthy working parents- are more likely to spend time sitting still being attentive to either a television or computer screen rather than moving around outdoors. This use and focus on technology not only takes away from physical activity time for a child, but also plays a role in negatively affecting a child's health.Technology being a direct factor to obesity goes hand in hand amongst children, teens and adults. Not only does the use and increase in technology affect the weight of children who tend to spend more time indoors using this technology rather than being active outdoors, technology advancements also play a role in those adults who spend most of their time working behind and using a computer in general. According to research done by two economists from the Milken Institute, a statistic shows for every 10 percent rise in what a country spends on technology, there's a 1.4 percent increase in obesity rates or approximately 4.2 million people in a country with the same population as The United State.
Technology as an obesity factor plays the biggest role in those adults who spend most of their working day at a desk- behind a computer screen. Not only does an increase in time spent behind a computer screen take away from time spent outdoors, it also takes away from time spent on physical activity such as exercise. The more time an individual spends sitting down at a desk working behind a computer, the less time her or she spends outdoors, at the gym, and just moving around in general. The increase in time spent using technology doesn't just take away from time spent being active, it also changes the way people eat. With the time consumption of work many individuals tend to spend more time focusing on their work rather than on their food consumption / everyday diet. According to Ross DeVol—a chief research officer at the Milken Institute claims—'Common sense says if you sit around in front of the screen, don't exercise while you are working, change your diet…you are going to gain weight,'.
Food access
Federal and national level studies
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. 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. 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. 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.
Local level studies
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. 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. 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. "In Washington, DC, the city's lowest income wards have one supermarket for every 70,000 people while two of the three highest-income wards 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." 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.Food deserts and obesity
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.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." 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. 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.
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." 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. 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. In the long-term however, studies show that the consumption of fast food hurts overall health, raising the probability of becoming obese.
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. 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 when they locate in a food desert. 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.
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. Along with this act CDC released its own guidelines to promote physical education and health education. 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. 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. 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.
Agricultural subsidies
Every five to seven years, Congress drafts legislation known as the United States Farm Bill. The farm bill is an umbrella that covers different bills affecting America's agriculture and food. It focuses on two major thrusts: " food stamps and nutritional programs and income and price supports for commodity crops."The farm bill has been touted as one of the biggest contributors to the ongoing obesity epidemic. Over the past decade the government's farm policy focused on the overproduction and the reduction in prices of commodity crops such as corn and soybeans. Low commodity prices offer incentives for firms to create new ways to use the commodity crops. The low prices of corn and soybeans led to the creation of high fructose corn syrup and hydrogenated vegetable oils—ingredients that have been linked to obesity. Throughout the years these ingredients have become a major component of everyday food products. In 1998 over 11,000 food products were introduced to Americans. Out of these products about 75 percent of them were candies, condiments, cereals, and beverages-all foods high in added high fructose corn syrup. Between 1974 and 2004, U.S. consumption of high fructose corn syrup increased over 1,000 percent. Agricultural subsidies in other countries also tend to favor energy-dense crops.
Unhealthy foods tend to be inexpensive when compared to their healthy counterparts. Because fruits and vegetables are not subsidized, the real cost of such crops have risen nearly 40 percent. On the other hand, the prices for soda, sweets, and fats and oils have declined due to the subsidy that the government provides for commodity crops. "Currently the least expensive food available is also the most caloric and the least nutritious: a dollar's worth of cookies or potato chips yields 1200 calories, while a dollar's worth of carrots yields only 250 calories."
The farm bill contributes to the low prices that fast food provides because farmers feed the commodity crops to the cows and livestock that people eventually eat. Essential nutrients are taken away when cows are fed corn and/or soybeans instead of their natural grass diet. "Grass-fed beef has been shown to be higher in health-promoting nutrients, omega-3 fatty acids and cancer-fighting conjugated linoleic acid than beef that is fed grain." Because the government provides a subsidy for the corn and soybeans that feed the cows, they essentially provide a subsidy for grain-fed livestock. As a result, it becomes difficult for farmers to raise grass-fed livestock due to the fact that they have to compete with livestock producers that have a quicker turn-around.
Another way the federal government has combated obesity is through the Farm Bill of 2008. The farm bill is reauthorized every 5 to 7 years and has been used to improve food security and nutrition since 1933. Throughout the years food security and obesity have been interrelated issues and low-income families have borne the brunt of this problem, often relying on inexpensive, but high-calorie, low-nutrient foods. These diets have contributed to poor nutrition, cardiovascular problems, diabetes, and child development issues. Part of the Farm Bill of 2008 funded community gardens especially in low income neighborhoods to promote healthy eating. A Michigan study of 766 adults in low income neighborhoods showed that community garden participants were 3.5 times more likely to consume fruits and vegetables at least 5 times each day, as well as to consume more than 1.4 times the amount of fruits and vegetables than those who did not participate in community gardening.
This bill has also attempted to lower the cost of purchasing vegetables; researchers found that lowering the cost of vegetables by just 10% would translate into people purchasing at least 7% more produce bought by low income families. Children who participate in a community garden tend to eat healthier and become interested in farming and eating locally grown food which is healthier than buying from a convenience store.