Lentis/Obesity and Diets in Economic Classes in the United States

Wiki Code November 26, 2012


Figure 1. Change in obesity rates in America based on economic class.[1]

Obesity is defined as having a Body Mass Index (BMI) greater than 30 due to too much fat. [2] On average, an uninsured non-obese person spends $512 per year on medical costs, whereas as an uninsured obese person spends $3,271 per year. This totals to approximately $190 billion in obesity related medical costs per year for America.[3]

Figure 1 shows obesity rates in four economic classes of the United States in the early 1970s and 2000s. The figure indicates that the obesity rates for all the economic classes in the US have increased within those 30 years. Currently, about one in every three Americans is obese [4]. However, throughout the years, low-income Americans have consistently displayed higher obesity rates than high-income Americans.

Each month the United States Department of Agriculture (USDA) develops four food budgets: Thrifty, Low-Cost, Moderate-Cost, and Liberal Food Plans. Each plan or budget corresponds to different income levels. The USDA claims that despite the differences in total cost of the four plans, each provides a healthy and nutritious diet, suggesting that all Americans are financially able to live a healthy life [5].

If this is the case, then why does America still have one of the highest obesity rates in the world? To answer this question, we examined the following socioeconomic factors that affect an American's food choices.

Food ChoiceEdit

Figure 2. Modern Food Pyramid for a healthy diet

Excluding genetic factors, much of variation in body weight is due to behavior. Analysis of socioeconomic factors explains how individuals choose to allocate their limited resources, including time and money, to different food choices.


The major obstacles that impede people of lower income groups from getting healthy food are food costs and physical accessibility. Lower income individuals tend to purchase food with lower unit cost, which tend to have denser calorie content. [6] This phenomenon explains the lower income groups' tendency to consume higher calorie content food, or more commonly referred to as "junk food". Low-income groups are also limited in their access to healthy food. Poorer communities tend to have scarcer healthy grocery stores. [7] Also, people in these communities are less likely to own a car, which makes it more difficult for them to travel to other areas to shop for healthy groceries.


People of different economic statuses place different levels of importance on their health. Although people of both low and high income tend to place great value in healthy eating, people of low economic status tend to devote less energy, money and time to maintaining a healthy lifestyle. [8] People's expectation of their future also influences their prioritization of healthy living. Generally, people with better education and higher income are more forward-looking and hold an optimistic view about their future, and are thus more willing to invest their limited resources in maintaining their own health. [9] In general, these socioeconomic factors alter people’s attitudes towards health and show that overall, a greater value is place on health in higher income groups. The higher value people put on health, the more they are motivated to keep a healthy diet.


Nutritional education and awareness helps people to obtain, interpret, and apply information that shapes their knowledge and attitudes about diet. Low-income people often are not aware of the fat or calorie content in foods that they frequently consume, and thus are not equipped with the knowledge to choose the healthier option. For example, only 47% of low income Americans know that a hot dog contains more calories than ham [10].

Culture and PerceptionEdit

Culture can shape dietary habits, and plays an important role in the different obesity rates between income groups. There is a nonuniform distribution of ethnic groups among economic classes; hispanic and black cultures are prevalent in the low-income category [11]. The foods typically eaten by both of these races is high in fat content [12], contributing to obesity within the low-income class. Among different ethnic groups, standards of ideal body image vary. For example, the perceived ideal body size of African American women is significantly larger than that of white women. [13] This perception of the "ideal" appearance affects if and how people pursue a healthy lifestyle. People eat a certain way to achieve or maintain the appearance they want. The USDA showed that nearly 60% of overweight people consider themselves healthy in terms of body weight, significantly more than those who are actually in the "healthy" BMI category [14]. Thus, people may not be willing to change their eating habits because they do not see themselves as being overweight.

Other Factors Influencing Obesity RatesEdit

Physical ActivityEdit

Low-income groups are likely to be less physically active. This trend is due to a variety of factors, including limited access to recreational facilities, unsafe neighborhood conditions, long commutes to and from work, and lack of time [15]. Exercise can be termed a "luxury" for those who have an hour of free time away from work or family responsibilities. Low-income Americans often do not have this free time to dedicate to exercise, hindering them from leading a healthy lifestyle.


Many people in low-income situations work jobs with inflexible hours. Their schedules are often not conducive to a regular exercise routine. Additionally, low-income workers may toil long hours and during night shifts. The labor/time consuming type of work exhaust them and leave them with few energy for exercise or cooking. At that point, it is much more convenient to pick up unhealthy fast food than to cook a healthy meal. In addition, irregular sleep time also leads to a higher risk of obesity. Thus, employees that work in such conditions are more susceptible to obesity [16].

Promoting Healthy ChoicesEdit

Many organizations and individuals have recognized the need to address the obesity crisis in America, and have taken action to promote healthy choices. However, these efforts are often unnoticed, unappreciated, or even opposed by the people they are trying to help.


Figure 3. Let's Move! logo for Bridgeport, CT
  • Michelle Obama's "Let's Move!" Campaign aims to promote healthy lifestyles among children by encouraging healthy eating and physical activity. The program educates low-income families on nutritional dining options, and supports the providing of healthy foods in schools [17]. However, critics of the campaign suggest that it increases the stigma against overweight children rather than raising awareness of healthy eating in the context of diverse body shapes and sizes. [18].
  • American Heart Association's "National Eating Healthy" Day. The AHA dedicates one day each year to the promotion of healthy eating in the workplace. Businesses and organizations are encouraged to participate to support healthy lifestyles in their employees [19].
  • HEAL (Healthy Eating Active Living) Cities Campaign [20] is a California-based statewide initiative that focuses on three main issues:
  1. Effective land use to positively affect the health of individuals living in that area
  2. Ensuring that cities have the proper tools and resources to attract healthy food vendors
  3. Improving employee wellness


Over the past 10 years, demand for federal, state, and municipal laws to address the "obesity epidemic" in America has increased. Lawmakers have responded with legislation to promote healthy awareness, limit consumer calorie intake, and prevent inadvertent consumption of unhealthy foods. For example, part of President Obama's healthcare plan states that all chain restaurants with 20+ locations must post calorie counts of each food item on the menus. The postings give consumers the opportunity to limit their calorie intake by providing them with information needed to make a healthy choice. In the state of New York, this law is already in place. Researchers tracked orders at fast food restaurants in low-income neighborhoods before and after the instatement of calorie counts [21]. Although 27 percent of customers claimed that the calorie postings would affect their choices, there was no change in the total number of calories ordered. The study suggests that people simply order what tastes good, regardless of the nutritional value. This apathetic consumer attitude could stem from a lack of education; low-income consumers often do not know how many calories are too many. Other examples of legislation to promote a healthier lifestyle are listed below:

  • NYC bans large sodas: In New York City, Mayor Michael Bloomberg has enacted a law to ban vendors from selling sodas greater than 16 oz in size [22].
  • San Francisco bans Happy Meals: In San Francisco, it is illegal to include any sort of free incentivizing item (such as a toy in a Happy Meal) with a meal containing over 600 calories. However, McDonald's avoided this limitation by charging a mere 10 cents for a toy with the Happy Meal [23].
  • Cities ban added trans-fats: Individual cities such as Baltimore [24] and Cleveland [25] adopted bans on added trans-fats in restaurant foods. The effort served as an attempt to lower incidence of heart disease and obesity within the cities.
  • Anti junk food laws in schools: In 2010, as part of the Let's Move! Campaign, President Obama signed the "Healthy, Hunger-Free Kids Act". The bill authorizes the use of federal funding to provide low-income students with access to healthy food options at school [26]. School junk food regulations have also been passed on a state-by-state basis. For example, schools in California cannot serve foods with over 175 calories per item [27] The legislation is believed to be effective; students who live in states with strongly enforced laws against junk food gain less weight between fifth and eighth grades than those in states with loosely enforced laws [28].


Much of the opposition facing legislation to promote health awareness is centered around the quintessential American value of liberty. One definition of liberty is “the freedom […] or power of doing, thinking speaking, etc. according to choice.” Many Americans feel that by imposing limits on what they can eat, lawmakers are impinging on their right to choose. In the case of the New York City large soda ban, 60% of New Yorkers opposed the ban [29] because they felt they had been stripped of their personal choice. The implementation of junk food laws in schools faces especially stringent public opposition. In 2011, New Jersey governor Chris Christie spoke the consenting opinion of many Americans when he said, "I don’t want the government deciding what you can eat and what you can’t eat." [30]. Personal liberty is a privilege that many Americans are unwilling to sacrifice, even if it would result in healthier lifestyles for themselves or their children.


An individual's choices depend on his or her values, which are in turn is influenced by his or her environment. Economic status is an important factor that governs the external influences of all Americans, and impacts the choices they make. However, no matter the socioeconomic environment, the decision to lead a healthy lifestyle belongs with the individual. Americans highly value the freedom of personal choice, and consistently oppose any restriction of this right.


  1. Hitti, Miranda. (May 2, 2005). Rich-Poor Gap Narrowing in Obesity. Retrieved from http://www.webmd.com/diet/news/20050502/rich-poor-gap-narrowing-in-obesity
  2. Dugdale, DC; Vorvick, LJ; Zieve, D. Obesity. PubMed Health. May 12, 2012. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004552/
  3. Bengley, S. As America’s Waistline Expands, Costs Soar. Reuters. April 30, 2012. Retrieved from http://www.reuters.com/article/2012/04/30/us-obesity-idUSBRE83T0C820120430
  4. Food Research Action Center. Retrieved from http://frac.org/initiatives/hunger-and-obesity/obesity-in-the-us/
  5. The Low-Cost, Moderate-Cost, and Liberal Food Plans, 2007. United States Department of Agriculture. 2007. Retrieved from http://www.cnpp.usda.gov/Publications/FoodPlans/MiscPubs/FoodPlans2007AdminReport.pdf
  6. The Rising Cost of Low-Energy-Density Foods Journal of the American Dietetic Association, Volume 107, Issue 12, December 2007, Pages 2071–2076 http://dx.doi.org/10.1016/j.jada.2007.09.009
  7. Treuhaft S., Karpyn A., (2010), The Grocery Gap, PolicyLink, retrieved from http://www.policylink.org/atf/cf/%7B97C6D565-BB43-406D-A6D5-ECA3BBF35AF0%7D/FINALGroceryGap.pdf
  8. Marmot M., The Influence Of Income On Health: Views Of An Epidemiologist, Health Affairs, 21, no.2 (2002):31-46, retrieved from http://content.healthaffairs.org/content/21/2/31.short
  9. Zhang Y., Fishbach, A., Dhar R., When Thinking Beats Doing: The Role of Optimistic Expectations in Goal-Based Choice, Journal of Consumer Research, Inc. Vol. 34, retrieved from http://faculty.chicagobooth.edu/ayelet.fishbach/research/ZFD_JCR07.pdf
  10. http://www.fns.usda.gov/Ora/menu/Published/NutritionEducation/Files/FSPDietSum.htm
  11. Simms M.C., Fortuny K., Henderson K.,(2009), Racial and Ethnic Disparities Among Low-Income Families, The Urban Institute, retrieved from http://www.urban.org/uploadedpdf/411936_racialandethnic.pdf
  12. Gans, K. M., Burkholder, G. J., Risica, P. M., & Lasater, T. M. (2003). Baseline fat-related dietary behaviors of white, Hispanic, and black participants in a cholesterol screening and education project in New England. Journal of the American Dietetic Association, 103(6), 699–706; discussion 706. doi:10.1053/jada.2003.50135
  13. Parnell K, Sargent R, Thompson SH, Duhe SF, Valois RF, Kemper RC., (1996), Black and white adolescent females' perceptions of ideal body size, The Journal of School Health, 66(3):112-8, retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8857160
  14. Mancino L., Lin B., and Ballenger N., (2004), The Role of Economics in Eating Choices and Weight Outcomes, United States Department of Agriculture, retrieved from http://ageconsearch.umn.edu/bitstream/33781/1/ai030791.pdf
  15. Low Income Populations and Physical Activity, Retrieved from:http://www.bms.com/Documents/together_on_diabetes/2012-Summit-Atlanta/Physical-Activity-for-Low-Income-Populations-The-Health-Trust.pdf
  16. Schulte, P. A., Wagner, G. R., Ostry, A., Blanciforti, L. A., Cutlip, R. G., Krajnak, K. M., … Miller, D. B. (2007). Work, Obesity, and Occupational Safety and Health. American Journal of Public Health, 97(3), 428–436. doi:10.2105/AJPH.2006.086900
  17. http://www.letsmove.gov/about
  18. Brown, E. (2011, June 15). The Not So Popular Criticism of the Let’s Move Campaign. Madame Noire. Retrieved December 14, 2012, from http://madamenoire.com/61405/the-not-so-celebrated-side-of-the-lets-move-campaign/
  19. American Heart Association's National Eating Healthy Day Resource Guide, Retrieved from: http://www.heart.org/idc/groups/heart-public/@wcm/@gsa/documents/downloadable/ucm_446036.pdf)
  20. http://www.healcitiescampaign.org/
  21. Elbel, B., Kersh, R., Brescoll, V. L., & Dixon, L. B. (2009). Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City. Health Affairs, 28(6), w1110–w1121. doi:10.1377/hlthaff.28.6.w1110
  22. Grynbaum, M. M. (2012, September 13). Health Board Approves Bloomberg’s Soda Ban. The New York Times. Retrieved from http://www.nytimes.com/2012/09/14/nyregion/health-board-approves-bloombergs-soda-ban.html
  23. San Francisco Happy Meal Toy Ban Takes Effect, Sidestepped By McDonald’s. (2011, November 30). Huffington Post. Retrieved December 14, 2012, from http://www.huffingtonpost.com/2011/11/30/san-francisco-happy-meal-ban_n_1121186.html
  24. http://www.baltimorehealth.org/info/Trans%20fat/Trans%20Fat%20Ban%20Enforcement%20Procedure.pdf
  25. http://www.city.cleveland.oh.us/clnd_images/PDF/Mayor/TransFatComplaintInfo.pdf
  26. http://www.whitehouse.gov/sites/default/files/Child_Nutrition_Fact_Sheet_12_10_10.pdf
  27. http://nojunkfood.org/?page_id=32
  28. Taber, D. R., Chriqui, J. F., Perna, F. M., Powell, L. M., & Chaloupka, F. J. (2012). Weight Status Among Adolescents in States That Govern Competitive Food Nutrition Content. Pediatrics, 130(3), 437–444. doi:10.1542/peds.2011-3353
  29. Grynbaum, M. M., & Connelly, M. (2012, August 22). Most New Yorkers Oppose Bloomberg’s Soda Ban. The New York Times. Retrieved from http://www.nytimes.com/2012/08/23/nyregion/most-new-yorkers-oppose-bloombergs-soda-ban.html
  30. “Let”s Move!’ Oversteps its Bounds. (2011, March 2). Human Events: Powerful Conservative Voices. Retrieved December 14, 2012, from http://www.humanevents.com/2011/03/02/lets-move-oversteps-its-bounds/