Wednesday, October 7, 2009

Poverty and obesity

I wrote this in a lengthy discussion of health care reform and thought I would post it here as well. The discussion had turned to one of the role of obesity and encouraging wellness in our broader healthcare reform push.

I spent sometime working on wellness issues (among other things) as part of a broader healthcare reform work. I have to say after working on the issue I think that rich (mostly white) people lecturing poor (mostly minorities) on their diet is about the most obnoxious form of nanny-ism there is. Yes, it would be better if people ate better and exercised more but making that a prime focus of government policy is pointless and degrading. There was some good discussion at The Atlantic recently on obesity and class. Here's a good email to James Fallows (Te-Nesihi Coates wrote on this topic too if you're interested),

"It is one thing for a successful, financially comfortable, socially accepted and respected person who has multiple things happening every day that are pleasurable (golf, driving a nice car, nice home, stylish clothing, success at work, interesting social events, kids doing well, planning vacations, etc) to take just one pleasurable aspect of life (overeating) and sacrifice some of that pleasure for the good result of losing weight.

"Now, for people struggling financially and socially, trying to just get through the day and keep their lives together to varying degrees...their meals are often the only consistently happy and pleasurable events they can count on each day.

"Obviously, a generalization. But, if one gets up and faces a day with a tedious and unfulfilling job, not much money to spend on anything but necessities, and no "fun" things ahead, how much more difficult it is for that person to also think ahead to a day of denying themselves the pleasure of their mealtimes...."

Lecturing about obesity is a way for upper-middle class (mostly white) people to feel as though they are doing something to help the working poor (mostly minorities). It's about making yourself feel good for "helping", not actually doing something substantive to change people's station in life.

A bit of a tangent but I feel many education "reformers" operate in the same fashion. In both instances the underlying economic statusis the root cause of most of the other symptoms of poverty - obesity, doing poorly in school. Dealing with poverty is incredibly hard, talking about people's economic situation in very real terms and discussing solutions to poverty tends to make people uncomfortable. It's a hard topic and the solutions proposed are not always pretty and sometimes require some sacrifice from the "haves" so that others may simply live. It's much simpler to tell the poor kid to eat an apple, exercise after school and tsk-tsk his parents for not helping him study more.

The other issue is if we're going to really talk about changing diet habits that means we have to discuss this nation's wretched agriculture policy and the gross distortions of our food markets thanks to agricultural subsidies. Our ag subsidies grossly deflate the actual cost of calories through corn and other carbohydrates. If there is one lobby in this country more powerful than Big Insurance and Phrma (besides Wall Street) it's the farm lobby. No politician is going to touch our agricultural subsidies. Certainly not a former Senator from the corn state of Illinois and certainly not his Secretary of Agriculture, a former Iowa governor.

And then there's the issue of not just the high-cost of healthy foods but also the distribution of healthy foods into areas of the country that have high poverty. In South Central L.A. a year or so ago they pushed back against opening any more fast food chains in those neighborhoods. People eat what's available and what's available, in low income neighborhoods, is fast food.

Obesity is a far more complex issue than just giving people step counters and telling them to walk an extra block.

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