The geographical spread of diabetes and obesity occurs in many of the areas stricken by poverty. The pertinent question is then, does the impoverished environment cause or at least aid the development of obesity and diabetes, or is this correlation merely coincidental? Type 2 diabetes affects 7.8% of the United States population, which seems small. However, obesity, the most potent risk factor of diabetes, is on the rise . Experts estimate that nearly 68% of the United States population above age 20 is overweight, 33.8% are obese, and 5.9% are morbidly obese . There are specific risk factors for obesity and ultimately diabetes that are present, or at least amplified, in poverty stricken areas. Impoverished communities are home to cheap food; food deserts, which are areas with a high ratio of poor foods to highly nutritional foods; crime; and underfunded schools, all of which contribute to the unusually high obesity and diabetes rates in these areas.
The present obesity problem has its roots in government policies aimed to increased energy intake. Obesity is essentially an excess of energy intake and a deficit in energy expenditure, which leads to an increase to energy storage, or fat. The energy intake can be modified positively by avoiding high fat diets and instead eating a diet of vegetables, fruits, whole grains, high-quality proteins, and high-quality fats. Since the turn of the 20th century, the United States government has increased agricultural subsidies on high-calorie crops at the expense of more healthy crops in order to stave off hunger . These commodities feed the livestock which in turn feed the country by forming the basis of many processed foods. These governmental actions have led to an increase in cheap, high-caloric but low-nutritional content food in the United States. In economics, the law of demand states that a decrease in price will lead to an increase in consumption. It follows, at least at first glance, these actions are justified. The combination of high-caloric, low-nutritional content food and meat from livestock fed on these foods, however, has led to the modern fast food restaurant . This food is characterized by “low-quality carbohydrates and fats, few essential nutrients, little fiber, high-energy value, and poor satiety value,” the latter of which leads to overconsumption of these foods . Relating this phenomenon to poverty, people with less money tend to be more frugal to maximize their earnings or welfare money . These individuals purchase too much food that is unhealthy and too little food that is healthy and are thus at a higher risk for obesity and diabetes.
The quality of the food in the community has effects on overconsumption, obesity, and diabetes [5-9]. Poor diet and obesity have been linked to neighborhood poverty, minority composition, and low area population density . Many studies have found that the proximity of a supermarket greatly decreases BMI but the presence of convenience stores and fast food restaurants in an area increases BMI [6,7, 9]. This effect was studied further to find that if stores had more shelf space dedicated to calorie-dense foods and snacks and less to fruits and vegetables then in the area BMI would be higher [6,7]. With this, food deserts correlate with higher BMI in the community. Analysis of different communities has found that impoverished areas are disproportionally likely to be “food deserts” [6, 7, 9].
Crime in an area can also decrease physical activity and heighten the risk for obesity [3, 4]. This is pertinent because crime, especially gang related violence, is a problem in most impoverished areas in the country [4, 10]. As crime increases, people feel less comfortable leaving their homes and their physical activity decreases. Even without poor food choices or overconsumption, this decrease in activity can lead to obesity due to the imbalance of intake of energy and energy expenditure from exercise. This is especially problematic for children who do most of their physical activity outside. Children who play more outside and less inside are less likely to be obese, which has led many organizations to recommend more outdoor playtime for children . Surveys of impoverished neighborhoods show that parents and their children are aware of the dangers in the area and don’t do the activities they wish to pursue . In these environments, children spend their time doing more sedentary activities and less time outside. Only the perception that a neighborhood may be dangerous, with actual reported crimes in the area or not, was enough to get most parents to keep their children inside more and decrease their outdoor activity . This illustrates the perceived barrier that crime poses to physical activity, which affects many residents in impoverished areas
Shortcomings in primary and secondary education in impoverished areas further augment the environmental impact on obesity in children . Many of the schools that have been underfunded nationwide have been in impoverished areas . With less money, these schools cut back on areas that they feel don’t affect tests scores as much, including physical education . Without this requirement children tend to be less active, which can lead to pediatric obesity. Surveys in these areas show that parents and children notice the effects of decreased physical education funding but feel that they are unable to make up for it after school due to the crime in their neighborhoods .Without a specified time in school to be physically active, living in a neighborhood with high crime rates is, put simply, a recipe for disaster. This may seem to only affect the children of impoverished areas but pediatric obesity has been found to persist into adulthood, as 25 to 50 percent of adolescent obese patients remain obese when they mature into adults .
Obesity and diabetes are both complex diseases affected by a host of factors. The nature of these conditions makes it difficult to attribute a single factor to the development of obesity and diabetes. The fact that many environmental factors in a specific type of area are all potential causes of obesity and diabetes, for example, is alarming. Indeed, studies show that environmental factors may affect residents as much as their personal health decisions. With this is mind, obese individuals in impoverished communities may be considered victims, for there are clearly factors out of their control.
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Author’s Note: I would like to thank Dr. Robert M. Sargis and Dr. Matthew Brady of The University of Chicago Department of Medicine, Institute of Endocrine Discovery and Clinical Care for their valuable input and guidance.