The Fat Studies Reader

3. Does Social Class Explain the Connection Between Weight and Health?

25 3 Does Social Class Explain the Connection Between Weight and Health? Paul Ernsberger SES and Weight Adiposity is strongly related to socioeconomic status (SES) in modern Western societies (Sobal, 1991; Sobal & Stunkard, 1989). SES is usually measured by household income or years of education, although these two measures are clearly different and have many limitations as indices of social standing. In their seminal review in 1989, Sobal and Stunkard showed strong links between low social status and high body weight. This relationship only applied consistently to adult women in developed nations. For adult men, half the surveys showed the same trend as for women, but the remainder showed no relationship between SES and weight; in fact, some demonstrated the opposite relation, with high status males being heavier. Sobol and Stunkard offered one explanation for this gender difference: smoking. Tobacco consumption falls with rising SES, especially for men, and body weight is lower for smokers. But higher rates of smoking among low status males are probably not enough to explain such a fundamental difference, as Sobol and Stunkard admit. Reevaluating their summary of previous studies, there is a striking trend over time toward stronger links between SES and weight in men. For surveys dating from 1949 to 1967, five linked high SES with high weight and only one linked poverty to fatness. For surveys between 1968 and 1988, twenty-one linked poverty to fatness in men, whereas only three linked high SES with high weight. More recent surveys have shown increasingly strong relationships of poverty to high body weight (Banks, Marmot, Oldfield, & Smith, 2006). Thus, the link between adiposity and poverty, always strong for women, has been getting progressively stronger for men since the 1960s. Surveys of children and adolescents did not show a consistent relationship between their body weight and the social status of their parents, at least in the seventy published reports that existed in 1988 (Sobal & Stunkard, 1989). This was true for both girls and boys. Sobol and Stunkard concluded that whatever process links fatness and SES must begin in early adulthood. Their conclusion, however, must now be 26 Paul Ernsberger revised. Nearly all the surveys reported since 1988 show a strong inverse correlation between children’s body weights and the SES of their parents (Gortmaker, Must, Perrin , Sobol, & Dietz, 1993). The process that concentrates fatness in the lowest strata of society now appears to operate as early as kindergarten. A shift in society seems to have taken place in the last twenty years. What Is Behind the Link Between Weight and SES? Why are the poor so fat? The typical assumption made by experts in many different fields is that poverty is fattening. Living in poor neighborhoods with high levels of crime and pollution can limit the opportunities for leisure-time physical activity . Also, foods that are high in nutrients and relatively low in calories, such as fresh fruits and vegetables and lean meats, are difficult to come by in poor neighborhoods. Processed or fast foods may be the only alternative, especially because many of the working poor hold more than one job and have child-care duties. What is the critical aspect of poverty that is most closely linked to body weight? More than income or education, it is the status of the neighborhood that people live in (Barry & Breen, 2005; Schrijvers, Stronks, van de Mheen, & Mackenbach, 1999; Yen & Kaplan, 1999). Thus, people living in the same poor neighborhood will all have higher body weights, whereas people living in affluent areas are thinner. Neighborhood of residence is more important than individual income or other characteristics. Thus, it appears to be a true environmental effect and not the result of limited income or education. Another significant risk factor is financial problems. Economic difficulties are associated with a doubling of the risk of heart attack, and this applies across the spectrum of income and education (Ferrie, Martiekainen, Shipley, & Marmot , 2005).Thus, disposable income is probably a key factor relating socioeconomic well-being with health. Poverty has been strongly linked to low-quality nutrition, which can result in weight gain because excess calories must be consumed to maintain adequate intake of vital nutrients. Household income is highly correlated with diet quality as judged against a reference such as the Healthy Eating Index (Drewnowski & Specter, 2004). This may partly be driven by economics, because the price of food on a per-calorie basis is much higher for nutrient-dense foods, and thus recommended dietary patterns are much more expensive than the average...