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Obesity and poverty: a physician's perspective

What parents should know about the complex causes of the obesity epidemic.

Photo: flickr_Wisley

By Connie Matthiessen

As a society, we often blame weight problems on poor eating habits and a lack of willpower. But when families have neither access to nutritious food nor the resources to buy it, healthy meals are a luxury they can't afford.

Gena L. Lewis, a pediatrician at Children's Hospital and Research Center in Oakland, CA, should know: many of the children she sees every day are both overweight and chronically hungry. GreatSchools caught up with Lewis and asked her to talk about childhood obesity and how parents and educators can make a difference.

First: stop thinking of weight as a personal choice

Can you explain the link between poverty and obesity? I'm not sure it's well understood.

I think you're right, because it's a difficult concept to understand.

We tend to think about weight as a personal choice: we assume that people make the choice to eat healthy food or to eat junk food. In reality, in this country, it costs more to eat healthy food than it does to eat junk food.

Fast food is easily accessible and it's filling, but there are many more fat calories than in fresh fruit and vegetables. But fresh fruit and vegetables cost more. Many families don't have the money to make healthy food choices. So they buy bulk processed food so their kids don't go hungry. I see that in my practice all the time.

The accessibility factor is huge: families living in poverty often don't have access to markets that sell fresh produce. When I'm working with medical residents, I ask them to drive through the neighborhoods where our families live. In East Oakland, for example, there are no markets for fresh fruits and vegetables, there are only liquor stores, payday lenders, and corner convenience stores. My patients tell me that when they can find fruit in the convenience stores, it's often old and moldy. Many don't have cars, they walk or take the bus. After work they rush to get their kids from childcare. They don't have time or easy access to large supermarkets outside the neighborhood.

This comes as a shock to people who live in areas with ready access to big grocery stores that offer lots of fresh fruits and vegetables. In poorer neighborhoods, you aren't going to see that kind of diversity of food options.

So access is a huge issue, and money — how much it costs to buy healthy food — those two issues get in the way of families being able to make healthy food choices.

Hungry and overweight

What about the kids you see in your practice who are hungry and also struggling with weight issues?

Unfortunately, I have many patients in this situation; it's a problem I see every day. All the pediatricians I work with are dealing with this issue, and it's really scary to us.

One of my patients is a morbidly obese teenager. She has many other health problems — diabetes, chronic back pain, reflux, joint pain. These are problems you'd expect to see in a middle-aged person with weight problems. She weighs over 300 pounds.

Her mom tries to buy the right kind of foods. She really wants to do the right thing, but by the end of month she's running out of money. This mom is incredibly frustrated: she wants her daughter to be healthy, but she feels like she doesn't have any option but to make bad choices. At the end of the month, it's often a question of eating unhealthy food or going hungry.

There's a lot of judgment in this country about weight, and some people might say, well, if this girl is morbidly obese, it might do her good to go without a few meals. In fact, the opposite is true: skipping meals causes your body to hold on to weight. When you skip meals, your body's metabolism feels threatened with starvation. People with weight issues shouldn't skip meals. You need to let your metabolism know that your body can afford to lose weight by eating regular meals.

Better bad choices

How should families facing these kinds of economic challenges tackle weight issues?

I'm a realist, so if healthy food isn't an option, I encourage families to make better bad choices. For example, I counsel patients to avoid soda and juice if they only have a little money to get through the end of the month. If it's a choice between buying a bottle of cola or a loaf of white bread, I advise them to choose the white bread. It isn't a great option, but it has more nutrients and better calories than soda or juice.

I encourage parents to look for foods that are good value. We talk a lot about reading labels and looking for cheap food that has lots of fiber and protein. For example, beans and legumes have more nutrients than white potatoes or Top Ramen noodles, they're cheap, and they're also more filling and nutritious. Dense processed carbohydrates are the worst in terms of nutrients. They give your blood sugar a quick spike, and then you're hungry again. That's why sugared cereal is not a good choice for breakfast. If you give that to kids they'll soon be hungry again. Oatmeal will stick with them a lot longer.

I tell patients to check labels and to look for foods with over three grams of fiber and five grams of protein. In some cases, it's possible to find food that's better for you and cheaper than junk food, even if it's not fresh fruits and vegetables.

Connie Matthiessen is an associate editor at GreatSchools.

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