Obesity and poverty: the evidence
“Not everybody who is overweight comes from deprived backgrounds but that’s where the propensity lies.”
Anna Soubry, 23 January 2013
Comments by public health minister Anna Soubry prompted a lively debate on the link between poverty and obesity today.
Miss Soubry told the Daily Telegraph: “When I was at school you could tell the demography of children by how thin they were. You could see by looking at their eyes.
“When I go to my constituency, in fact when I walk around, you can almost now tell somebody’s background by their weight. Obviously, not everybody who is overweight comes from deprived backgrounds but that’s where the propensity lies.
“It is a heartbreaking fact that people who are some of the most deprived in our society are living on an inadequate diet. But this time it’s an abundance of bad food.”
The minister suggested that poor parenting – with children no longer encouraged to sit down and eat family meals – and an excess of fat, sugar and salt in food were to blame.
But Imran Hussain from Child Poverty Action Group put the burden of blame on government policy, saying: “Rather than blaming parents, ministers should look at the piles and piles of evidence that make it absolutely clear that the real reason why our obesity problem is going to get bigger in the years ahead is because our child poverty problem is going to get much bigger as a result of the Government’s own policies.”
Are poor people really fatter? If so, why? And what can we do about it?
Are you obese? If you dare, use this NHS web page to calculate your body mass index (weight divided by height). A score of 25 to 29 makes you overweight (if you’re an adult). Between 30 and 40 is obese.
FactCheck’s just done it. We don’t want to talk about it.
The latest figures suggest that all of us – men and women, young and old, rich and poor – have been getting fatter in recent decades.
Those are the headlines, and they are pretty depressing, although there are some surprising statistical trends buried in the evidence.
While nearly a third of children are either obese or overweight, obesity among boys and girls aged 2 to 15 actually fell after 2004 and has remained flat in the last few years:
And while there is evidence of a strong correlation between various measures of deprivation and the likelihood of being fat, that only really holds true for women and children.
This graph from the National Obesity Observatory tracks the prevalence of obesity among year six children (aged 10 or 11) in low income households, as measured by benefits data. The lower the household income, the greater the chance of the children being obese.
Numerous other local and national studies confirm this trend.
This paper on children in England from 2007 to 2010 used the indices of multiple deprivation, an official government measure that looks at income, employment deprivation, health, education, housing and other factors.
It showed a strong correlation between obesity and deprivation scores, although there was no obvious link between deprivation and children who were merely overweight.
The researchers suggested that this was “likely to be the result of various social and cultural changes over recent decades, which have simultaneously increased children’s energy intake and decreased their energy expenditure across the socioeconomic spectrum”.
In other words, being slightly overweight has become so normal for children that there isn’t much difference between rich and poor any more.
Adults are trickier. With women, there is a very clear correlation when you measure obesity against household income, social class (defined by skill level from “professional” to “unskilled manual”), educational attainment and “socioeconomic status” (based on things like career prospects and employment rights).
In each case the trends are much less clear with men. This graph provides a good illustration:
The stats for women show a nice clear trend: the higher the income, the lower the prevalence of obesity. But obesity rates for the richest and poorest men are almost exactly the same.
While there are some strong correlations in some of these figures, that doesn’t prove cause and effect. We can’t say that “poverty causes obesity”, only that there is a link between the two.
Perhaps people on low incomes tend to smoke or drink more, or have a worse education, or suffer from more stress, and it’s one of these factors that is really to blame for obesity.
In a paper based on evidence gathered in Spain, Dr Joan Costa-i-Font from the London School of Economics said statistical analysis showed that lack of education was the most important single factor.
He suggested that governments concentrate their efforts on educating people about health, rather than trying to boost poor people’s incomes or penalise food manufacturers.
That doesn’t help Miss Soubry, but neither does it provide any ammunition for the Child Poverty Action Group, who suggest that relative poverty is the real issue here.
There’s more support for that point of view from Professor Kate Pickett, co-authors of the Spirit Level, who suggested in a 2005 paper that absolute poverty – having enough money to buy healthy food – isn’t as important as relative deprivation.
She wrote: “Low social status is for instance likely to increase anxiety and stress levels and to reduce people’s ability to exercise control over their lives…psychosocial factors related to social position or relative income may be more important than absolute living standards.”
It’s difficult to find fault with what the public health minister actually said. There is good evidence that poor people tend to be fatter overall, although there are some big buts.
While childhood obesity is clearly a huge worry, the figures from the last few years have been more positive than you might think.
And there is a huge difference between men and women, with income and social status far less of a predictor of obesity for men.
The biggest question mark here is why there is such a strong correlation for women and children and what we can do about it.
While there is some academic support for the idea that failing to curb relative inequality could make Britain fatter, it’s not an open-and-shut case.
On the other hand, the government’s preferred strategy of cajoling food manufacturers into cutting sugar, salt and fat doesn’t appear to be based on any scientific evidence either.
By Patrick Worrall