Since the 1980s, the UK has been experiencing an economic boom, but the wealth that has been amassed is far from evenly distributed [1]. Wealth inequalities very much exist, and are growing steadily ever-wider; in the last financial year, the income of the richest fifth of our population was over 600% of that of the poorest fifth, and 22% of the population – including 4.2 million children – were living in poverty [2,3]. With this social inequality comes health inequality, as we know that a ‘social gradient in health’ exists, meaning that health issues are not experienced equally by different socioeconomic groups [4]. Despite calls for the government to address said inequalities, the health of the poorest is in fact deteriorating relative to more affluent portions of society [5]. Disparities in the incidence of non-communicable diseases (NCDs) are of particular concern as they account for 89% of all mortality in the UK [6]; one such NCD is obesity.
What is Obesity?
Obesity is a condition characterised by excess body fat that is associated with increased morbidity and mortality [7]. The burden of obesity has been gradually increasing since the 1970s, such that 60% of women and 67% of men in the UK are now overweight or obese [8]. Not only has this obesity epidemic likely reduced the quality of life of many of those affected, but it has brought astronomical costs to the tax-payer along with it, with NHS costs attributable to overweight and obesity reaching a staggering £6.1 billion per annum, and wider societal costs estimated at £27 billion [9]. As such, it has become of paramount importance to prevent obesity in order to protect both the health and prosperity of the nation.
The Association Between Poverty & Obesity
It is known that some people are more likely to become overweight or obese than others. One factor that appears to affect one’s susceptibility to the condition is their wealth. The way in which wealth affects the weight of individuals has changed significantly over the last few decades; in the post-war era, socioeconomic deprivation was associated with lower weight in children, but is now associated with increased weight. Obesity prevalence in the most deprived 10% of children is currently two times higher than that of the least deprived 10%, whilst children in the bottom income quintile are at three times greater risk of obesity than those in the top income quintile at age 11 [9, 10]. This association persists in many areas across the globe in adolescents – particularly in urban settings [11, 12] – and adults, where socioeconomic disadvantage and downward social mobility significantly increase one’s risk of abdominal obesity [13, 14].
Why Might Obesity be Associated with Poverty?
There are a number of possible explanations for this phenomenon:
Time: we must consider that people in low-income households may work long hours or multiple jobs in order to make ends meet, or may have additional caring responsibilities relative to higher earners due to being unable to afford care. This means they may have less time at home than more affluent individuals, so may be less able to spend time preparing healthy meals. As such, they may resort to eating fast-food and takeaway meals – the consumption of which has been linked to excess weight [15].
Cost: low-income families may turn to less healthy food simply because it is often cheaper. 27% of households in the UK would need to spend more than a quarter of their disposable income in order to meet the Eatwell Guide recommendations, limiting the ability of these families to follow healthy eating guidance [16]. In addition, many healthy recipes require ingredients, herbs and spices that may be inaccessible to people who do not have a ‘middle class store cupboard’. On the other hand, it is known that highly-processed ‘junk’ food is cheaper than healthy ‘real’ food on a calorie-by-calorie basis [17]. What’s more, price promotions – which are a key driver of shopping behaviour – are more likely to be found on unhealthy foods than healthy foods, further incentivising those with limited budgets to buy junk food that is associated with obesity [18].
Obesogenic environment: the most deprived areas of the UK have a significantly greater density of fast-food outlets, the presence of which is associated with greater consumption of fast-food [19], and in many countries outdoor advertising of unhealthy food is found at a much higher rate in low-income neighbourhoods than high-income [20]. Furthermore, people who live in socioeconomically deprived neighbourhoods tend to have lower access to safe green space where individuals can take part in sports, exercise or outdoor recreation, which is known to be associated with increased obesity rates [21] (see previous blog article on Access to Green Spaces).
Lack of education: despite education being a right in the UK, we know that wealthier individuals have greater access to, and uptake of, nutrition education than less affluent individuals. This may be because they have more time and resources – such as stable internet connection and access to books – to educate themselves, or because they may be able to enrol on paid nutrition courses that lower income families may be unable to afford. Whatever the cause, we know that lacking the education and knowledge required to make healthy food decisions is a key driver determining an individual’s food choices and, thereby, their metabolic health; one study found that 34% of nutritional inequality could be attributed to disparities in education and nutrition knowledge, showing the importance of this factor in this inequality [22]. (see our previous article on Health Literacy).
What Can be Done?
Previous government strategies to tackle obesity have been almost entirely ineffective. This is likely because tackling obesity is not generally perceived as a matter for public policy to address, but is instead seen as a matter of ‘personal responsibility’. Strategies have therefore been largely limited to guidance on eating and exercise, putting the responsibility on each obese individual to change their behaviour in order to reduce their weight. But how do we expect individuals to change their behaviour if the environment in which they live does not allow for this, or if they don’t have the education to know precisely how to change their behaviour? To effectively reduce obesity rates, we should be looking to public policy to change the current obesogenic environment. The recent ban on junk food marketing before the watershed is certainly a step in the right direction, but much more needs to be done. Potential future strategies should focus on subsidising healthy food, limiting the marketing and promotion of junk food, widening access to free healthy eating education programmes, and making healthy food more accessible to those in poorer neighbourhoods, amongst many other things. If not, the epidemic of obesity will likely continue to expand, along with our waistlines.
More about the Author: Jennie Leggat
Jennie is a 3rd year PhD student in Clinical Biochemistry, with an interest in public health, particularly in relation to the incidence and prevention of metabolic disease.
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