Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Obesity in the Lower Socio-Economic Status Segments of American Society

Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Obesity in the Lower Socio-Economic Status Segments of American Society

Article excerpt

Introduction

Obesity has been shown to be associated with low socioeconomic status (SES) in industrialized, developed nations. Overwhelming evidence has been demonstrated in the United States (Albrigth et al. 2005; Bove and Olson 2006; Estabrooks et al. 2003; Giles-Corti and Donovan 2002; Gordon-Larsen et al. 2006; Hanson and Chen 2007b; Luepker et al. 1993; Mauro et al. 2008; Molnar et al. 2004; Okosun et al. 2006; Richardson et al. 2004; Robert and Reither 2004; Sallis et al. 1996; Wang 2001; Wang et al. 2006; Wang et al. 2007; Wilson et al. 2004), Australia (Dollman et al. 2007; Kavanaugh et al. 2005; Najman et al. 2006; O'Dea and Wilson 2006; Proper et al. 2007; Salmon et al. 2005; Spinks et al. 2006), China (Zhang et al. 2007) Finland (Huurre et al. 2002) France (Lioret et al. 2007; Wagner et al. 2003), Great Britain (Brodersen et al. 2007; Power and Parsons, 2000; Wardle and Griffith 2001), Ireland (Share and Strain 2008), Italy (La Torre et al. 2006), New Zealand (Metcalf et al. 2007), Northern Ireland (Wagner et al. 2003), Scotland (Inchley et al. 2005), Spain (Serra-Majem et al. 2006), and Sweden (Bergstrom et al. 1996; Lindstrom et al. 2001). Multiple mechanisms have been proposed including the relationship of education levels, income, and other markers of SES to lower levels of recreational physical activity, poor nutrition, and certain psychosocial factors. Lower SES has been associated with less health consciousness (thinking about things to do to keep healthy) stronger beliefs in the influence of chance on health, and lower life expectancies. These attitudinal factors were in turn, associated with unhealthy behavioral choices (Wardle and Steptoe 2003). Some investigations, however indicated no evidence of a link between SES and obesity in developed countries (Freitas et al. 2007; Kelly et al. 2006; Moussa et al. 1994; Rutt and Coleman 2005; Wagner et al. 2004).

In developing countries, however, the level of obesity is greater in the higher socioeconomic status segments of society (Wang 2001). Evidence exists in Brazil, (Montiero et al. 2004), Cameroon (Fezeu et al. 2005), India (Reddy et al. 2002) Jordan (Montiero et al. 2004) and Madagascar (Montiero et al. 2004). It has even been suggested that the obesity rates in various segments of the population can be used to describe the developmental status of a nation in that as a country's GNP increases, obesity shifts to the lower SES segment of the population (Montiero et al. 2004; Sobal and Stunkard 1989). Proposed rationale for the increased risk for obesity in higher SES groups include: the greater capacity of the elite to obtain food, cultural values that favor round body shapes, and lower levels of physical activity (Fezeu et al. 2005; Montiero et al. 2004). Lack of food and high energy expenditure are less frequent once a society reaches a certain level of economic growth, particularly among its poorer sections (Montiero et al. 2004). This link between obesity and high SES is translated to the incidence of cardiovascular events (Reddy et al. 2002).

Mechanism of Obesity

Obesity results from a positive caloric balance in that intake of calories is greater than caloric expenditure. Nutrition plays a direct role in determining caloric balance by being the sole variable accounting for caloric intake. Caloric output, however is dependent on three specific variables. These include physical activity, resting metabolism, and the thermogenic effect of food. Of the three, physical activity is the most often altered in order to increase caloric expenditure. Psychosocial factors may influence (O'Dea, 2008) and be influenced by nutrition, physical activity (Zhang et al. 2007), or both.

Obesity increases the risk for a variety of chronic diseases including coronary artery disease, strokes (Pyle et al. 2006), glucose intolerance (Swallen et al. 2005) and some forms of cancer. Obesity is not a direct cause of most diseases, but unfavorably alters the risk factor profile. …

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