Obesity is a major public health problem in the United States, associated with a significant burden on health and the economy. Important initiatives in the field of public health that have been put forward by medical organizations recently have confirmed the need to reduce the global burden of obesity. At the same time, only few of them are aimed at addressing the growing social and economic inequalities in regards to obesity. Such inequality is observed throughout the world and its growth exacerbates the inequality associated with health.
To understand the importance of fighting the inequality in the United States, the research paper describes the various symptoms and causes of the spread of socio-economic inequalities in obesity in adults, gaps in knowledge related to the issues studied, literature review of the outcomes performed at the moment, as well as provides conclusions on the research question.
Socioeconomic status is traditionally defined by a profession, education and income. However, researchers have increasingly recognized that a comprehensive understanding of the socioeconomic status of an individual must go beyond these determinants and include such factors as ethnicity, sex, residence, community and religion in terms of today’s complex society.
Furthermore, a variety of social, economic and demographic health determinants interact with each other. For example, gender affects the way socioeconomic status influences obesity and entire health as well. Similarly, the ability to make healthy choices depends essentially on ethnicity, while religion determines lifestyle and risk factors. The research paper will focus mostly on the three traditional indicators of socioeconomic status because most of the literature draws the most attention to them. However, they are all interrelated with other socioeconomic and demographic variables.
A significant amount of historical data suggests that the socioeconomic differences in terms of obesity exist all over the world. The relationship between socioeconomic status and obesity is not static. There have been variations marked between regions and population subgroups, as well as changes associated with time periods. All of this is directly related to the US region, which unites the population, characterized by considerable diversity in terms of geography, culture, a way of life and level of economic development.
Social and economic inequalities in obesity are defined as the difference in the prevalence of obesity among individuals with high and low socioeconomic status. This definition should always be considered in terms of the fact that socioeconomic inequalities in obesity may be perceived in different ways in the community, family and on an individual level, as well as various subpopulations like men and women, elderly and young, ethnic minorities, migrants and refugees.
It has been examined the prevalence of obesity in relation to economic development and inequality of national income in accordance to the study researches. Comparing the national economic indicators with the average body mass index (BMI) among adults in more than 100 countries, it was noted that BMI increased rapidly but leveled then. Additionally, it was probably decreased with increasing national income. The decline was particularly noticeable among women, which was consistent with other population-based studies on the socioeconomic feedback status and obesity among women from countries with high and upper middle income. The study of the countries with highest gross national per capita income allowed stating that the countries with the highest income inequality have the highest rate of obesity among both men and women. Similar results were previously reported in the United States on the basis of studies showing the relationship between state income inequality and middle abdominal weight gain, especially when having a low income. Such findings suggest that the increase in income inequality that has been identified in recent years may be associated with increasing obesity, including in the United States.
Many studies have examined the relationship between socioeconomic inequalities and obesity in high-income countries through a variety of indicators of socioeconomic status, including income, education, profession and other indicators, as well as in regards to body obesity. One of the first studies in which special attention was paid to socioeconomic inequalities in obesity was published by Midtown Manhattan Study in 1965. According to it, obesity was six time more common among women with low socioeconomic status that among those who had higher socioeconomic status. An innovative research conducted by Sobal and Stunkard in 1989 confirmed these results pointing to a constant feedback between socioeconomic status and obesity in women in several high-income countries. At the same time, the results for men were controversial.
With the increasing prevalence of obesity in the world and an increase in the need for concerted action, numerous studies of the relationship between socioeconomic status and obesity suggest that the scenario proposed in 1989 have apparently not been applied so far. For example, a review of 14 studies of adults covering the period 1989 – 2003 suggests that obesity is no longer limited to the socio-economic elite in low and middle income countries. There is an inverse relationship between socioeconomic status and the prevalence of obesity can be traced among half of men-respondents, as well as a direct connection among another half. In regards to women, seven studies showed an inverse relationship between socioeconomic status and obesity, two studies indicated a direct connection, while another two studies did not report any significant association. Obesity not only has a tendency to move to groups with a low socioeconomic status in accordance with the growth of the country’s GDP, but falls to them in the early stages of economic development and more on women than on men.
The prevalence of obesity among people living in the same country is often very different, depending on ethnicity and country of origin. For example, the complex nature of the variation index of obesity based on race in the United States. However, some researchers believe that ethnic and racial differences in obesity within one country can be explained by socioeconomic, rather than ethnic factors.
It is often noticed in studies of socioeconomic inequalities in obesity that the socioeconomic status leads to obesity but some researchers suggest the presence of feedback, namely that obesity can negatively influence the socioeconomic status. Another possibility is must less discussed in literature, which is that the external factors can affect both the socioeconomic status and obesity. Furthermore, all of these options may appear simultaneously.
Assuming that the first explanation is most likely, which is that the socioeconomic status determines the majority of the linkages between them causing obesity, the need to study specific mechanisms are retained. The intermediary factors are diet food, sedentary lifestyle, physical activity, social and psychological factors and heredity. Thus, socioeconomic inequalities in obesity may be caused by the influence of the complex relationship between micro- and microenvironment. For example, the fact that some woman prefers breastfeeding depends on a combination of factors, including her personal beliefs, access to health care, education and cultural environment. It may also depend on the marketing activities of companies producing baby food. People from different social strata are subject to different influences and some of them may affect the environment favorable for the development of obesity, which includes all of these elements or many of them.
The Influence of Socioeconomic Status on a Person’s Health Outcome in the United States
The following mechanisms can affect the socioeconomic distribution of obesity. These are diet and nutrition, lifestyle and physical activity, socioeconomic consequences of obesity and social mobility, as well as heredity.
Diet and Nutrition
Dietary preferences of different groups of the population are often caused by socioeconomic factors. Some people tend to choose less healthy food since the time when the unborn baby is still in the womb. It potentially has a decisive influence on the risk of obesity in adulthood.
The main factors determining food preferences are financial opportunities, accessibility, attractiveness, usefulness and practicality. As stated in the conclusions of the latest report of the Pan American Health Organization in regards to obesity and poverty, poor people eat not what they want and not what they know that it is necessary to eat, but what they can afford. Thus, the cost of food can be one of the barriers to switching to a healthier diet, especially for low-income households. Studies suggest that high-calorie and dense nutrient-poor foods most likely contain refined grains, added sugar and fat. It makes it possible for an individual to provide himself with the necessary supply of energy at a lower cost than the lean meat, fish, fresh vegetables and fruits. A relatively low price of these products, combined with their higher ability to increase appetite, low saturating capacity, noodles and ever-increasing proliferation of these products pricing on the basis of marginal cost may lead to an increased consumption of energy-dense foods in between meals, as well as an increase of the size of servings. All this contributes to the obesity epidemic. Cross-sectional studies conducted in the US showed that another key determinant of eating habits among the unemployed and low-income people is the palatability of foods.
Another factor complicating the choice of healthier food, especially with a lack of resources and education is a permanent and often contradictory information flow promoting to bot a deficiency and an excess of targets. Finally, the factors that could also affect the socioeconomic differentiation of obesity are changing attitudes to weight gain, as well as differences in the methods used to control body weight.
Lifestyle and Physical Activity
Differences in levels of physical activity of socioeconomic groups are an important potential factor explaining the socioeconomic inequalities in obesity. First, a sedentary lifestyle and associated low power consumption are widely recognized as factors that contribute to obesity. Second, studies conducted in high-income countries show that adults with low socioeconomic status are less prone to regular physical activity, but more likely to sedentary lifestyle than those with higher socioeconomic status.
There are several potential causes that could explain why people with a high socioeconomic status tend to have more physical activity than others. One of them being marked by researchers is inequality in the distribution of sports facilities, like sports schools, youth organizations and parks, as well as programs and opportunities for physical activity. At the same time, poorer people have less financial means to do it. In the United States, many public schools do not have the funds to purchase equipment needed for the classes of physical training in communities with low socioeconomic status.
People with high socioeconomic status have both a higher income allowing them to pay extensive types of physical activity, as well as free time and much greater chances for the use of both free and paid views of outdoor activities. Perhaps, they also experience more social pressure encouraging them to do sports. Moreover, such people can know more about the benefits of physical trainings or be more positively inclined toward it. It is noticed that women with the high socioeconomic status spend more time of physical exercises, trying to consciously control their weight.
Finally, the socioeconomic differences in the level of physical activity are related to sedentary lifestyles and behaviors associated with it that often occur among the population belonging to the groups with lower socioeconomic status. It includes the use of a personal vehicle, as well as a sharp increase in the time spent in front of the screen, like TV, computer or so, contributed to more widespread sedentary lifestyles and associated risk of obesity.
Socioeconomic Consequences of Obesity and Social Mobility
Some evidence suggests that obesity has mental and economic consequences. For example, records show that such factors as prejudice and discrimination, as well as bullying and mockery can be both a cause and a consequence of obesity. The socioeconomic inequality in obesity may be at least partly the consequence of the fact that obesity can affect the socioeconomic status. People who are overweight or obese are being stigmatized and discriminated in many societies. According to the researches, such a situation can be traced in less than six areas of performance, like at work, school, health care, household, family relations and the media.
Another factor associated with the socioeconomic status and obesity in adults is a social mobility. It is related to the upward and downward changes in social status for generations. Long-term studies showed that people, especially women, who had improved their social status, had lower degree of obesity in the middle age than those who remained on the same social level with the parents, as well as those whose social status declined. All this suggests that changes in the socioeconomic status of people suffering obesity from childhood may be partially reversible over time. The creation of a family and professional activities are among the potential ways to achieve this goal as these are two areas related to the discrimination against the weight.
Previous studies showed that obesity is inherited, at least partially, and that a genetic component is a basis of socioeconomic differences measured by the level of education. Some of the genetic factors that predispose to a higher BMI can also explain the genetic variation level of education.
A social factor is a concept which is related to the objective existence of the world, reflecting the result of the interaction of individuals, social groups, communities, classes and other social formations. The social factor is a single, socially significant event or a set of similar events that are typical for particular spheres of social life or specific to certain social processes. Social factors have a direct impact on the individual throughout life. They regulate their behavior, encourage of subordination and punished for opposition. A person is born in a society with established social facts that are already existed. A person dies but the society remains. Society is more than the individual, the logic and affirmation of the mechanisms are enclosed in itself, but not its components. If social facts are true facts, which means they are regarded as existing elements outside of the individual’s consciousness, this means that they can be studied as well as the phenomena of nature as given to by some observational empirical objects.
Obesity affects the population of the United States very fast. The government of the country has marked the socioeconomic inequalities in obesity in the United States, but too little has been done to deal with it so far. The data for countries from both economic point of view as well as nutrition confirm the existence of the urgent need to control the epidemic. The reason is that the growth of economy is a very desirable and necessary goal in a country. It can substantially increase the prevalence of obesity and contribute to the growth of inequality in health related. Everyone including the representatives of health and ending the members of Congress, are the projects aimed at changing attitudes of Americans to nutrition and lifestyle. Some corporations completely prohibit the spread of fast food for the citizens of the country.
The socioeconomic status determines the majority of the linkages between them causing obesity, the need to study specific mechanisms are retained. The intermediary factors are diet food, sedentary lifestyle, physical activity, social and psychological factors and heredity.
The main factors determining food preferences are financial opportunities, accessibility, attractiveness, usefulness and practicality. Studies suggest that high-calorie and dense nutrient-poor foods most likely contain refined grains, added sugar and fat. It makes it possible for an individual to provide himself with the necessary supply of energy at a lower cost than the lean meat, fish, fresh vegetables and fruits. Differences in levels of physical activity of socioeconomic groups are an important potential factor explaining the socioeconomic inequalities in obesity. They include a sedentary lifestyle and associated low power consumption, as well as the tendency to a less regular physical activity, but more likely to sedentary lifestyle than those with higher socioeconomic status. Some evidence suggests that obesity has mental and economic consequences, as well as a social mobility. Moreover, obesity is inherited, that is a genetic component of a basis of socioeconomic differences measured by the level of education.
As for the gaps in knowledge regarding the social factors in obesity in adults in the United States, it is impossible to state for sure about the findings. BMI is a conditional indicator used in addressing the degree of obesity or a person’s underweight. The body mass index is convenient for a numerical assessment of the patient’s body. In most cases, it correctly reflects the presence and degree of obesity or leanness. Me health conditions proved the existence of a correlation between the BMI and the changes of BMI. However, the BMI cannot be considered as an indicator when analyzing the state of obesity of the person as it reflects absolutely true and fear health. In particular, individuals with the developed muscles and the absence of obesity can have a high BMI corresponding to the obesity.
Another gap is the ethnic factor. Thus, obesity is most common in the United States among the poor socioeconomic strata of the population. Ethnicity also plays a role in the development of obesity. For instance, black people are lesser extent to overweight than the white ones. Conversely, black women of all ages are more obese than the white women, while the prevalence of obesity among Hispanic men and women is higher than among the white people. In addition, the onset of obesity in early puberty occurs among black and Hispanic women faster than the white women.