Epidemiologists have known for decades that rates of obesity are much higher in low income and minority groups. However it’s only in the past few years that medical science has understood the mechanisms behind this finding. In my own practice I’ve identified four specific reasons for excessive weight gain in poor Americans:  1) insulin resistance, also known as metabolic or dysmetabolic syndrome – which, according to epidemiologists, is linked to increasing income equality, 2) a system of government food subsidies that penalizes low-income Americans for making healthy food choices, 3) the refusal of major supermarket chains to operate in low income inner cities, and 4) a for-profit, insurance-based health care system that deprives the vast majority of low income Americans access to regular preventive care and nutritional guidance.

How Insulin Resistance Relates to Low Income

I have blogged previously about income inequality being the primary driver of poor health (see http://stuartbramhall.aegauthorblogs.com/2010/08/30/income-inequality-the-real-cause-of-poor-health/ ). Statistical evidence reveals that the mother’s income when she gives birth is the single most important predictor of her child’s lifetime health status. Epidemiologists now believe it relates to epigenetics – a phenomenon whereby early environmental influences determine the range of protein enzymes produced by specific genes.

One of the most important epigenetic effects is the development of insulin resistance or metabolic syndrome when a fetus is repeatedly exposed to high levels of cortisol and other stress hormones from the mother’s bloodstream. Insulin resistance is a lifelong condition that causes glucose (blood sugar) to be preferentially stored, rather than utilized by the body. It results in serious appetite imbalance and a strong tendency towards weight gain. It’s a common condition among disadvantaged minorities – among African and Native Americans in North American, as well as Maori in New Zealand and indigenous Australians.

from http://www.medscape.com/viewarticle/496269 – easy to understand article explaining how stress hormones influence gene expression.

Government Subsidized Junk Food

Michael Pollan and others have written eloquently on the problem of government subsidies on corn, soybeans, and wheat. Federal food subsidies started during the Depression – to protect small family farmers when the price they received for their crops fell below their overhead costs. With the advent of factory farming, these subsidies are mainly going to corporate food giants like Monsanto, Cargil and Archer Daniel Midlands – making it even harder for small farmers to compete with them.

These subsidies also enable Food Inc to sell Big Macs, candy, and starchy, calorie empty junk foods much more cheaply than healthy foods, such as vegetables, fruits and nuts. Subsidized corn provides 90% of the diet of beef cattle, as well as being processed into high fructose corn syrup – a cheap sweetener used in breakfast cereals, candy, soft drinks, and other junk foods – or, along with soy, into the oil fast food restaurants use to deep fry foods. With increasing unemployment, declining wages, and spiking food prices, fresh fruits and veggies are an unaffordable luxury for many low income families – leaving them no choice but to go for the government subsidized junk food.

Absence of Major Chains or Fresh Food in the Inner City

There was extensive NPR coverage several years ago when the last major supermarket chain closed in Detroit. However 21 of America’s largest cities are experiencing what is known as an “urban grocery gap” – characterized by fewer stores and less square footage per store than in suburban. The poorest neighborhoods typically have about 55% of the grocery square footage of wealthier neighborhoods.  (See http://en.wikipedia.org/wiki/Supermarket_shortage).With no or limited public transportation options, this many inner city residents have no choice but to rely on KFC or the corner store for their starchy, high fat, high fructose corn syrup meals.

Americans Don’t Receive Preventive Care

Last but not least is the total is the virtual absence in the US of preventive health care – including nutritional counseling and advice –  a direct result of its for-profit, insurance-company dominated health care system. The weight gain caused by insulin resistance can be limited if identified early in life. As can that caused by a host of common nutritional deficiencies (omega 3, vitamin D, iron, folic acid, etc) that can cause appetite increase and weight gain if not identified and treated (the body tries desperately to compensate for deficiencies by making us overeat).

Unfortunately close to one-third of low-income Americans don’t have a regular family doctor, much less access to preventive care. Preventive health services, to reduce the incidence of expensive chronic conditions like heart disease, strokes, cancer and diabetes, is an extremely high priority in other industrialized countries, which all provide publicly funded health care.

Most patients lose their insurance coverage when they develop severe chronic conditions. And the federal government (i.e. the taxpayer) covers the cost of their treatment via Medicare or Medicaid.

To be continued with an examination of potential solutions.