The Obesity Crisis: A healthy diet often beyond the means of poor, hungry


		New York Times
	The larger chair in a New York hospital provides more room for an obese person. Obesity has become the fastest-growing major health problem in the U.S.

The 12-year-old was gaining 4 to 5 pounds a month and a little boy at school called her "fat."

Davis, 26, knew they weren't eating right, but finding the cash to pay for lean meats and veggies was tough.

"We didn't have enough to really go shopping, so we'd go to McDonald's," she said. "We just got junk food because it was so much cheaper and it was filling and it tastes good."

While obesity rates are climbing among all ages, races and incomes, evidence shows that the poor are more likely to weigh too much than wealthier Americans.

In King County, nearly 22 percent of adults living in households with incomes of less than $15,000 a year are obese, compared with almost 15 percent in homes pulling in $50,000 a year or more, according to an analysis by Public Health -- Seattle & King County of survey data from the federal Centers for Disease Control and Prevention.

High-fat, high-calorie foods are a common refuge for the hungry and poor, who tend to favor bulk and low prices over nutritional value, experts say.

But a $3 fast food meal can add up to more than 1,000 calories and a whole day's worth of fat with little or no fruits and vegetables.

"It's just a lot more difficult to eat well when you don't have very much money," said Marilyn Townsend, professor of nutrition at the University of California-Davis. "Your major concern is not the nutrients in your food but having enough so your kids are full."

Despite higher obesity rates among the poor, most weight-loss strategies, including high-protein diets such as Atkins and health-club memberships, are aimed at the middle class, said Adam Drewnowski, director of the Center for Public Health Nutrition at the University of Washington.

"This is a population we want to help and telling them to eat fresh grapes and maybe play a bit of tennis is not going to be effective," Drewnowski said.

Adherence to the popular Atkins diet costs about $15 per person per day, according to a USA Today analysis of the high-protein diet. Low-income families spend closer to $25 per person per week on food, Drewnowski said.

Between 1985 and 2000, the cost of fruits and vegetables shot up nearly 120 percent, while the price tags on soft drinks, fats, sugars and sweets increased by less than 50 percent, according to the U.S. Department of Agriculture.

In a 2003 survey at a Seattle supermarket, Drewnowski found that foods considered culprits in the obesity epidemic, including chips, cookies and soft drinks, were cheaper per calorie than more nutritious options such as fresh carrots, lean meats and fruits.

Drewnowski and Townsend recently received a grant from the Agriculture Department to study the cost of a healthy diet and food preferences among low-income women.

Their goal is to develop a realistic dietary plan for people with limited incomes that accounts for both taste and price.

"We spend a lot of time looking at genetics and metabolism," Drewnowski said. "We ought to be looking at something as basic as the cost of healthy food."

Societal hurdles

Eating healthy and exercising means bucking a culture organized around fast meals and sedentary days. But getting over that societal hurdle can be especially tough for the poor.

Mini-marts packed with chips, sodas and candy bars are often more common in low-income areas than full-fledged grocery stores with their gleaming produce aisles. And poor neighborhoods aren't always perceived as safe for an after-dinner walk or playing outside.

Parents might also be juggling more than one low-wage job, leaving little time for meal planning and cooking.

People who don't know where their next meal is coming from tend to splurge when food is available, said Sara Lynch, a registered dietitian who works with homeless men in downtown Seattle.

Lynch counsels men with diabetes, high blood pressure and other maladies related to obesity. They come off the streets hungry, she said, and fill up on the cartons of doughnuts donated to shelters.

And for families that rely on food stamps or other government assistance, the beginning of the month is a time to load up their shopping carts.

"A lot of families tend to celebrate," Lynch said. "They get all the things they couldn't afford, like steaks and cookies and chips. But then nothing is left in the cupboard at the end of the month."

"This kind of feast or famine thing ... screws up your metabolism and makes it harder to lose weight," Lynch said.

Still, the relationship between poverty and obesity isn't entirely clear.

Some studies suggest that spotty access to food can lead to excessive weight gain, especially among low-income women. Affluent African American and Latino men, however, tend to weigh more than their less wealthy counterparts.

At Harborview Medical Center, registered dietitian Aliya Haq sees low-income mothers and children who are struggling with their weight.

Nutrition and health messages get lost in the bombardment of advertisements for junk food, especially for undereducated parents, Haq said.

"I have seen moms come back to see me (the next time) with plastic bags with grapes and apple slices and plain water instead of juice," she said. "It's not always the cost. It's a lack of knowledge, too."

Access to healthy foods seems to make a difference as well.

Girls from low-income households who participate in food assistance programs are less likely to be overweight than those from families with no help, according to a study published last year in the Archives of Pediatrics & Adolescent Medicine.

Hands-on training

In the waning days of their summer vacation last month, a group of young teenagers sat around a conference table dicing red peppers, shredding cheese and chopping Swiss chard at the Yesler Community Center.


		Mike Urban / P-I
	Mariah Williams, left, laughs -- and cries -- as she chops onions and Amari Ray cuts chard as they fix healthy meals in a King County S.N.A.C. class.

Their summer day camp included one day of nutrition education taught by workers from the Seattle Nutrition Action Consortium (S.N.A.C.), a King County program aimed at promoting healthy meals and preventing obesity among low-income families.

"Some parents are working two jobs and they just have time to put food on the table. They're not seeing what their kids are eating when they're not around," said Ronald Brown, director of the center's teen programs.

The mandate for nutrition educators who work with the poor has changed in the past half-century. More and more, dietitians focus on tips to keep weight off rather than making sure there's enough food on the table, said Janis Harsila of S.N.A.C.

"Our basic message is eat more fruits and vegetables," Harsila said. "We try to teach them how to enjoy and learn to make healthy recipes."

While the teen cooks waited for their vegetable lasagna to finish baking, instructor Tammy Forsberg peppered them with questions.

Where does a hamburger bun belong on the food pyramid?

Are chips a healthy option for a snack?

Which is healthier: macaroni and cheese or spaghetti?

How big is a serving of turkey?

"This class made me not want to eat fast food anymore because I don't want to get fat," said Amari Ray, a slim 13-year-old whose mother is overweight.

"My mom says I should stop now while I can."

A turnaround

Thanks to a new job and healthier habits, Davis has been choosing better foods and getting some exercise. Jazzmine's weight gain has leveled off and Davis, who used to weigh more than 300 pounds, has dropped 45 pounds.

"We just now started coming up in this world," said Davis. "I'm working now and I'm starting to cook and prepare more meals at home."

Mother and daughter have been seeing Haq, the Harborview dietitian, since early this year.

Raised on fatty, starchy meals of corn bread, fried chicken, corn and mashed potatoes, Davis is now more likely to make baked chicken and green vegetables or fish and a salad for dinner.

She and Jazzmine also try to walk at least twice a week for 30 minutes in their Burien neighborhood.

"I was like, you know we just got to do this together and start eating right so we can be healthy," said Davis. "(Jazzmine) thinks it's fun."

P-I reporter Julie Davidow can be reached at 206-448-8180 or juliedavidow@seattlepi.com

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