2/12/2009 12:03:00 PM Getting to the root of America's obesity epidemic
Adam Drewnowski, University of Washington Professor of epidemiology, is conducting researach that is changing the way we view obesity. His current work involves data collection in Seattle and King County. Photo by Erik Hansen.
How being poor increases obesity risk
How being poor can make you obese
"It is quite possible to be poor and obese," University of Washing epidemiologist Adam Drewnowski noted. "This is not a contradiction in terms."
Drewnowski's 2004 study, Poverty and obesity: the role of energy density and energy costs, shows that:
■ The highest rates of obesity occur among population groups with the highest poverty rates and the least education.
■ Energy-dense foods composed of refined grains, added sugars or fats may represent the lowest-cost option to the consumer.
■ The high-energy density and palatability of sweets and fats are associated with higher energy intakes.
■ Poverty and food insecurity are associated with lower food expenditures, low fruit and vegetable consumption and lower-quality diets. A reduction in diet costs leads to high-fat, energy-dense diets that are similar in composition to those consumed by low-income groups. Such diets are more affordable than are prudent diets based on lean meats, fish, fresh vegetables and fruit.
■ The association between poverty and obesity may be mediated, in part, by the low cost of energy-dense foods and may be reinforced by the high palatability of sugar and fat.
■ More and more Americans are becoming overweight and obese while consuming more added sugars and fats and spending a lower percentage of their disposable income on food.
Drewnowski's work is currently being expanded upon with a National Institute of Health-funded study using data currently being gathered from Seattle and King County.
Adam Drewnowski's research foreshadows how we view obesity, and, more importantly, poverty in America.
"There has been research saying that all Americans are getting fatter and fatter, but what our research is showing is that some are and some are not," said Drewnowski, a biochemist who serves as the director of the University of Washington's Center for Obesity Research and as a UW Department of Medicine epidemiology adjunct professor.
"What we're saying is that obesity occurs at a higher rate in some specific areas than other's." said Drewnowski. "One zip code can be high and a neighboring zip code within a mile of the first is not. It really has to do with lack of adequate resources. Those resources may be financial resources or educational resources."
The implications of Drewnowski's research, which garnered world-wide attention since he published "Poverty and obesity: the role of energy density and energy costs" in 2004, are controversial, for they challenge the notion that becoming obese or overweight is totally within one's control.
"[Our research] makes a big difference with any kind of prevention program, because what we're saying is that it's really not anybody's individual fault, and motivation and education can really only go so far," said Drewnowski. "It's really the question of the economic climate."
Since the 2004 paper, Drewnowski has taken a deeper look at poverty and obesity by analyzing food prices in 2005 and 2006, but the data was based on information gathered by French government officials.
"There was a reluctance to look at those issues inside the United States, especially with the last administration," said Drewnowski when discussing the study's European roots. "There was a reluctance to look into the issue of social disparity and [food] cost."
An example of this reluctance comes in the release of a national food price database released by the Department of Agriculture in 2008 using information gathered in 2001.
With the Obama administration in office, Drewnowski is hoping such data collection delays by the government will go away. However, his team is not waiting for new federal figures to fill their data needs.
Drewnowski, in conjunction with around a half-dozen of his UW colleagues, is now using a grant from the National Institute of Health to study Seattle and King County's obesity rates by the area's zip codes and United States Census tracts. The work is arguably placing the Emerald City at the forefront of research linking obesity to poverty.
"The quality of the diet depends on what you can afford," Drewnowski said. "Not everyone can choose a healthy diet."
The data collection will wrap up in early spring with the project moving into the data analysis phase by both the University of Washington's Department of health and the Department of Architecture and Urban Planning, a crucial partnership, said Drewnowski, who noted his Urban Planning colleagues know the location of all the area's food sources.
"It gives the epidemiology a sense of place so we don't just deal with abstract numbers and say 25 percent of the population of Seattle is overweight or obese," Drewnowski said. "We're saying these are real people living in real places and these are the resources they lack and the problems they face."
Affecting an epidemic
An emerging network of nutrition, obesity and poverty researchers has taken up expanding Drewnowski and his team's work to both nationally and globally. Drewnowski notes that the power of garnering a unified, international approach based on solid, locally-gathered data has a much better chance of inluencing legislative and health care organization policy, and, therefore, the lives of people they serve.
"We feel that the local politicians have the responsibility to tell people what's going on here," said Drewnowski when discussing the potential impact of his current study. "The local decision makers can not say, 'Well, the obesity rates are going up in Texas, it must be bad there.' We can say, 'This is what's happening in South Seattle.' Having local data is extremely important for local interventions."
But how will an intervention of the obesity epidemic we are now experiencing take shape? Drewnowski feels such action will have to come from grassroots, community- based movements to have a true impact.
"I think local people need to have a better idea of what's happening in their own neighborhoods," Drewnowski asserted.
His latest study of obesity rates in zip codes and census tracts, when finished, could be a powerful tool to influence local policies, if a critical mass of people use it to make politicians and health care leaders legislate changes in urban planning policies and health-care institutions.
"What I would like to see is, for example, a map of obesity, diabetes, metabolic syndrome and all those illnesses not just at state or county levels," Drewnowski said. "I would like to have a map like that for all neighborhoods."
Ultimately, Drewnowski hopes his research will radically alter how obesity is seen in the United States.
"There needs to be a transformation in the perception of what obesity is all about," Drewnowski asserted. "I think we have been conditioned to think, perhaps through the efforts of the drug industry, it's based on genetics and is a long-term disease for which you can take a pill everyday for the rest of your life."
Drewnowski feels this is an inaccurate mindset, especially when juxtaposed with the power of America's traditionally held notion that freedom of choice rules our dietary decisions.
"We're saying it's more about the social disparities and that people aren't necessarily in control of everything," Drewnowski asserted. "This is really something that needs a change in attitudes and a systematic, local - perhaps federal - plan for intervention trying to shift the perceptions of individual behavior and genetics [leading to obesity] that may be remedied by education and motivation to [obesity as a] social issue."
One goal is creating better ways of making information available to the public.
"We're interested in improving access to healthy foods in Seattle. I would love to have, at some point, a web-based consumer tool that tells people where nutritious foods are and at what cost. I think the technology is there," Drewnowski said. "My position is obesity and ill-health have to do with a lack of access [to healthy food], and a lack of access is due to a lack of resources."
Erik Hansen may be reached via editor@southseattlebeacon.com or by calling 461-1311.
