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Men, Women, Poverty, Education, and Obesity

How much of a role do poverty and education play in the growing American problem with obesity?  A report from the National Center for Health Statistics had some interesting findings on the subject as detailed in this Yahoo!/Reuters article.

Women who are poor are much more likely to be obese but men are not, the U.S. government researchers noted.   They found income does not greatly affect whether a man is obese but that education seems to affect both sexes. “Among men, obesity prevalence is generally similar at all income levels, with a tendency to be slightly higher at higher income levels,” the team at the National Center for Health Statistics wrote.

Specifically, they found that 33% of men living in well-to-do households with income at 350% of the poverty level were obese, compared to 29% of men who lived below 130% of the poverty level.

The percentage point differential among women is far more striking:  29% of women in well-to-do homes were obese, but 42% of women living below poverty level were. 23% of women with a college degree were obese, compared to 42% of women with less than a high school education.

A second study found children and teens living in homes with college-educated adults were less likely to be obese, and found stronger associations between obesity and income.

Just under 12% of boys and girls living in prosperous homes were obese, compared to 21% of boys and 19% of girls in the poorest homes.

Though the study doesn’t address causalities, relationships between these factors—education, income level, gender differences, and weight—are important points in mapping the core causes of, and therefore finding solutions to, the American obesity crisis.  Being overweight or obese raises the risk of heart disease, diabetes, some cancers and arthritis, and a study published  in December. More specifically, a December 2011 article in the New England Journal of Medicine confirmed that adults with a BMI* of 25 or more are likely to die from these illnesses than someone the same age who is slimmer.

(*BMI, or Body-mass index, is the weight in kilograms divided by the square of the height in meters. A BMI of between 25 and 30 is overweight and a BMI of 30 or over is obese. A person 5 feet 5 inches tall is classified as overweight at 150 pounds (68 kg) and obese at 180 pounds (82 kg). A 5-foot-10 inch (1.8 meter) tall person who weighs 209 pounds (95 kg) has a BMI of 30 and is obese.)

Who bears the responsibility for health and the cost of health?


I am troubled on many levels by themes in this article from The New York Times: The concept that individuals need to be incentivized with cash for taking care of themselves is perverse. Those who care about their health should need no incentive to take care of themselves on an ongoing basis. And the notion that employers must bear the burden of flagrantly poor health choices of their employees appears to underlie employers taking on the creation of incentives to change.

In the US, it is illegal to discriminate in hiring on the basis of a number of attributes, most of which are out of the control of the individual, such as age, gender and national origin. But employers discriminate regularly on the basis of past experience, academic standing and accomplishment, interviews, references and many other factors, some of which—but not all— may be under the direct control of the applicant, or at least flow from choices made at the application process or over time. Employers make no apology for such discrimination and applicants expect to be measured on many qualities.

Is an employer well served who ignores or downplays choices of prospective employees that increase their health risks? Is there a correlation on work quality and employment costs that can be observed among employees who engage at the time of hiring in fewer risky health behaviors? And what is the actual success rate of employer incentives, “wellness” programs (the trendy word “wellness” itself is in dire need of its own rehab – “health” would suffice), in creating long term results and change?

What would be the impact of employers making hiring decisions in part based upon legal discriminators that are health related, such as smoking, physical fitness appropriate to age and other factors. We tell our children to get a good education to increase their chances of successful employment, and this is strong incentive for study. Were there similarly explicit conversations about the relative employability of individuals based upon their physical lifestyle choices, might it have a positive social impact on the health of society overall?

Our declining health status and dramatic increases in chronic diseases relating to lifestyle—such as Type 2 diabetes—is creating billions in expense and much human tragedy. Society’s conversation on who bears the responsibility for health and the cost of health is one that must continue.