Status, Stress, and Struggle: How Socioeconomic Circumstances Impact Obesity

| October 1, 2022

by Jennifer Ng, MD, DABOM

Dr. Jennifer Ng is an internist with a secondary specialization in obesity medicine; Assistant Professor of Medicine of the Mount Sinai Icahn School of Medicine in New York City, New York; and committee chair of the Obesity Medicine Association (OMA)’s outreach committee. 

Funding: No funding was provided.

Disclosures: The author has no conflicts of interest relevant to the contents of this article. 

Bariatric Times. 2022;19(10):21.

Socioeconomic status touches every aspect of our lives: the food we eat, the physical activities and work we do, and how we access healthcare. Unfortunately, it isn’t a level playing field for individuals managing the socioeconomic aspects of obesity. Environmental, personal, and economic factors create a perfect storm that hinders individuals from properly managing their health and improving their socioeconomic circumstances.

Socioeconomic status and weight management are intertwined. The answer to weight management isn’t as simple as eating healthy and staying active. In many low-income neighborhoods, access to nutrient-dense food can be difficult, and when it is available, it’s expensive. Food inequity directly contributes to increased obesity rates, as “food insecure adults have 32-percent increased odds of [developing obesity] compared to food secure adults.”1 Food with less nutritional value is cheaper and quicker to prepare, forcing people to make tough decisions between their health and their budget.1 

Access to healthy food isn’t the only limitation; low-income communities also experience hindrances to physical activity. Many low-income neighborhoods are less safe for walking and biking due to increased crime rates and a lack of protected spaces (e.g., sidewalks and bike lanes). With fewer gyms, sports centers, and green spaces, individuals must go much farther out of their way to be physically active. Higher socioeconomic areas generally have more workout facilities, which is associated with increased odds of adolescents participating in at least five weekly sessions of physical activity and decreased rates of adolescent weight issues.2 

Another barrier to health is work hours in low-income populations. Night shifts and long hours take a massive toll on sleep, which is a risk factor for obesity. Studies show that lower-wage workers are more likely to hold positions with lower hourly rates, few to no benefits, and schedules that create work-life challenges.3 Finding time for healthcare visits and physical activity is a huge challenge when a person has a rigorous work schedule, in addition to personal responsibilities. Lack of good childcare options, transportation, adequate insurance coverage, and nearby healthcare facilities also hampers a person’s ability to prioritize health. 

These interconnected hurdles create a difficult situation for people who must navigate both obesity and a lower socioeconomic status. Not only do these factors present a logistical challenge, but they also create a negative impact on a person’s overall health.

Socioeconomic status directly impacts the body. The stress response is our body’s way of protecting itself against external threats. We often think of an acute reaction as a fight or flight response. Many experience this as a fleeting sensation, or a temporary state of heightened awareness or anxiety, but for people of a lower socioeconomic status, worries about food availability, healthcare costs, job security, and other critical concerns amplify and extend the effects of stress. Living in a constant state of stress intensifies the body’s response and essentially traps metabolic functions into a perpetual stress reaction. The symbiotic relationship between socioeconomic status and disease and mortality has even been referred to as the “Status Syndrome,” underscoring the connection between chronic stress and weight gain.4  

Stress responses vary by the individual, but it’s common to leverage food as a source of relief. The idea of comfort foods and stress eating demonstrate the link between managing stress and maintaining a healthy weight. When food becomes a coping mechanism, it can cause insulin resistance and increased calorie intake, which can lead to obesity. In times of stress, it’s common to crave high-sugar, high-fat foods. Consuming comfort food activates the brain’s reward systems and diminishes the body’s stress response.3

Society often stigmatizes obesity, which is internalized by people managing obesity. Fear that society will label them as lazy or undisciplined heightens their level of stress and anxiety. Factors outside of their control, such as employer bias, threaten to keep them stuck in a socioeconomic cycle of inequity. A recent study found that among working people over the age of 40 years, higher body mass index (BMI) levels are associated with “a lower likelihood of being in work, with more working hours if people were in paid employment, living in a more deprived area, and with less income and education.” 5

The unfortunate reality is that a person’s socioeconomic status correlates with their ability to proactively manage their weight. When individuals in lower socioeconomic circumstances are faced with the added challenge of managing obesity, the cards are often stacked against them. 

Disparities fuel childhood obesity. Socioeconomic obstacles can prevent children from accessing nutritious food, physical activities, and the healthcare resources necessary to maintain a healthy weight. The United States (US) Centers for Disease Control and Prevention (CDC) found that “childhood obesity prevalence decreases as the education of the head of household increases,” although this varies across race and ethnicity groups. Children of color across most racial categories are more likely to experience poverty, and Black, Hispanic, and American Indian and Alaskan Native children face the highest poverty rates.6 

Kids starting with low-income circumstances face an uphill battle. Whereas resources and education often come easily to their counterparts in middle-to-high-income families, kids from lower socioeconomic backgrounds must navigate a path laden with roadblocks. Obesity can impact a person’s job prospects, threatening their earning potential and preventing them from advancing their socioeconomic status. This cyclical pattern keeps children and families from improving their health, habits, and future prospects. 

Incorporating an equitable treatment approach. When working with patients with obesity, considering their socioeconomic status is a crucial part of the treatment plan. By recognizing that not every patient has the same access to resources, nutrition, insurance, and time, providers can develop a personalized treatment plan that is optimized for success.

Investing the time to understand a patient’s unique needs and circumstances can lead to better outcomes, and for patients with lower socioeconomic circumstances, you aren’t just helping them improve their health, you’re helping them break a cycle of poverty and impact future generations through enhanced health, resources, and education.

For more information, online resources, and a network of obesity medicine providers, join the Obesity Medicine Association (OMA).7 OMA is the largest clinical obesity organization in the US and offers specialized resources to help providers implement evidence-based treatment into their practices. 

References

  1. Pan L, Sherry B, Njai R, Blanck HM. Food insecurity is associated with obesity among US adults in 12 states. J Acad Nutr Diet. 2012;112(9):1403–1409. 
  2. Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care. 2016;22(7 Suppl):S176–S185.
  3. American Psychological Association. Work, stress, and health & socioeconomic status. Updated Apr 2022. https://www.apa.org/pi/ses/resources/publications/work-stress-health. Accessed 10 Sep 2022.
  4. Scott KA, Melhorn SJ, Sakai RR. Effects of chronic social stress on obesity. Curr Obes Rep. 2012;1(1):16–25. 
  5. Campbell DD, Green M, Davies N, et al. Effects of increased body mass index on employment status: a Mendelian randomisation study. Int J Obes. 2021;45:1790–1801.
  6. Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in children: United States 1988–1994 and 2005–2008. NCHS Data Brief no 51. National Center for Health Statistics; 2010.
  7. Obesity Medicine Association. https://obesitymedicine.org/?utm_campaign=pr&utm_source=Bariatric_Times_Sept2022&utm_medium=article. Accessed 15 Sep 2022.

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Category: Medical Methods in Obesity Treatment, Past Articles

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