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The Persistence of Obesity

Ta-Nehisi Coates posted this over at his place, though it's originally from a reader of James Fallows's blog.

It is one thing for a successful, financially comfortable, socially accepted and respected person who has multiple things happening every day that are pleasurable (golf, driving a nice car, nice home, stylish clothing, success at work, interesting social events, kids doing well, planning vacations, etc) to take just one pleasurable aspect of life (overeating) and sacrifice some of that pleasure for the good result of losing weight.

"Now, for people struggling financially and socially, trying to just get through the day and keep their lives together to varying degrees ... their meals are often the only consistently happy and pleasurable events they can count on each day.

Coates agrees. His 20s were a rough period. And aside from the support of his family, "I have two words for you -- Breyer's and Entenmann's. It sounds disgusting when I write it. But that little a'la mode pick-me-up made things a little more bearable."

This reminds me of Charles Karelis's "The Persistence of Poverty." The basic argument is that the wealthy misunderstand the mental state of the poor, which leads them to make conceptual errors when creating policies to address poverty, or, in this case, obesity. Think of a bee sting, he advises. If you have a single bee sting, you'll go buy some salve to take away the pain. Now imagine three bee stings, a sprained ankle, a burn, a cut, a crick in your neck, a sore throat, and arthritis. Does the bee sting matter anymore?

Karelis argues that this is more the situation of someone in poverty. Obesity is bad, but it may be just one of many bad things. Overdue bills. A horrible part-time job. Endless commuting time on the bus. A mother with diabetes. A child running with the wrong crowd. A leaking roof. In that scenario, slowly reversing your weight gain might be a good idea, but it hardly makes a dent in the overall crumminess of the conditions. It won't replace pain with pleasure. So you do things that are surer to replace pain with pleasure, like have a delicious, filling, satisfying, salty, fatty meal. That may make your overall situation more unpleasant, but then, making that situation pleasant didn't seem like an option in the first place.

This, he would say, is fundamentally different than the situation of someone who is fundamentally happy with his life but thinks he should lose 30 pounds. For that person, those 30 pounds are the main thing standing between him and perceived happiness. It's one bee sting instead of a dozen ailments. The condition seems manageable, and so it gets managed. Conversely, if the aggregate condition does not seem manageable, people are less likely to manage any individual part, because it will not bring obvious reward -- life will still be pressuring and difficult. The things that will bring obvious reward, however, often make the underlying situation worse -- think spending, overeating and drinking. But then, that's why they call poverty a cycle, and obesity fits there, too.

Anyway, I don't know if this reasoning is true. But I've always found it interesting.

By Ezra Klein  |  October 2, 2009; 10:06 AM ET
 
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Comments

My understanding was that, statistically, wealth (and hence class) did not correlate with happiness in any meaningful way. This whole line of reasoning starts with the premise that the rich have less to complain about, surely they must be happy, surely the simple pleasures of a meal are as nothing when your life is so blessed!

Posted by: adamiani | October 2, 2009 10:23 AM | Report abuse

I think there's a lot of truth to that, but I also think there's a lot of just different preferences in food, you could call it cultural, and they feed their kids different foods so the kids grow up with simple tastes, too. I'm not any sort of health nut and I like several kinds of junk food, too, but I don't eat fast food more than maybe three or four times a year, travelling. Plus a lot of the cheapest foods are the ones most loaded with fat and calories and HFCS. I would never consider colored water with HFCS to be a substitute for orange juice, for example, but you'll see low-income mothers put that kind of stuff in bottles, along with the occasional Dr. Pepper, and it always makes me cringe. Water is free, so there really isn't any economic excuse for that kind of thing. I do think we need a pretty dramatic overhaul in the way our entire food delivery systems are structured and subsidized, but it definitely wouldn't fix everything.

Posted by: Jenn2 | October 2, 2009 10:24 AM | Report abuse

We are talking here culture and upbringing when you are 'poor'. Any mental strength which does not sustain you in periods of serious hardship; that is not a true strength at all.

Now the problem is those who have got good education and reasonable family upbringing in the first place are the only ones who can have that 'reservoir' of what is 'good' to work off hardship. Those who in the upbringing have never even get chance or never even get handle on what is 'good and strength'; don't have chance in real life then. Because they do not have any solid mental constructs to 'draw upon' to fight the crisis in life as and when it erupts.

It is very, very difficult for any human to grasp these 'mental constructs' on her own without any environment where there are 'no definitions exhibit of what is good or what it means to fight out'.

Reading Paul Krugman's column and today's disastrous employment number; it is clear that America is on her away to loose a substantial generation who will not have any conceptual means to 'fight out tough times'. Bernanke was honest to say in Congress that sustained unemployment essentially makes people loose the skills and hence employability. We are witnessing those dramatic happenings unfolding in America today.

This 'disease of poverty and unemployment' does not make dramatic news like failures of Lehman Brothers or how Paulson kneed to Pelosi to get TRAP. That is another trait of Rich - ability to project their problems as serious enough to warrant the attention of politicians. Poor and unemployed do not have that ability and whatever 'silver' of help otherwise would be available is lost in the attacks on 'State Dole out' and types of 'welfare queens' criticism.

One, not so unrelated suggestion here - time has come to 'tax' Stock Market Transactions and all investment banking Transactions, if only for few years, so as to generate stream of income to directly fund employment programs (not extending unemployment allowance).

Wall Street is responsible to bring us in this mess, they need to pay here for a while to get us out.

Otherwise we are in for 'dramatic effects' of sustained poverty.

Posted by: umesh409 | October 2, 2009 10:55 AM | Report abuse

Jenn2, did you read the post? The sugar-water you sneer at is a cheap pleasure the poor can afford. No, it's not good for them. But their lives aren't good, and losing weight is a long-term goal that, even if they reach it, still won't make their lives good.

Without wanting to minimize the plight of the poor, the psychology Ezra describes is a lot like what I (more or less financially secure, up to my eyeballs in education) experienced when I felt trapped in a bad marriage. I couldn't see my way out of a bad situation, but I sure could see my way to some nice comforting mashed potatoes that would take the edge off temporarily. Now that I'm out of the marriage food doesn't have anything like the hold on me that it did, and I'm losing weight. Stress is powerful, and it's one thing the poor have plenty of.

Posted by: csdiego | October 2, 2009 10:58 AM | Report abuse

But let's think of the successful overweight people who are setting a bad example for all Americans: Barney Frank, Barbara Mikulski, and above all the poster child of obesity, Debbie Stabenow. Why are those people, esp. the latter, still in the senate? It's interesting that it's hard to think of republicans who are like that. I say that there is also a Caligula like self indulgence that strikes people at the top of the heap, the top of the world, the top of the food chain, where they think they can do anything and eat anything. Your thoughts?

Posted by: truck1 | October 2, 2009 11:07 AM | Report abuse

Makes sense to me. Part of this is the reality of "survival mode". People with a degree of security behave differently than those on the edge living day to day. If a person isn't sure what tomorrow holds, there isn't a healthy balance and that manifests itself in wide range of high-risk behaviors (e.g. related to food, substance abuse, etc -- things which tend to create a vicious circle and amplify problems).

I agree with adamiani that wealth and happiness don't always correlate -- a person can be wealthy and financially secure and still miserable. However, my sense is that some degree of financial security is still better for a person's sense of well-being than sustained financial insecurity. I would guess to that societies with higher average incomes, but also high levels of income inequality the differences in perceived well-being might be even more pronounced (e.g. the level of dissatisfaction and insecurity in a country like the U.S. would be higher than a country like Denmark where the median wage and income disparity are less pronounced).

It would be interesting to see this quantified, I'm making a guesstimate here based on mostly anecdotal observation.

Posted by: JPRS | October 2, 2009 11:09 AM | Report abuse

I'm not aware of evidence that the ability to LOSE weight has much relationship to income or 'class.' My understanding is that 95% of people who lose weight eventually regain it. Obesity is a disease that is damn near incurable once you have it.

I do agree that the financial and social factors you cite are factors which put low income people at increased risk of DEVELOPING obesity, but your post addressed the ability to 'pull yourself together' and lose weight - I don't think there is a good case that is income related.

Posted by: exgovgirl | October 2, 2009 11:14 AM | Report abuse

Americans at all income levels have struggles with obesity, to be sure. But clearly its a problem among lower income families, because the cheapest stuff in the grocery store is at once delicious and cheap and convenient.

You're asking people to basically, for their health and any number of other good reasons, make food choices that cost more, take longer to prepare, and are as emotionally satisfying.

I used to be able to live on $25 a week for food in college, when my glorious menu consisted of ramen noodles, eggo waffles, and lunchmeat sandwiches. But now as an adult eating organic vegetables, and occasional meat, its easily four times as much, sometimes more. Which is fine for me I have the income and I'm single, but for a family of four living at even 200% of the poverty level, they just dont have the time or money it takes to buy fresh produce, and probably have now adopted a culture of eating crappy food that is terribly hard to turn away from even when u know better.

Posted by: zeppelin003 | October 2, 2009 11:20 AM | Report abuse

Americans at all income levels have struggles with obesity, to be sure. But clearly its a problem among lower income families, because the cheapest stuff in the grocery store is at once delicious and cheap and convenient.

You're asking people to basically, for their health and any number of other good reasons, make food choices that cost more, take longer to prepare, and are as emotionally satisfying.

I used to be able to live on $25 a week for food in college, when my glorious menu consisted of ramen noodles, eggo waffles, and lunchmeat sandwiches. But now as an adult eating organic vegetables, and occasional meat, its easily four times as much, sometimes more. Which is fine for me I have the income and I'm single, but for a family of four living at even 200% of the poverty level, they just dont have the time or money it takes to buy fresh produce, and probably have now adopted a culture of eating crappy food that is terribly hard to turn away from even when u know better.

Posted by: zeppelin003 | October 2, 2009 11:20 AM | Report abuse

It is apparent from these few posts that Ezra is correct. The wealthy have no understanding of the mental state of the poor. LBJ intimated that if the priveledged do not help the underpriveledged to improve, society cannot advance. This is what caused a Texas bigot from a culture of racism rise above it, wreck his short term legacy and advance the civil rights of a despised minority. History will look favorable on him but I don't think that was why he did it. He did it because it was in the interests of all and that made it the right thing to do. We need a dose of that now from both sides of the aisle. The institutionally poor bring down our culture. We must find a way to move them up Maslows pyramid. It will be a better world.

Posted by: BertEisenstein | October 2, 2009 11:32 AM | Report abuse

this would make more sense if you didn't have wealthy fat people and thin poor people. I do believe it happens to a certain extent and wealth gives you more opportunity for things including exercise but it doesn't mean that poor people can't be healthy. So are you basically saying that poor people are unhappy with their lot in life so they eat to the point of obesity as a "painkiller" to that? Ya that may be possibly true but again many people come from poverty to become amazing successes. I was listening to CNN radio the other day of a story of a latino immigrant who had basically nothing growing up in California. He worked very very hard, had a great mentor and made it all the way to Harvard Medical School and graduated with several degrees including one in public policy. In fact I think he had 3-4 degrees. What did he do with it? He went back to his community and gave back and is helping others by mentoring kids who want to follow in his foot-steps. I never saw him since it was on the radio but I get the impression he wasn't obese. Poverty can be a crutch, but it doesn't have to be unless you want it to be.

Posted by: visionbrkr | October 2, 2009 11:34 AM | Report abuse

Ezra,

You turned me on to the book, "The End of Overeating" from a brief blog post you made months ago. I bring this up as it does reinforce part of your basic premise in this post. Salt, sugar, and fat change our neurological make-up and hit that 'pleasure' button in a way almost identical to many addictive drugs. As anyone who has struggeled with denying an addicition knows, it requires your individual committment and it also frequently requires replacing one habitual behavior with another.

Money doesn't buy happiness, but it does provide more opportunities to change your lifestyle. So coming at this from the opposite direction from the bee sting/pain analogy, the 'rich' can more easily find substitute pleasures... a less affluent person can pay $20 to have Applebees throw 4,000 calories at you in a single meal that will be intensly satisfying (and gastronimcally painful) while their more wealthy counterpart can pay $100 to have 'le Bistro' craft 1,500 exqisit calories into an intense dining experience.

Posted by: Jaycal | October 2, 2009 11:53 AM | Report abuse

interesting post, and discussion. I do think the food chain is poisoned nowadays, and with genetic modification now loose and untracked in the fields there are a lot of untested imponderables going into our mouths no matter how rich we are.

But as to your main point, that the poor suffer extreme stress, and your secondary point, that the rich don't really understand this because of their own relative insulation from stress - this is clearly true, and verified by all of our experiences if we review them in this light.

As for answers...

Posted by: rosshunter | October 2, 2009 12:03 PM | Report abuse

Here are some numbers to support the notion that there is a correlation between poverty and obesity . . .

http://www.sciencedaily.com/releases/2008/02/080207163807.htm

In reference to the anecdote about the immigrant, who worked up the economic ladder -- it happens. My sense though is that there probably is a kind of self-selection bias at work too in the case of those who come to the U.S. at great risk -- by definition they are already highly motivated. For someone who is in cyclical, generational poverty the self-destructive mindset probably becomes hard-wired earlier.

In behavioral psychology too there is the concept of learned helplessness (e.g. the case of a mouse that gets shocked and then jumps across a barrier to avoid the shock, only to be shocked on the other side of the barrier. Eventually the mouse gives up and tends to enter a kind of catatonic state. In terms of more normal conditioned behavior, the mouse gets a shock and learns to avoid the shock by jumping over the barrier. That is the more typical kind of way that life experience conditions a person. For people who are already behind the 8-ball, the path of learned helplessness is the more common outcome. Even what we'd consider positive actions don't relieve sources of stress, so at a certain point the will gets broken and the mode of existence is one of pure day to day survival).

I suspect this is one reason that we look at poverty as a self-perpetuating phenomenon. Over-eating or other activities are simply a means of coping with the sense of helplessness that gets ingrained. In exceptional cases someone will make the leap, but the more common case is one where resignation because the default mode. In order to break the cycle you need early intervention and a support structure that softens the impact of set-backs.

Posted by: JPRS | October 2, 2009 12:05 PM | Report abuse

Part of the reason that countries with higher local public transport reliance and higher rates of transport cycling have lower rates of obesity ... the greater the mode share, the greater the diversity of options available, and for the capital-intensive options, the lower the normal ticket price.

And when that is added to larger reliance on bikes, a lot more people under financial stress are free to ditch the car and cycle to the train station instead.

And of course, the absurd "OMG, but I have a kid! how do I get groceries!" disappears from people's mind, because they see for themselves how other people answer those questions.

http://www.progressiveblue.com/diary/4384/a-creative-clean-energy-alternative

And of course, the fewer low-income people are extremely overweight because they drive back and forth from a low wage, high stress job and collapse in front of the television with some cheap, high calorie comfort food, the harder the upper middle class have to work at the gym to look like they have the leisure time to go to the gym.

Posted by: BruceMcF | October 2, 2009 12:12 PM | Report abuse

The post is totally, totally wrong.

It is true that the poor are more likely than the rich to become obese. Ezra has posted before on the reasons why - junk food is subsidized more via corn, the lack of supermarkets in poor neighborhoods, etc.

However, once you ARE obese, you stay that way, whether you're rich or poor. Obesity is not psychological. It is physiological.

Once you gain weight, for all practical purposes it is permanent. Less than 5% of dieters keep the weight off after five years. For ten years even less. For twenty years probably close to zero.

The act of trying to reduce calorie intake will increase your body's physiological demand for sugar and fat. It's not a matter of willpower, or eating for emotional comfort; it's the physical demands of the body.

Expecting people to fight this is no more realistic than abstinence-only sex education.

Posted by: tyronen | October 2, 2009 12:20 PM | Report abuse

I think this reasoning is dead on accurate.

Posted by: bcbulger | October 2, 2009 12:48 PM | Report abuse

Truck1

Nice of you to expose yourself as an idiot.

Limbaugh
Gingrich
Cheney
Ensign
Beck

Need I go on?

Posted by: Dollared | October 2, 2009 12:49 PM | Report abuse

Visionbrkr, yes many people come from poverty to be amazing successes. They are what we call "exceptional".

And many children of rich people end up fat and lazy. They are what we call "disappointments."

And nothing Ezra said conflicts with that.

The reason why people are called "exceptional" or "disappointing" is that they ended up performing far beyond the average for similarly situated people.

Some of us are trying to create a nation where people don't have to be "exceptional" to succeed, even if their parents weren't wealthy.

Posted by: Dollared | October 2, 2009 12:54 PM | Report abuse

Generally speaking, money does make people happier (because it relieves stress) but only up to a level about equivalent to middle income. Beyond the level where basic insecurities are reduced to a manageable level, more money definitely doesn't bring happiness. The key is adjusting wants and desires to ones means.

I think that it is the stress level poor people experience (from multiple sources, including a great many petty indignities visited on them by the more well off) that leads to overeating for much the reasons Coates explored. From my acquaintence with poor kids, convenience is uppermost, then cost; hence the kids sent off to school with chips and soda for lunch instead of lovingly made sandwiches with organic bread and free-range turkey. Just getting the kids to school on time is a huge deal for a whole host of reasons upper middle class parents can't guess at.

That said, Berkeley has had a lot of success with its fresh,largely organic snack and lunch program. The kids really came to prefer the food. They get healthy breakfast, snacks (fruit) and lunch. But it is not cheap.

Maintaining weight can be very fraught for some people, particualrly women. It is easy for people who don't have a problem with eating to criticise those who do, but this society is riddled with bad, unhealthy, self- and other-destructive habits. Perhaps if we were a more nourishing, supportive society with fewer rugged-to-the-point-of-hostility individualistic, selfish social darwinists we would have a healthier society and not just in terms of weight.

Posted by: Mimikatz | October 2, 2009 12:58 PM | Report abuse

People are also biologically predisposed during times of uncertainty to crave all the high-fat, high-calorie food they can get - being able to store fuel reserves for lean times was critical to our survival as a species. The body doesn't distinguish if a product was chemically engineered to feel fattier and more satisfying when eaten, it doesn't calculate that no energy was expended to hunt it down and prepare it for consumption, and it doesn't look far enough ahead to assure itself that the same meal will be available tomorrow. It responds to stress by doing what it was designed to do during hard times - grab all the available fuel that it can when that fuel is available.

Posted by: jackiebinaz | October 2, 2009 1:01 PM | Report abuse

csdiego, of course I read the post. Wanting to engage in a cheap luxury has no bearing, to me, anyway, of why you'd put sugar water in the BABY's bottle. My kids definitely get healthier food than I do, I hide the chocolate and give them the salad. bwahaha!

Posted by: Jenn2 | October 2, 2009 1:11 PM | Report abuse

If you have never participated in a poverty simulation run by qualified people, you should seek one out and do it. I thought I wouldn't learn anything but I was floored by what I realized I would do to cope and survive - and this was a one-hour sim. I was also shocked by the assumptions that people had about the poor. I ran into a lot of deeply internalized beliefs (often to the point of subconscious acceptance) that the poor are not to be trusted, addicted to drugs and/or alcohol and are neglectful parents. If I could, I'd run poverty simulations in every high school in the country.

Posted by: eRobin1 | October 2, 2009 2:07 PM | Report abuse

Stabenow>Cheney
Mikulski>Limbaugh
Jerrold Nadler>Gingrich + Ensign
Axelrod>Glen Beck

Not one of the dems I named is in show business or a commentator. All are people who are proposing to put Americans on a stringent diet of healthcare restrictions and massive taxes, while eating themselves silly. That is the only reason their weight matters.

Posted by: truck1 | October 2, 2009 2:46 PM | Report abuse

The argument boils down to the paternalist notion that "poor people have less self-control than the rest of us." It doesn't stand up to empirical scrutiny; does anyone seriously believe that thin people don't have stress in their lives?

P.S. The sugar in orange juice is 50% fructose.

Posted by: tomtildrum | October 2, 2009 3:13 PM | Report abuse

*The argument boils down to the paternalist notion that "poor people have less self-control than the rest of us."*

No. The argument is that "people have very little self control. If you're poor, food is the only affordable outlet for your moments of weakness." This seems pretty logical: the last time I wanted to de-stress, I bought a plane ticket to Boston to see some old friends. That's not an option that the poor have when they are faced with similar situations.

Posted by: constans | October 2, 2009 4:35 PM | Report abuse

Based on truck1's rhetoric and his fixation of Debbie Stabenow's figure, it's pretty clear that he is the troll who consistently used the name "Anonymous" on Ezra's old blog at TAP. Congrats to the guy formerly known as too-stupid-to-use-a-pseudonym for finally choosing one.

Posted by: tyromania | October 2, 2009 9:05 PM | Report abuse

dollared,

i'm not saying that everyone needs to be as transformational as the latino immigrant I heard the story about. There are all levels of transformation. The child who works hard even though they have ADHD. The one with the "silver spoon" who expects everything handed to them and acts and treats others like it. To me, it comes down to work ethic. Some have it some don't and some don't ever have a chance even if they have it. We need to help the last group and we need to praise the first group and we need to teach the second group not to be that way.

Posted by: visionbrkr | October 2, 2009 9:29 PM | Report abuse

--"[T]he wealthy misunderstand the mental state of the poor, which leads them to make conceptual errors when creating policies to address poverty"--

That's the crux of the snicker, ain't it?

It isn't "the wealthy", as a rule, who are intent on "creating policies" for this and that. It's a small percentage of bloviating know-it-alls and ignoramus busybodies who spend their lives trying to figure out how to make other people better, when the same time would be better spent minding their own damn beeswax. See Klein for a case in point.

See Jethro Tull, "Thick as a brick" for more clues.

How many billion have been thrown at stupid LBJ's 'Great Society' and what is there to show for it? Greater dependency upon The State and a greater demand for "sacrifice" from those who would be better off without any part of it. And Klein running around like an old housewife peering into everyone else's laundry wondering how to write the perfect laundry policy to shove down everyone's throat.

Posted by: msoja | October 3, 2009 9:02 PM | Report abuse

*How many billion have been thrown at stupid LBJ's 'Great Society' and what is there to show for it? *

A distinct lack of ricketts, severe malnutrition, parasite infections, urban shantytowns, and other ailments common in 2nd and 3rd world countries without the modern safety net programs that things like the Great Society programs provide and which the USA faced before they were in effect.

Posted by: tyromania | October 4, 2009 12:34 AM | Report abuse

--"A distinct lack of ricketts [sic], severe malnutrition, parasite infections, urban shantytowns"--

LBJ wiped out rickets, malnutrition, parasites and shanty towns?

Rickets was widespread in the 19th century, not the 20th, but is making a comeback in *this* century.

What is obesity but another form of malnutrition? See Klein wring his hands.

Bedbugs (a European import) and head lice were virtually wiped out by the 1950s, but the methods used (and those subsequently) were found to be poisonous to the environment, etc. Drug resistance is also a problem, so now there is a resurgence of both bedbugs and head lice around the world, including in the U.S.A. Way to go, "Great Society".

And last but not least, shanty towns, which were a feature of the Roosevelt era, not the late sixties, are once again popping up in and around our bigger cities despite all the effort expended to prevent them.

So, frankly, I don't know what you're talking about.

Posted by: msoja | October 4, 2009 8:44 AM | Report abuse

hubba hubba. Tyromania (formerly known as tyro, formerly known as ...) needs to go on an all expenses paid trip to Detroit (shantytowns), New York City (bedbugs), any upper middle class suburb (head lice) and many other places in our own country for parasites. Ricketts????

Posted by: truck1 | October 5, 2009 11:54 AM | Report abuse

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