31 May 2018 Poverty and childhood obesity: a 21st century role reversal
Traditionally, poverty-stricken households often struggled to feed the family, resulting in underweight, thin children and in some severe cases, symptoms of malnutrition.
At the same time, being overweight or obese was often arguably regarded as a sign of wealth and prosperity. However, the relationship between poverty and weight status has undergone a significant change in the last 50-60 years – to which the interplay now appears to have completely switched, according to a recent study from University College London.
The study found that today’s children from disadvantaged families are at a greater risk of being overweight, compared to those from more affluent households and to those born in the 1940s, 50s and 70s. The findings suggest that 11 year olds from low income families were 4.4lbs lighter compared to more affluent children in 1957. In a stark comparison, in 2015 the poorest children were 4.6lbs heavier than wealthier children .
Whilst the study indicates a dramatic shift in weight status of deprived and wealthier children across the century, we know that obesity is heavily influenced by deprivation. In fact, the National Child Measurement Programme indicates that deprived children are twice as likely to be obese than more affluent children . Whilst there is more to defining poverty than deprivation, it can be regarded as a cumulative and important indicator of poverty.
But how can this be?
How can children from poorer families, with less money to spend on food, thus theoretically less food to consume, be more likely to be obese than their wealthier counterparts?
‘Modern Malnutrition’ is a term coined to describe a new wave of malnutrition that represents diets that are high in fat, sugar and salt (HFSS) – which often results in overweight and obesity – and low in vitamins and minerals from fresh fruit, vegetables and wholegrains. This may also help to understand the role reversal, as modern malnutrition is also more common in those living in lower socioeconomic households – of whom are also more likely to suffer from poverty .
The availability, quality and affordability of food and drink HFSS is an important factor to consider in this role reversal. There is a conflicting amount of research around whether ‘healthier food’ (fresh fruit and vegetables, wholegrain goods, nuts and lean meats) is cheaper, more expensive or equal to the cost of unhealthy food (processed, predominantly white goods and processed meats) [4, 5]. However, there is research to suggest that HFSS products are more often subjected to promotions in supermarkets – and price will undoubtedly be an important lever in what food and drink low income families purchase .
Furthermore, there is some evidence to suggest there are a higher concentration of fast food takeaways in disadvantaged areas, meaning the availability of HFSS is higher compared to more affluent areas. Recent studies have found that children living in poorer areas are exposed to up to five times more fast food takeaways and concentrations of these outlets are greatest in deprived areas [7, 8].
Thus, it can be argued that the rise of obesogenic environments over the past few decades is one of the many factors that has led to this change in the relationship between poverty and obesity – alongside the ever-persisting health and income inequalities in the UK that cause poor health outcomes in disadvantaged communities.
However, in the same week as the UCL study was published, a news story hit the press following a number of head teachers voicing concerns about child poverty, claiming “pale and hungry pupils fill up pockets with school food”. In another story in The Telegraph, the National Education Union and the Child Poverty Action Group has revealed in a latest survey that teachers often have to lend money to parents, and wash some children’s dirty clothes and undergarments. One five of schools also now run low-cost food clubs. Therefore, it would be wrong to claim that malnutrition and underweight is no longer an issue for children in poverty.
Both the new UCL study and recent news story covered in the press highlight a very harrowing truth. Children living in poverty now face the dual burden of both underweight and obesity – and both can be as equally damaging to children’s short and long term health, development and opportunities in adulthood.
Latest figures suggest that almost half of children in three core cities in England are living in poverty, and the Child Poverty Action Group claims that poverty affects nine children in a classroom of thirty. In a country of such affluence, these levels of child poverty are shocking. In tackling childhood poverty, there may be positive implications in the fight against the childhood obesity crisis in the UK. Policymakers must look to policies which can alleviate the both – for example, free school meals are crucial for lower income families to help provide a nutritious hot meal during the day. However, in the face of new universal credit proposals which reduce the inclusion income threshold mean that thousands of low income households, at risk of poverty, will miss out on free school meals. This is most certainly a backwards step in treating both childhood poverty and obesity and will negatively effect the most disadvantaged families in the country.