The Epidemiology of Obesity

Recently, there has been a great discussion regarding obesity since this word appears more and more frequent. Both advantages and disadvantages of being obese have been cited as the perception and cultural connotation has changed over time. Obesity has evolved from an evolutionary advantage to a disease. In fact, those who had an evolutionary advantage in the tough environment of early hunters and gatherers were those who were more likely to store fat. Further, for women, being fat could obtain greater attention.

This esthetic value and cultural significance linked to obesity was presented in the mysterious nude female figurines of stone Age Europe 20 000 year ago. Those statues illustrated both mother goddess and matriarchal icons of fertility. Being fat was considered good and appropriately reflected in the literature, arts and politics of the time as it was symbol of health, strength and prosperity (Eknoyan, 2006). While today, it can be defined as an excessive fat accumulation and storage in the body that may weight on human’s health.

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Obesity has become a social problem since the eighteenth century when it became cause of heart disease, diabetes or many other illness, and considerable collective actions have been established to overcome this problem (Cullen, 1710). Today, nearly 30% of people in the world are either obese or overweight and will not cease increasing.  In the nineteenth century, the World Health Organization (WHO) and the government around the world noticed that obesity prevalence has reached epidemic levels, and then declared it a worldwide and global public-health crisis. However, obesity affected not only physical health but also psychological health.

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Obesity is associated with a broad variety of stigmatization and discrimination in everyday life that brings forth self-esteem issues and higher levels of depression. Therefore, my question is how does inequality lead to obesity? This research paper will focus on number factors to analyze the cause of growth in obesity rate.

First, the patterning of obesity is gendered since the prevalence of obesity is greater in women than in men which attaches to the role of gender inequality (Garawi, Devries, Thorogood, Uauy,2014). A country within low gender inequality such as a GII (gender inequality index) inferior to 4, the sex difference in obesity is also small. The average sex difference in obesity for countries within GII< 4 was 2.1% while for countries with GII ⩾0,4 it was 11.01%. In this way, gender inequality is associated with obesity. Further, the relationship between income and obesity can vary by gender. Based on 2005 to 2008 national data, the decrease in income rate among women, increases the obesity rate since women are more exposed to inequality in the workplace than men. Then, food consumption is also gendered. It occurred as early as teenage when boys and girls obtain masculine and feminine eating styles. Then, research from high-income countries deduces that girls suffer more frequently from dieting and eating disorders than boys and also that girls experience more discontentment with their body form as women are more likely to meet higher levels of weight stigmatization than men while often an excessive attempt of losing or maintain weight can lead to, for example, Bulimia, an eating disorder fact, and so obesity. To exemplify the gender difference in perception of weight, some data have been analyzed. Men may experience weight discrimination at a Body Mass Index (BMI) of 35 or higher while women may meet stigmatization at a lower BMI of only 27. As a result, the perception of others may push women to change their behavior and conduct women to obesity. According to conflict perspective, obesity is becoming a problem when there is a “conflict between the goal of eating enjoyment and the goals of weight control” (Heshmat,2011, p.180). Further, according to biological perspective, in female, the biological factor of menopause affects fat distribution that may increase risk of obesity (Power, Schulkin,2012), but also women are more likely to eat more sugar-laden foods than men. Then, physical activity is also gendered. In fact, during adolescent, girls are usually expected to do less sports than boys and this difference continues into adulthood. Rules, expectation or norms of behavior considered proper in a given culture, emphasize these gendered behaviors. Women are being denied access to certain sports just because of their gender or they are discriminate. For example, some endurance sports like weightlifting or marathon was argued that women were too weak for those exercises. Moreover, social institutions involve. Not only do they strengthen, but also reproduce inequality and discrimination between men and women, so it is these gendered social institutions that trigger gender inequality. Food and physical activities between men and women are unequally distributed that shows women have fewer access to resources which leads to a change of women’s behavior, then cause obesity. In addition, gender norms set men and women’s role in the household and their status in society which lie the root of gender inequality consolidates probably behavioral and social causes of obesity. According to Functionalist perspective, men and women are expected to do different works, that explains the domestic division labor in which the role of women is spending most of their life to be pregnant; however high pregnancy weight gain can bring about obesity.

Then, geographical inequality results in obesity. People who live in the rural tend to be more obese than those who live in urban or near urban because they are less likely to have enough programs in disposition to help them overcome the problem of obesity. In addition, other research shows that living in isolated part of the nation results in fewer access to healthy food when shopping. This disparity is proved by some data in age and gender. 38.9% of rural adult men are obese compared to 31.8% of urban adult men. 21.7% of rural youth have obesity compared to 17.1% of urban youth. Between 2013 and 2016, the analyze of 7,000 children shows that the prevalence of obesity in rural area are nearly 5% higher than in urban area. Then, 47.2% of rural adult women suffer obesity in comparison to only 38.1% of urban adult women. Therefore, demographic variation in obesity trend is adjusted by number different factors such as economic, local-level social and environmental factors.

Next, there are evidence on the relationship between obesity and inequality in education. Research shows that individuals that have completed more years tend to drunk less, smoke less and are less likely to become obese. Likewise, those people are more probably to obtain preventive care and practice exercises (Curtler and Lleras-Muney,2006). Around 33% of adults who did not graduate high school have obesity in comparison to 21.5% of individuals who graduates from high school. Education enables individual to get more information about the energy content of food and provide them a critical thinking (Sparkman, et al, 2005). A study shows that those who are lacking in knowledge may neglect the energy content of snack food or alcohol drinks unlike non-obese individuals, that may so contribute to the effect of social class on obesity. A lack of information of energy content of food can also have an impact on one’s own perception of their body weight. Obese or overweight people tend to ignore their body mass compare to those who have a normal weight (Haas ,2008). In addition, highly educated people are more likely to choose a healthier way of life since they possess the ability to conduct a wholesome life and are also conscious of the risks hidden behind obesity (Yoon,2006). It is estimated that the fact of increasing education by one year in the whole population would decrease the overall obesity rate of 4% in Canada and 9% in England. By this way, Crossman and Kaesther (1997) argued that education policies conducted in unequally treated group may decrease the current health disparity.

Nevertheless, inequality in income and distribution of wealth and poverty involved in obesity. In fact, previous studies have also shown positive associations between obesity and wealth and obesity and inequality. To point out, people who earn fewer than $15,000 per year hold an obesity rate elevated to 33% compared to 24,6% of those who gain about $50,000 per year. The relationship between income and obesity can also vary by race-ethnicity. For example, obesity affects mostly minority group in the Us. To clarify, research has informed important difference in the obtainability of food stores. Compared to White households, less than 50% to 70% chain supermarkets are available to African American and Hispanic household. Nonetheless, due to the denial of available supermarkets, minority group are preventing from accessing for more healthful diets, consumption of vegetable and fruit and so lower rate of obesity which justifies African American have the highest rate obesity in the US with 31.45%(Ethn, 2011). Furthermore, different factors can also explain obesity such unemployment levels, income level, the percentage of people below the poverty line. Chart (fig1) shows the higher the poverty, the higher the obesity rates (BMI> 30). Thereupon, the incapability to purchase healthy food is one of the essential contributor to the increase rate in obesity while affording more expensive but healthy food has been proved that it can ensure a better health and weight. Moreover, the increase in unemployment implies that people will have more difficulty in purchasing nutrition foods. The chart (fig3) shows that the more the poverty rises, the more elevated the obesity. Further, low-income communities face to the combination of lack of recreational programs and supermarket and full service grocery result in low nutrition and fast food and little or not at all physical activity (Shantell, 2016). As a result, the reasons of why low income people are more likely to be obese or overweight are because of a sedentary lifestyle. They are less cable to purchase a gym membership, violent areas overlap with poor areas impede them from being active outside, fewer accessible parks and sportive location. Then this inability to purchase healthy food drive them to consume low in nutritional value but high in fats, salt, refined sugar and preservatives food. After all, conflict theorists state that obesity is a social problem because of the inequality in the quality of food between the bourgeoisie and proletariat. People grew up in a disadvantaged social condition are more probably touched by obesity, and once they do become obese it would be more difficulty for them to become well because of the inadequate health care (Weitz,2013) whereas the bourgeoisie have the opportunity to get healthier food and access to better medical care. In case they become obese, they would have more change to overcome this problem compared to low income overweight people. Functionalist perspective state that the good health is crucial to ensure the normal operation of society. When a person become obese, which means ill, then it threatens his ability to perform his role in society and play a “sick role “instead. By this way, society’s functioning and stability suffer (Parsons, 1951). For functionalist theorists, health care institution, food manufacturers and distribution chain of products result in obesity. Symbolic Interactionists say that obesity has little or no objective reality, but there is a social problem when the society defined it so.

However, inequality in income and poverty result in psychological effect that leads to overeating, and so then obesity. Since eating is enjoyable, people when feeling stressed, sad or whatever negative emotions, end up using eating as a source of spiritual comfort and appeasement. Because of this, it turns out that there is no surprise that stress-provoked eating engender obesity. In addition, study from Scotland proves that negative emotion provoked by income inequality push the individuals to consume more calories even in the absence of hunger because they eat when they have the opportunity to do so. Those people grew up in a difficult socioeconomic environment, even after drinking 12-ounce can of Sprite still can eat cookies compared to those who grew up in favorable families consume fewer snacks. “It appears that humans and animals respond similarly to harsh and scare environments, and this response takes the form of preemptive increases in food consumption” (Bratanova, Loughnan,2016). For this reason, food consumption of individual living in distinct condition differ from each other’s. For instance, an individual grew up in a difficult economic circumference consume more food even he is already full than individuals living in a prosperous family “These individuals consumed more calories when their current energy need was high than when it was low” (Hill,2016). Thus, food intake and physiological needs of individuals suffered poverty are separated because their food consumption is directed by the opportunity and this may be created during childhood and continues into adulthood. Those who feel poor have the tendency to eat more due to the anxiety produced by social dislocation. As a result, from the point of view of biological perspective, mood, food intake and brain signaling are connected. Mood disorder are associated with abnormal eating behavior which means anxiety and depression are comorbidities of obesity (Novick et al.,2005; Simon et al.,2006; Kloiber et al.,2007).

Obesity can also begin in childhood. Childhood Overweight and obesity (COO) are linked with parental factors. A child whose mother have suffered malnutrition before and during pregnancy is linked with the highest possibility of obesity and metabolic disorders in later life, so the health of offspring can be affected by parent factors prior to and at conception. Infants are, therefore, associated with the socioeconomic of their parents, especially mothers. Breastfeed are, however, less likely to become overweight while mother in low-income position do not breastfeed they children. Research shows that although breastfeeding rates have increased for black women, it is still very weak compared to those for white mothers. Mothers who occupy a low-income position are less likely to breastfeed because of the misunderstanding of which feeding forms are better for infants, so this reflects their education levels. Highly-educated households will search out health information about the impact of feeding choices on infants. As a result, inequality in education produces an influence in breastfeeding by being a signet of attitude and knowledge. In addition, children living in low-income family are 20% to 60% more probably to be overweight than other in high-income family and healthy constructed environment.

It is also important to analyze genetic and social environmental changes with development result in obesity. Our current society is characterized as an obesogenic society where people can access to food easily and low cost, and fewer demanded for physical activities. However, it turns out that some people within genes that lead to obesity, may not be obese or contrary because obesity is also linked with environmental factors. Although chemical in the environment can results in metabolic changes bring forth obesity, people’s lifestyle such as working or living condition, the ability to access to resources play a major role in people’s weight. The development of society like urban sprawling brings about a lack of safe place to exercise physical activity and the extension of fast food as healthy foods may be inaccessible because it is more expensive, push people in low-income countries to change their way of life. The evolution of society includes also food and agricultural industries that choose food for their customers in favor of their profit rather than human’s health.  Then, in the US, vegetables and fruits have increased 118% in 1885 to 2000 whereas price for fats have only increased 46%, for carbonated soft drinks 20% and sugar 46%. This change of social factors conducts people to behave differently. Thereupon, a global changes has emerged including an increase of intake of sugary drinks, consumption of convenient, processed and less expensive food. In nowadays, we live in an obesogenic society where people can access to food easily and low cost, and fewer demanded for physical activities unlike before when human needed to use their force to find food such as hunting, fishing or picking fruits.  Moreover, advanced technologies lead the majority of people to have a sedentary lifestyle. Unlike a century ago, now people spend the majority of their time in front of their computers and TVs for both word and pass time; as a result, they spend just little energy. According to the functionalist perspective, technology makes industrial society so fewer have to work to sustain as robotizing replaces human forces. Thus, easily accessible food, coupled with reduced physical activity account for the increased prevalence of obesity.

It turns out that inequality in different factors are interrelated and shows clearly a vicious cycle. In everyday life, obesity and overweight are connected with discrimination and stigmatization. People affected by this illness have more difficulty in being in leadership position, finding a job and often have a lower wages. In term of employment, employees with excess weight have fewer opportunity to either get hired or be promote compare to normal-weight people. They also obtain lower wages and may face to a higher risks of jobs because of their weight. Then, in term of healthcare, they may experience lower quality of care and even prejudices. At school, students who have obesity may be discriminated by teachers and peers. Because of the discrimination, obese people are more likely to suffer psychological problems such as depression, social anxiety and affective disorders. Thereupon, those people cope the situation with irrational behavior such as binge eating, dysfunctional eating and physical inactivity as a reaction to the discrimination. As overweight or obese people are often discriminated by other, symbolic interactionism in this context would state that obesity is considered as a problem result from human behavior, interpretation and interaction with others. Human behaviors are influence by social interaction and so the self is socially constructed.

It is estimated that the United States spent about $147 billion in the annual medical cost. Among those amount of money, $1.429 of medical cost for either overweight or obese people was higher than for people with normal weight. As a result, in reaction to the problem of obesity, some regulations have been established by the government such as preventive through multi-component family and school-based programs and clinical interventions including behavioral and surgical. Behavioral which is a crucial part of effective assistance are exercised at different level. At individual level, it consists to reduce obesity through reducing socioeconomic inequalities in childhood obesity by tailoring a weight loss programs equally work for all social classes and even provide more advantages for those in low income group. Then mentor-based health promotion who provide long-term effects on obese children in low income households. At community level, some successful programs such as family-based group weigh loss programs work equally across the socioeconomic statues, so provide long-term benefits to maintain weight and shot-term weight loss. Reducing inequality obviously reduced obesity since a more equal society where members feel a sense of belongings can produce less stress and so reduce overweight problem. Surgical intervention, a socialized medicine consists to conduct a bariatric surgery. Critics of this proposal argue that lower income individuals have difficulty in affording this practice. Other may say that healthcare, education institutions and politicians should make some changes that lead to an environment where people can have accessed to healthy food and physical activity. However, health care programs in order to promote healthy lifestyle failed because it may work only for highly-educated and higher income people. Speakman et al.2005 argue that people in low social class might know how many energies contented the food but ignore to act on this information because they are unable to develop a healthy lifestyle neither purchasing healthier food nor being member of a gym.

All in all, economic and social conditions determine individuals’ health. Neither do they affect the health status of people and even more communities, they also indicate the stratification of the social system because those conditions are shaped by the power, amount of money, and resources that people hold. As a result, more powerful people play a more important role in the influence of society as they react in favor of their benefits, so then emerged inequality and cause obesity. Obesity has, therefore, to be considered in a wide perspective where number of major factors included income, gender, ethnicity and race, education, social and physical environment play a powerful role in human social behavior and so occupy an important role in this society.

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The Epidemiology of Obesity. (2021, Apr 19). Retrieved from https://studymoose.com/the-epidemiology-of-obesity-essay

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