Vol. 3 No. 1 Specials

Some find the concept so absurd, it’s laughable. In a world plagued by dearth—so many live without education, health, or food—America’s major crisis is excess. Obesity has grown to such enormous proportions that professionals are calling it an epidemic. But when we learn that in 2000, 64% of American adults were overweight and 30% were classified as obese, all the jokes about eating ourselves into oblivion and the Mid- West sinking into the Earth’s core begin to lose their humor.

The American public is waking up to the consequences of unhealthy diets, and the media is increasingly publicizing the social and medical toll of obesity. Health problems related to obesity account for $70-99 billion per year in domestic healthcare costs—7% of all expenditures. But before Americans begin to grapple with the problem of obesity we first have to surmount long-standing misconceptions about its origin.

We often associate laziness, gluttony, and stupidity with fatness, thinking of it more as a depraved lifestyle than as a medical condition. While personal responsibility is an important component in the fight against obesity, the dialogue should not—and cannot— stop there. If we look at the groups most affected by obesity, we find the disease to be most common among precisely those people who have the least ability to modify their lifestyles. According to researchers Adam Drewnowski and S.E. Specter, “There is no question that the rates of obesity and type 2 diabetes in the United States follow a socioeconomic gradient, such that the burden of disease falls disproportionately on people with limited resources, racial-ethnic minorities, and the poor.” It is one of America’s ironies that material poverty begets caloric over-abundance.

The link between cost and diet is complex, but the work of Dr. Drewnowski challenges the notion that obesity can be overcome by more informed and careful food choices. He has found that healthy foods cost considerably more than their less nutritious counterparts. One of the keys to rating the healthiness of food is identifying its energy density, which is defined as the available energy per unit weight. Since energy-dense foods contain less water and provide less satiating power, their regular consumption leads to increased food-intake and weight gain. Intriguingly, Drewnowski discovered an inverse relationship between energy density and cost; on a calorie for calorie basis, energy-dense foods like grains, fats, dairy, and sweets cost considerably less than foods with lower energy densities like vegetables and fruits. For example, the difference in energy cost between refined sugar and sugar in fresh raspberries is 10,000%. Each calorie in salmon or arugula costs several hundred times as much as a calorie found in grains or sweets.

In short, if a person has both the education and the will to seek out healthy, fresh foods, then she has to be willing to back her desire with cash. A 1998 study conducted by Havas, Treiman, et al. found that the simple substitution of whole grain for refined grain triggered a 30% increase in price.