Environmental and Socioeconomic Factors in Obesity

The long-term consequences of obesity are well-known and well-defined, but the root cause of obesity itself is a bit less clear. The reasons for obesity are multifaceted, stemming from both environmental and socioeconomic factors. Let’s review each of these factors, while touching on how policy and public health efforts may change the tide of the obesity epidemic.

What is obesity?

We throw around the terms overweight and obesity a lot – but what exactly defines being overweight or obese? The World Health Organization (WHO) defines being overweight or obese in adults as the following:

overweight: a body mass index (BMI) of more than or equal to 25
obese: a BMI of more than or equal to 30

When it comes to children, age influences whether or not a child is considered overweight or obese (1).

How common is obesity?

In the US, almost 42 percent of adults are obese, with as many as nine percent being severely obese. This translates to greater than 100 million adults with obesity and 22 million adults with severe obesity in the US alone. The incidence of obesity has risen by over ten percent over the past two decades (2).

On a global scale, as of 2022, as many as one in eight individuals were considered obese, and as many as 43 percent of adults were overweight. More than 390 million children and adolescents were considered overweight, whereas 160 million were considered obese. These numbers are striking, especially when accounting for the upwards trend over the past several decades. Since 1990, adult obesity has doubled and adolescent obesity has quadrupled (1).

Key factors contributing to obesity

There is no one root cause of obesity. Instead, it is a complex condition with multifaceted origins, stemming from environmental, socioeconomic, and genetic factors.

Environmental factors in obesity

Food Environment

Over the past several decades, we have seen a significant uptick in aggressive marketing of high-calorie, low-nutrient foods, usually referred to as “junk foods”. The prevalence of these types of foods, along with their accessibility, have contributed significantly to the obesity epidemic. Typically, these meals, snacks, and drinks are packed with sugars, fats, and salt, that while palatable are also addictive. Marketing schemes advertise these foods as being tasty, convenient, and affordable, promoting their consumption amongst children and adults alike.

Additionally, fast food has also contributed to the rise in obesity. Fast food chains are common in low-income neighborhoods where healthy options may be limited. Though low in price, these meals are usually calorie dense. Additionally, some areas have minimal access to affordable yet nutritious options, referred to as “food deserts”. Individuals living food deserts tend to rely on fast food chains, leading to unhealthy choices and the development of obesity.

Physical Environment

Many urban areas don’t have safe or accessible spaces for physical activity like sidewalks, parks, or walking trails. In turn, one’s physical environment can discourage physical activity. As we know, exercise and movement are essential components of weight loss and maintenance strategies. To maximize weight loss, we should try to increase calorie expenditure.

Another issue with physical environment arises in car-dependent areas. When public transit, bike lanes, and pedestrian-friendly areas aren’t present, individuals are less likely to get active when moving from one place to another. For example, in these types of areas, someone might be more likely to drive to their destination as opposed to walking or biking.

Socioeconomics factors in obesity

Income levels and obesity

Lower income individuals tend to have a hard time getting hold of healthy and nutritious foods like fresh fruit, veggies, and lean proteins. Instead, they tend to opt for more affordable options which are usually high in calories and overly processed, contributing to weight gain.

Additionally, lower income individuals tend to have lower accessibility to healthcare, be it limited financial means or lack of health insurance. As a result, they may be less likely to go in for regular doctor’s visits to get preventative care, nutritional counseling, and weight management support and treatment.

Education level can also play a role in one’s likelihood of developing obesity. For one, individuals with higher education levels tend to have higher paying jobs, giving them the financial means to make healthier choices. Additionally, those that have received higher levels of education may have received obesity education and thus have increased awareness on the importance of exercise and a healthy diet.

Culture and obesity

Culture can play a huge role in one’s susceptibility to obesity. For example, one’s culture may influence the types of foods they typically prefer and eat, which may or may not always be the healthiest choices. Additionally, certain norms around eating, such as the expectation to finish your entire plate, can lead to weight gain. Culture can also influence things like one’s body image, stress levels, and trust in the medical system, all of which can impact obesity.

Policy and Public Health

So, how do we influence society at large and shift towards a healthier community? The answer is through policy and public health efforts. Public health and obesity are intimately linked, so creating policies at a larger scale can help to reach more people.

Success Stories

To give you some examples of successful policy changes, let’s start with the Mexico sugary drink tax. Sugary drinks are not a healthy choice, and with consistent consumption they can lead to downstream health complications like weight gain, obesity, type 2 diabetes, cavities, and heart disease. The US government has continuously mulled over the idea of implementing excise taxes on sugary drinks as a way to minimize consumption.

Perhaps the US and the globe should take note of Mexico, who implemented a tax of one Mexican peso per liter on sugar-sweetened beverages in 2014. This was a public health policy aimed at preventing obesity and was fairly successful. In urban areas, purchases on these taxed beverages decreased by 8 to 17 percent within two years of implementing the sugar tax (3).

In the US in 2010, Congress passed the Hunger-Free Kids Act. This was an act that aimed to promote proper nutrition in American children to help lower obesity and its impacts. It gave children access to healthy foods at school, and as a result:

Breakfast consumption increased by 25 percent
Children ate 23 percent more fruit and 16 percent more vegetables
90 percent of schools successfully lived up to these new nutrition standards (4)

Prevention and Management Strategies

Aside from public health efforts, there are a multitude of things we can do on an individual and societal level to work towards a healthier community.

Individual-Level Strategies

It’s no secret that diet and exercise are the cornerstone of weight management. A nutritious diet packed with vegetables, fruits, lean proteins, and whole grains that minimizes sugar, salt, alcohol, and processed food will set you on the road to success. Additionally, healthy habits surrounding eating, like portion control, can be imperative to shedding the pounds. And physical activity is a great way to increase your calorie expenditure. A minimum of 150 minutes of aerobic cardio a week is suggested, but even more can do wonders for one’s health.

It’s also important to understand the role that healthcare providers can play in one’s weight journey. Especially with the newer weight loss drugs hitting the market, healthcare providers can provide support in many ways, be it through medication, nutritional counseling, or referral to other professionals.

Community and Policy-Level Strategies

Community-based programs can provide support on a more intimate, local level. Community-based programs like local exercise groups can bring together individuals while also promoting a healthy lifestyle. Other initiatives like farmer’s markets can help bring healthier and more nutritious options to an individual’s area.

As aforementioned, policy is really the way to make the biggest impact when it comes to fighting the obesity epidemic. Policies that prevent obesity, like stringent regulation of food marketing, subsidies for healthier foods, and urban planning for active transportation can all be integral in promoting wellness on a large scale.

Healthcare System Changes

Finally, there is much work to be done within the healthcare system to foster an environment that supports overweight and obese individuals. Healthcare institutions may improve obesity prevention and treatment through initiatives like integration of nutrition counseling into primary care. Additionally, there is a lot of stigma surrounding individuals that are overweight or obese, even at the healthcare provider level. Appropriate training for healthcare providers in fighting this stigma can be beneficial, helping to care for patients with more empathy and understanding.

Conclusion

In summary, obesity is a chronic and complex condition that has multifaceted origins. From an environmental perspective, factors like one’s food and physical environment may impact the kinds of meals they eat and what they have access to. From a socioeconomic perspective, things like income, education, and culture can also preclude healthy choices. In order to implement widespread change, policy and public health initiatives should be implemented to have a large-scale influence on the obesity epidemic.

References

https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
https://www.cdc.gov/obesity/php/data-research/adult-obesity-facts.html
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-15041-y#:~:text=In%202014%2C%20Mexico%20implemented%20a,%25%20for%20adults%20%5B1%5D.
https://www.usda.gov/media/press-releases/2014/05/20/fact-sheet-healthy-hunger-free-kids-act-school-meals-implementation

Author

David J. Bauder, PA-C David Bauder, PA-C, is a certified physician assistant and the assistant medical director at Weight Loss and Vitality in Manassas and Alexandria, Virginia, Washington, DC; and Gaithersburg, MD. He enjoys helping patients optimize their physical and mental health to improve their overall well-being. He earned his physician assistant degree from the University of Texas Health Science Center at San Antonio. Afterward, he gained admission into the reputable graduate program for physician assistant studies at the University of Nebraska Health Science Center in Omaha. David has over 26 years of experience working as a physician assistant. He’s practiced in podiatry, family medicine, emergency medicine, general surgery, urgent care, and functional medicine.