Recent reports from the CDC and Trust for America’s Health have heralded a decline in obesity. Although still high, the obesity rate has lowered, particularly among children aged 2-5, across multiple states. However, two statistics remain troubling: obesity rates stayed higher for racial/ethnic minorities, and obesity rates remained high in socioeconomically disadvantaged communities. From an intervention perspective, the problem lies in (1) the reductionist belief that obesity is a modifiable condition that rests on the individual’s responsibility to change, and (2) the assumption that fixing one component of a community will fix all place-based inequities. Once we have debunked these prevailing thoughts, we will see dramatic declines in obesity across all communities.
Most obesity research has focused on individual-level explanations: biology, food culture, health knowledge, activity engagement, and child rearing practices are just a few of many mechanisms that researchers have used to frame the problem of, and solution to, obesity. This body of work has led to many individual-level interventions, such as Michelle Obama’s Let’s Move campaign, the NFL’s Play 60 campaign, and the Children’s Healthcare Stop Sugarcoating advertising campaign. The messaging of the problem is clear: Americans need more awareness of the problem and behavioral modifications to curb obesity. It is a compelling, visual message.
However, these interventions fail to illuminate the structural conditions that perpetuate health inequalities. For instance, it is incredibly challenging for the working poor to afford healthy foods, since they make just enough to disqualify for food assistance. Or, it is difficult to be motivated to exercise after working long hours at multiple places of employment. The larger structural injustices present in the labor market, as well as in other dynamics such as immigration policy and racial discrimination, play a role in determining who can engage in active lifestyles, which perpetuate a poorer and heavier underclass.
How we deal with spatial challenges to obesity is even more concerning. My research has demonstrated that place matters, particularly for obesity, diabetes, and cardiovascular illness. Indeed, my recent research suggests that one’s residential environment is shaped by larger social inequalities, perpetuated by local elites who continually funnel resources into some areas, but not others. This uneven development has created stark social class differences, and in some cities, these differences can be seen simply by crossing the street. However, in combating obesity, interventions such as increased supermarket access and building recreation centers have been deemed appropriate – despite some evidence that obesity rates may not vary significantly among individuals who live close to or far from these amenities.
However, the absence of these structures is telling of a larger concern: strategic public investment needs to occur in low-income areas to increase geographic health equity. The “build it and they will come” philosophy has helped lower obesity in some communities, but the larger structural conditions of capital flows/investments that create socioeconomically disadvantaged neighborhoods will continue to stifle any progress of eliminating health disparities.
So, while we have some exciting news on the obesity front, our continued progress in achieving health equity is contingent upon reframing the problem as less about the individual, and more about the larger social forces that shape behavior. Similarly, instead of dealing with geographic inequities in a piecemeal fashion, we need to end the cycle of non-investment in poor and underserved areas, so that “place” is no longer tied to large socioeconomic and health disparities.
Antwan Jones, Ph.D. is an assistant professor in the Department of Sociology at The George Washington University. He received his B.A. in Sociology and African & African-American Studies from Duke University and his Ph.D. in Sociology from Bowling Green State University. Dr. Jones is trained as a social demographer, and his research examines various intersections in the areas of race/ethnicity, socioeconomic status, and health. As an urban sociologist, he is particularly concerned with how socio-environmental processes affect the health and well-being of children and adults.