Obesity and poverty: Q&A with a dietitian nutritionist
Kristen Gradney , RDN, LDN, is the director of nutrition and metabolic services at Our Lady of the Lake Regional Medical Center, and former manager of nutrition services at the Women’s Center for Wellness, both in Baton Rouge, Louisiana. She is also the state policy representative for the Louisiana Dietetic Association, and a spokeswoman for the Academy of Nutrition and Dietetics. Gradney spoke to Endocrine Today about the possible link between poverty and obesity, and how physicians can better care for low-income patients.
Endocrin e Today: There are studies and research linking poverty and obesity, but what is the source of the link, in your view? Is it a lack of affordable, nutritional food? The prevalence of cheap, unhealthy food? Inactivity or sedentary habits after work and school?
Gradney: Poverty and obesity can be linked to an increasing incidence of food-insecure households as a result of poverty and unemployment. This basically means the household does not have adequate resources to obtain consistent access to food, in general, much less nutrient rich foods.
Living in impoverished areas often means that you have limited access to food, even if you have Supplemental Nutrition Assistance Program (SNAP) benefits. These areas are often “food deserts” and do not have stores with fresh foods available. This leaves many families having to choose available, quick, cheap meals that can be higher in fat, sodium and calories. On the other hand, some families do not have the resources and cannot purchase enough food to feed all members of the household; when they do, it is choosing the same type of quick and unhealthy food.
Endocrin e Today: What can physicians do to assist low-income patients, and their children, who may be at risk for obesity? Should they be more proactive and vigilant with low-income patients?
Gradney: Physicians should ask patients and parents about the availability of food in the area and find out if they can obtain food when they need it, and then determine if the patient or parent needs additional assistance from a registered dietitian. We can assist in choosing healthier foods or identifying resources that can help supplement food, such as a food bank.
Physicians are typically the first to encounter patients, and if they can ask questions about their habits and diet, then they can get them to the resources to assist.
Endocrin e Today: According to the CDC, obesity rates are particularly high among African Americans of all incomes, and that obesity rates among African American men rise with higher incomes. What should physicians be doing to address that issue?
Gradney: Again, I believe physicians should ask questions to assess if the patient is either unable to obtain what is needed for a healthy, well-balanced diet or if the patient simply needs help and education in making the decision about what to eat, in which case they can be referred to a registered dietitian for more education and resources.
Dietitians can assist with providing alternative methods of preparation for foods that are culturally important to the African American diet and culture. As a result of enhancing foods that were considered “leftover” during slavery, African Americans have adopted many foods that are high in cholesterol, saturated fat and sodium as a part of the diet based on the history of the culture. It is important to be culturally sensitive while still providing beneficial health education.
Endocrin e Today: A recent study found that poverty-based obesity is more prevalent among women than men. What can physicians do to meet the health needs of girls and women who are more strongly impacted by the effects of poverty with regard to obesity?
Gradney: Early intervention and introduction of resources available to help modify and improve diet and exercise habits. Physicians should also refer to registered dietitians to make sure that when reducing overall caloric intake for weight loss, women are still obtaining the nutrients they need, such as folic acid, calcium and iron.
Endocrin e Today: Another study linked poverty and the feeling of being unsafe to childhood obesity. Is there anything health care providers can do to address this aspect?
Gradney: By empowering children, even if it is to help them feel more confident and in control of something like their food choices, they can be motivated to make good choices and start to improve how they feel about themselves. Educating the child in addition to the parent can make them feel valued and, in turn, promote good decision making to help them feel better. – by Jason Laday
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