I like Michelle Obama. I really do. Or rather, I like her as much as one can form a valid opinion of someone one has never met as presented by the media. She’s always struck me as someone I would like if I did meet her. Maybe she eats live kittens in real life, but if so she hides it well.
Anyhow, as much as I’ve liked her and admired her decision to make childhood obesity her focus as First Lady, I’ve remained skeptical about how much of an impact it will have. In previous posts I’ve discussed how difficult it is for obese people to lose weight sustainably, and I don’t really see how the same advice I give with limited effect will somehow become more potent or efficacious coming from the President’s wife, no matter how charismatic she may be.
Thus, I was unsurprised to read this:
It has become an article of faith among some policy makers and advocates, including Michelle Obama, that poor urban neighborhoods are food deserts, bereft of fresh fruits and vegetables.
But two new studies have found something unexpected. Such neighborhoods not only have more fast food restaurants and convenience stores than more affluent ones, but more grocery stores, supermarkets and full-service restaurants, too. And there is no relationship between the type of food being sold in a neighborhood and obesity among its children and adolescents.
This squares with what I have observed, both in my current practice and the job I had before.
Where I am now, I see patients from across the socioeconomic spectrum, from the very affluent to the very poor. In general, I have observed less obesity in the wealthier patients, but not to a degree that is totally obvious. I have plenty of overweight patients from well-to-do families. But for those families with less money, I am confident that their somewhat disproportionate obesity rates are not related to access to fresh fruits and vegetables. The area has many well-stocked grocery stores, in rich and poor neighborhoods alike.
My last practice was in a much less affluent part of the country, and in my recollection a greater proportion of my patients were overweight. But some of the poorest areas also had the greatest proximity to a grocery store with an ample supply of healthy foods.
Now, it may be that the healthier foods were still too expensive for many families. It’s all very well for me to say that store-brand frozen vegetables aren’t that expensive, but I don’t really know what counts as “that expensive” for an impoverished family. I don’t know their household budgets, and I have no business telling people of limited means what I think they should be spending their money on. Cost could well be a factor when choosing to buy the unhealthy items, even with a gleaming produce department two aisles over.
But I strongly suspect there’s more to it than that. Partly because of the Better Half’s vocation, we were relatively closely involved with the local food pantry. And we learned pretty quickly that the items that were the first to fly off the shelves were some of the least healthy ones. Even presented with free nutritious foods, patrons would still clear out the instant ramen noodles. It was actually kind of a quandary when deciding what to provide, one that the Better Half and I discussed at length. Do you donate ramen noodles because you should give what you know people like, even if they’re pretty nutritionally lousy? Is it paternalistic and high-handed to donate foods you think people ought to be eating?
In any case, simply giving people access to healthy foods doesn’t mean that they’ll eat it more or unhealthy foods less. Insofar as poor people want healthy alternatives, I applaud efforts to increase their availability on the merits of giving people as much of an equal opportunity as possible. But it looks like the intractable problem of obesity will need a deeper solution than just raining produce on food deserts.