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The Obesity-Hunger Paradox

By Sam Dolnick. Published in the New York Times.

Link to the original newspaper article.

When most people think of hunger in America, the images that leap to mind are of ragged toddlers in Appalachia or rail-thin children in dingy apartments reaching for empty bottles of milk.

Once, maybe.

But a recent survey found that the most severe hunger-related problems in the nation are in the South Bronx, long one of the country's capitals of obesity. Experts say these are not parallel problems persisting in side-by-side neighborhoods, but plagues often seen in the same households, even the same person: the hungriest people in America today, statistically speaking, may well be not sickly skinny, but excessively fat.

Call it the Bronx Paradox.

"Hunger and obesity are often flip sides to the same malnutrition coin," said Joel Berg, executive director of the New York City Coalition Against Hunger. "Hunger is certainly almost an exclusive symptom of poverty. And extra obesity is one of the symptoms of poverty."

The Bronx has the city's highest rate of obesity, with residents facing an estimated 85 percent higher risk of being obese than people in Manhattan, according to Andrew G. Rundle, an epidemiologist at the Mailman School of Public Health at Columbia University.

But the Bronx also faces stubborn hunger problems. According to a survey released in January by the Food Research and Action Center, an antihunger group, nearly 37 percent of residents in the 16th Congressional District, which encompasses the South Bronx, said they lacked money to buy food at some point in the past 12 months. That is more than any other Congressional district in the country and twice the national average, 18.5 percent, in the fourth quarter of 2009.

Such studies present a different way to look at hunger: not starving, but "food insecure," as the researchers call it (the Department of Agriculture in 2006 stopped using the word "hunger" in its reports). This might mean simply being unable to afford the basics, unable to get to the grocery or unable to find fresh produce among the pizza shops, doughnut stores and fried-everything restaurants of East Fordham Road.

Precious, the character at the center of the Academy Award-winning movie by the same name, would probably count as food insecure even though she is severely obese (her home, Harlem, ranks 49th on the survey's list, with 24.1 percent of residents saying they lacked money for food in the previous year). There she is stealing a family-size bucket of fried chicken from a fast-food restaurant. For breakfast.

That it is greasy chicken, and that she vomits it up in a subsequent scene, points to the problem that experts call a key bridge between hunger and obesity: the scarcity of healthful options in low-income neighborhoods and the unlikelihood that poor, food-insecure people like Precious would choose them.

Full-service, reasonably priced supermarkets are rare in impoverished neighborhoods, and the ones that are there tend to carry more processed foods than seasonal fruits and vegetables. A 2008 study by the city government showed that 9 of the Bronx's 12 community districts had too few supermarkets, forcing huge swaths of the borough to rely largely on unhealthful, but cheap, food.

"When you're just trying to get your calorie intake, you're going to get what fills your belly," said Mr. Berg, the author of "All You Can Eat: How Hungry Is America?" "And that may make you heavier even as you're really struggling to secure enough food."

For the center's survey, Gallup asked more than 530,000 people across the nation a single question: "Have there been times in the past 12 months when you did not have enough money to buy food that you or your family needed?"

The unusually large sample size allowed researchers to zero in on trouble spots like the South Bronx.

New York's 10th Congressional District, which zigzags across Brooklyn and includes neighborhoods like East New York and Bedford-Stuyvesant, ranked sixth in the survey, and Newark ranked ninth, both with about 31 percent of residents showing food hardship. (At the state level, the South is the hungriest: Mississippi tops the list at 26 percent, followed by Arkansas, Alabama, Tennessee, Kentucky, Louisiana, the Carolinas and Oklahoma. New York ranks 27th, with 17.4 percent; New Jersey is 41st, with 15.5 percent; and Connecticut is 47th, with 14.6 percent.)

The survey, conducted over the past two years, showed that food hardship peaked at 19.5 percent nationwide in the fourth quarter of 2008, as the economic crisis gripped the nation. It dropped to 17.9 percent by the summer of 2009, then rose to 18.5 percent.

Though this was the first year that the center did such a survey, it used a question similar to one the Department of Agriculture has been asking for years. The most recent survey by the agency, from 2008, found that 14.6 percent of Americans had low to very low food security.

Bloomberg administration officials see hunger and obesity as linked problems that can be addressed in part by making healthful food more affordable.

"It's a subtle, complicated link, but they're very much linked, so the strategic response needs to be linked in various ways," said Linda I. Gibbs, the deputy mayor for health and human services. "We tackle the challenge on three fronts - providing income supports, increasing healthy options and encouraging nutritious behavior."

To that end, the city offers a Health Bucks program that encourages people to spend their food stamps at farmers' markets by giving them an extra $2 coupon for every $5 spent there.

The city has also created initiatives to send carts selling fresh fruits and vegetables to poor neighborhoods, and to draw grocery stores carrying fresh fruit and produce to low-income areas by offering them tax credits and other incentives. The city last month announced the first recipients of those incentives: a Foodtown store that burned down last year will be rebuilt and expanded in the Norwood section of the Bronx, and a Western Beef store near the Tremont subway station will be expanded.

But the Bronx's hunger and obesity problems are not simply related to the lack of fresh food. Experts point to a swirling combination of factors that are tied to, and exacerbated by, poverty.

Poor people "often work longer hours and work multiple jobs, so they tend to eat on the run," said Dr. Rundle of Columbia. "They have less time to work out or exercise, so the deck is really stacked against them."

Indeed, the food insecurity study is hardly the first statistical measure in which the Bronx lands on the top - or, in reality, the bottom. The borough's 14.1 percent unemployment rate is the highest in the state. It is one of the poorest counties in the nation. And it was recently ranked the unhealthiest of New York's 62 counties.

"If you look at rates of obesity, diabetes, poor access to grocery stores, poverty rates, unemployment and hunger measures, the Bronx lights up on all of those," said Triada Stampas of the Food Bank for New York City. "They're all very much interconnected."

 

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