Tuesday, September 28, 2010

Income, obesity, and heart disease in US states

The figure below combines data on median income by state (bottom-left and top-right), as well as a plot of heart disease death rates against percentage of population with body mass index (BMI) greater than 30 percent. The data are recent, and have been provided by CNN.com and creativeclass.com, respectively.

Heart disease deaths and obesity are strongly associated with each other, and both are inversely associated with median income. US states with lower median income tend to have generally higher rates of obesity and heart disease deaths.

The reasons are probably many, complex, and closely interconnected. Low income is usually associated with high rates of stress, depression, smoking, alcoholism, and poor nutrition. Compounding the problem, these are normally associated with consumption of cheap, addictive, highly refined foods.

Interestingly, this is primarily an urban phenomenon. If you were to use hunter-gatherers as your data sources, you would probably see the opposite relationship. For example, non-westernized hunter-gatherers have no income (at least not in the “normal” sense), but typically have a lower incidence of obesity and heart disease than mildly westernized ones. The latter have some income.

Tragically, the first few generations of fully westernized hunter-gatherers usually find themselves in the worst possible spot.


Tom Naughton said...

That fits perfectly with a point I'll be making in an upcoming speech: when we find correlations, we are often simply looking at two very different groups of people. A lower income doesn't cause heart disease, but the behaviors that are more common among the poor certainly may.

Kindke said...

In supermarket's in the UK, cheap food tends to be the most processed (along with an ingredients list that covers half the food label - lots of additives), while organic natural food is alot more expensive.

Things like white bread, highly processed milk, baked beans, cereal's, frozen french fries, concentrate fruit juices, etc etc are staples in most low income families because these foods are dirt cheap, along with being the most advertised by supermarkets foods in newspapers.

It's compounded by the various supermarket chains competeing for lowest prices all the time.

Meanwhile, grass-fed organic unprocessed meat is very expensive.

Ned Kock said...

Hi Tom.

Yes. I remember that we discussed a related issue not too long ago, based on a post on your blog.

Ned Kock said...

Hi Kindke.

The same seems to be generally true of the US in general, I think. But if you look for what is in season here, the difference is not very large.

For example, certain types of seafood are more abundant at certain times of the year. A reasonably good "mark" of what is in season is the price. If it is relatively high, that is because the food is scarce at that time of the year, and/or has to be shipped from a long distance.

The problem is when people try to buy things like exotic fruits or seafood etc. that are not in season. Those are a lot more expensive.

malpaz said...

if anyone would like the see the obesity-income-live-off-the govt impacts you have got to come down here to Mississippi where I live. it id depressing. everyone in section 8 housing living off food stamps and unemployment. of course they are going to buy a pack of 4 sleeves of 'great value' fudge filled cookies for ONE dollar. there is SOOO much that needs to be done that i wouldnt even know where to begin.

i am sick of though, seeing all my paycheck go to welfare and medicaid in an industry that promote healthy whole grains.

Mark said...

I am by no means sticking up for refined flour or sucrose, but I think the most offensive variable in low-income diets is industrial seed oil. It might be literally impossible to find "fast food" that is not made with industrial seed oils. Imagine eating at McDonald's in 1980 - the french fries would be cooked in lard or tallow instead of the unbelievable current choice of corn oil. I don't think one can find *any* fast food or processed food that is not made with something like soybean oil.

Again, white flour and sucrose are a health disaster, but I think the anti-metabolic effects of vegetable oils is the cause of most obesity today. (Dr. Ray Peat's writings on vegetable oils were a revelation to me. What a horrible "food"!)

js290 said...

malpaz, I'm from MS. They're trying...


malpaz said...

i see, so what is acuall being done??? i live in he biggest city in mississippi and we have one farmers market geared 100% toward vegans. it is full of soy-crap-mock meat, grains/flours andhey have a SMALL selection(like 3 veggies) of local produce.

not to mentin, farmers markets arent all that cheap. regardless the culture and historical upbringing of this place is entered around food, EVERYTHING.

there is a 'lets get walking' MS campaign... i dont ever see anyone walking...

js290 said...

I don't think it's necessary or useful to make wholesale changes. Small incremental changes for people that you know.

Cutting sugar out is a good start. Sharing Dr. Lustig's Sugar: The Bitter Truth or the Lustig approved <a href="http://www.youtube.com/watch?v=chXCvduiAbs>short version</a> with friends and acquaintances is a good start. Or, even Tom Naughton's Fat Head documentary. I think all you can do is expose better info to people. What they choose to do with it is up to them.

The sad thing for Mississippians is I don't think they know any better. And, they're too poor to worry about what they're consuming. That is, they're consuming what they can afford.

Jack C said...


You said "Low income is usually associated with high rates of stress, depression, smoking alcoholism and poor nutrition".

The causes of stress and depression are abundantly available to the poor at no cost. Poor nutrition due to the high cost of good nutrition is also the rule amongst the poor.

Rates of smoking and alcohol consumption are fairly uniform over all income levels in some studies that I have seen, perhaps because alcohol and cigarettes cost money.

I would be interested in knowing the basis for your statement that smoking and alcoholism are associated with low income.

Ned Kock said...

Hi Jack C.

Nice to see you commenting here. Always good points, and attention to detail. Hi rates of smoking seem to be associated with low income:


Alcohol consumption, as you noted, is another matter, as we can see from the paper above: "... moderate drinking is associated with 10 percent higher income, and heavy drinking associated with 12 percent higher income, than drinking abstention."

However, I didn't refer to alcohol consumption on the post, but rather to alcoholism. Even heavy drinking is very different from alcoholism, which is actually a disease. Alcoholism seems to be much more widespread among the poor:


Jack C said...

Hi Ned,

Thanks for the quick reply.

The first article you referred to regarding smoking seems to address the question of smoking versus income only to the extent of determination of the "penalty" that smoking imposes on earnings. It does not seem to address the broad question of smoking rates versus income level.

The second article concerns those receiving S.S.I. and were categorized as abusers of alcohol and drugs. The article concludes that the majority of such recipients are impaired (mentally I assume) beyond their alcohol and drug problems. That is to say, they are impaired, and the alcoholic and drug abuse is secondary to their impairment. These are people who are unemployable and that is why they get S.S.I.

Jack C.

Ned Kock said...
This comment has been removed by the author.
Ned Kock said...

Hi Jack.

There are a lot more refs out there. I used two that seemed in line with the idea that smoking and alcoholism are associated with low income.

I watched the film "Monster" the other day, with the extremely talented Charlize Theron. I hadn't seen it before. It is stereotypical, but it does illustrate quite well some of the paths through which one can get trapped in a low income situation, and how that can lead to a lot of problems.

Here in South Texas, low income often starts with one key event - dropping out of high school. Also, not having an undergrad. degree here increases significantly your chances of getting trapped for life in a low income situation. It seems much harder to get back on track after staying away from college for several years.

chris said...

In the past poor people knew how to prepare food. Hamburger on sale along with a potato and some greens are very inexpensive. But you have to know how to prepare them and you have to be willing to invest a little bit of time. Previous generations of poor folk knew how to prepare food and were disciplined enough to prep and clean-up.

The poor today have palettes that have been deformed to high sweet and salt and are, generally speaking completely present-tense orientated. (Why mess the kitchen when I can throw away a fast food bag?)

So I don't see it as "the poor" per se as much as the 21st century industrialized poor. (All four of my grandparents were dirt poor, but they ate real food and all lived well into their 80s.)

Ned Kock said...

Hi chris, very good points.

Hans Keer said...

It does not have to be difficult for poor people to consume a healthy diet on a small budget. Just skip the processed packaged food and beverages. Buy the cheaper cuts of meat, fish and animal fats. Look for special offers of vegetables and fruit. Drink water. You easily can live for some dollars/euros per day. It's the food industry and the dietary guidelines that drive the poor to the abyss.