By Dr Ananya Mandal, MD
The obesity paradox encompasses two basic premises. One of these includes the fact that obese individuals tend to survive longer and better after a major cardiac surgery or cardiac event like a heart attack or heart failure. Another paradox is the fact the low income, hungry populations seem to suffer more from obesity than the high income affluent populations.
Obesity and heart disease survival benefit
The obesity paradox is a finding that reveals that although obesity is a major risk factor in the development of several conditions like heart disease, and peripheral vascular disease, in cases of severe heart conditions like heart attack (myocardial infarction) or heart failure (congestive heart failure), obese individuals have a survival benefit over those who are not-obese.
The paradox also shows that obese patients tend to fare better after certain surgical procedures, such as coronary artery bypass surgery for multiple artery blockages in the heart compared to the non-obese individuals.
Another major finding reveals that obese men who have long term high blood pressure are seen to live longer than men of normal weight. When controlled for other confounding factors that may have affected the results like age, medical care, or therapy, it is seen that obese individuals have the benefit of surviving longer than non obese individuals. This is termed as the obesity paradox.
Obesity and poverty
Another issue that is a paradox is co-existence of hunger and poverty with obesity in the same families and communities. Both hunger and obesity can be consequences of low income that leads to lack of access to enough nutritious food and lack of awareness that helps families pick nutritious foods over junk foods or fast foods.
In the United States 17.1 million households are food insecure and this includes 32.4 million adults and 16.7 million children. Food insecurity is defined as lack of access and resources to enough food for a healthy life.
The paradox is that with rising food insecurity there is a rising obesity. While all segments of the population are affected by obesity, low-income and food insecure people are especially vulnerable.
Factors that link low income groups to obesity include:-
Lack of awareness of nutritious foods.
Increased calorie intake from junk and fast foods with low nutritious value.
Low-income neighbourhoods usually lack full-service grocery stores and farmers’ markets that can provide fruits, vegetables, whole grains, and low-fat dairy products. As an alternative there are more convenience stores.
Healthy foods when available are usually more expensive. Alternatives of refined grains, added sugars, and fats are inexpensive and readily available in low-income communities.
Lack of filling and nutritious foods also means eating less or skipping meals. This also means that when food is available there is overeating. This leads to cycles of food restriction or deprivation followed by overeating.
Lack or limited access to healthcare. This results in lack of diagnosis and treatment of emerging obesity.
Lack of physical activity is also common among low income neighbourhoods. There are fewer parks, gymnasiums, bike paths. Unsafe neighbourhoods also mean children get less time to spend out of doors playing.
Low-income families also face high levels of stress due to food insecurity, financial pressures, lack of access to health care, inadequate transportation, poor housing and surrounding neighbourhood violence. Stress may lead to weight gain and obesity as well.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)
Last Updated: Apr 8, 2013