Health Vs Wealth

health-wealthLooking At Food and Money A Little More


This post is going to ask more questions than it actually answers. So, if you’re looking for something definitive, I’m sorry, but I’m going to leave you frustrated, full of pondering and the unknown.

A couple weeks ago, I wrote a post about how I was pretty disappointed in myself for not saving more money. There’s no excuse for it other than that I just wasn’t doing it. I was spending my disposable income instead of tucking it away somewhere for the future.

One of the things I identified as a category I could cut back in needless spending was food, particularly food I eat away from home. I do save some each month, but could be saving more. I was kind of operating under the mindset of ‘Pay bills first, spend what’s left.’ And don’t get me wrong, that can be fun sometimes. But I don’t want to look back when I’m 75 and wish I had not eaten so much Thai food in lieu of investing.

So I started an experiment, with a handful of other people who volunteered to do it, too. We’re monitoring our food -related spending and measuring if we spend less on food away from home, if we’ll actually eat less overall calories, thereby resulting in any weight loss.

While this experiment is still ongoing, I’ve been thinking in broader terms about the whole economics surrounding food, consumption and trends I’ve been fascinated by in America lately.

We’re definitely a culture of consumption. We enjoy relatively low taxes, spend a lot on unnecessary things and consume goods and services at rates per capita greater than many other western nations. We love to have stuff.

In fact, studies show that as people in the US make more money, they tend to spend it, rather than save it (with the exception of the very wealthy, who do not need the extra money they are receiving, and tend to just save it). And it’s this habit that I’ve been really dissecting in myself lately.

If you’re an insomniac and want to sift through the data tables in hopes that it will put you to sleep, you can go here to the Bureau of Economic Analysis and look at the rates of income increase correlating with rates of spending increase (and sometimes that spending increase actually exceeds the income increase) and savings decrease.

So, here we arrive at the question bothering me lately. All this spending on excess stuff seems to mimic all our eating of excess stuff. But what’s the connection?

Are we choosing between being healthier vs wealthier? Or can we be both? And to what extent can we be wealthier before it affects our health, if at all?


supermarketshelvesAre We Becoming More Overweight Because We Can Afford To?


But, wait…aren’t there higher rates of overweight and obesity in lower income populations compared to higher income populations?

It’s pretty well established in the scientific research base at this point that there is a connection between income and overweight/obesity, with some exceptions for age, race and gender.

For the last couple of decades, studies have been showing the connection between low income groups and higher rates of obesity, however, that link is weakening over time, as overweight/obesity becomes more widespread across all demographic groups.

Now, first, its important to understand that overweight and obesity are not the same thing. Overweight is categorized as having a body mass index (BMI) of 25.0 – 29.9. Obesity is categorized as a BMI of 30.0 or greater.

There are several reasons why lower income groups have higher rates of obesity. And several theories emerging as to other contributors to the obesity epidemic in these populations. Education level, economic limitations on access to healthy food sources, availability of resources in food deserts and cultural food patterns are among those theories.

But are the poorest people the most overweight and obese? And, conversely, are the wealthiest people the least overweight and obese?

Let’s look at some numbers.


The Poor and Obesity


This study from 2005 using data from NHANES, everyone’s favorite government sponsored health data collective, showed that if you compare the lowest income bracket to the highest, BMI is higher overall for individuals making the least money compared to those making the most money. This study also showed, however, that education level was also a variable predictive of this trend.

Another study from 2010 also reflected this income disparity related to higher incidence of obesity [1]. So the poorer and least educated, with an income <$20,000/year, are more likely to be obese compared to the richest and/or most educated making $100,000/year or more (although, these two things are not always mutually exclusive).

This connection is stronger in women than in men [2]. So, in women, they are more likely to be obese if they are poorer.

There also appears to be a positive correlation between income and obesity in men, particularly in African American and Hispanic men, but not in Caucasian men [3, 4]. That means that men are more likely to be obese as they make more money.

Over the last few decades, obesity has actually increased in all income levels, not just the lower end of the spectrum. And, lower income groups did not see a proportionately larger increase in obesity that other higher income groups did [5].

So, we could say that the trend is beginning to show that the connection between income and obesity is starting to disappear for the low income groups. As obesity rates climb, especially in the middle class and upper class income brackets, this connection becomes weaker and weaker.


The Rich and Obesity


According to the CDC’s National Center for Health Statistics, as income goes up, risk for obesity goes down. When I dug into this data a little bit deeper, though, I found that as income goes up, rates of non-obese overweight increase. Remember, this is the category of people who have a body mass index (BMI) between 25.0 and 29.9. A BMI of 30.0 and above is considered obese.

In fact, in the highest income earners (400% or more of the poverty level), the rates of overweight are the highest, compared to the lowest income earners (<100% of the poverty level). For the sake of simplicity in this post, I’ve used the poverty limit calculations for a family of 4 (2 adults, 2 children).


So, the highest family incomes in this group are $94,496 and up, and people in that income group are more likely to have higher rates of overweight compared to their counterparts who make less annually.

But, this group making 400% of the poverty limit or greater is conversely less likely to be obese.

Selected characteristicOverweight
(but not obese)
Poverty status
<100% of the poverty threshold 30.232.1
100% - <200% of the poverty threshold33.131.4
200% - <400% of the poverty threshold3530.2
≥400% of the poverty threshold36.524.8

This provides a partial answer to the question “Are the poorest people the most likely to be overweight and obese? And are the richest the least likely to be overweight and obese?”

Poorer people are more likely to be obese, but wealthier people are more likely to be overweight, but not obese.

If families earning more are more likely to be overweight, but not obese, we might try to develop theories as to why that may be and apply them to lower income populations.

It might seem more obvious that obesity rates are lower in families making the most, as they would have greater access to food variety, fitness opportunities, as well as usually higher levels of education, which also have a strong correlation to obesity, but not to overweight.

Selected characteristicOverweight
(but not obese)
Less than high school diploma36.734.1
GED or equivalent 633.438.1
High school graduate36.733.6
Some college, no degree35.134
Associate's degree35.333
Bachelor's degree36.123.1
Master's, professional, or doctoral degree3620.2

The more educated a population tends to be, the less likely it is to become obese, but the more likely it is to become overweight. Some professions correlate well with education level to income, such as healthcare where doctors have the highest level of education and typically earn the most; but others, such as the education sector, do not always follow this trend, with many college professors making less than some public educators.


What Does This All Mean?


The data seem to point to the trend that we’re mostly all becoming more overweight, as we earn more and become more educated, but that we’re becoming less obese as we earn more and become more educated.

Middle America, therefore, seems to be taking the blame for most of the increasing obesity trends. These are typically the blue collar, low-moderate levels of education and low-moderate income earners. They have, across the board, the highest rates of obesity, collectively.

It’s possible that the higher earning families are simply putting more of their money toward things that make them healthier.

These might include:

  • Higher fresh vegetable and fruit intake
  • Increased purchasing of perceived ‘health foods’
  • Increased access to exercise options, both at home or away from home
  • Live in areas with greater concentration of exercise outlets such as personal training, fitness studios and gyms
  • Greater emphasis placed on personal appearance in socio-economic circles (peer pressure to be “healthy”)
  • Increased time and financial resources to spend on leisure sports activities
  • Living in areas with safe outdoor access to physical activity options

I’ll use myself as an example. I realize it may be taboo to some to talk about income, but let’s go there for a minute. When I look at all income sources combined, I’m in the 300% of poverty level for the group in question (2 adults + 2 kids family). In fact, if I made just $1,000 more per month, which I expect to in the next 2 years, I’d be over a 6 figure income, so I’m not too far off from the 400+% of poverty level group.

And that’s as a single earner, and a parent of one child. So if I were looking at the tables for 1 parent + 1 child, I’d actually be at 500% of the poverty limit currently, and if I made that extra $1,000/month I’d be over 600% of the poverty limit for my group.

I also have multiple college degrees, one of which is an advanced degree, and soon will have more than one of those.

So I have a couple of important risk factors going on here that place me in that group that has higher rates of overweight, but not obesity. I’m also in the group that’s least likely to be obese, based on my income and education level.

Why am I not overweight or obese? I can’t speak for everyone else, but I would say that my personal reasons for not being either overweight or obese are:

  • Having a strong foundation for health education (given my profession)
  • Placing high priority on physical fitness (It is important to me to be fit, because I work with patients all day that are not, and I see the consequences firsthand of not being fit)
  • Peer pressure/social group (the majority of my close friends also place high priority on health/fitness)
  • I’m shallow and vain (let’s be honest)
  • I can afford a high protein, high plant food diet (Studies show that higher lean protein intakes are strongly correlated with lower levels of body fat)
  • I can afford to eat better quality meals when I do eat away from home (I choose restaurants with smaller portion sizes, but higher nutrient quality foods, such as locally grown produce and organic ingredients)

Are these things the same for everyone? Not at all. I would imagine that anyone else in my particular demographic group that’s also not overweight or obese has maybe a few of these things in common, but also has some others that are different.


Digital Camera

Is It a Problem of Excess?


Here’s my theory. And, keep in mind, it’s a theory. I can’t find just the right data sets to compare these concepts, but if someone wants to do this research, I’d be really interested to see what the outcomes are.

The numbers say that people earning more are more overweight. Before someone chimes in with the “Well, BMI is just a height to weight ratio and they could have more muscle mass,”–the 35% of people who earn more and are overweight are not all bodybuilders with high lean body mass.

The more they earn, the more they are able to afford luxuries such as dining away from home often. They are also more likely to be families where both parents work, so time is a commodity and preparing meals at home can often seem more inconvenient to busy families.

Meals away from home contain more calories than do those we prepare ourselves. They range from an additional 200-1000 calories, usually. That’s significant.

So these people can afford to eat out more, and when they do so, they’re consuming more calories. But not enough to be obese; but, if they are consuming enough to be obese, they’re doing something to offset at least some of it, such as going to the gym often, or participating in some kind of leisure physical activity like biking or jogging.

Or maybe there is some other habit or lifestyle characteristic present I haven’t mentioned in the highest income category that’s not present in the lower ones that is buffering them from the progression from overweight to obese?

This post is meant to be thought-provoking, if nothing else. I’m interested to see how future research into consumer habits focuses on spending, income, food intake and energy expenditure because I really think this is a large part of our overweight and obesity epidemic.

Just like my experiment to change financial spending surrounding food in order to change calorie spending surrounding food, I think that if Americans changed their consumption habits across the board, we’d see overweight and obesity decrease.

Have any thoughts or insights on this? Want to share your theories or opinions? Feel free to comment below.


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