The hunger-obesity paradox: Why it’s a modern problem

It’s a uniquely modern problem. We have the most obese impoverished population in the history of the planet and its been called the “hunger-obesity paradox.” Even the homeless are now more than likely to be overweight with over 32% being officially obese. Think about that.

Then think about every single picture you have ever seen from the Great Depression when 1 of every 4 Americans were out of work and millions were drastically affected by starvation and hunger.  The subject in Dorothea Lange’s iconic 1936 picture “Migrant Mother” appears bizarrely healthy by today’s standards even though her family was reduced to scavenging for vegetables and killing birds for food on their way to California.

The hunger-obesity paradox appears to be a tailor-made Conservative argument against the excesses of government social programs akin to the myths about “welfare queens” driving around in Cadillacs. The truth is far more complex though it does not exonerate social welfare programs from being culpable at least in part.

Far from being a case of fraud or gluttony on the public dime, most of the cause appears to be one of surprisingly rational economics. Contrary to standard belief, eating healthy and nutritional food actually costs more than eating so-called “junk food”.  This is not by accident. The food industry has become very good at producing high caloric and high energy but low cost processed food that is of low nutritional value. I.e. they include things like saturated fats and high carbohydrate amounts that make the food taste great while eliminating more costly and less tasty nutritional ingredients.

For people with limited means it makes economic sense to maximize the energy content of the food while minimizing costs. Junk food has other advantages as well including minimizing preparation time and effort, being easily stored, and usually being easily available in poorer neighborhoods that typically lack grocery stores.  The net result is long term poor dietary habits such as increased meal portions and massive weight gain. Impoverished Americans are no longer “hungry” or “starving” but have become “food insecure” meaning that they do not have the financial resources to have regular access to nutritional food.

It also makes sense for the poor to utilize subsidies for such essentials as food and housing in order to maximize disposable income to purchase nonessential items. This could come in the form of consumer electronics or even and frequently alcohol and cigarettes which cannot be purchased with food stamps.  Disposable income can even be used for home food delivery services which Texas food stamp beneficiaries pay for in cash. Almost 100% of delivery customers of Randy’s Fine Foods in Houston Texas are food stamp beneficiaries and junk food is a top seller.

Pop Tarts, Famous Amos and Oreo cookies. Honey buns, candy bars and corn dogs. Laffy Taffy and cheesecake. Pickles are the only vegetable listed on a Randy’s menu.

Terrible dietary habits and obesity are certainly not limited to people poor enough to be eligible for food stamps but there is evidence that links food stamp use with greater rates of obesity (at least among non-elderly women).  And obesity increases the risk of diabetes, high blood pressure and cholesterol, all of which increase the rates of serious and chronic disease and can easily lead to a downward spiral of arthritis, mobility limitations, sedentary lifestyle, deconditioning, and depression. Such health issues are devastating for any hope of gaining economic security in a population that is heavily dependent on jobs involving unskilled manual labor. Certainly the last thing food assistance programs want to do is to contribute to the rates of obesity and obesity related diseases in susceptible and dependent populations. First, do no harm.

There have been efforts in several states to ban the use of food stamps for junk food but many of the companies that make these types of food contribute heavily to political campaigns and frequently these efforts go nowhere. The other approach is limit food stamp use to an approved list of healthy foods like what the Women, Infants, and Children program (WIC) does. But again, these efforts are frequently opposed by the food industry which stands to lose billions – 46 million Americans spend an average of $135 a month in food stamps -  and opposed by liberals who fear that significant restrictions will deter use by those who need these programs. There are educational programs about good nutrition as part of many food stamp programs but there is no significant data that shows that education alone is able to overcome economic reality, convenience, and entitlement that are parts of the junk food culture.

The only other option is to individually monitor food stamp recipients similar to how welfare recipients are monitored for continued economic need and an inability to find a job. After all, hunger, nutrition, and obesity are all public health issues. Why shouldn’t food stamp recipients be regularly monitored by medical professionals? These populations are at risk both for malnutrition as well as obesity and frequently are complicated with substance abuse and poor dietary habits. I would never consider treating a patient with a chronic health problem without regularly monitoring them. And I am a firm believer in establishing fairly rigorous but reasonable requirements for anyone who seeks government assistance.

But significant barriers to such a common sense approach exist. There is as of yet no data to suggest that regular monitoring of the health of food stamp recipients would make any difference in health outcomes and though there are no indications that such requirements would significantly deter participation in these programs for those who truly need them, liberals would still oppose such legislation based on these concerns.  And even though many food stamp beneficiaries would be eligible for Medicaid benefits under “Obamacare” it’s far from certain that enough primary care providers would be available to regularly see all of these new patients.  And who would pay for those not eligible for Medicaid? And what if a beneficiary is morbidly obese? Or smokes? Are they to be kicked out of the program? Much more thought and work on this needs to be done.

Chris Rangel is an internal medicine physician who blogs at

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  • Geilt

    Its not a paradox its a paradigm. It is by design. A continual source of income, especially from those who are on government supported healthcare. You do not monitor them because you can’t help them pay for more expensive and healthier foods. Often times those with severe health problems have no choice but to stay below the poverty line in order to survive. It then becomes a catch 22. Eat and live cheap, have the government pay for your healthcare, and as a side affect, get sicker due to poor lifestyle and continue to become a source of medical revenue. You are never again given the impetus to better yourself because you can’t, you’re stuck…and your life has now become focused solely on managing your ever worsening condition.

  • Bill

    I don’t agree that healthy food costs more than prepackaged. I grew up in the rural south and we ate simple meals – beans, rice, greens, potatoes, squash, eggs, milk and a little meat. Price it out, family cooked meals of this sort are cheap per serving and much cheaper than pre-packaged food and snacks per serving.
    The problem is that families don’t value taking time to prepare meals anymore. If they did, believe me the free market would see that these value-priced staples were available even in the inner city.
    The proponents of the healthy is costly idea probably don’t even know what they spend on food and eat out much of time. Salmon and arugula, free range chicken with organic raspberries, local goat cheese churned by the hand of a Buddist monk and so on may be healthy, but is not required for a healthy diet.
    This is an urban legend that is doing much harm by lifting the responsibility for healthy eating and replacing it with blame anywhere and every other than the individual.
    And, I still relish a simple meal of beans, rice and cornbread…and am quite healthy as well.

    • Jane Overton

      Have you factored in the energy cost of cooking? Gas or electric? Have you factored in the cost of the stove? The home to keep the stove in? How about the hours necessary? That might be a hardship for a single mom who has to work a lot. How about the elderly that lacks strength and mobility. This is definitely not a one size fits all thing.

    • Niamh van Meines

      It still doesn’t compare to a dollar meal at Mc Donalds which is really shameful that reality has created this shocking truth. I don’t think that the average person has any idea that the processed food they are eating is so tainted. The corn & sugar subsidies have put these ingredients in our food where they don’t belong and most of us don’t even know it.

    • Dayna Gallagher

      Very well said, thanks!

  • GaviMensch

    I have explained for years that there are only 2 obvious
    matters that could explain obesity in an impoverished population, apart from
    bad habits.

    One is
    the satisfaction that food can give, by chewing and swallowing, there is no
    greater pleasure in the life of a person conscious of his or her worst possible

    And the
    second is especially for woman an instinctive one, women’s bodies ‘save’ fat
    for the bad times to come: she has got to survive to feed the children.

    might be ‘old-fashioned’ but to me, as a community nurse, it still seems a valuable
    explanation why I find more obese people in a ‘poor’ neighbourhood.

    • William Plaster

      Why do you not observe this in photographs in the 1930′s and 40′s? You don’t see obese people, yet those times were worse than today. Fast food, automobiles, and sedentary lifestyles have contributed to the problem. This is sad because people have access to education concerning obesity and health problems. They can probably find this on their cell phones while driving to their local fast food joint.

      • GaviMensch

        Why didn’t we see this in the 30′s and 40′s? Well I
        guess boredom has a lot to do with that. It was probably easier to satisfy the
        brain in those days. A lack of challenge and a surplus of help have spoiled the
        satisfaction rates.

        But I mentioned bad habits in my reply to you. Bad habits
        don’t create themselves all of the sudden, they develop slowly. In
        places where being hungry is a daily item you can see mothers with extra fat.
        As soon as the mother gets skinny, the end of the children is nearby. But here,
        although you see the same phenomena, overweight parents are not all that
        familyminded. They keep themselves from getting depressed by eating and drinking.
        Very often their offspring is not overweight. And in my practise as a community
        nurse in ‘poor’ neighbourhoods, shows me that many parents will never get out
        of a vicious circle: no job, no money (although enough to buy more healthy
        food) no diversion, bad health, no job etc.

        In supermarkets the fast food is half the price of the
        spinach and biological chicken. And a raise in VAT for fastfood might be a help
        but only if you lower the VAT on healthy food.

        I proposed free cooking classes for my patients, but
        that could not be done………

        • William Plaster

          If I were as obese as too many people I see in the ED, I would be depressed also. BTW, most people in the 30′s and 40′s weren’t bored; many were trying to survive, and many performed long hours of physical labor. I was a youngster in the late 30′s and 40′s and know what was fact. BTW, I was not bored and did not sit on my butt waiting for someone to provide for me.

      • Dayna Gallagher

        as per 30′s 7 40′s….there was no media in their faces pressing them to avoid getting fat, then ambivalently showing a near skeleton as the ideal. More young adult men are too thin, they look like 12 year old boys. Have you seen them?
        We women have been badgered so much that many of us take our few extra 10 or 20 pounds and just do the best we can.

  • David Brown

    “The food industry has become very good at producing high caloric and
    high energy but low cost processed food that is of low nutritional
    value. I.e. they include things like saturated fats and high
    carbohydrate amounts that make the food taste great while eliminating
    more costly and less tasty nutritional ingredients.”

    Actually, the food industry has boosted the omega-6 content of food and reduced the saturated fat content. In addition, the edible oils industry has vigorously promoted the myth that saturated fats clog arteries. Google: “Hunger Confronts Bigger Issue” and “David Brown Omega-6″ and “Your Brain on Omega-3″ to learn more about the anti-saturated fat campaign and the omega-6 hazard.

  • Dorothygreen

    The US indeed has the worst Eating Culture in the world. It is shameful. People didn’t starve to death during the depression like people in Africa. Excess weight has never been shown to prevent, slow or halt disease while caloric restriction and the paleo diet (before agriculture foods) have been shown to actually reverse some diseases – diabetes II, heart disease and in the paleo – MS so far in one physician.

    The driving forces of the obesity/malnutrition phenomenon are addiction (in this case of to sugar, fat and salt), and maintenance of corporate profits over public health. The US has so much more addiction to well not just “drugs” but the low nutrtition foods that contain layer upon layer of sugar, highly processed vegetable fat and salt. NOTE: I do not distinguish good fats from bad fats here – it is another discussion. All other advanced countries have: 1) functional health care systems inclusive of strong public health measures 2) incentives for producers of nutritious food 3) are addressing their obesity rates which are far less than US, in schools, communities, by taxation, and preventive medical advice.

    As long as our Congress is owned by corporations we will have the obesity/malnutrition problem and unsustainable health care costs that result from this problem. Unhealthy food will: continue to be cheaper than healthy, advertized 24/7 everywhere, dominate grocery stores (just saw one for sugar laden popcorn that said say “100% addictive”), be purchased with food stamps and or just because many folks cannot control this addiction (like gambling, alcohol or tobacco, prescription pain killers). At least with tobacco, the US has shown there is a workable model to reduce consumption.

    • David Willetts

      Dorothy Green, <>

      We are catching up fast in the UK.

      Evidence: booming junk food sales and rocketing obesity.

  • drjoekosterich

    Pound for pound unprocessed foods cost less. Corn on the cob is cheaper than corn flakes. It always comes back to individual choice. However that can be influenced (not controlled)by education.

  • Pat Brown

    Why is it acceptable to Americans that the poor cover spend their own money on booze, smokes, and I-Phones while the taxpayers cover their food and rent? I am sick of hearing that I just do not understand “the culture of poverty”. All that “culture” teaches is how to stay poor, and often how to game the system.
    We need to stop feeding and housing those with enough money for expensive toys and goodies, and use that funding to subsidize those who are working a minimum wage job and trying to support their kids. We need to support the WORKING poor, not yank benefits and encourage unemployment.

  • David Willetts

    I speak for what I see in the UK and it’s not true here that cooking healthy meals is more expensive than fast food,take out, ready meals and snacks. In fact a diet of this stuff would blow a big hole in your wallet.

    It seems to me that many middle class people are now overweight not because they can’t afford fresh food but because they can afford to live on takeaways and ready meals.

  • Bradvee

    The elephant in the room is our GMO food supply. Our staple foods have been transformed over the last 30 years. Wheat for example has gone from 14 chromosomes to 40+ and gluten content has soared. Wheat now has one of the highest glycemic index of all the foods we consume. Wheat has become ubiquitous in our food supply – in soy sauce and the powder around gum for example. Healthy low fat high protein cereals are loaded with wheat. It’s no surprise that despite dropping fat from our diet and exercising more we as a nation are in the midst of an obesity and diabetes epidemic.

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