Fat Trap: Environment, Access, and Opportunity

The focus on Obesity of African American [in these neighborhoods] would be a major challenge because most of them believe they look good regardless. Social figures with similar weight in the entertainment industry supports that belief. Most of them are on state assistance and supermarkets offer sales on sugar food and drinks that they buy in bulk. Though some have made changes with their health, the rest of them are not interested in changing their lifestyle where their health is concerned.

This is one of the responding comments from a community reviewer when my organization applied for a grant with my local grant foundation to offer access to a physical fitness and nutrition education programs for residents of low-income communities. More than offended by these discriminatory comments coming from an African American woman from the community, I was also disappointed in myself for not anticipating the perceived blame of poor health on economically disadvantage populations.

Like blaming people for their economic situation by assuming they have no job because they are lazy or they are on welfare by choice, often people believe poor people are overweight because they choose to be. However, obesity itself multilayered combination of several things that cause, effect, and interconnect factors that lead to obesity.

• Genetics - a contributing factor, not destiny.
• Food choices quantity, quality, and access to healthy food options.
• Environmental factors high rates of crime and lack of access to decent recreational options.
• Social influences recognizing that health and wellness are in part shaped by immediate environmental factors. While many of these barriers also exist for other income groups, they often exist to a greater degree in low-income communities. Being poor adds several levels to the complexity in health and weight. Poor = Fat There was a time in history when being plump was sign of wealth. It meant that you could afford the luxury of food and the means to pay someone to do your work. For poor or working class population, being overweight was not an option. Not being about to afford an over abundance of food and the required manual labor

expended created and energy balance that didn't make being over weight either common or practical.

Today the exact opposite is true. Many studies show that low-income adults and children are far more likely to be overweight than those of higher-income. When combining the U.S. Census Bureau for median income and The State of Obesity, the 10 poorest states by income correlate strongly with the 10 states with the highest rates of obesity. Mississippi, West Virginia, Arkansas, Tennessee, Kentucky, Louisiana, Oklahoma, Alabama, and South Carolina are all among the top 10 poorest and fattest states.

In the state of Connecticut, we have the 4th highest median income but the worse economic disparity in the nation, ahead of only New York. And our health disparity mirrors our economic disparity. The overall obesity rate in the state of CT according to the latest research by the Trust for Americas Health is 25-percent, ranking us as #7 of the top 10 states with the lowest rate of obesity; however, in low-income neighborhoods within New Haven, CT 69-percent of adults are overweight and 43- percent of those overweight are obese according to DataHaven Greater New Haven Community Index, 2013.

Safe = Fat

Part of my community reviewers comment indicated that low-income people are overweight because of personal choice; and apparently our effort to create access to nutrition education and fitness activities would not overcome their psychological desire to stay fat and unhealthy.

As key as an individuals choice is when it comes to health, no one person behaves in a vacuum. The physical and social environment in which people live plays a huge role in the foods they consume and the activity level of their lifestyle.

According to the Trust for Americas Health [TAH], a Washington think tank that publishes the State of Obesity annual report, access to public recreation and healthy food also play a strong role. States like Colorado, Utah and Montana are not in the top 10 for median income, but they are rich in natural resources and associated outdoors leisure activities, which contributes to their lower rates of obesity. But what happens when access to activities is just as limited as ones economic resources? Obesity becomes almost inevitable.

Local research confirms the TAH finding. A survey by Yales Community Alliance of Research and Engagement [C.A.R.E], a health research group of Yales School of Public Health found that the six low income neighborhoods in New Haven, CT not only have high rates of overweight and obese residents (70-percent on average); the highest rates of obesity within these neighborhoods also correlates with the highest percentage of residents that do not feel safe walking in their neighborhoods at night. In one neighborhood, 68-percent feel unsafe to go on

walks at night and 36-percent feel unsafe to go on walks during the day. Because of these and other safety concerns, children and adults alike are more likely to stay indoors and engage in sedentary activities, such as watching television or playing video games. When you feel unsafe doing something as basic as walking down the street and you have no access to indoor recreational facility, obesity is almost inevitable. Not surprisingly, those living in unsafe neighborhoods are at greater risk for obesity.

The lack of recreational alternatives in a community plays a key role in activity levels and lifestyle of the residents.

• Low-income neighborhoods are less likely to have green spaces, bike and walking paths, and parks. Research confirms that limited access to such resources is a risk factor for obesity.
• Existing recreational resources have fewer natural features (e.g., trees, lakes), and are more likely to have faulty equipment, more visible signs of trash, disrepair, and more noise making it difficult to lead a physically active lifestyle.
• Existing parks are more likely to have gates surrounding them. Gates, even unlocked, create a mental barrier for residents of perceived unauthorized access to an essential component to the community and a healthy lifestyle
• Lack of recreational community centers for both adults and youth leads to fewer physical activity resources, making it difficult to lead a physically active lifestyle. And unlike higher-income residents, being able to afford and travel to an alternative gym membership, participate in a yoga class, or hire a personal trainer is not an option. Living in a neighborhood with limited access to recreation and physical fitness resources exacerbates the existing problems of genetics, food, and social influence. Until cities make crime reduction a health priority and community centers a part of a disease prevention action plan, low income residents will continue to be plagued with obesity and cities and tax payers will continue to pay an astronomical cost of obesity and its related illnesses. The Blame Game Pointing out these factors as barriers for low-income populations does not relieve people of personal responsibility for their own health and well being; but neither can we alleviate our communal responsibility to provide disadvantaged individuals with both access and opportunity to options that allow them to live a healthier

lifestyle. In the end we all pay. What doesn't affect us directly will inevitably affect us indirectly.

To my community member who reviewed my grant application - it is our collective responsibility to improve the health and well being of our community regardless of race, geographical location, or economic status. We cannot blame a man with one leg for not being able to walk when we are sitting on his prosthesis.