Abstract
In the 1990s, epidemiologists noticed a trend in the United States that seemed also to apply to other affluent societies. Compared with the previous two decades, the population was getting heavier. Just what was causing this trend, which has seemed to stabilize in the first decade of the twenty-first century, provoked much speculation. Commentators opined that people were eating more, exercising less, or both, as they debated whether this, in turn, reflected a decline in moral fiber or predatory corporate food practices. These explanations would seem to predict universal weight gain across social classes and capitalist societies. And yet, as we know, trends in weight gain vary systematically by social class and by nation. The poor and ethnic minorities are more likely to fall in the obese weight category. And, as this new edited volume further shows, among affluent societies, rates of obesity are highest in nations with the smallest welfare states.
These patterns, and what accounts for them, are the puzzle at the heart of Insecurity, Inequality, and Obesity in Affluent Societies. The volume as a whole, and several of the specific chapters, proposes that growing rates of obesity are a response to stress produced by economic uncertainty and insecurity. Such stress is highest, it reasons, for the most vulnerable members of society. Whereas generous welfare states provide some protection from such uncertainty and insecurity via education, health care, and social insurance, more stingy welfare states leave people to process these stressors literally through their individual bodies.
Avner Offer, the book’s first editor and economic historian, introduces this central argument in the introductory first chapter, pointing out that “the rise of obesity [in the 1980s and 1990s] has coincided with a hiatus of government expenditure” (p. 6). Chapter Two, authored by economists Jon D. Wisman and Kevin W. Capehart, and Chapter Eleven, authored by the editors, suggest that it is specifically the stress produced by economic insecurity that produces higher rates of obesity. Chapter Two reviews both laboratory studies of animals and human studies showing that stress prompts weight gain (especially abdominal fat) when high-fat, high-sugar food is available. It further reviews research pointing to an increase in insecurity and stress as capitalist nations shifted risk from governments onto workers and their families in the last two decades of the twentieth century. It points to evidence of other growing sources of stress, including increased job insecurity, more stressful workplaces, growing inequality and status insecurity, soaring health care costs, declining social capital, concentrated neighborhood-level poverty, rising prison populations, and weight-based stigma during this same period. Pooling several national studies of obesity conducted during 1994–2004 in a range of countries, the book’s eleventh and final chapter tests and finds support for the hypothesis that market-liberal countries are marked by greater economic insecurity and that this, in turn, drives higher levels of obesity in those countries.
The intervening chapters provide complementary evidence. Chapter Six by Ruth Bell, Amina Aitsi-Selmi, and Michael Marmot, and Chapter Ten by Kate E. Pickett and Richard G. Wilkinson, focus on a somewhat alternative source of stress: that of subordination generated by inequality. Other chapters examine how food insecurity leads to weight gain among animals in the wild and in captivity (Chapter Four), the evolutionary roots of food cravings (Chapter Three), environmental influences during or even prior to gestation (Chapter Nine), food insecurity (Chapter Five), historic trends in weight gain (Chapter Eight), and the relationship between sleep deprivation and stress (Chapter Seven).
This engaging and coherent volume sensitizes readers to the various ways in which different forms of government and economic systems, as well as our place within such systems, provide varying degrees of protection from stress and how exposure to such stress gets written on the body. As such, it makes an important contribution to the literatures on obesity, inequality, and comparative welfare regimes.
While identifying important and understudied aspects of obesity, this volume has its own notable blind spots, weaknesses, and inconsistencies. It often reads as if authors are selectively focusing on examples to fit their hypothesis, while ignoring those that do not. For instance, in Chapter Two, Wisman and Capehart note that African American and Mexican American women have relatively high rates of obesity, consistent with their claim that more marginal populations are subjected to greater stress via economic insecurity, and therefore more obesity. But they fail to explain why African American and Mexican American men, who also experience extremely high levels of economic insecurity do not have significantly higher rates of obesity. This same chapter notes that the 1960s and 1970s—a period of “exceptional optimism” (p. 41), economic growth, and low unemployment—saw stable population weights, despite an explosion of fast-food restaurants, increased television watching, greater use of cars, and increased female employment. Again, this supports their argument that low levels of economic insecurity are associated with correspondingly low levels of obesity. However, they do not explain why we have also seen a stabilization in population weight in the first decade of the twenty-first century, by all accounts a period marked by extremely high levels of economic insecurity in the United States.
Moreover, the volume glosses over important scientific debates and uncertainty related to the nature of and consequences of obesity itself. Obesity is univocally undesirable, according to the editors, clearly associated with poor health and shortened life expectancy. Yet, the relationship between obesity, on the one hand, and health and life expectancy, on the other, is considerably more complex than that. To take one example, many studies show that among clinical populations of patients with heart disease, those who fall into the obese category are less likely to die than those of “normal” weight. This is commonly referred to as the “obesity paradox.” To take another example, a 2013 metanalysis of weight and mortality showed that those with a body mass index (BMI) greater than 30 but less than 35 (the most populous group among the obese category) were not significantly more likely to die in a given year than those of normal weight. It was not until BMI surpassed 35 that there was a significant association (Flegal et al. 2013). The claim that obesity is a “leading cause of preventable death,” which is cited in Chapter Two (p. 16), was disproven in a 2005 study by scientists at the Centers for Disease Control and Prevention (Flegal et al. 2005). The editors’ characterization of the “fat pride movement” and “contrarian writers [who] carve a living from denying the evidence, or looking on the bright side” (p. 2) misrepresents this movement and the real scientific uncertainty and debate, as well as economic and political interests, that mark this field, as is documented elsewhere. These critiques aside, Insecurity, Inequality and Obesity in Affluent Societies provides much nourishing and tasty food for thought.