The Paradox of Being Hungry and Fat

When unemployed, poor and homeless women come to work out at the Healthworks Foundation Fitness Center in Boston's rough Dorchester section, many will climb treadmills for the first time.

The nonprofit gym's 800 members are likely to be overweight or obese when they sign up, and few know the basics of good nutrition. At Healthworks, they can work up a sweat in a safe environment and learn healthy eating habits from registered dietitians.

It's a luxury few low-income Americans can enjoy.

"In many cases, it's the first time they ever had an opportunity to exercise in their lives and eat healthfully," says Maria Shea, corporate fitness director of Healthworks Fitness Centers for Women. "Some of them are just trying to find a way to work and support children, and [they] have very hard lives."

Indeed, America's poor find themselves at the intersection of two serious public health problems. Hunger and food insecurity affect more than 30 million people, including 13 million children. And the epidemic of fat, which affects two-thirds of all Americans regardless of income, has not spared even those households with little money to spend on food.

Researchers are just beginning to understand the paradox that allows hunger and obesity to exist in the same household -- and even the same individual. A report issued this month by the Waltham, Mass.-based Center on Hunger and Poverty tries to explain the confusing coexistence.

For some poor families, the need to stretch food dollars could lead to weight gain, experts say. Those with limited funds often turn to cheap but high-caloric foods, or settle for high quantities of food rather than nutritional quality.

"For low-income people, the economic decision that goes into purchasing food is an important one and one that makes sense from an economic point of view," says Ashley Sullivan, program director of the Food Security Institute of the Center on Hunger and Poverty, "but doesn't make as much sense when looked at from a nutritional point of view."

At Healthworks, education has been key to showing low-income gym members that cheap eating does not have to mean unhealthy eating, Shea says.

"A lot of it for me has been really basic education and understanding that chocolate cake costs more than an apple and teaching them that they can choose fresh fruit and vegetables for less cost," she says. "Even though it is inexpensive to buy a value meal, it's still less expensive to buy fruit from a corner vendor than to go to McDonald's."

Food, Food Everywhere But Not a Drop That's Healthy

But for many of America's poor, food choices are limited, experts say.

"In many urban areas, supermarkets are not available or maybe there are only liquor stores or small convenient stores," says Katherine Alaimo, a researcher at the University of Michigan School of Public Health. In poor areas, "maybe the choices of fruits and vegetables are more expensive, milk is more expensive and maybe they only have whole milk," she says.

For a case in point, compare two Michigan cities of similar population, Alaimo says. Flint, the infamously rusted-out former automotive town, has only one supermarket in its city limits. Ann Arbor, a flourishing college town, has nine.

"There's a differential for the availability of food," Alaimo says.

Obesity can also be a body's adaptive response to periods when food is scarce, researchers say.

Those who cannot depend on a steady stream of healthy food might find themselves in a cycle of overeating and then going hungry when money or food stamps run out. Like restrictive dieters who periodically turn to binge eating, the "feast or famine" cycle can lead to weight gain.

Government and industry can take steps to help America's poor overcome the dueling crises of obesity and hunger, experts say.

The Center on Hunger and Poverty advocates that eligibility for federal nutrition programs -- such as food stamps, the Women, Infants and Children program, and free school lunches and breakfasts -- should be expanded to reach more in need.

On the contrary, conservative critics have said that federal nutrition programs should be changed, in part because they contribute to obesity among the poor. An American Enterprise Institute publication advocated giving poor people cash for food instead of a set number of coupons that they must use to buy food. That way, families can choose how much food they want to buy.

How Companies Can Help

Making school cafeteria food and vending machine choices healthier would help children of all income levels, Alaimo says. In Los Angeles, for example, soda sales have been banned in schools.

Companies should take the lead of Kraft, which recently announced it would adjust portion sizes and food composition to be healthier, Alaimo says. Moving more supermarkets and farmer's markets into poor areas would also help, she says.

Encouraging companies to change marketing and food content is not a sure thing, of course. And so far, amid lawsuits that have accused industry of making America fat, government has avoided stepping in and forcing companies to take responsibility for obesity.

"In my opinion it is a little bit bold to expect [government] to do that [regulate industry], but it is something people will be talking about more in the future," Sullivan says.

Meanwhile in Massachusetts, Healthworks, which is partly funded by the company's for-profit gyms, plans to expand its services to combat health problems among poor women.

"The members inspire each other. When you see one woman ask another if she added a fruit [to her diet] every day -- they hold each other accountable," says Healthworks' Shea. "It's been so successful beyond our imagination."

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