NOT HAVING ENOUGH TO EAT MAY CAUSE OBESITY, diabetes, high blood pressure, and heart disease. Most of us think the chronic disease epidemic is fueled by abundance, but it may be fueled as much by food scarcity and insecurity as it is by excess. And, right now, America is suffering from the highest levels of poverty and food insecurity that it has seen in more than a decade.
In 2008 49 million Americans—including 16.7 million children—lived in a home at risk of not having enough food on the table every day. After working in Haiti , the poorest country in the Western hemisphere, I learned that one in two Haitians wake up every day not knowing where their next meal will come from. But right here in the wealthiest nation in the world, one in five children live in poverty, one in four children live on food stamps, and one in 10 people don’t know where their next meal will come from.
The Census Bureau recently reported that the nation’s poverty rate increased to 14.3 percent in 2009—the highest level we’ve seen since 1994. 43.6 million Americans lived below the poverty line in 2009, earning less than $21,954 per year for a family of four or $10,956 for an individual. We now have the highest number of people living on the threshold of poverty in the history of government record keeping.
The poorest areas of the country are also the sickest and have the highest rates of obesity, diabetes , and premature death. These people are dying younger, and life expectancy is plummeting in the poorest states. These states also happen to be the fattest. For example, Mississippi—the poorest state in the union—has poverty rates over 20 percent, obesity rates over 33 percent, and extremely high childhood obesity rates. This is no coincidence.
How does not having enough to eat cause obesity, diabetes, heart disease , cancer, and early death? Let’s investigate.
Food Insecurity: The Root of Obesity and Disease
The Life Sciences Research Office says food insecurity exists “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways (e.g., without resorting to emergency food supplies, scavenging, stealing, or other coping strategies) is limited or uncertain.” This may mean going hungry for some. But for a large portion of Americans floating on or sinking beneath the poverty line this means bingeing on cheap, sugary, starchy, fatty calories in order to avoid hunger.
Many poor people in this country are consuming an excess of nutritionally depleted, cheap calories from sodas, processed foods, and junk food. These folks scarcely eat whole, fresh foods at all, and for good reason: We have made calories cheap, but real food expensive.
We need to rethink how and what we feed our nation or the epidemics of disease and obesity will consume us.
Almost $300 billion of government subsidies support an agriculture industry that focuses on quantity not quality, on producing cheap sugar and fats from corn and soy that fuel both hunger and obesity. These calorie-rich, sugary, processed foods are what most people buy if they don’t have enough money. You can fill up on 1200 calories of cookies or potato chips for $1, but you’ll only get 250 calories from carrots for that same $1. If you were hungry, what would you buy?
Processed foods have become cheaper as real food grows more expensive. The US Department of Agriculture (USDA) reported that between 1985 and 2000 the retail price of carbonated soft drinks rose by 20 percent, fats and oils by 35 percent, and sugars and sweets by 46 percent. Compare that to the 118 percent increase in the retail price of fresh fruits and vegetables. In 15 years the price of vegetables ballooned six times as fast as the cost of sugary, calorie-rich, nutrient-poor sodas.
This is further compounded by the fact that in some communities in America, the only place to buy food is a local convenience store where fruits, vegetables, or other whole, fresh, real foods  cannot be found. Without a car in an urban setting you may have to walk miles to find anything resembling real food.
Social factors like these set the stage for the epidemics of obesity and disease we are facing. This in combination with the nature of human metabolism put our nation’s poor in a trap from which it is very difficult to escape.
How the Biology of Starvation Contributes to Disease
What often happens in poverty-stricken families is a hunger-bingeing cycle that follows the economic conditions in the household. When resources come in, people buy cheap, abundant calories in the form of junk and processed foods that fill them up and stave off hunger. This leads to rapid fat storage—a common biological effect after a period of lower calorie intake or hunger. This is simply how human metabolism works.
When calories are scarce metabolism slows down and muscle is lost. As a result the blood sugar imbalances that drive the process of insulin resistance and lead to pre-diabetes and diabetes  worsens, and soon people are caught in a recurrent pattern of bingeing on nutrient-poor calories once resources are again available.
Certainly people can learn to eat better for less  as I pointed out in my recent blog on the topic, and doing so is an essential part of what needs to happen to break out of this cycle of poverty and disease as I will discuss more below. That said, breaking the hunger-binge cycle is easier said than done. Bingeing after food scarcity and the increased fat accumulation and insulin resistance that come along with it are hard-wired biological mechanisms to prevent us from starvation. Once you have diabetes, engaging in this cycle makes blood sugar control that much more difficult and leads to the swings of high and low sugar that drive health problems and their related costs.
Diabetics without access to adequate food have fives times as many doctor visits as diabetics who have enough to eat on a regular basis. The burden this creates in families already struggling to stay afloat is unspeakable. It’s like they are caught in a Grecian hell—pushing the boulder of economic burden up a hill they will never see the top of, reaching for fruit that grows ever further from their reach.
We need to rethink how and what we feed our nation or the epidemics of disease and obesity will consume us. In Haiti, one in two people worry about where their next meal will come from. In America it is one in 10. In order to shift this we need a bold new vision and initiatives that can change our food culture and food availability.
Here are a few initiatives and ideas that may help shift this frightening tide of poverty and disease:
- Stop or reduce subsidies of agriculture products that allow for the glut of cheap, high-calorie, nutrient-poor sugars and fats from corn and soy into the marketplace.
- Consider taxing sugar and processed food to support national food programs and community projects, and help cover the hundreds of billions of dollars of health care costs from increasing obesity, diabetes, and heart disease.
- Fund community-based initiatives to support healthy eating including community kitchens, gardens, and cooking classes that teach how to make good food cheaply. This is part of the new health care bill, and on the agenda of the new Council on Prevention, Health Promotion, and Public Health .
- Make school lunches healthy by providing only real food and modeling healthy eating. Food can be both fun for you and good for you. Create national standards based on sound 21st century nutritional science and common sense. Most schools have only a microwave or deep fryer, hardly the tools needed to feed our children real, fresh food.
- Expand the Supplemental Nutrition Assistance Program  (formerly the Food Stamp Program). Increasing eligibility, helping those who are not aware they are eligible enroll, and creating new programs that support consumption of more healthful foods could shift the tide of the widening socioeconomic disparities in chronic disease. You should not be able to buy chips and soda with food stamps.
Everyone reading could also sign up for Jamie Oliver’s Food Revolution  and learn a recipe using inexpensive, fresh, whole food to create a delicious meal and teach that recipe to three people. They, in turn, could teach three more people. After just a few rounds of that, all of America would learn how to feed themselves again.
We need to reclaim our food supply and revive traditional ways of eating. As Michael Pollan says: “If ‘food’ was made in a plant, don’t eat it. If it grows on a plant, then enjoy!”
To your good health,
Mark Hyman, MD