Deconstructing Dialogue on Obesity, pt. 1
Things more academic today. For some context: I’m working as program administrator for the MS Center for Obesity Research at UMMC in Jackson. I’m still defining my job role, choosing tasks and projects to help develop the center. Yes, believe it or not, a state with an obesity rate of 35.5% hasn’t yet developed a strong collaborative network of academic researchers, clinicians, and scientists. It does slightly begin to help explain the resulting health issues we face.
In particular I believe that I can help lay some of the groundwork for these larger efforts by starting to change the way we talk and think about obesity in Mississippi. This series of writing is intended to help organize these thoughts for later publications and internal briefs.
One thing that almost immediately struck me – and continues to haunt me – as I began working here was the persistent narrative around Mississippians’ nutrition. Particularly how when talking about obesity as a general problem, we kept drifting into a narrative very distinctly directed toward low-income earners and their food choices:
“And, for a single mom who’s got three kids screaming in the backseat, it’s a lot easier to stop at McDonald’s and get a Happy Meal. But, if she felt that she had the time to go home and…make some taco soup with several cans of beans, and corn, and ground turkey, it would be cheaper to feed herself and all of her kids…”
Through this series I’ll try to analyze and deconstruct elements of this quote to better understand the power structures embedded within, thus using a critical theory perspective. Critical theorists acknowledge the ability for social, political, and economic factors, ideologies, to conceal the processes “which oppress and control people,” and “distort understanding of [the world].” As Carolyn Mahoney (2015) puts it, “The notion of hidden forces and the need to unmask them is central to critical theory.”
Today we’ll look at the notion that low-income earners are fast-food consumers, based on the assumption that fast food is cheap.
We’ve all heard it before, the notion of a single mother struggling to feed her family going through the drive-through to calm everyone down. I’ve heard it in academic discussions by well-meaning students and clinicians: “It makes sense, I’d do it too, she doesn’t have time and it’s cheap food, just look at the 4 for $4 deals.”
An Othering Process Begins
Things fundamental to our lives often can expose the ultimate divisions between us. Food is no exception. Watch this fantastic excerpt from PBS’s People Like Us: Social Class in America to see how bread becomes the foundation for a class war:
The low-income single mom, fast-food consumer narrative embodies an “othering” process, a divisive narrative to disassociate those who consider themselves “healthy” from those they deem not healthy. This in turn validates the norms and practices of the healthy, strengthening their own identities.
It also demonizes the not healthy; and in this example, also low-income earners and single mothers.
On the one hand, this state decisionmaker is recognizing it is possible to prepare home-cooked meals on a budget. That healthy food can be relatively affordable (fresh produce that is affordable, available, and preservable is still an issue). More on this later. The rest of the statement is laden with assumptions:
- There’s the assumption that single mothers are unhealthy and don’t have time.
- There’s the assumption that she doesn’t know better than being unhealthy.
- There’s the assumption that she doesn’t know that fast food is expensive.
- Thus, if we could just teach her better, things would change.
Education is the primary focus in these evaluations of the Mississippi Healthy Schools Act:
“Education is required to change habits.”“I think parents have to be educated…obesity is a real problem and it is connected to poverty and ignorance.”
These are dehumanizing narratives that abstract people from reality, from their own realities, real family dynamics, needs, wants, priorities. They’re reduced to people who simply don’t know better and lack the will to change.
The reality is that middle and high-income earners consume more fast food than low-income earners. Researchers found that consumption of fast food increases as income rises, and then after $60,000 drops off (but not table-service restaurant patronage).
“Higher proportions of the above-average (income) group exercised, drank, and were white and male, whereas a higher percentage of the below-average (income) group smoked, watched TV, were obese, and were relatively more concerned with food prices and convenience.”
In other words, all people in all income brackets, all marital statuses, all racial backgrounds, all sexualities engage in unhealthy behaviors. Obesity affects everyone.
Decision-making and Power
The fact is, people don’t consume fast food because it’s cheaper (it’s not cheaper). People consume fast food, or convenience store food, because it’s there.
The cost of fast food isn’t cheaper (Ross and Hill 2013). Those who think that 4 for $4 is a cheap meal should try living on $300 a month of SNAP benefits to feed a family of 6:
My problem with the research that has been done looking at the prices of healthy versus unhealthy food is that it often compares price per calorie (Rao et al 2013). There are a number of issues here. Fresh produce is by default going to be more expensive by this measurement, because there are fewer calories in fruits and vegetables than processed snacks (their comparators). This old rhetoric focusing on the calorie dismisses the nutritional and fiber value from fresh produce that processed food can’t provide. Secondly, it dismisses the affordable nutrition of traditional staples like beans, rice, and pasta (Ross and Hill 2013).
Lastly, people aren’t buying food by price of calorie. People often make food purchases based on satiety, norms and routine, and perceived convenience (Antin and Hunt 2012; Mulvaney-Day et al 2012). The field of behavioral economics (despite its shortcomings) has shown us that in decision-making, individuals don’t evaluate value of a good based on price alone, let alone by a measure they don’t have a way of making tangible, like a calorie. A critique of standard economic theory, BE research shows how people use mental “shortcuts:” heuristics, norms, and values override any sense of “rational” thinking. People prioritize the present and present wellbeing, they underestimate future consequences of present actions, and when they feel like they have nothing more to gain, they risk everything (Frederick et al 2002; Kahneman 2011).
“The ability to purchase fast food and other convenience foods at a reasonable price gave women the opportunity to decrease their own stress…This luxury provided women with one less task to deal with during the day. Notably, a couple of women who struggled with severely restricted budgets did not associate fast food with convenience. Instead these women perceived fast food to be a luxury item for those who could afford it.” (Antin and Hunt 2012).
In many cases, the strain from work, child care, other daily demands limit people’s freedom to consume and prepare cheaper, healthier food products. Even a reliable source of electricity has to be taken into consideration, and knowledge and self-confidence in preparing home cooked meals. Rationales don’t involve a caloric evaluation. Note what’s revealed in this excerpt from the National Geographic series, The New Face of Hunger:
Yet in the suburbs America’s hungry don’t look the part either. They drive cars, which are a necessity, not a luxury, here. Cheap clothes and toys can be found at yard sales and thrift shops, making a middle-class appearance affordable. Consumer electronics can be bought on installment plans, so the hungry rarely lack phones or televisions.
Jacqueline Christian is another Houston mother who has a full-time job, drives a comfortable sedan, and wears flattering clothes. Her older son, 15-year-old Ja’Zarrian, sports bright orange Air Jordans. There’s little clue to the family’s hardship until you learn that their clothes come mostly from discount stores, that Ja’Zarrian mowed lawns for a summer to get the sneakers, that they’re living in a homeless shelter, and that despite receiving $325 in monthly food stamps, Christian worries about not having enough food “about half of the year.”
Christian pulls into the drive-through and orders a combo of fried gizzards and okra for $8.11. It takes three declined credit cards and an emergency loan from her mother, who lives nearby, before she can pay for it. When the food finally arrives, filling the car with the smell of hot grease, there’s a collective sense of relief. On the drive back to the shelter the boys eat until the gizzards are gone, and then drift off to sleep.
Christian says she knows she can’t afford to eat out and that fast food isn’t a healthy meal. But she’d felt too stressed—by time, by Jerimiah’s insistence, by how little money she has—not to give in. “Maybe I can’t justify that to someone who wasn’t here to see, you know?” she says. “But I couldn’t let them down and not get the food.”
Jacqueline seems to be knowledgeable about food choices, and she seems very resourceful despite not having the money to pay for the food she wants. This is not a matter of educating this mother. Her story is about living in a world that absolutely insists upon appearance – of having it all together, for others, for her kids. Of not admitting help. Of immediacy. One that doesn’t prioritize time for families and for people.
What is often lacking (but this is changing) in the public health, health promotion, and nutrition literature is a discussion on power. Not only ‘who’ and which bodies have the power to create and disseminate nutritional and health standards, to judge individual bodies and health (as shown in this persistent narrative about fast-food consumers), but also those systems that prevent individuals from accessing health-promoting resources and environments. And, interestingly enough, I’m sure this low-income narrative only perpetuates policy development, which wrongly assumes that low-income earners won’t purchase, don’t want to consume, and can’t afford healthy, unprocessed food.
Takeaway
The thing is that a lot of people in Mississippi do care about improving its health statistics. Just how many groups are there that are committed to making us not be last in every category? But the problems lie in their beliefs about how to go about doing it. We’re not talking about the bigger picture here and not asking the right questions. We’re not looking at the right thing, and instead, creating false narratives that aren’t based on reality.
The questions I keep asking, and what I would encourage you to ask are: who isconsuming fast food? How directly linked is fast food consumption with obesity? What are low-income earners consuming, and how, and how often? How does class bias creep into health debates, and end up shaping policy?
Works Cited:
Antin, Tamar M.J. and Geoffrey Hunt. 2012. “Food Choice as a Multidimensional Experience. A Qualitative Study with Young African American Women.” Appetite58:856-863.
Frederick, Shane, George Loewenstein, and Ted O’Donoghue. 2002. “Time Discounting and Time Preference: A Critical Review.” Journal of Economic Literature(40):351-401.
Kahneman, Daniel. 2011. Thinking Fast and Slow. London: Penguin Books.
Mahoney, Carolyn. 2015. Health, Food and Social Inequality: Critical Perspectives on the Supply and Marketing of Food. London: Routledge.
Mulvaney-Day, Norah E., Catherine A. Womack, and Vanessa M. Oddo. 2012. “Eating on the Run. A Qualitative Study of Health Agency and Eating Behaviors Among Fast Food Employees.” Appetite 59:357-363.
Rao, M. et al. 2013. “Do Healthier Foods and Diet Patterns Cost More than Less Healthy Options? A Systematic Review and Meta-Analysis.” BMJ Open 3.
Ross, Catherine E. and Terrence D. Hill. 2013. “Reconceptualizing the Association between Food Insufficiency and Body Weight: Distinguishing Hunger from Economic Hardship.” Sociological Perspectives 56(4):547-567.