Michelle Ngugi

January 23, 2019

Annotated Source List

Bennett, G. G., McNeill, L. H., Wolin, K. Y., Duncan, D. T., Puleo, E., & Emmons, K. M.
(2007). Safe to walk? Neighborhood safety and physical activity among public housing
residents. PLOS Medicine, 4(10), 1599-1607.
https://doi.org/10.1371/journal.pmed.0040306
Summary:
This scholarly article discusses the findings of a study that examined the relationship
between perceived neighborhood safety and the level of physical activity among residents living
in low-income neighborhoods. The participants in the study were "1,180 predominantly
racial/ethnic minority adults recruited from 12 urban low-income housing complexes in
metropolitan Boston" (Bennett et al., 2007, p. 1599). "Participants completed a 5-d pedometer
data-collection protocol and self-reported their perceptions of neighborhood safety and self-
efficacy" (Bennett et al., 2007, p. 1599). What the study found was that those who felt unsafe at
night in their neighborhoods were less physically active than those who did feel safe at night
(Bennett et al., 2007, p. 1602). The results showed that "[r]esiding in a neighborhood that is
perceived to be unsafe at night is a barrier to regular physical activity among individuals,
especially women, living in urban low-income housing" (Bennett et al., 2007, p. 1599).
Application to research:
I can use this article to show high levels of criminal activity and perceived neighborhood
safety can keep residents in low-income neighborhoods from going out to exercise at available
open spaces and parks.

Blumenthal, S. (2012, April 11). Poverty and obesity: Breaking the link. Retrieved December 6,
2018, from https://www.huffingtonpost.com/susan-blumenthal/poverty-
obesity_b_1417417.html
Summary:
This article discusses the factors that contribute to obesity, some of the initiatives that
have been taken to improve the health of our nation and what still needs to happen. "A
significant body of scientific evidence links poverty with higher rates of obesity" (Blumenthal,
2012). "Major contributing factors to the disproportional impact of obesity on low[-]income
populations in America include the barriers faced by people living in poverty in accessing
healthy foods, a lack of nutrition education, a dearth of safe environments for physical activity
and recreation, and food marketing targeted to this population" (Blumenthal, 2012). Many low-
income neighborhoods have an abundance of convenience stores, and often the convenience
stores are filled with nothing but junk and often the healthy foods that they do have are priced
higher, thus making them harder to obtain. "Therefore, in developing a strategy to reverse the
obesity epidemic in America, a comprehensive 'health in all policies' approach must be
implemented" (Blumenthal, 2012). "At the national level, several initiatives have been launched
to address these fundamental issues" (Blumenthal, 2012). Initiatives such as the Affordable Care
Act, the Healthy Hunger-Free Kids Act, and former First Lady Michelle Obama's Let's Move
Campaign to name a few (Blumenthal, 2012). "At the community level, new[ly] affordable
housing neighborhoods like Greenbridge, Washington (located in King County near Seattle) are
being designed and built as models for creating an environment that promotes healthy diets and
active lifestyles for their residents" (Blumenthal, 2012).
Application to research:
I am glad to have found an article that discusses some of the actions the government has
taken to make our nation healthier. I will use this information to discuss what the government
has been doing about the obesity epidemic.

Cohen, M. (2018, February 19). It's poverty, not individual choice, that is driving extraordinary
obesity levels. Retrieved December 1, 2018, from http://theconversation.com/its-poverty-
not-individual-choice-that-is-driving-extraordinary-obesity-levels-91447
Summary:
This article discusses how poverty drives extraordinary obesity levels and why people
need to change the way they respond to the obesity epidemic crisis. "It is, after all, thought to be
killing nearly 3m people a year worldwide" (Cohen, 2018). "It is putting huge pressure on health
services, yet the public policy response in developed countries such as the US and UK is pitiful,
largely confined to finger-wagging at children's sugary treats" (Cohen, 2018). "The story that has
not been getting out is that there is a clear and extraordinary correlation between obesity and
social inequality" (Cohen, 2018). Take a look at the U.S. for example. "Here, the most 'obese'
state, Arkansas, is also the fourth poorest state overall, whereas the poorest state, Mississippi, is
also the third most overweight" (Cohen, 2018). "Recent studies in England also illustrate this
link between obesity and income" (Cohen, 2018). "England's most obese council, Brent, is also
its ninth poorest, whereas England's wealthiest council, Richmond, despite being a neighbo[]ring
council in London, is one of the sprightliest, with a relatively low rate of obesity" (Cohen, 2018).
While the factors that push poorer people towards unhealthy eating are unknown, "[w]hat is sure
is that [people] cannot deal with the obesity epidemic by taxing popular snacks, [any more] than
[people] could deal with rocketing suicide rates by taxing sales of rope" (Cohen, 2018). "The
point is that [people] need to collectively tackle the places where obesity germs breed – in
stressed communities characteri[z]ed by insecure and erratic employment, inadequate education,
stress, depression and a lack of social cohesion" (Cohen, 2018).
Application to research:
I enjoyed reading this article because of how well it demonstrates the connection between
obesity and income. I also like it because it shows that the connection between obesity and
income isn't just in America but also in other parts of the world as well. I can use this article to
show how far the U.S. and U.K. still have to go despite being two of the most developed
countries in the world.

Drewnowski, A. (2009). Obesity, diets, and social inequalities. Nutrition Reviews, 67(suppl_1),
S36-S39. https://doi.org/10.1111/j.1753-4887.2009.00157.x
Summary:
This scholarly article discusses obesity as an economic phenomenon. "As incomes drop,
energy-dense foods that are nutrient poor become the best way to provide daily calories at an
affordable cost" (Drewnowski, 2009). "Researchers have shown that low-income neighborhoods
attract more fast-food outlets and convenience stores as opposed to full-service supermarkets and
grocery stores" (Drewnowski, 2009). "By contrast, more affluent areas generally have access to
better restaurants, fresher produce, and more opportunities for physical activity" (Drewnowski,
2009). Still, there are some who think that obesity has nothing to do with what socioeconomic
class the person falls under and that most Americans could follow a healthy diet but simply
choose not to. Although, "The rapid rise in food prices has helped demonstrate that healthier
diets are no longer merely a matter of choice" (Drewnowski, 2009). One study of the food prices
obtained in 2006 from supermarkets in Seattle found that "the difference in energy costs between
the healthy and unhealthy foods was several thousand percent" (Drewnowski, 2009). For
families who limit their food budget to $100 for 4 people per week, or to less than $4 per person
per day, "The only foods that can be obtained for this amount of money are high in refined
grains, added sugars, and added fats, and the healthful, recommended foods are separated by an
immense gap in energy costs" (Drewnowski, 2009). One way this problem can be solved is
through "A combination of agricultural subsidies, pricing policies, regulatory action, and
consumer education, involving cooperation among governments, academia, and the food
industry" (Drewnowski, 2009). This combination could facilitate access to an affordable supply
of fresh, nutrient-rich foods.
Application to research:
This article helped me to learn more about why obesity and poverty are so closely linked
together. This article also supports my hypothesis that people who earn a low income have a
higher tendency to buy fast food than people who earn a high income or middle income.

Drewnowski, A., & Eichelsdoerfer, P. (2010). Can low-income Americans afford a healthy diet?
Nutrition Today, 44(6), 246-249. https://doi.org/10.1097/NT.0b013e3181c29f79
Summary:
This scholarly article discusses how food prices get in the way of those trying to balance
a healthy diet with affordability and the downsides of the Thrifty Food Plan, a model of a healthy
low-cost diet. "When incomes drop and family budgets shrink, food choices shift toward cheaper
but more energy-dense foods" (Drewnowski & Eichelsdoerfer, 2010, p. 246). "The first items
dropped are usually healthier foods – high-quality proteins, whole grains, vegetables and fruit"
(Drewnowski & Eichelsdoerfer, 2010, p. 246). These foods then get replaced with energy-dense
sweets and fats because these kinds of foods are tasty, cheap, readily available, convenient, and
have a long shelf-life. To help solve this problem, "[t]he computer-generated Thrifty, Low-Cost,
Moderate-Cost, and Liberal Food Plans were designed to illustrate how different cost nutritious
diets can be obtained at different income levels" (Drewnowski & Eichelsdoerfer, 2010, p. 247).
The Thrifty Food Plan was the lowest costing. "One way that the TFP achieves its cost
objectives is by using inexpensive foods" (Drewnowski & Eichelsdoerfer, 2010, p. 247).
"Another way that the TFP achieves its low[-]cost objectives is by ignoring the current eating
habits of the American population" (Drewnowski & Eichelsdoerfer, 2010, p. 247). "TFP goals
could only be achieved by pushing the consumption of rarely eaten foods to unacceptable
amounts ... , sometimes exceeding current amounts by a factor of 20 or more" (Drewnowski &
Eichelsdoerfer, 2010, p. 247). So while a low nutritious diet is possible with the TFP framework,
"such diets may be low in palatability and variety, may require dramatic shifts in eating habits
and may be time intensive to prepare" (Drewnowski & Eichelsdoerfer, 2010, p. 247). "More
realistic dietary guidelines would do well to emphasize nutrient-rich foods that are affordable,
appealing and that are part of the mainstream American diet" (Drewnowski & Eichelsdoerfer,
2010, p. 248).
Application to research:
I like this article because it brings up the topic of food prices and how it creates a barrier
for those trying to balance a healthy diet with affordability. I can use this article to counter the
belief of the nutritionists that say all Americans have access to a nutritious diet of whole grains,
lean meats, and fresh vegetables and fruit.

Dwyer, M. (2013, December 5). Eating healthy vs. unhealthy diet costs about $1.50 more per
day. Retrieved December 15, 2018, from https://www.hsph.harvard.edu/news/press-
releases/healthy-vs-unhealthy-diet-costs-1-50-more/
Summary:
This article discusses the price difference between a healthy diet and an unhealthy diet.
According to a research study done by the Harvard School of Public Health (HSPH), "[t]he
healthiest diets cost about $1.50 more per day than the least healthy diets" (Dwyer, 2013). For
those with limited budgets, higher costs of fruits and vegetables limit better diet habits. Dariush
Mozaffarian, the study's senior author and associate professor at HSPH and Harvard Medical
School, said that " '[o]ver the course of a year, $1.50/day more for eating a healthy diet would
increase food costs for one person by about $550 per year' " (Dwyer, 2013). "The researchers
suggested that unhealthy diets may cost less because food policies have focused on the
production of " 'inexpensive, high volume' " commodities, which has led to " 'a complex network
of farming, storage, transportation, processing, manufacturing, and marketing capabilities that
favor sales of highly processed food products for maximal industry profit' " (Dwyer, 2013).
"Given this reality, they said that creating a similar infrastructure to support [the] production of
healthier foods might help increase availability—and reduce the prices—of more healthful diets"
(Dwyer, 2013).
Application to research:
I love the fact that this article discusses the price difference between a healthy diet and an
unhealthy diet because I can use that to show why low-income earners' food choices are limited
so much and how the price difference between the two diets affects their budget.

Eagle, K. (2018, December 22). Research request [E-mail to the author].

Summary:
This email was sent to Michelle Ngugi by Dr. Kim Eagle. In the email were Dr. Eagle's
answers to Michelle Ngugi's questions. Ngugi sent Dr. Eagle three questions. The first question
she sent asked Dr. Eagle whether or not he thinks the government is doing enough to help fight
the obesity epidemic and why. Eagle responded by saying that he does not think the government
is doing enough and proceeded to explain why. The second question sent asked Dr. Eagle how
giving low-income earners access to full-service grocery stores could help if many low-income
earners have trouble being able to afford fresh fruits and vegetables in the first place. Dr. Eagle
responded by mentioning how urban markets and less expensive high-value foods are
increasingly making their way into food deserts and how "local farmers can be huge partners in
this" (K. Eagle, personal communication, December 22, 2018) for "direct sales remove a profit
layer to make food more affordable" (K. Eagle, personal communication, December 22, 2018).
The last question sent asked Dr. Eagle what he thinks is the reason why some racial and ethnic
groups are affected by obesity much more than others, despite being in the same socioeconomic
class as those less affected. Dr. Eagle responded by explaining how some of the reasons pertain
to culture while others pertain to genetics.
Application to research:
I can take Dr. Eagle’s answers and compare them to Tamar Haspel’s answers and to the
answers of the other professionals to see how they compare and where the disagreements lie.

Gardner, A., & Healthday Reporter. (2018, March 23). Many Americans can't afford to eat right.
Retrieved November 16, 2018, from
https://abcnews.go.com/Health/Healthday/story?id=4509496&page=1
Summary:
This article discusses the issues that the poor face when it comes to trying to eat right.
While some people might think that obesity is all a matter of choice, numerous studies have
proved that to be false. Studies have shown that low-income families have it way harder when it
comes to trying to eat healthy because of the economic and environmental factors that play in.
"One study shows that low-income Americans now would have to spend up to 70 percent of their
food budget on fruits and vegetables to meet new national dietary guidelines for healthy eating"
(Gardner & Healthday Reporter, 2018). "And a second study found that in rural areas,
convenience stores far outnumber supermarkets and grocery stores -- even though the latter
carr[ies] a much wider choice of affordable, healthy foods" (Gardner & Healthday Reporter,
2018). A study conducted in Orangeburg County, S.C., "a rural county with a population of more
than 91,000, 63 percent of whom are [the] minority" (Gardner & Healthday Reporter, 2018),
found that out of 77 stores identified in the area, "only 16 percent were supermarkets and 10
percent were grocery stores" (Gardner & Healthday Reporter, 2018). The remaining 74 percent
were convenience stores (Gardner & Healthday Reporter, 2018). This was a problem because
"healthy foods were more available at supermarkets and grocery stores" (Gardner & Healthday
Reporter, 2018). Low-fat/nonfat milk, apples, high-fiber bread, eggs[,] and smoked turkey were
available in 75 percent to 100 percent of supermarkets and grocery stores versus 4 percent to 29
percent of convenience stores (Gardner & Healthday Reporter, 2018).
Application to research:
This article informs me of some of the disadvantages that low-income families face and
shows that obesity isn't just a matter of choice for them. The fact that those who live in poverty-
dense regions are surrounded by so many convenience stores that mostly sell junk food, rather
than supermarkets that provide fresh food, shows that even if they did want to eat right, they
would not easily be able to, which is not their choice. I wonder though, why doesn't the
government do more to help those who live in low-income neighborhoods have better access to
fresh foods?

Haspel, T. (2018, July 20). The true connection between poverty and obesity isn’t what you
probably think. The Washington Post, Food. Retrieved from
https://www.washingtonpost.com/lifestyle/food/the-true-connection-between-class-and-
obesity-isnt-what-you-probably-think/2018/07/19/8d3a61e4-8ac8-11e8-a345-
a1bf7847b375_story.html?noredirect=on&utm_term=.e6f401ad03c8
Summary:
This article discusses the reasons why obesity should not be seen as a problem that only
greatly impacts the poorest Americans. "If we look at people with income below 130 percent of
the federal poverty level (which translates to $32,630 for a family of four), 39 percent of them
are obese, vs. 41 percent for people with income between 130 percent and 350 percent of poverty
level ($32,630 to $87,850)" (Haspel, 2018). There is only a two-point difference between the
numbers forty-one and thirty-nine, so people "can look at the two groups as just about equally
fat" (Haspel, 2018). This doesn't mean obesity is unrelated to class. "There most definitely is a
class element, but it's not the poor vs. the rest" (Haspel, 2018). "It's the poor and the middle vs.
the top" (Haspel, 2018). Class is not the only factor that affects people's chances of becoming
obese though. The food giants play a role too. "The people engineering the food that's all around
[the population] are doing it with the specific intention to override ordinary human willpower"
(Haspel, 2018). Therefore, "The food environment, not poverty, is the culprit" (Haspel, 2018).
Application to research:
This article shows me that obesity does not only greatly affect the poor, but the middle
class as well. It shows me that the percentage difference between the obesity rate among those
who are poor and the obesity rate among those who are middle class is not even as great as I had
thought it would be.

Haspel, T. (2018, August 23). Food deserts don't cause obesity. But that doesn't mean they don't
matter. The Washington Post, Food. Retrieved from
https://www.washingtonpost.com/regional/
Summary:
This news article discusses the reasons why food deserts do not cause obesity and why
simply moving supermarkets into low-income neighborhoods is not enough to lower obesity
levels. To answer the question about whether or not food deserts cause obesity "[s]cientists
looked closely at the relationship grocery access has to obesity, and tracked changes to obesity
and other health outcomes in low-access neighborhoods that got a new supermarket" (Haspel,
2018). What they found out was "that grocery access doesn't correlate cleanly with obesity"
(Haspel, 2018), and that these results were the same for numerous studies (Haspel, 2018). This
evidence does not mean that supermarkets do not matter, it just means that supermarkets alone
are not the solution to the obesity epidemic. Our food environment is filled with "diabolically
irresistible food specifically designed to swamp our willpower, both by being engineered for
deliciousness and by being available everywhere we turn" (Haspel, 2018). "In that context, it
makes sense that simply moving a produce section into the neighborhood won't change much"
(Haspel, 2018). So, while having access to healthy food is necessary to maintain a healthy
lifestyle, simply giving people access is not enough.
Application to research:
This article disagrees with the data that I have collected from some other articles. Some
of the other articles that I have read argue that food deserts do cause obesity; therefore, I can use
this article to show the disagreements among the data related to this topic.

Haspel, T. (2018, December 19). [Personal interview by the author].

Summary:
This interview was conducted by Michelle Ngugi on December 19, 2018, and focuses on
the topic of what impact income has on one's chances of becoming obese. The interviewee was
Tamar Haspel, journalist and American food columnist for The Washington Post. To begin the
interview, Ngugi asked Haspel whether or not she believed a tax on junk foods would help
counter obesity and why. Haspel responded by saying she thinks that "it is possible that a tax on
junk foods would help counter obesity because it is known that people are price sensitive" (T.
Haspel, personal communication, December 19, 2018), but she thinks "the impact is likely to be
relatively small" (T. Haspel, personal communication, December 19, 2018). Ngugi also asked
Haspel whether or not she thinks the government is doing enough to help fight the obesity
epidemic. Haspel responded by saying that she does not think the government is doing enough
and that if she could increase government efforts and have the government do more, she would
have them focus on "education with kids" (T. Haspel, personal communication, December 19,
2018) instead of just school lunches, for it is harder to get adults to change their habits than it is
to get children to change theirs (T. Haspel, personal communication, December 19, 2018). Ngugi
then wrapped up the interview by asking Haspel about what successful programs have been
implemented to curb obesity in rural areas and introduce healthy food options in food deserts.
Haspel then proceeded to tell Ngugi details about a program that took place outside of Boston
called Shape Up Somerville, and about another program that took place in France. Haspel also
told Ngugi how scientists have studied what happens when people in food deserts are given
access to healthy foods and how they found that doing so does not work to help improve health
outcomes or decrease obesity.
Application to research:
Tamar Haspel mentioning how scientists have found that giving people in food deserts
access to healthy foods does not work contradicts some of the information I have found in other
articles that say giving people in food deserts access to healthy foods does work. I can use her
answers to show where the disagreements among the data lie.

Hoffman, J., Cookson, S., & Doob, N. (Producers). (2012). The weight of the nation: Poverty
and obesity (HBO docs) [Motion picture]. United States: Home Box Office.
Summary:
This video discusses the differences in eating habits and lifestyles between people living
in low-income neighborhoods and people living in high-income neighborhoods. The obesity
rates among different counties in different states in America, all of which were either a low-
income county or a high-income county, were discussed and compared in this video. One county
that this video looked at was Bronx County in New York. A map that showed the obesity rates
among the different counties in New York showed that the highest prevalence of obesity and
diabetes was in the lowest income county in New York, the Bronx, and the lowest prevalence of
obesity and diabetes was in the highest income county in New York, a county located in the
Manhattan area (Hoffman, Cookson, & Doob, 2012). This same pattern was observed in other
counties in America as well, low-income neighborhoods repeatedly had the highest prevalence of
diabetes and obesity, and high-income neighborhoods repeatedly had the lowest prevalence of
diabetes and obesity (Hoffman, Cookson, & Doob, 2012). One factor that was shown to
contribute to the high obesity prevalence in low-income neighborhoods was the low sources of
healthy foods in these areas (Hoffman, Cookson, & Doob, 2012). For high-income
neighborhoods, the opposite was true, these neighborhoods were found to have high sources of
healthy foods all around (Hoffman, Cookson, & Doob, 2012). Another factor that contributed to
the high obesity prevalence in low-income neighborhoods was the lack of parks and open spaces
in these areas (Hoffman, Cookson, & Doob, 2012). High-income counties were found to have
plenty of open spaces and parks available for the people to exercise, while in low-income
neighborhoods, there was either too much crime in the area for people to go walking out or no
parks (Hoffman, Cookson, & Doob, 2012).
Application to research:
I like this video because it is informative and it shows me what life is like for those living
in poverty-dense counties. It shows that some people truly lack the opportunity for a healthier
life and better eating habits simply because of how much they earn and where they live.
Jackson, E., & Eagle, K. (2016, January 7). Low-income communities more likely to face
childhood obesity. Retrieved December 1, 2018, from https://ihpi.umich.edu/news/low-
income-communities-more-likely-face-childhood-obesity
Summary:
This article explains the reasons why low-income communities are more likely to face
childhood obesity and why race matters less than expected. "Using a model created from data on
111,799 Massachusetts students, the University of Michigan Health System showed that as
poverty rises, so does the rate of obesity among children in 68 of its public school districts"
(Jackson & Eagle, 2016). "Although obesity rates were higher among African-American and
Hispanic kids, the relationship disappeared when factoring in family income, according to the
study published in the journal Childhood Obesity" (Jackson & Eagle, 2016). "Authors concluded
that fewer resources like recreational programs and parks and access to full[-]service grocery
stores appear to have a greater impact on the nation's childhood obesity rate than race" (Jackson
& Eagle, 2016). There rarely tends to be many places where those living in low-income
communities can play or can shop for healthy foods and so as a result, the consumption of low
nutrition and fast food and little to no physical activity gets promoted (Jackson & Eagle, 2016).
"Among the school districts for every 1 percent increase in low-income status[,] there was a 1.17
percent increase in rates of overweight/obese students" (Jackson & Eagle, 2016). "Grassroots
efforts are changing the tide in children's health status" (Jackson & Eagle, 2016). "Project
Healthy Schools, which was founded by Eagle 10 years ago in collaboration with public and
private partners, teaches sixth[-]grade students the importance of making healthy food choices
and reducing time spent watching TV and video games" (Jackson & Eagle, 2016). "Following
the program[,] students had lower levels of cholesterol and other blood fats" (Jackson & Eagle,
2016).
Application to research:
I like the fact that this article shows how race isn't the major factor that plays into obesity
because a lot of people tend to tie the two together. I can use this article to disprove those that
think that there is a connection between the two and to show what efforts are being made to slow
down the increasing obesity rates in the country.

Jo, Y. (2015, December 7). Gap in obesity rates between low- and high-income children widens
with age. Retrieved December 6, 2018, from https://www.ers.usda.gov/amber-
waves/2015/december/gap-in-obesity-rates-between-low-and-high-income-children-
widens-with-age/
Summary:
This article discusses the widening gap in obesity rates between low- and high-income
children. "A higher proportion of children from low-income families are obese, compared with
their peers from higher income families" (Jo, 2015). "ERS researchers investigated if the gap in
obesity rates exists at birth or develops over time, and what factors may explain the gap" (Jo,
2015). "For their analysis, researchers used the U.S. Department of Education's Early Childhood
Longitudinal Study, Kindergarten Class of 1998-1999, which tracked a nationally representative
sample of children attending kindergarten in 1998 until they reached eighth grade in 2006" (Jo,
2015). What the researchers found was that in kindergarten the BMI distribution between the
low-income and high-income children were roughly the same, but "by the time they reached
eighth grade, a higher proportion of low-income children were obese, compared with high-
income children" (Jo, 2015). "Questions posed to 5th and 8th graders about their eating habits
and physical activity levels revealed that a larger percentage of low-income children consumed
sweets and fast food more frequently than high-income children in the sample, and a smaller
percentage of them exercised frequently" (Jo, 2015). Despite the study though, "the researchers
could not pinpoint a single factor explaining why low-income children's net caloric intake is
higher than that of high-income children" (Jo, 2015). Not being able to identify one main factor
to the widening gap "could be attributed to data limitations or the complex nature of the
underlying mechanisms" (Jo, 2015).
Application to research:
I like the fact that this article included a study that proved that there is, in fact, a
connection between income and obesity. I can use the study provided to prove my hypothesis
right, that those who earn a low income have a greater chance of becoming obese than those who
earn a higher income.

Kurtzleben, D. (2012, October 30). Americans in poverty at greater risk for chronic health
problems. Retrieved December 21, 2018, from
https://www.usnews.com/news/articles/2012/10/30/americans-in-poverty-at-greater-risk-
for-chronic-health-problems
Summary:
This article shows the relationship between illness, healthy habits, and economic status.
"According to data from the Gallup-Healthways Well-Being Index, Americans in poverty are
more likely to suffer from a variety of chronic health problems, both psychological and physical"
(Kurtzleben, 2012). Also according to the data, "[s]moking was far more prevalent among adults
in poverty, 33 percent of whom said they were smokers, compared to 19.9 percent of those not in
poverty" (Kurtzleben, 2012). Another reason that could be associated with why Americans in
poverty are more likely to suffer from chronic health problems is due to their limited access to
fresh foods. "Only 83.7 percent of those in poverty said it was "easy to get affordable fresh fruits
and vegetables," compared to 91.7 percent of those not in poverty" (Kurtzleben, 2012). Fresh
fruits and vegetables help keep people healthy, but many people living in low-income
neighborhoods cannot afford them. As a result, they are most likely to end up buying low-cost,
energy-dense foods which will only end up raising their chances of suffering from chronic health
problems such as obesity.
Application to research:
I like this article because it shows me how those living in poverty and not living in
poverty compare when it comes to different topics. I wonder though, why was the gap between
adults in poverty who smoked compared to adults not in poverty who smoked so wide?

Levine, J. A. (2011). Poverty and obesity in the U.S. Diabetes, 60(11), 2667-2668.
https://doi.org/10.2337/db11-1118
Summary:
This scholarly article talks about the association between poverty and obesity. To see
whether there actually was an association between the two, "Poverty rates and obesity were
reviewed across 3,139 counties in the U.S." (Levine, 2011). What the data from the review
revealed is that "Counties with poverty rates of >35% have obesity rates 145% greater than
wealthy counties" (Levine, 2011). A reason for this is due to poor access to fresh foods among
the individuals who live in impoverished regions (Levine, 2011). Fresh food is more expensive
than fast food, and "Thus, in many poverty-dense regions, people are in hunger and unable to
access affordable healthy food, even when funds avail" (Levine, 2011). Another reason why
obesity tracks with poverty is due to the high level of sedentariness among individuals who live
in the poorest counties. "Sedentary individuals move 2 h per day less than active individuals and
expend less energy, and they are thereby prone to obesity, chronic metabolic disease, and
cardiovascular death" (Levine, 2011). "More than half of county-to-county variance in obesity
can be accounted for by variance in sedentariness" (Levine, 2011). There a couple of reasons
why people living in poor counties are less active. "One reason may be that violence tracks with
poverty, thereby preventing people from being active out-of-doors" (Levine, 2011). "Similarly,
parks and sports facilities are less available to people living in poor counties, and people who
live in poverty-dense regions may be less able to afford a gym membership, sports clothing,
and/or exercise equipment" (Levine, 2011).
Application to research:
This article provides me with more information to add to my research for the year since I
have finally decided to research what impact income has on the chances of someone becoming
obese. According to this article, income has a huge impact on the chances of someone becoming
obese. It appears that those with a low income have a higher obesity prevalence than those with a
high or middle income.

Ogden, C. L., Fakhouri, T. H., Carroll, M. D., Hales, C. M., Fryar, C. D., Li, X., & Freedman, D.
S. (2017). Prevalence of obesity among adults, by household income and education —
United States, 2011–2014. Morbidity and Mortality Weekly Report, 66(50), 1369-1367.
https://doi.org/10.15585/mmwr.mm6650a1
Summary:
This scholarly article discusses the findings of a study performed by the National Health
and Nutrition Examination Survey (NHANES) between the years 2011-2014. In the study, the
NHANES examined the association between obesity and education and obesity and income
among U.S. adults. What the NHANES found through the data that they collected was that "The
prevalence of obesity decreased with increasing income in women (from 45.2% to 29.7%), but
there was no difference in obesity prevalence between the lowest (31.5%) and highest (32.6%)
income groups among men" (Ogden et al., 2017, p. 1373). "Moreover, obesity prevalence was
lower among college graduates than among persons with less education for non-Hispanic white
women and men, non-Hispanic black women, and Hispanic women, but not for non-Hispanic
Asian women and men or non-Hispanic black or Hispanic men" (Ogden et al., 2017, p. 1373).
All the adults included in the study were aged ≥20 years and were among "three levels of
household income, based on percentage (≤130%, >130% to ≤350%, and >350%) of the federal
poverty level (FPL) and individual education level (high school graduate or less, some college,
and college graduate)" (Ogden et al., 2017, p. 1369).
Application to research:
This article helped me get deeper into my research by not only exploring income and
obesity in general but by also breaking down the data and separating it among different racial
subgroups. Now I can begin to get an idea of which groups of people specifically are affected by
obesity and among those groups, which level of household income is affected the most.

Siple, J. (2012, January 27). Researchers untangling link between hunger and obesity. Retrieved
December 14, 2018, from https://www.mprnews.org/story/2012/01/27/hunger-obesity
Summary:
 This article discusses how "[t]he picture of hunger in America is changing" (Siple,
2012). "In the past, hunger may have conjured up images of gaunt faces or rail-thin children"
(Siple, 2012), but "[t]oday, some people who struggle to feed their families are actually obese"
(Siple, 2012). Take Gwendolyn Smith for example. Gwendolyn Smith, a single mom who lived
in poverty, often worried about food and being able to provide enough of it to her family (Siple,
2012). "That scarcity ha[d] changed how she [ate]" (Siple, 2012). "Sometimes, when food
bec[ame] available, she [ate] more than she should" (Siple, 2012). Smith, 46, weighed 383
pounds, grew up in poverty, and blamed herself for her weight for "she sa[id] she ate far too
much junk food, sometimes for comfort" (Siple, 2012). Dr. Diana, a doctor at the Hennepin
County Medical Center where Smith was a patient, "s[aw] many families who struggle[d] with
both hunger and obesity" (Siple, 2012) and said that the issue is "way more common" (Siple,
2012) than most would think. "Research from the University of Minnesota [found] parents who
struggle[d] to get enough food [ate] fewer fruits and vegetables and dr[a]nk more sugar-
sweetened beverages than other parents" (Siple, 2012). That was largely due to poor access to
healthy foods and higher costs of fruits and vegetables.
Application to research:
I like this article because it includes a real example of how poverty can affect an
individual's or family's food choices. By discussing how poverty affected the food choices of
Gwendolyn Smith's family, the article shows that the issue is real.

Previous Topic

Aamodt, S. (2013, June). Why dieting doesn't usually work [Video file]. Retrieved from
https://www.ted.com/talks/sandra_aamodt_why_dieting_doesn_t_usually_work#t-5240
Summary:
This video explains why dieting usually does not work. In this video, Neuroscientist
Sandra Aamodt talks about how the brain affects the results people get from dieting. Aamodt
says that the brain already has its own sense of how much it thinks a person should weigh, no
matter what the person actually thinks they should weigh. This is known as a person's set point,
"but that's a misleading term because it is actually a range of about 10 or 15 pounds" (Aamodt,
2013). So because the brain already has a range of which a person can move up and down
between, trying to go down to a weight outside of that range will often end up failing in the end.
This is because the hypothalamus, which is "the part of the brain that regulates body weight"
(Aamodt, 2013), will respond "to weight loss by using powerful tools to push [the person's] body
back to what it considers normal" (Aamodt, 2013). So while many dieters often rely on
willpower to stick to their diets, often what will end up happening is they will diet for a while but
eventually end up binging in the end because their brain keeps trying to make them gain it back.
This is true even for a person who has been successful at dieting for as long as eight years.
Sandra Aamodt says the solution to this problem is to eat mindfully, that people should only eat
when they are hungry and stop once they are full. By using this technique people will ensure that
they do not overeat and in the end, will often find themselves being a lot more comfortable when
around food.
Application to research:
This video is one of my favorite sources so far because it gives me an insight on how the
brain works against people when they are trying to lose weight. I have gained plenty of new
information on the brain and dieting just by watching this video, and I will definitely make sure I
use the knowledge I gained from this source in my research.

Attia, P. (2013, June). Is the obesity crisis hiding a deeper problem [Video file]. Retrieved from
https://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes#t-628710
Summary:
This video talks about how the obesity crisis might actually be hiding a bigger problem
than we think. In this video, surgeon and self-experimenter Peter Attia talks about how instead of
blaming patients who struggle with obesity by saying it is just because they overeat and
under-exercise, we should try to look deeper into the crisis and see where the problem really
begins. Before, Peter used to think that patients with obesity brought the problem onto
themselves and actually used to mentally blame them for putting themselves into that situation,
that is until he got diagnosed with metabolic syndrome despite exercising everyday and
following the food pyramid precisely. The time that Peter got diagnosed is the time he realized
that having obesity is not always the fault of the patient, that it is not always due to overeating
and under-exercising. Peter now believes that there is a possibility that obesity is just a proxy for
metabolic illness. That metabolic illness is the real problem and instead of obesity leading to
insulin resistance, insulin resistance leads to obesity. Peter's hypothesis is that when a cell
becomes insulin resistant, "the answer probably isn't too much food" (Attia, 2013). The answer is
"more likely too much glucose: blood sugar" (Attia, 2013). That our increase of "refined
grains, sugars, and starches" (Attia, 2013) is what drives the epidemic of obesity and diabetes
"but through insulin resistance and not necessarily through just overeating and under-exercising"
(Attia, 2013).
Application to research:
I very much enjoyed watching this video because it provided me with a brand new
perspective on obesity. It made me realize that maybe obesity is not always the fault of the
person struggling with it, that maybe obesity is just a symptom of an even bigger crisis.

Brewer, J. (2015, November). A simple way to break a bad habit [Video file]. Retrieved from
https://www.ted.com/talks/judson_brewer_a_simple_way_to_break_a_bad_habit#t-
552635
Summary:
This video offers a simple way to break a bad habit. In this video psychiatrist and
addiction expert Judson Brewer talks about how people being curiously aware of what they are
doing while performing a bad habit can lead them to eventually break the habit. When people get
curious they are essentially stepping out of their "fear-based, reactive habit patterns" (Brewer,
2015) and stepping into being. In one study, Brewer found that mindfulness training was twice as
good as gold standard therapy at helping people quit smoking" (Brewer, 2015). The same applies
for overeating and other bad habits. Basically, the prefrontal cortex of the brain, "the youngest
part of [the] brain from an evolutionary perspective" (Brewer, 2015), understands on an
intellectual level that people shouldn't perform bad habits and it tries its hardest to help people
change their behavior. "Unfortunately this is also the first part of [the] brain that goes offline
when [people] get stressed" (Brewer, 2015). This is why people being curiously aware of what
they are doing is so important. By seeing what they get from their habits, people can then be able
to understand them at a deeper level. Once people are able to understand their habits at a deeper
level, they stop having to force themselves back from doing them because they become less
interested in the actions. Brewer advices that next time people feel the urge of a bad habit, they
should "notice the urge, get curious, feel the joy of letting go, and repeat" (Brewer, 2015).
Application to research:
I found this article to be useful because it provided me with an insight to how bad habits
form and what people can do to break them. In my research, I can use this source to talk about
how one way to prevent obesity is by just being more curiously aware of our actions.

Currie, J., Vigna, S. D., Moretti, E., & Pathania, V. (2010). The effects of fast food restaurants
on obesity and weight gain. American Economic Journal: Economic Policy, 2(3), 32-63.
https://doi.org/10.1257/pol.2.3.32
Summary:
This scholarly article looked at the correlation between fast food restaurant proximity
and the obesity rate among the people close to the fast food restaurant. The research was
conducted mainly through observational trials. The researchers in this study observed two
groups, in particular, young teens and pregnant women. The young teens that were observed
were from California and the pregnant women were from Michigan, New Jersey, and Texas. The
researchers studied these two groups for years and wrote down and collected qualitative data
about the relationship they saw between the obesity rate among these groups and their proximity
to fast food restaurants. What researchers found, in the end, was that "The presence of a fast food
restaurant within one-tenth of a mile of a school [was] associated with at least a 5.2 percent
increase in the obesity rate in that school" (Currie, Vigna, Moretti, & Pathania, 2010). For the
pregnant women, "A fast-food restaurant within half a mile of [their] residence result[ed] in a 1.6
percent increase in the probability of gaining over 20kg" (Currie, Vigna, Moretti, & Pathania,
2010). This effect escalated "to a 5.5 percent increase when a fast food restaurant [was] within
0.1 miles from the residence of the mother" (Currie, Vigna, Moretti, & Pathania, 2010). "These
findings contribute to the debate about the impact of fast food on obesity by providing credible
evidence on magnitudes of the effect of fast food" (Currie, Vigna, Moretti, & Pathania, 2010).
Application to research:
This article proved my thinking correct. I always thought that the closer people were to a
fast food restaurant, the higher the obesity rate would be among them. This article proved that to
be true. I believe this happens because there is a greater temptation to go out and buy from the
restaurant when you are close to it than when you are far from it.

Jackson, H. (2017, April 1). Maybe being fat isn't your fault: A look at lipedema. St.Louis Post-
Dispatch. Retrieved from https://sks.sirs.com
Summary:
This article describes a little-recognized disorder known as lipedema. Lipedema is "a
genetic fat disorder of too many fat cells that get too full of fluid" (Jackson, 2017). It "makes
[people] look like [they've] been eating too much when in fact, [their] fat cells are retaining
fluids and growing exponentially larger than normal because of this condition" (Jackson, 2017).
"The enlarged cells cause the butt, legs and, in rare cases, the upper arms to enlarge, sometimes
to the point of deformation" (Jackson, 2017). This disorder affects "an estimated 15 million
American women" (Jackson, 2017) and yet "insurance companies classify treatments as
cosmetic" (Jackson, 2017). This disorder occurs mainly in women and is little known by most
physicians and health professionals. Usually what happens is women with this disorder will go to
a doctor and instead of being correctly diagnosed, they will be sent through numerous weight
loss therapies, all of which are destined to fail. Often this disorder gets confused with obesity,
but the way to tell the difference between the two is to know that lipedema hurts. Unfortunately,
there is no cure for this disorder. Ultimately, "liposuction, vacuuming fat cells from the body, is
the only lasting relief" (Jackson, 2017).
Application to research:
This article informed me on a disease I had never even heard of before. I can see how one
can confuse lipedema for obesity. I might choose to add this to my research to show that being
fat is not always the fault of the person. I wonder though: Why don't a lot of doctors know about
this condition?

Mandal, A. (n.d.). Obesity and fast food. Retrieved October 25, 2018, from News Medical
website: https://www.news-medical.net/health/Obesity-and-Fast-Food.aspx
Summary:
This webpage discusses the relationship between obesity and the consumption of fast
food. Over time, "There has been an exponential rise in the number of obese individuals
especially in developed nations like [the] United States and [the] United Kingdom" (Mandal,
n.d.). "Studies have shown that this rise of obesity among the world population could be
attributed to an increase in calorie intake coupled with lack of adequate physical activity"
(Mandal, n.d.). With a fast food restaurant located at practically every corner now, people do not
even have to go far to eat out. As a result of the numerous locations of fast food restaurants, the
consumption of fast food has risen significantly over the past couple of decades. In 2010, "Fast-
food consumption costs were nearly $164.8 billion" (Mandal, n.d.). "This was a 3% rise from
2009" (Mandal, n.d.). Fast food is associated with higher body mass index, less successful
weight-loss maintenance and weight gain. Fast food restaurants often target children and
teenagers with their advertising. As a result, fast food restaurants often affect children and youth
worse than adults. Eating out is a major contributor to childhood obesity. Obesity is linked to
several long-term health conditions, premature death and illness including diabetes, heart
disease, stroke, gallbladder disease, fatty liver, arthritis and joint disorders and some cancers.
"Studies show that calorie content of out-of-home meals that children consumed was 55% higher
than that of in-home meals" (Mandal, n.d.).
Application to research:
The information from this webpage adds to my research about whether or not there is a
relationship between fast food consumption and obesity. It shows that there is a strong
relationship between the two and explains how.

Mann, D. (n.d.). Sleep and weight gain. Retrieved October 25, 2018, from WebMD website:
https://www.webmd.com/sleep-disorders/features/lack-of-sleep-weight-gain#1
Summary:
This webpage discusses the relationship between lack of sleep and weight gain. When
people are sleep-deprived they tend to grab fatty, sugary foods instead of nutrient-dense whole
foods as a source for quick energy. While grabbing something such as a doughnut might help
people immediately fight off sleepiness, it will ultimately add unwanted pounds "as poor food
choices coupled with lack of exercise set the stage for obesity and further sleep loss" (Mann,
n.d.)."Exactly how lack of sleep affects our ability to lose weight has a lot to do with our nightly
hormones" (Mann, n.d.). "The two hormones that are key in this process are ghrelin and leptin"
(Mann, n.d.). Ghrelin is the hormone that tells people when to eat, and leptin is the hormone that
tells people to stop eating. Sleep deprivation results in more ghrelin and less leptin. "More
ghrelin plus less leptin equals weight gain" (Mann, n.d.). Some solutions to sleep deprivation
include exercise, no caffeine in the afternoon, and no big meals or junk foods before bedtime. If
all else fails then it is suggested that people go see a sleep specialist for professional help.
Application to research:
I am contemplating about changing what I'm going to be researching about now that I
have read this webpage. I think I would rather research the relationship that exists between sleep
and obesity than the one that exists between fast food and obesity. I find this topic to be more
appealing than my former topic.

Miller, M. A., Kruisbrink, M., Wallace, J., Ji, C., & Cappuccio, F. P. (2018, April 16). Lack of
sleep leads to obesity in children and adolescents. Retrieved September 27, 2018, from
https://warwick.ac.uk/newsandevents/pressreleases/lack_of_sleep_leads_to_obesity_in_c
hildren_and_adolescents1/
Summary:
This study in a scholarly article looked at how lack of sleep can lead to obesity in
children and adolescents. To begin, researchers "reviewed the results of 42 population studies of
infants, children and adolescents aged 0 to 18 years old which in total included 75,449
participants" (Miller, Kruisbrink, Wallace, Ji, & Cappuccio, 2018). The participants were broken
up into two groups, those who were short sleepers and those who were regular sleepers. What the
researchers found after following the participants for a median of three years, is that that those
who slept for shorter durations than needed "gained more weight and overall were 58% more
likely to become overweight or obese" (Miller, Kruisbrink, Wallace, Ji, & Cappuccio, 2018).
Researchers concluded that even though health and dieting is important, getting enough sleep is
equally as important.
Application to research:
To me, this article was useful but at the same time it did not give me as much information
as I would have preferred. By reading the article, I learned that lack of sleep contributes to
weight gain, though I would have liked to go deeper into the research and discuss how exactly
lacking sleep leads to being overweight and raises your chances of being obese.

National Institute of Diabetes and Digestive and Kidney Diseases. (2017, August). Overweight
and obesity statistics. Retrieved October 5, 2018, from https://www.niddk.nih.gov/health-
information/health-statistics/overweight-obesity
Summary:
This webpage looks at the overweight and obesity statistics of people in the United
States. The statistics showed that in the US, "more than 2 in 3 adults were considered to be
overweight or have obesity" and "about 1 in 6 children and adolescents ages 2 to 19 were
considered to have obesity" (National Institute of Diabetes and Digestive and Kidney Diseases,
2017). The statistics also showed the estimated percentage of US adults with obesity by
race/ethnicity. The statistics showed that out of all the races/ethnicities compared, non-Hispanic
black adults had the highest percentage of people who were considered to have either obesity
"(48.4 percent)" or extreme obesity "(12.4 percent)" (National Institute of Diabetes and
Digestive and Kidney Diseases, 2017). Among adolescents, children ages 12 to 19 had the
highest percentage of people who were considered to have either obesity "(20.6 percent)" or
extreme obesity "(9.1 percent)" (National Institute of Diabetes and Digestive and Kidney
Diseases, 2017). "The prevalence of obesity [has] increased significantly among adult men and
women between 1980-2000" (National Institute of Diabetes and Digestive and Kidney Diseases,
2017). For children ages 2 to 19, the prevalence of obesity has "increased between 1988-1994
and 2003-2004" (National Institute of Diabetes and Digestive and Kidney Diseases, 2017).
Application to research:
This article was helpful because it provided me with plenty of information on the
statistics of obesity among both adults and children. I am glad that they separated the statistics up
based on age because this way I am able to see which age group of adults and which age group
of children struggle the most with obesity. I am also glad that they separated the statistics based
on race/ethnicity because that provides me with more information on which specific group of
people struggle with obesity the most.

Wadley, J. (2017, May 3). Recognizing food brands puts preschoolers at risks. Retrieved
September 27, 2018, from https://news.umich.edu/recognizing-food-brands-puts-
preschoolers-at-risk-for-obesity/
Summary:
This study in a scholarly article looked at how recognizing food brands puts
preschoolers at risk for obesity. For this study, 247 preschoolers were measured for BMI and
"completed recognition and recall indicators for a selection of 30 U.S. food brands" (Wadley,
2017). As researchers conducted the study, they found that children who were overweight
recognized "10 food items more often" (Wadley, 2017) than children who were at a healthy
weight. These ten brands were "M&M's, Cocoa Puffs, Keebler cookies, Pringles potato chips,
Rice Krispies, Cap'n Crunch, Coca-Cola, Planter's peanuts, KFC and Hamburger Helper"
(Wadley, 2017). The researchers also found that recognition rates remained relatively high
among the children, despite some foods having very low recall rates. Out of all the brands used,
"McDonald's registered the highest recall percentage (62 percent)" (Wadley, 2017) among
children who were overweight, while Pepperidge Farm Goldfish was the most recognized among
the brands (96 percent).
Application to research:
This article was helpful because it provided me with one answer to a big question I had
about why obesity affects kids today more than ever. I now know that kids ability to recognize
and recall junk food brands these days, is one factor that could possibly contribute to them
having a high BMI.