Poor and fat: The link between poverty and obesity in Canadian children

Brett Taylor is an associate professor of pediatrics and emergency medicine, and holds a Masters in health informatics. He works as a researcher, lecturer and emergency pediatrician through Dalhousie University and the IWK Health Centre in Halifax.

Obesity is a particularly pernicious illness. Children who are obese have higher risks of being obese adults. Children with obesity-related illnesses such as Type 2 ("adult form") diabetes and high blood pressure are becoming increasingly common.

Fractures that can be related to obesity, including certain hip fractures of early adolescence, are also increasing. Obesity has been linked to depression and to poor self-esteem. The shadow of these psychosocial impacts can extend well into adulthood, even in cases where the individual manages to achieve a normal weight as an adult.

To many, it may seem that our collective problems with body weight are a result of our prodigious wealth, and to some extent that is true. In developing nations, obesity exists largely within a narrow class of individuals who can afford more food than they need. (Even in these nations, however, the issue is not clear. Examples of obesity among the poorest inhabitants of urban and semi-urban developing states are known.)

In the developed world, however, the relationship between wealth and body weight is strangely turned on its head. Here in Canada, for example, obesity is increasingly coming to be seen as a disease of the poor.

There are many factors involved, of course. Obesity in the child has been linked to obesity in the parent; it is thought that either modelling of unwise food choices or inappropriate eating and exercise behaviour might play a role.  Similarly, children with very large birth weights, often caused by diabetes in the mother during pregnancy, face a greater risk of obesity than those born with smaller weights.

Time spent in front of TV or computer screens is an issue, as is the amount of time not spent engaged in physical activity.

Many of these factors are also linked to poverty, however. A 2009 study in Montreal, for example, demonstrated that low-income areas have less access to quality food than their high-income equivalents. The prevalence of fast-food restaurants has been shown in other studies to be greater in low-income neighbourhoods. As well, the cost of high-quality food is generally higher than the cost of pop, chips and other high calorie snacks.

Put simply, for those who are poor, it is easier and cheaper to buy junk than it is to buy real food for your kids. Vendors that sell quality food are harder to find and reach, and wise food choices take a bigger chunk of your annual income in the process.

The cost of exercise

What about exercise? Unfortunately, in modern Canadian society, screens are cheaper than hockey. The opportunity to take part in sports programs is much more limited for parents with lower income, simply because the costs of these programs are often remarkably high.

My son swims competitively. One would think, naively, that swimming would be a pretty cheap sport: a pair of trunks, a set of goggles, and that's about it. By the time a coach is paid, precious and rare pool time is rented, and travel costs to meets are included, however, competitive swimming runs into the thousands of dollars per year for elite competitors. Even for the early adolescent just breaking in, an annual cost of well over $1,000 a year is common.

Hockey players, dancers, gymnasts, divers, figure skaters and all other athletes involved in organized sport can sympathize: sport in Canada is expensive, especially compared with laying out a few hundred dollars for the latest Xbox at Christmas.

Furthermore, low-income neighbourhoods don't have the same access to safe, high-quality recreation facilities that are found in their high-income counterparts. Not only is it expensive to join in, transportation (often by foot or bus, remember) adds yet another barrier for the young would-be athlete.

All of these factors contribute to a distressing pattern: in Canada, obesity and poverty are clearly, inextricably linked. While other developed countries have similar findings (studies in Australia, Britain, Sweden, France and the United States have shown links between both neighbourhood and individual incomes and the risk of obesity), some countries do better than others.

A study of Norwegian, American and Canadian children in 2005, for example, showed marked differences between low-income and high-income children in Canada and the USA, but relatively muted differences in Norway, which in any case had the lowest incidence of obesity of the three countries.

What can we do? A study based in Edmonton this year suggested the obvious: we might be able to get our young people moving and cut obesity rates if we increase access to parks and play spaces, improve accessibility to sports and recreation programs, and add sidewalks so that youth can walk or bike to school. A 2009 study showed that youth activity programs in Calgary have been found to change the behaviour, and more importantly the attitudes, of sedentary children.

At the same time, a report in 2009 by the British Columbia Recreation and Parks Association showed that funding to build recreational facilities has been inconsistent, not just in B.C. but also across the country. Construction has fallen in B.C. from a high of 270 indoor facilities built in the 1970s to a low of just 67 facilities in the decade just ending.

Yet another study of Canadian young people showed that increased screen-time behaviour was heavily influenced not by the amount of blood and gore or the number of explosions being shown, but rather by simple boredom. That is, the children often didn't have anything else to do.

Finally, a study in the Journal of Public Health in 2006 showed that in Hamilton, Ont., subsidizing children's recreational programs pays for itself inside of one calendar year, on the basis of decreased health and social services costs. Further, the programs had a positive effect beyond the children themselves; the families of these children left welfare at a significantly faster rate than those who weren't subsidized.

Spending priorities

We can afford this. Stephen Harper's government plans to spend as much as $9 billion in the next few years on new prisons (during a recession!) at a time when crime rates have been falling for more than a decade. Nine billion!

In Halifax, the Mainland Commons recreational facility is just being completed, with a projected cost of $40 million. Let's increase that cost by 50 per cent, just to be cautious, and distribute $9 billion by population across the country to be spent on swimming pools and ice rinks instead of incarceration.

If we do this, a small province like Nova Scotia would get five new facilities with competition-capable pools, indoor ice rinks and gymnasiums; a larger province like Ontario would get more than 60 such centres. Given that we have an epidemic of obesity, and an increasingly small number of criminals, maybe the evidence points to a better way.

After all, it isn't as though childhood obesity simply vanishes with age. Many obese children go on to become obese adults, with costly preventable diseases that come with that territory. Solving this problem today means a healthier, happier population, and a larger tax-paying workforce in the future.

And that means more money for the costs of greying health care, social programs and pensions. The child we ignore today is the one that has to take care of us tomorrow. Making him or her healthy is in our best interest.

Bottom line: one big cause of childhood obesity is societal neglect of children's needs. Children should be well and properly fed, be offered safe and engaging play areas and be driven by their peers and their own interests to excel at sport. To leave children behind simply because we are too short-sighted to see the costs would be a national tragedy.

So do me a favour. Go poke your politicians. Make the funding of happy, healthy childhood play one of their obsessions.