Socioeconomic Status and Obesity: What's the Link?

Written on July 30, 2023 by Lori Mulligan, MPH. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• How Are Obese Individuals Perceived?
• Can’t Overweight and Obese People Just Eat Less and Move More? It's Not That Simple
• Is Obesity Linked to Where You Live?
• Are Poverty and Obesity Associated?
• What Can We Do to Address the Overweight/Obesity SES Disparity?
• How Can Everlywell Telehealth Help?
• Related Content

Obesity rates continue to increase domestically and globally, which is associated with a rise in medical and economic costs. In 2017–2018, prevalence reached 42.4% in adults in the United States. Predictive modeling suggests the prevalence of obesity in U.S. adults will be 48.9% by the year 2030.[1]

There are disparities in obesity rates based on race/ethnicity, sex, gender and sexual identity, and socioeconomic status (SES). SES factors contribute to obesity on an individual and community level, and any viable approach to addressing the obesity epidemic must take these factors into account.

SES can be determined using variables such as education, income, and occupation, with education considered to be the most stable variable over time.

How Are Obese Individuals Perceived?

Individuals with obesity encounter bias in multiple settings, with reported rates of weight discrimination approaching those due to gender and race/ethnicity. In the workplace, employees with obesity are perceived as having lower supervisory potential, lower self-discipline, and worse personal hygiene; as less likely to be seen as suitable for public-facing sales positions; and as having lower promotion prospects compared to average-weight peers.[2]

Can’t Overweight and Obese People Just Eat Less and Move More? It's Not That Simple

Unfortunately, it is not so straightforward. Research has shown that overweight/obesity is a multifaceted problem, with a complex interplay of individual, community, social, and environmental factors. These risk factors of overweight/obesity often interact with each other and might be direct or indirect influences on the weight status of individuals.

Is Obesity Linked to Where You Live?

Low neighborhood socioeconomic status (NSES) has been linked to a higher risk of overweight/obesity, irrespective of the individual’s own socioeconomic status.

Meta-analysis research was done to pool the existing empirical evidence on the link of NSES to obesity, BMI, and being overweight. Overall, NSES was found to be significantly associated with the three outcome measures, such that low NSES was significantly linked to high odds of being overweight or obese, and a having higher mean BMI. The findings of this work were consistent with the reports of previous studies that reported higher odds of overweight/obesity as well as other poor health outcomes in individuals living in low SES neighborhoods than in individuals living in high SES neighborhoods.[3]

Are Poverty and Obesity Associated?

Although low SES is an established risk factor for obesity, its impact may be mediated in part by psychosocial stress. Effects of neighborhood poverty and psychosocial stress on central adiposity demonstrated that people living in neighborhoods with increased poverty and unfair treatment were at an increased risk of central adiposity (fatty tissue around the middle of your torso).

In 2010, 15.1% of Americans lived in poverty based on family income census data. With the economic downturn, the number of people in the United States living in poverty rose to 46 million people—the greatest number in more than 50 years.

In one study, poverty rates and obesity were reviewed across 3,139 counties in the United States. People in the United States who live in the most poverty-dense counties were found to be the most prone to obesity. Counties with poverty rates of >35% have obesity rates 145% greater than wealthy counties.[4]

What Can We Do to Address the Overweight/Obesity SES Disparity?

Reshaping fiscal, social, and physical environments to make it easier to access healthier practices—via, for example, planning restrictions on hot food takeaway outlets, taxes on less healthy foods, and subsidies on children’s access to sports—is likely to help. However, the most powerful way to ensure that everyone has adequate access to the resources required to achieve and maintain a healthy weight may be through stronger welfare and employment policies, including higher minimum wages, working hour mandates, and universal basic income.[5]

As mentioned above, obesity is the result of a multifactorial problem and requires a systems approach. By systems approach, it includes reducing long-standing structural and historic inequities that have been intensified by the pandemic, targeting obesity-prevention programs in communities with the highest needs, and scaling and spreading evidence-based initiatives that promote healthy behaviors and outcomes (e.g., within healthcare, transportation, and education sectors). Below are a few of the federal, state, and local policy recommendations to curb obesity, including addressing the relationship between SES and obesity[6]:

1. Increase health equity by strategically focusing on efforts that reduce obesity-related disparities
2. Decrease food insecurity while improving nutritional quality of available foods
3. Update marketing and pricing strategies that lead to health disparities
4. Make physical activity and the environment safer and more accessible for all
5. Strengthen obesity prevention throughout the healthcare system

How Can Everlywell Telehealth Help?

Our comprehensive online weight loss program pairs a weight loss drug, GLP-1, with regular clinician care, lab testing, and support for related conditions. (Age 18+) Specifically, clients receive:

• Access to GLP-1 prescriptions for qualified candidates
• Regular 1:1 virtual visits with a licensed clinician
• Included quarterly at-home lab tests* or supplements
• Lifestyle content and support for health conditions

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References

1. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018 NCHS Data Brief No. 360, February 2020. https://www.cdc.gov/nchs/products/databriefs/db360.htm. Accessed on July 20, 2023.
2. Anekwe CV, Jarrell AR, Townsend MJ. Socioeconomics of Obesity. Curr Obes Rep. 2020 Sep; 9(3): 272–279. doi: 10.1007/s13679-020-00398-7.
3. Mohammed SH, Habtewold TD, Birhanu MM, et al. Neighbourhood socioeconomic status and overweight/obesity: a systematic review and metaanalysis of epidemiological studies. BMJ Open 2019;9:e028238. doi:10.1136/ bmjopen-2018-028238.
4. Levine JA. Poverty and Obesity in the U.S. Diabetes. 2011 Nov; 60(11): 2667–2668. Published online 2011 Oct 17. doi: 10.2337/db11-1118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198075/.
5. Adams J. Addressing socioeconomic inequalities in obesity: Democratising access to resources for achieving and maintaining a healthy weight. PLoS Med. 2020 Jul; 17(7): e1003243. Published online 2020 Jul 28. doi: 10.1371/journal.pmed.1003243. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386612/.
6. The State of Obesity: Better Policies for a Healthier America: 2021. Trust for America’s Health. https://www.tfah.org/wp-content/uploads/2021/09/2021ObesityReport_Fnl.pdf.