Economic Conditions and Obesity

To the Editor: In their Commentary on obesity and the economy, Drs Ludwig and Pollack¹ provided some useful suggestions for reducing obesity by taking advantage of the opportunities presented by the global financial crisis. However, their major premise—that obesity will increase in the current economic downturn—is unsupported by existing data. This is often missed by health experts but is of epidemiological significance.

Counterintuitively, health indices from a number of countries since as far back as the 1920s have been shown to improve in economic downturns and decrease in booms.² Obesity in particular is positively correlated with prosperity and decreases with economic downturns.² This might be expected because of the link between obesity and consumption (eg, by increased eating of high energy–dense foods or increased use of effort-saving technology). Major decreases in fat consumption and obesity with unexpected associations with fewer deaths caused by cardiovascular disease and diabetes were observed in German-occupied countries during World War II and also in Cuba in the economic crisis of the early 1990s after the Soviet pull-out.³

The short-term link between health and economic expansion is thus robust and negative. In the past, however, economic prosperity (with its associated correlates of improvements in nutrition, sanitation, hygiene, and living conditions) has been a contributor to population health. But what was positive in the past may have become negative in the present. For example, data from Sweden show that in recent decades, growth in the gross domestic product was associated with a reduced rate of improvement in health, whereas the opposite occurred in the 19th century.⁴

The potential for increasing negative returns with economic growth beyond a point may relate to the effects on the environment as well as obesity and chronic disease. Use of nonrenewable fossil fuel, for example, increases obesity (by driving instead of walking) as well as greenhouse gas emissions.⁵

Thus, there may be even greater public health opportunities from the current crisis than suggested by Ludwig and Pollock. This is unlikely to be realized, though, if health experts ignore the bigger economic picture, and economists continue to see the solution to the current situation as simply bailing out the existing system. The inevitable maturation of any growth system and the need to ultimately change this should be clear.