Obesity, Classism and Racism
January 2021
by
Lead Author: Araceli Camargo, MSc Neuroscience
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DESCRIPTION
The latest health campaign adverts from the NHS look perfectly helpful at first glance. They depict an overweight Black woman eating a salad to promote healthier eating habits, especially in the wake of COVID. It is now well known that comorbidities such as obesity and diabetes played a key role in Covid susceptibility. Additionally, these comorbidities were identified as being prevalent amongst Black communities and offered an explanation to the high prevalence of Covid within the community. However, when we look deeper there are three things wrong with this and more insidiously these three factors point to the prevalence of structural racism within the health system.
Point number one: Habitat Not Race
There are various problems with targeting a community based on their race, specifically in the context of health. To say “Black community” or “Indigenous Community” is a misnomer as it doesn’t see the person to place relationship, which is essential to understanding health. Health is a process that requires a multi-systemic engagement between our bodies and external environment, this engagement happens throughout a person’s entire lifetime. Engagement meaning the interactions, relationships, experiences and encounters between all our biological systems and our external environment. Secondly, the engagement is either supportive or non supportive. For example, if we live close to nature, breathing clean and nourishing air, then this interaction is supportive of our health, as oxygen provides all of our biological systems with sustenance. However, if we live close to a high traffic road, where we breath air pollution, causing damage to all of our biological systems, then this is an interaction that is not supportive to our health.
When our bodies are forced to engage with environments that have high environmental pollutants, extreme climatic events, contaminated food sources, non nourishing food, and violence our health suffers. We have published several papers on the phenomena of biological inequality, which identifies that poverty exposes people to disproportionate levels of biological stress through the aforementioned factors. In these environments our bodies “wear and tear” through a process called allostatic load, which is one the pathways to disease, including obesity.
Given how much habitat plays a role in a person’s health, it is inaccurate to simply correlate poor health outcomes with a phenotype or “race”, additionally, it is more important to look at the interaction between a person in a specific place than just their “race”. Finally, it is a person who experiences the environment not their phenotype, race, or ethnicity. In other words if a Black person is living in a neighbourhood with clean air, water, access to healthcare, access to safety, access to nourishing food they will have very different health outcomes than a Black person living in an environment with high air pollution, no running water, no feelings of safety, etc.
Therefore putting out the narrative that the Black women should be eating salads, simply because being Black is a health risk rather than structural racism that forces Black people to disproportionately live in biological inequity is incorrect. It also leans into eugenics.
Point number two: Habitat Not Individual Choice
Obesity is a very complex disease, it is a dysregulation of the endocrine, immune, digestive, and metabolic systems. Its disease pathology is complex. For example, people that experience childhood trauma are more at risk of obesity due to allostatic load. There are also various studies linking obesity to both air and light pollution as well as with food insecurity. Most people think children are obese because of too much food, however, once the body’s metabolic system is dysregulated its interaction with food, nutrients, fat storage, and insulin change, meaning that quantity of food only plays a small factor.
Therefore, to simplify a complex disease to the food choices a person is making is damaging. Firstly, it gaslights people into thinking they are personally to blame for a complex disease. Secondly, it is not an honest depiction of the disease pathology, which means we don’t solve the problem. Thirdly, if we want to get serious about solving obesity, then we have to look at the places people live, which means that public health also extends to those that build cities.
Point number three: Lived Experience and Habitat
A crucial element of a habitat are our experiences within it. It is important to take into consideration where people work, the type of work, the length of communities, their urban footprint, their economic standing, their social network, their age, physical mobility etc. For example, a person that lives in an area of biological inequality, who is neurodiverse and has not been able to build economic or social infrastructure might be more at risk for social isolation and loneliness than a person in the same area but with stronger economic and social infrastructure. Loneliness is a risk factor for obesity and cardiovascular disease. Another person in the same community, could be a bus driver, which exposes them to over eight hours of air, noise, and light pollution due to being a driver, they also may not have the time to eat proper meals or eat them at regular schedule. All of these factors play a key role in whether or not their metabolic system will dysregulate due to their stressors and whether or not they are more at risk for obesity. Conversely, take a person in the same exact neighbourhood as the bus driver, but they work as a security guard in a leafy area, close to their home. The job may afford them outdoor breaks away from traffic, more physical mobility, and a shorter commute, which can contribute to longer sleep cycles, more time to pack a nourishing meal, more downtime, more exercise. All of these different factors can change the level of risk for obesity for the security guard despite living in the same community as the bus driver. Furthermore, both could have the same exact diet, but when these extra factors are added in, the way their body metabolises the food will be different.
Again this illustrates that it is not about race or ethnicity nor is it not as simple as eating a salad. Therefore, if health campaigns are to be anti-racist and anti-classists they have to be honest about the contributing factors to complex diseases such as obesity. Whilst healthy eating habits are important, the outcomes will not be as effective if a person in living in biological inequity.
Looking at this ad from the NHS and given what we know about the complexities in the disease pathology of obesity, it is very difficult to deny its racist and classist approach. To succeed in our effort against obesity, we need to identify all the factors that contribute to its disease pathology, which includes creating healthier neighbourhoods, eradicating poverty, eradicating inequity, eradicating racism, and eradicating classism. It is time that we look at obesity in a more accurate light.
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