Social experimentation with obesity: “big brother” or “big idea”


It is almost impossible to separate obesity issues from political minefields.  A study published this month in in NEJM will do nothing to diffuse those issues.

In short, University of Chicago researchers looked at the movement of people using housing vouchers out of low income housing (I’m paraphrasing, and please read the article for the exact design), and followed their weight and HbA1c over time. Essenitally, if people moved away from low income neighborhoods, they became less obese and improved glycemic control, although somewhat modestly.

A few years ago, I had the amazing Dr. Anne Peters speak for me to a group of Indian health physicians.  She talked about the challenges of diabetes control within the inner city, but really about the challenges of trying to eat something healthy in the inner city.  It is somewhat late on the West Coast, particularly for a father of two young ones, and I can’t remember the study she cited, but if memory serves, Dr Peters and USC’s mapping experts looked at the availability of grocery stores in lower income areas, a simple concept. And guess what they found?  You will be SHOCKED, SHOCKED, to learn that it is really hard to buy decent quality food in low income areas of Los Angeles. It was an amazing discussion, in that the simplest things of potentially finding a way of providing decent access to non-processed foods would likely have a profound effect on the obesity/diabetes crisis.

A recurring theme: is this leveragable?  can we move people to healthier areas?  what is the role of government?  should there be a role for government intervention or is the Invisible Hand at work? With such a publicly borne health care burden, can the government not afford to become involved?

On a concordant note, some day soon we will talk about government cheese, white flour and the Native Americans, but not tonight.




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