Poverty leads to fear leads to obesity . . . or something.

From Why Are So Many Low-Income People So Overweight? by James McWilliams.

I think McWilliams is both right and wrong.

You’d think that only the surliest contrarian would challenge the premise that access to fresh food results in improved health. But the idea—which is embodied in the notion of a “food desert”—has come under friendly fire in the last couple of years. It appears that the evidence weakening the connection between food accessibility and personal health is frustratingly, annoyingly, peevishly convincing.

Back in 2012, in the New York Times, Gina Kolata wrote that “there is no relationship between the type of food being sold in a neighborhood and obesity among its children and adolescents.” She quotes Kelly Brownell, director of Yale’s Rudd Center for Food Policy and Obesity, as saying, “if you are looking for what you hope will change obesity, healthy food access is probably just wishful thinking.” More recently, in Slate, Heather Tirado Gilligan cites peer-reviewed research to conclude: “[M]ore fresh food closer to home likely does nothing for folks at the bottom of the socioeconomic ladder. Obesity levels don’t drop when low-income city neighborhoods have or get grocery stores.”

I hate this kind of news. But given that scores of expensive food-access initiatives, most of them following the lead of Michelle Obama, have been established to eradicate so-called food deserts, and given that many food reformers are working under the impression that “if you stock it they will eat it,” these relatively recent studies should inspire a more skeptical look at what seems to be the sensible move of making more fresh food available to obese, low-income consumers. Unfortunately, too much evidence indicates that the matter isn’t quite so simple. When it comes to food, nothing is.

He's right. Food deserts have been a convenient myth conjured by advocates and used as a rationale to waste a lot of federal money solving a problem that doesn't exist. See an earlier post for a humorous example, They really need to try harder.

McWilliams acknowledges the facts but doesn't like them for two reasons. 1) It makes it harder to figure out what to do to address obesity, and 2) "it becomes very, very easy to blame the overweight victim".

He's right that it does mean that the solution is probably far harder to achieve. Why? Fundamentally, it is no longer possible to argue that it is ignorance and inaccessibility that causes obesity. People know they need to eat better, they broadly know what they ought to eat and what they ought not to eat, and the food that is good for them is readily available. They are simply choosing not to eat the way that would allow them to be less obese. What that really means is that they have different goals they are pursuing than those who want them to be thinner. So getting people to change their ways that will diminish their own objectives and improve the advocates objectives is a pretty tough sell.

But to me the interesting thing is the characterization of the individual as a victim. Why do that? You are disempowering them and you are stripping them of their agency. You are also creating a hierarchy where you, the smart advocate, know better what's good for them than they do themselves.

So McWilliams drifts from being right to being a self-anointed altruist, wanting to take over other's decisions and help them escape their false consciousness and make the decisions he wants them to make. There's a term for that - pathological altruism.

But then he drifts back to what I think is a valuable insight and one that I discussed in The brittleness of tactical decision-making. Part of the challenge for the poor is that with scarce resources, most of their decision-making is very tactical and there is very little resiliency in terms of making bad tactical decisions. The decision is made and the consequences are immediate. With strategic decisions you usually have some latitude to adjust the decision as new information becomes available. Not so for the poor.

There’s a critically important aspect to McMillan’s story that’s essential to this shift in perspective: the people she profiles live lives defined by persistent scarcity—not necessarily food scarcity, but a generalized and even traumatizing kind of material instability. Absolutely nothing about their lives is secure.

He's so close, but then he goes off the rails again.

Critics of McMillan’s piece complained about how the low-income cohort she profiled possessed houses, cell phones, decent clothing, and televisions. Nobody mentioned how precariously close these people were to losing those things, much less the anguish such anxiety entails. One unexpected medical bill, one glitch with the car, one minor brush with the law, one argument with your shift manager—all these events could have sent the entire edifice of material life crumbling. And that’s terrifying. The subjects pictured and videotaped in McMillan’s story are not just overweight. They’re scared out of their minds.

I understand McWilliams revulsion at the demonizing of the obese. But in his eagerness to hold individuals not accountable for their own behaviors, McWilliams descends into psycho babble.

The part I think is right is that scarcity constrains the nature of decisions one can make and puts one at greater risk. But I disagree with McWilliams that people are scared into bad eating. There's no evidence of that. However, it does allow McWilliams to reach the conclusion that "you remain, in fact, a victim" which seems to be the important thing.

Just as the availability of healthy food does not necessarily lead to healthy eating, the availability of unhealthy food need not lead to unhealthy eating. But for that to happen—for more Americans to choose healthier food—they must have a basic sense of security about their future. No matter how much fresh produce is imported into our food deserts, it will never compete with the junk when life is marked by scarcity.

Its hard to imagine how you arrive at a more incorrect conclusion than McWilliams in his final paragraph.