Obesity Epidemic, Low Income And Mental Health Problems: ‘A Vicious Cycle’

Long Beach Health Department Outlines Targeted Effort To Address Community Issues; Local Rates Higher Than L.A. County’s

By Tiffany Rider - Senior Writer

November 20, 2012 - Health professionals agree that obesity is a growing epidemic affecting Long Beach residents and our nation as a whole, a situation that has shown to not only impact physical wellbeing but also mental health.

According to the Centers for Disease Control and Prevention (CDC), more than one-third of American adults are considered obese, meaning that these individuals are carrying an excessive amount of fat on their body relative to their lean body mass.



Dr. Michael M. Siegel, corporate vice president and medical director for
Molina Healthcare, told the Business Journal that obesity and mental health
problems go together because low-income individuals with weight problems tend
to have difficulties interacting in society. Here, Siegel shows a map on the
U.S. Centers for Disease Control and Prevention website showing self-reported
obesity prevalence across the United States.
(Photograph by the Business Journal’s Thomas McConville)

The Body Mass Index (BMI) is the standard measure of obesity, and individuals with a BMI of 30 or more are considered obese (see below for calculation).

Several studies over the past 15 years have shown a relationship between high rates of obesity, low-income or poverty and high rates of mental illness, such as depression, anxiety or other psychological issues. Obesity and its related public health issues are affecting populations on the local level in staggering numbers.

“All health departments started recognizing the pattern of obesity throughout the 1980s and ’90s,” Mitchell Kushner, MD, the public health officer for the City of Long Beach, said in an e-mail. “However, in the year 2000 the CDC started utilizing the term obesity epidemic, when over 280,000 annual deaths as a consequence of obesity were recorded. The epidemic has progressed dramatically over the last decade, and currently no state within the U.S has an obesity level less than 20 percent.”

Kushner confirmed that Long Beach has a childhood and adult obesity epidemic, having higher rates of both when compared to Los Angeles County. At the request of the Business Journal, Kushner used data from the most recent community health research assessment showing rates of childhood obesity, diabetes diagnosis and mental health hospitalizations to break down the top impacted areas for each by Long Beach zip code.

“Besides all the journal articles we have found linking these conditions, you will see a striking correlation here in Long Beach across the 11 zip codes in our city,” he said. According to Kushner, the top five zip codes with the highest incidence of childhood obesity are: 90804, 90805, 90813, 90806 and 90802. The top five for diabetes diagnosis are 90813, 90810, 90805, 90806 and 90804. The top five zip codes for mental illness hospitalizations are 90802, 90813, 90804, 90807 and 90805.

Three out of the top five zip codes among these three health issues are shared: 90804, 90806, 90813. In addition, four out of the five top zip codes for mental health and childhood obesity are shared: 90802, 90804, 90806 and 90813. “All these shared zip codes fall within designated medically under-served areas (MUA) and are considered low-income areas or areas with higher rates of poverty,” Kushner said. “Based on data from the health department’s community health assessment, conducted over the past year, you have found a correlation in comparing Long Beach zip codes and incidence of obesity, diabetes and mental health.”

Lillian Lew, director of the Families in Good Health program with St. Mary Medical Center, described the relationship between low income, obesity and mental health problems as “a vicious cycle.” Families in Good Health is a multilingual, multicultural health and social education program for minority communities in Long Beach to help families make informed decisions about their health. The program also has a focus on advocacy, pushing for increased access to social and health resources.

According to Lew, the cycle of low income, obesity and mental health problems has a lot to do with chronic stress, or “toxic stress.”

“The toxic stress is this low-lying stress that never goes away and affects your body,” she said. It can be caused by low social economic status, living in poor areas, being surrounded by crime, food insecurities and other issues related to lack of resources and support.

“Low-income people have a higher rate of disease that goes down to the cells,” Lew continued. “Obesity leads to chronic illnesses. If you get ill, that becomes another toxic stress. Recent studies on toxic stress and adverse childhood experiences deals again with poverty, it changes the neurons in your brain, so you don’t cope with it well. It affects child development and can lead to a lot of mental health issues.”

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When the health department presented the findings of its community health assessment to stakeholders, Kushner said the top issues raised were the same – obesity, mental health and diabetes. In brainstorming sessions, strategic priorities presented included increasing access and affordability of healthy foods, such as fresh fruits and vegetables, discouraging the consumption of sugar-sweetened foods and increasing physical activity.

“The approach here is a focused collaboration between the health department and our community partners through multiple grants, working in impacted low-income neighborhoods,” Kushner said. “The approach is to target the environmental and behavioral factors that are contributing to the obesity epidemic such as increased marketing of junk food and sodas to children, increased portion size of food and beverages, decreased physical education in schools, fewer safe areas for exercise in impacted communities, and less access to fresh, nutritious and affordable food.”

The Long Beach City Council has the power to create and implement policies that would set the stage for making a healthier city, Dr. Kushner said. So far, the council has approved new green space for exercising in those impacted Long Beach zip codes, bicycle routes that encourage ridership, a healthy beverage and snack policy for city-sponsored events, an updated city general plan integrated with health promotion goals and supporting the activities of the health department, such as the three-year North Long Beach HEAL (Healthy Eating, Active Living) Zone Initiative. Long Beach also signed on as a “Let’s Move” city as part of a national campaign to increase physical activity and healthy eating to battle obesity.

Those in public health and private health tend to agree that society needs to look at obesity the way we look at smoking, to create policy that discourages obesity. In the past, big tobacco companies were allowed to advertise smoking through mass media channels, using characters like the rugged Marlboro Man and Camel’s Joe Cool.

Smoking was much more prevalent in mainstream media and popular films 20 to 30 years ago, and since then cigarette smoking has been tied directly to cancer and chronic lower respiratory problems. Yet smokers become addicted physically and psychologically, a habit that can end in disease and/or death. Long Beach banned smoking inside restaurants years ago. The city has bans on smoking in parks, and some restaurant patios are becoming 100 percent smoke free.

While studies are linking obesity to diabetes and hypertension, increasing individuals’ risk for heart disease and cancer, in some instances mainstream media outlets have glorified being overweight or obese in reality television shows. TLC’s “Here Comes Honey Boo Boo” does this by promoting its star Alana Thompson, a seven-year-old beauty pageant contestant whose mother gives Thompson what she calls her “Go Go Juice” (a mixture of Red Bull and Mountain Dew) before she performs.

“Look at what we are advertising for our kids and for ourselves to eat,” said Dr. Michael M. Siegel, corporate vice president and medical director of Molina Healthcare, which treats low-income patients through government programs in 15 states. “We should be recommending in school lunch programs that they serve skim milk over whole milk [and] look at more nutritious offerings.”

Under executive order by Gov. Jerry Brown, the Let’s Get Healthy California Task Force is working on deadline to prepare a written report that outlines targets for reducing obesity and obesity-related illnesses such as diabetes and hypertension. The task force was formed to promote personal responsibility for individual health. Individual cities have taken action against obesity by attempting to place taxes on products with high sugar content, or ban certain products as New York Mayor Michael Bloomberg did with his ban on the sale of large sodas and sugary drinks at restaurants, movie theaters and street carts. More recently, the council of the City of Los Angeles declared all future Mondays be “Meatless Mondays” to encourage its residents to go vegetarian once a week.

“Look at what Mayor Bloomberg has done,” Siegel said. “We have to look at obesity the way we did smoking. If you are a smoker, your use of medical services goes up about 15 percent over the average person. If your blood pressure is elevated, if you have hypertension, your use of medical services [increase] 15-plus percent. If you’re depressed, your services go up 75 percent.”

While on the surface this issue seems to be isolated to people in poverty, those service increases attributed to obesity and mental health issues among low-income people become a strain on government healthcare programs, which in turn can mean more of an impact on taxpayers. “Eating potato chips and drinking pop doesn’t hurt anyone else; it basically hurts the individual,” Ron Arias, director of the Long Beach Health and Human Services Department, said in his “15 Minutes With” interview in this edition of the Business Journal.

“But, ultimately, low-income families that may be in a public health insurance program may impact us [if] we end up paying for their long-term treatment of diabetes and other chronic diseases. Being overweight sets up the individual for high risk heart issues,” Arias continued. “There is some evidence of cancer. These are all the reasons that the chronic condition of obesity becomes everybody’s problem.”

Calculate Your Body Mass Index

Body Weight _____ x 703 = ______ ÷ Height (inches2) = ______ Body Mass Index

“A BMI of 30 or more is considered obese, and a BMI of 25-29 is considered overweight,” according to Dr. Mitchell Kushner, public health officer for the City of Long Beach. “BMI charts are available everywhere and most providers are now recording this measure similarly as a vital sign (blood pressure, etc.). We are encouraging and working with the medical community to educate residents by measuring, explaining, and promoting ways to decrease BMI. BMI is calculated differently for children, and is measured as a percentile ranking on growth charts.”

There are calculators online for simple determination. For the U.S. Centers for Disease Control and Prevention adult BMI calculator, visit http://www.cdc.gov/healthyweight /assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html.