The Weight of the Nation: Poverty and Obesity (HBO Docs)

this joa is as heavy as me, how loud are you around 280, more than 18% of our children right now are obese. If you go with the flow in America today, you will end up over

weight

or obese like 2-thirds of Americans do. I don't want to I will be fat for the rest of my life I have diabetes Sleep apnea High blood pressure I get dizzy when I get up everything hurts, although if we don't take this now as an urgent and really serious

nation

al priority, we are all individually and as a

nation

it is going to pay a really serious price, so here in the South Bronx, this is the lowest income county in New York State, we have the highest rates of

obesity

, and this map shows the neighborhood we are in now, more of 30% of obese people Very high prevalence of diabetes within walking distance here in Manhattan, the Upper East Side, where it is the highest income neighborhood in the city.

We have a very low prevalence of

obesity

. Very low prevalence of diabetes. 2 thirds of adults citywide are over

weight

or obese, but in the darker areas of this map, over 90% in some cases of adults are overweight or obese and you can see in the areas that are lighter around University City lower obesity rates and look at all the healthy food sources Yeah, all the farm produce, the supermarkets, the farmers markets and when you go back to these areas that have higher obesity rates, you see a lot less healthy food sources. The seriousness of obesity has been recognized as a problem for the entire country. but if you look at the state of Tennessee in Nashville, which is where we are located, there is a level of crisis here.

I mean we're in last place, about one in 10 adults walk with diabetes if you look at people who haven't graduated from high school it's one in five the red dots on this particular map are where they are located. highest

poverty

rates, we know that in this area almost one in three children is considered overweight or obese. and this is an area as you said with

poverty

, the average family income is less than $25,000 for a family of four. Orange County, California is an extremely wealthy county, one of the richest counties in the United States. Orange County has a very high number of parks. and park space, in fact, for every 1,000 residents in Orange County there are 41 acres of open space parks, but not in Santa Ana, this red circle reflects the proportion of children who are overweight or obese.

Look at the difference between that circle and this little circle. in Irvine and all this yellow that reflects relatively high rates of wealth right next to these deep pockets of poverty, overweight and obesity, so what's happening here is that we have data that can document that not everyone has the same resources to combat the diseases and in the end, epidemics are reduced to pockets of poverty. We formally and welcome everyone. I want to take the committee on a very brief journey from the perspective of a local public health professional, so the death certificate is actually a pretty good source.

A lot of data can tell what someone died of, you can tell how old they were when they died, you can tell what their race and ethnicity is and you can tell where they lived, and those four pieces of data can tell you a lot about death patterns in a La community where you live matters and is very important. Another way to say it is: does your zip code matter more than your genetic code? This is Baltimore, Maryland where they have a census located near the Inner Harbor with a life expectancy of 62 years and another life expectancy in North Baltimore 82 years 20 year life expectancy difference this is Kyoga County In Cleveland, where we have so far found the largest disparity in life expectancy, this is Huff, an inner-city neighborhood with an average life expectancy of 64 years, and 8 miles away is Lind Hurst with a life expectancy close to that. at 90 years old.

Understanding what drives that disparity will help us understand what is driving the chronic disease epidemic. It will help us understand the tools and strategies to overcome obesity. Epidemic obesity is the leading driver of chronic disease, the huge contributor to diabetes, cardiovascular disease, stroke and some cancers, so with our healthcare costs of more than $2 trillion, Our nation's costs are enormous in a low-income neighborhood, there is a different food environment, not only do people make less money? It is surrounded by lower quality foods. It is difficult to get fresh vegetables and she is more stressed. So the question arises as to what degree of free will people really have when they are in a certain controlled environment. environment and until we can understand that there are large social and economic forces that predict obesity we will never solve the epidemic there is a design there is an urban design that is making people sick there is an urban design that is making people obese overweight there is a design that is causing people to develop chronic diseases there are no healthy places in my neighborhood the most we have is like the Chinese McDonald's uh KFC with all the burger joints and deals and 99 cents this and it's 99 cents everywhere if I have $3 you go to buy two hamburgers for 99 cents each and a soft drink for us it is more affordable to go to fast food I have a family of five children and it is difficult to do it alone with cheap food you know that there are limited resources I am going to choose what I can afford to feed to my family, you know, going to the grocery store and finding healthier foods, then having to prepare those foods and the expense is almost out of the picture for someone in my situation, if that. confined to living in a particular neighborhood because of the amount of money you make, obviously the choices that are in that neighborhood are going to be your only options, so the same populations where people are food insecure where people worry about Where they go to have the money to get their next meal are the same populations where we are seeing the highest obesity rates.

I can live in a community if I am low income in this country where there are food deserts where there are no services that give me access to fresh vegetables, fruits and other high quality foods and the streets where I want to go to exercise can be crimes , there may be cars or highways or there may not be parks, so here I am trying to exercise personal responsibility and I can. You're not healthy, so if you're ever told that you don't have options to eat well, you should definitely come to my neighborhood because there you have McDonald's, you have Subway Fried Chicken and then you can go get a coffee or a donut.

Dunkin Donuts, if you're still hungry, you can go to Wendy's right there. This is junk food heaven. When you see food, even pictures of food, it makes you feel hungry. In poor neighborhoods there are many more posters and billboards, and you know. External advertising. for food that you don't see in rich neighborhoods people here have two or three jobs to pay the rent to pay for a Metro car you know they don't have time to cook at home in a low income neighborhood there are more convenience stores in fact , two to four times as many small convenience stores that predominantly sell foods high in sugar, fat, salt, hello, hello, go to a poor neighborhood anywhere in America, in a small store, what do you see there ? chips, soda, candy, these are products made from sugar, uh, they're made from wheat, they're made from corn and they have a huge shelf life of a year or more.

These are products that have a very large profit margin. You see, this is my downfall. Honey Buns right here, two for a dollar. cheap cow are unhealthy calories that you can easily get at Bodega and South Bronx get 1,300 calories for a little over $2 you can get more than you need for a whole day for less than $3 2 liter soda you can get a special offer of 99 And water, why is it more expensive? We really can't make a dent in the obesity epidemic if we don't start making a dent in the disparities between low- and high-income communities. We have to understand that in a very low-income community there are much deeper challenges and we have a much greater obligation as a society to create change in that environment.

There is a social responsibility, not just a responsibility, but I think there is an investment problem here, because everyone benefits from everyone else being healthy. More people are unhealthy, that's less economic productivity. it's more health care costs, a variety of other costs that everyone has to shoulder what kind of nation can live without a workforce that is healthy, so what diabetes and obesity are doing to this nation is crippling the force work, but beyond that, paralyzing families and individuals. and the communities, we are a city with a high population density uh and so there are street vendors all over the city and there are more people who want to sell than there are permits available and so we said we could take advantage of that um what came from that is where the idea of ​​the green carts, what we did was increase the limit of the total number of street vendors in the city, but only for vendors who were willing to sell fresh fruits and vegetables according to our specifications and only if they sold themselves in underserved neighborhoods people pass and you see this healthy food here and it competes with all the advertising you see for junk food all my customers come every day every day my strawberry is the number one selling strawberry everyone loves strawberries it's not too expensive it's cheap and it's fresh, that's the best part, it's very fresh, this doesn't last in my house, we eat like two bags a day, can I have some cherries?

The biggest changes in health will occur if we create a world where people naturally behave in healthy ways your way thank you bye ok bye kids I'm responsible for a city of 8.3 million people every one of those people I consider them my patients as a doctor, um and all the health problems that I face. It's the only problem that's getting worse, obesity and diabetes, we haven't solved it yet, there are a lot of things we're working on here, I think each of them can contribute to the solution, but we haven't turned it around yet, so I think I'm always trying to better understand the nature of the problem and trying to see where the leverage is.

Where can we make changes? That can really change things. How are you? I am doing it right. How are you. I am doing it right. poverty problems, certainly, crime, eh, but also lack of options, so a proliferation of bad options arises, that is a market, yes, it is a small market, and look what kind of things mainly concern mobile phones , yeah, I don't think they have too much food, that's why they sell water, sugar, sweetener and drinks and hot dogs, where would you buy a salad here? Yeah, I don't think you would, so, food options, okay, Chinese store, right, and giant bets, that would be it, yeah. look at the yellow sign, everything is yellow, it's really and all the way down too, so people are bombarded and if this is it, you have nothing else to buy, yeah, nothing else to buy if you don't have a car, yeah, and there is not a big market. right in your neighborhood, I mean, how much shopping can you carry?

Try it in a lot of Philadelphia neighborhoods, unfortunately, you literally have what we call these food deserts, so the alternative I'll go to the store, you know two? blocks on the street unhealthy products prices too high limited options and I'll just deal with it and the result is bad Health I have two bananas and an apple 125 if you are in this area this bag is 25 cents if you go to City Line Avenue and you will find a Vending machine. This bag will cost 75 cents and up and won't be marked 25 so start with the company, they charge a little more in neighborhoods where they can offset the cost and they keep it cheap here and move the product.

Is there anything you can sell that is healthier and that competes in price with this? No, nothing at all for 25 cents. Nothing, children, you don't know vegetables or fruits. You know, maybe they know apples and oranges, but I mean, I'm telling you, I had a kid the other day who was eating here and he asked me what that was. He was eating broccoli, fresh broccoli, you know, raw broccoli by dipping it. Some of the kids grew up on this stuff, it's candy chips. soda, you know, this is a big part of these kids' diet and you can see it reflected in their waistline.

Every community may not be able to have a supermarket, but we want to work with the stores that are already in the neighborhoods to help them sell healthy products. We have had a great response. No, this is actually very nice. I mean, we're very excited. I wanted to comment on these labels because it is actually a traffic light. Assemble something really easy for people, they can just look at the colors. especially easy for kids to remember, yes, I got married and moved to this community in 1973, when II moved here I realized there was no supermarket when you talk to people and tell them I don't have a supermarket in my area, oh my gosh, well where?

You go? I didn't want to move. I just wanted to make a difference and I wanted to make a change. They made this happen and pushed the political community. They pushed their neighbors. They pushed the business community and convinced people that this. not only could it happen, but we would all work our time as volunteers fighting blood sweating tears to make this happen this used to be wasteland weeds covered in concrete rubble dumping all kinds of things that happen here uh and over the course of about a year and a half, uh, this whole section was transformed into what we see now, a brand new supermarket, they haven't had a supermarket in this community in 30 years, okay, we're shopping.

I have to get some broccoli, broccoli down here, yeah, so we'll do that. Green is like paradise. I can come here and get fresh vegetables. Wonderful, it's a convenient market, it means everything to this neighborhood, having the tools and resources here in the community, that's when you're making progress, exactly what I'm looking for, seeing this whole community transform. , it was really incredible, I had never done it. I have seen something similar. It's the best project I've ever been involved in in my life. I know. I know there are many small programs at different levels that we can use to solve the problem.

Over time, step by step we will implement them. systems and interventions that will make it easier for people to be physically active and change our food environment so that people eat healthier. We need more people to be involved in the decisions being made about investing in open space and parks. Investment in groceries. stores, farmers markets and educating our children about healthy eating and healthy diets. I am one of those people who believes that we can reverse this trend and we don't do it as individuals, we do it together with other people in communities.