On Poverty and Health: The Obesity-Conundrum

rich man poor man slimmer man fatEver since I started running (and enjoying it), I have been intrigued by the sociology and economics of health and fitness. It coincided with my “coming of age” in medicine, so to speak, so it has been in interesting and ongoing thought-experiment.

I want to address some pertinent falsehoods about health and fitness, and why the disenfranchised have such a hard time of it. Right now I intend to write a two-part series, but who knows.

Quick disclaimer: I would never suggest that being a student-on-a-budget is comparable in hardship to living in poverty. All the same, being a student on a partial scholarship and a heavy student loan certainly did teach me a little about struggling financially and its effects on health.

“Well if they’re so poor, why are they SO FAT?!”

this is a statement I’ve heard too often for comfort. It is not only unkind, but also really short-sighted.

I’ll carry on below, but you really should read this very articulate article, published about South Africa’s obesity crisis last year on Mosaic Science by Ian Birrell, who writes:

“Forget those tired old clichés beloved by the aid industry: today, more people in poorer countries go to bed each night having consumed too many calories than go to bed hungry, a revelation that underlines the breakneck pace of change on our planet.”

As a student, I learned that anything was edible. I had loans that barely covered my basic needs, poor cooking skills, and no transport. I lived in an area close to the university hospital that made it unsafe to walk to the shops, making me somewhat reliant on the campus cafeteria with its exorbitant prices (they did not buy wholesale, and their markups were often 50-100% above commercial).

During my first year of university I became a connoisseur of instant noodles, at times even eating them uncooked.

How much worse for mothers without loans, with other hungry mouths to feed, for whom even two-minute noodles are over-priced?

When my workload picked up, even my poor cooking skills flew out of the window and I started purchasing meals cooked by the campus cafeteria. Although more affordable than their other items, these were overcooked meats and veggies, with copious amounts of salts and sauces, often re-fried.

But I still had the privilege of being a student. I went home for holidays. My parents helped where they could. I was never at a real risk of starvation. I was not a mother coming home from a ten-hour shift in a different suburb, taking two or three buses to get home to her hungry children and (also tired) husband who expected food when there are so few ingredients and little motivation with which to conjure up a meal.

Even so, it took its toll on my health. My weight and my body distribution, but notably also my mental health. My mood took a nose dive, as did my motivation and academic performance.

And that is what I see in my patients every day.

I counsel them about “healthy fats”, but I know that healthy fats are expensive. Avocados? I can hardly afford avocados!

I urge them to cut down on their simple carbohydrates. And when I list these simple carbs, their eyes widen, because these are their staples. These are things they can actually afford, and things that can fill the tummies of their children.

why is a big mac cheaper than a salad

I tell them about eating fruits and veggies, while I know that the country is suffering a drought; that vegetables are not only scarce but expensive; that subsistence farming is a noble idea but one that often falls flat in our socioeconomic environment.

And then I tell them about leading an active lifestyle, and I can hardly take myself seriously. Because my patients don’t live in safe, walled-in suburbs. They live in places where simply being outside can get you a knife in your chest; and where the female body is often synonymous with violation. If I am afraid when I go for a run, why wouldn’t they be?

Am I being a naysayer? I am trying to be realistic. I don’t think it’s impossible for poor(er) people to lead healthy lifestyles. But if it is hard for the affluent, then I know it’s damned harder for those who suffer, and I want other healthcare workers to understand that too.


  1. Matt says:

    This is something I desperately try to get the 12 years I teach to see. Income disparity is not just about income, its about everything.

  2. Great post, and something that my patients face every day. For my own education, I recently did an exercise in which I put together a food budget based on what social assistance pays in my city, and it was shocking. In order to include enough calories, I would basically have to live off of pasta and tomato sauce. No fresh fruits or vegetables, minimal meat (and only the salty processed stuff), and no milk on that kind of budget. And that’s assuming I can use my full food budget on food and don’t need to pay for bus fare to get to the store!

  3. Shooo! Great post, Dr Megz! Wow!

  4. Nancy Ackelson says:

    Very interesting post Mariechen. think the situation is, sadly, pretty similar here.


  5. The Elderly Young Adult says:

    This post is so important and is really informative. Thank you!

  6. Kwanele Ngxoweni says:

    Dr Mega

    Your posts really are great. I am at UCT and currently doing my General Med block. I found myself annoyed today during a tutorial when a couple of friends and the tutor started blaming the patients for “excess adipose tissue”. I recommended they read this post immediately.

    Thank You. Very informative. Great Perspective.

    1. barefootmegz says:

      Hi Kwanele, thanks so much for your comment. It makes me happy to know that what I write means something to some students. Stay empathic, stay kind. Good luck with your rotations! ❤

  7. smallfitness says:

    You really hit on some good points

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