Start Making Sense

Lately there has been a revival of interest in a subject that many people, regardless of how well-intentioned, have trouble wrapping their heads around: the paradox of obesity and food insecurity. How can they both exist together?

According to government figures,

12.8 percent of American households (17.0 million households) were food insecure in 2022, meaning that they had difficulty at some time during the year providing enough food for all their household members because of a lack of resources.

Sadly, what a lot of it boils down to is a survival mode, “Get it while you can” philosophy. When it’s uncertain where the next meal will come from — let alone, next week’s groceries — a person tends to chow down on anything that happens to be available because it might be their last chance for a while.

The language has evolved. Instead of “poor neighborhoods,” we say “under-resourced communities.” Instead of “hunger” we say “food insecurity,” but it all boils down to the same thing, in the words of writer Ann Shovels:

[…] the state where there is limited, inadequate, or unreliable availability or access to obtain nutritionally sufficient and safe foods in socially acceptable ways.

Of course, that definition can be broken down even further. It is against the law, anywhere, to break into an establishment and steal food from the stockroom. But things are a little different in the tourist-friendly part of town, where restaurants feature outdoor seating adjacent to public sidewalks. After the customer has finished and left, it is socially acceptable for hungry people to swipe leftovers from the tables, as long as they aren’t too obnoxious about it.

There are people who depend on street scores for most of their calories, and there are even other people who will considerately leave a partly-eaten lunch on an accessible ledge, rather than stuff it into a trash can because they know this.

Challenges on every side

The CDC (Centers for Disease Control) speaks of obesity in terms of the social determinants of health, “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.” According to the CDC,

Examples of social determinants can be job opportunities and income, access to education, healthcare, transportation, housing, and a safe physical environment, as well as the experience of structural racism.

A lot of factors figure into the ability to obtain food that doesn’t promote obesity. A person with no kids and a car is going to have better access to healthful groceries than a person with five kids and no car, that is for certain.

Now, suppose that a family member is too sick to be left at home alone. If no one else is available to cover for a while, the primary caregiver can’t go shopping. For many Americans, especially since COVID, the answer springs readily to mind: Have the groceries delivered, of course! But delivery of any commodity generally involves an extra charge.

Prosperous people forget that little detail, or maybe never know it in the first place, because their underlings handle such matters. A famous queen of France, when informed that the peasants didn’t have any bread, supposedly retorted, “I don’t see the problem. Just tell them to eat cake.”

To a sensible human, the logical flaw here seems obvious. If the lower class can’t afford plain old bread, they almost certainly can’t afford cake. But well-to-do people are often clueless about the challenges of the under-financed life. They just don’t get it.

All kinds of things can go wrong in families, and even if close friends and neighbors are willing to step up, they often can’t, because they are just as broke as the people they wish they could help.

Your responses and feedback are welcome!

Source: “Understanding the paradox of obesity and food insecurity,”, 12/22/23
Source: “Is Online Grocery Delivery Worth It?,”, 1/24/23
Image by Michael Coghlan/CC BY-SA 2.0 DEED

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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