Obesity among homeless almost as high as in general population, study finds

By Evelyn Theiss

Cleveland Plain Dealer, May 22, 2012

When you think of destitute and homeless people during the Great Depression, it brings to mind painfully thin, haggard men and women as seen in iconic Dorothea Lange photos.

These days, malnourishment among the homeless looks very different. Surprisingly, according to a new study done by researchers at Harvard and Oxford universities, obesity may be the new picture of malnutrition, even among the poorest of us.

The researchers found that obesity is just as common among the homeless as among the general population -- a rate of about 1 in 3. Their findings will be published in the Journal of Urban Health (Bulletin of The New York Academy of Medicine).

Researchers examined the body mass index, or BMI, of 5,632 homeless men and women in Boston, and found that nearly a third of them were obese. They determined their BMIs by using electronic medical records from 80 hospitals and shelters, through the Boston Health Care for the Homeless Program.

It's one of the largest studies of adult homeless populations ever done.

The study found that just 1.6 percent of the homeless in the sample could be classified as underweight. In contrast, morbid obesity -- where people are 50 percent to 100 percent above their ideal body weight -- was three times more common, with 5.6 percent of homeless adults classified as morbidly obese.

The authors of the study also compared the BMIs of the homeless adults with 5,555 nonhomeless adults, using data from the National Health and Nutrition Examination Survey. They found that obesity among the homeless, at 32 percent, was almost as high as among the general population, where it is 34 percent.

However, homeless women had a significantly higher percentage of obesity (43 percent) than nonhomeless women (35 percent).

Why are today's homeless obese?

The study suggests a number of explanations. First, being homeless often means a mostly sedentary lifestyle, along with sleep deprivation and stress. Those three factors are known to contribute to obesity. Also, there are physiological changes in the body when food intake is inconsistent. Basically, since the body doesn't know when it's going to get food again, it's more likely to "hang on" to calories and fat.

Food that shelters or other "institutional" providers serve is often high in refined carbohydrates, and that likely adds to the problem. Food-pantry donations, which are usually nonperishable goods, are processed and often high in sugar and carbohydrates. And when homeless people buy food, it's likely to be inexpensive and low in nutrition but high in calories.

Study author Katherine Koh, a student at Harvard Medical School, explains that the overweight-homeless scenario mimics what's called the "hunger-obesity" paradox.

"The rise of obesity among populations that don't have regular access to food has recently been documented in developing countries and in certain low-income populations," she says. "This research shows that this paradox may affect homeless people as well."

Paul Montgomery, a co-author of the study who is a professor of psychosocial interventions at the University of Oxford in England, says the study shows the importance of the quality, as well as the quantity, of food that homeless people eat.

"Interventions aimed at reducing obesity in the homeless, such as improving nutritional standards in shelters or educational efforts at clinical sites, should be considered in the light of these findings," he says.

Helping one another

Can pairing older adults with children help both groups get more active? A new program that does so is designed to encourage healthier eating and exercise.

Created by the OASIS Institute (a national education organization), the "CATCH Healthy Habits" program recently received a $2.7 million grant for national funding, which will expand the program to 18 cities. The Cleveland program also received a $41,000 grant from the Anthem Blue Cross and Blue Shield Foundation.

The idea is not just to help children, but also the adult volunteers. Volunteers work with children in kindergarten through fifth grade for weekly one-hour sessions, during which they play active games, learn about healthy food choices and make nutritious snacks.

In the United States, 35 percent of people who are 50 and older lead sedentary lifestyles, and less-than-active lifestyles in children are believed to contribute to their rising obesity rates. Erin Hoeflinger, president of Anthem Blue Cross and Blue Shield of Ohio, says of the program, "We've seen the positive difference it makes in the lives of the students and adult volunteers involved in the program."

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The New York Academy of Medicine
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