German study links debt, obesity and access to healthy food

By Jess Halliday

- Last updated on GMT

Related tags Public health Healthy food Nutrition Obesity

People in financial debt are more likely to be obese, concludes a study from Germany that adds to concern that healthier foods cost more than energy-dense foods of low nutritional value.

The current financial squeeze has implications for household spending, and people may borrow more to make ends meet. In Germany, where the new study was conducted in 2006-7, 7.6 per cent of households (more than 6 million people) are over-indebted.

The researchers, led by Prof Eva Münster of the University of Mainz, noted that the link between socio-economic status, health and over-weight is well-documented but over-indebtedness has not been included in definitions of socio-economic status.

Prof Münster and her team found that on average over-indebted individuals tended to be younger, with lower education and income, than the general population. They had a higher prevalence of overweight, obesity, depression and tobacco use.

Healthy food access

The findings are “in accordance with international models assuming a link between individual’s financial situation and the diversity of access to healthy food,”​ wrote the researchers in the open access journal BioMedCentral.

Part of the reason for the higher risk can be “an inverse relationship between the energy density of food and its costs, combined with the inability to pay”.

“The choice of food is mainly determined by personal taste, choice and convenience, and less by health aspects or the will to maintain a well-balanced diet. Increasing the availability of healthy food by low-pricing campaigns can be an effective public health measure.”

The conclusions echo debate in the United States about the price and availability of healthy foods.

A public health research brief by the University of Washington Center for Public Health Nutrition, published last month, found that King county, Seattle is well-covered by supermarkets, but there was a vast difference in the price points between supermarkets serving different communities.

“There is an urgent need to provide consumer information on local food prices to improve access to affordable nutrient rich foods for all,”​ they said.

This week Prof Drewnowski, one of the authors of the Washington brief, submitted comments to the new Food and Fairness Inquiry, run by the Food Ethics Council in the UK, saying: ““Fat is a class issue,”​ he said. “Healthier diets cost more, so policies to tackle obesity must reduce economic inequality”.

Method and other factors

For the German study Munster and colleagues conducted telephone interviews with 8318 people in Rhineland-Palatinate and Mecklenburg-Western Pomerania, representing the general population.

An anonymous survey was also carried out amongst 949 clients of debt counselling centres.

Alongside their main conclusions the researchers pointed out that psychological associations could play a role: being depressed can lead to more food intake, and eating offers compensation and gratification.

Less money may limit leisure and sporting activities, too, which means less energy expenditure to burn off extra calories.

The researchers did not rule out a reverse association, either. They said that being obese could affect a person’s job prospects, so could become the cause of over-indebtedness.


Over-indebtedness as a marker of socioeconomic status and its association with obesity: a cross-sectional study
Authors: E Munster, H Ruger, E Ochsmann, S Letzel and A Toschke
BMC Public Health (in press)

CPHN Public Health Research Brief
The Search for Affordable Nutrient Rich Foods: A comparison of supermarket food prices in Seattle-King County
Authors: N Mahmud; P Monsivais; A Drewnowski

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