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Cited by 2,786Obesity, Physical Activity, DietFood Security and Health in Diverse PopulationsNutrition, Health and Food Behavior

Poverty and obesity: The role of energy density and energy costs

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Drewnowski, Adam, Specter, SE·2004·The American Journal of Clinical Nutrition
DOI 10.1093/ajcn/79.1.6
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Abstract

Many health disparities in the United States are linked to inequalities in education and income. This review focuses on the relation between obesity and diet quality, dietary energy density, and energy costs. Evidence is provided to support the following points. First, the highest rates of obesity occur among population groups with the highest poverty rates and the least education. Second, there is an inverse relation between energy density (MJ/kg) and energy cost (US dollars/MJ), such that energy-dense foods composed of refined grains, added sugars, or fats may represent the lowest-cost option to the consumer. Third, the high energy density and palatability of sweets and fats are associated with higher energy intakes, at least in clinical and laboratory studies. Fourth, poverty and food insecurity are associated with lower food expenditures, low fruit and vegetable consumption, and lower-quality diets. A reduction in diet costs in linear programming models leads to high-fat, energy-dense diets that are similar in composition to those consumed by low-income groups. Such diets are more affordable than are prudent diets based on lean meats, fish, fresh vegetables, and fruit. The association between poverty and obesity may be mediated, in part, by the low cost of energy-dense foods and may be reinforced by the high palatability of sugar and fat. This economic framework provides an explanation for the observed links between socioeconomic variables and obesity when taste, dietary energy density, and diet costs are used as intervening variables. More and more Americans are becoming overweight and obese while consuming more added sugars and fats and spending a lower percentage of their disposable income on food.

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  • Food insecurity drives reliance on energy-dense, nutrient-poor foods due to cost constraints and limited access to fresh produce.

    “Food insecurity paradoxically drives reliance on energy-dense, nutrient-poor foods due to cost constraints and limited access to fresh produce [30].”

    From Obesity: Clinical Impact, Pathophysiology, Complications, and Modern Innovations in Therapeutic Strategies (2025) · cites this paper as [30]

    The Energy-Density Cost Framework proposes that food-insecure consumers may choose cheaper, energy-dense foods to save money, and “Do Healthy Diets Cost More?” associates fresh produce with higher costs. The paper frames this as a hypothesis rather than an established causal effect; it supports limited financial access to produce, but does not establish a separate lack of physical access. (LLM, conf=0.86)

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  • Several foods traditionally supported by agricultural policy, such as wheat, corn, dairy, and beef, are typically more energy-dense and less nutrient-dense, served in larger portion sizes, and, in some cases, less expensive on a per-calorie basis than foods less supported by agricultural policy such as fresh fruits and vegetables, whole grains, nuts, and fish.

    “Several foods traditionally supported by agricultural policy, such as wheat, corn, dairy, and beef, are typically more energy-dense and less nutrient-dense, served in larger portion sizes, and, in some cases, less expensive on a per-calorie basis than foods less supported by agricultural policy such as fresh fruits and vegetables, whole grains, nuts, and fish.148,182,183”

    From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [182]

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Research works printed but not linked: 13

  1. [14]14. O'Beirne K. Poor and fat. A special problem in America. The National Review 2003;February 10.
  2. [19]19. Specter SE. Fat substitutes and fat-modified foods: realistic expecta- tions for palatability, satiety, and weight control. J Women's Health 2000;9:445.
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  5. [37]37. Basiotis PP. Validity of the self-reported food sufficiency status item in the U. S. In: Haldeman VA, ed. American Council on Consumer Interests 38th Annual Conference, Columbia, MO. Washington, DC: US Department of Agriculture, 1992.
  6. [41]41. Drewnowski A. Palatability and satiety: models and measures. Ann Nestle [Fr] 1998;56:32-42.
  7. [60]60. Specter SE, Ello JA. Improved liking for fat-modified foods follow- ing repeated exposures may depend on food-specific sensory at- tributes. Obes Res 2000;8:25S (abstr).
  8. [61]61. Specter SE, Bellisle F, Hémerey-Véron S, Fiquet P, Bornet FRJ, Slama G. Repeated exposure to low-fat ice cream does not engender decreased acceptance or lead to subsequent energy compensation. Eur J Clin Nutr 1998;52:703-10.
  9. [62]62. Skinner JD, Carruth BR, Bounds W, Ziegler PJ. Children's food preferences: a longitudinal analysis. J Am Diet Assoc 2002;102: 1638 -47.
  10. [84]84. Sharpe DL, Abdel-Ghany M. Identifying the poor and their consump- tion patterns. CNPP Fam Econ Nutr Rev 1999;12:15-25.
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  13. [98]98. Ziliak ST. Some tendencies of social welfare. Cato J 2002;21:499 - 513.

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Authors
Drewnowski, A., & Specter, S.
Affiliations
United States Department of Agriculture (US)
Corresponding author
Drewnowski, Adam
ORCID
Drewnowski, Adam
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2004-01
Volume
79
Issue
1
Pages
6-16
ISSN
0002-9165 (ISSN-L)
DOI
10.1093/ajcn/79.1.6
OpenAlex
W2155305187
Cited by
2,786
References
109
Citations by year
2026: 69 · 2025: 90 · 2024: 77 · 2023: 80 · 2022: 97 · 2021: 111 · 2020: 140 · 2019: 115 · 2018: 119 · 2017: 147 · 2016: 157 · 2015: 178 · 2014: 167 · 2013: 160 · 2012: 183
FWCI
114.27
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • University Libraries (University of Maryland) (submittedVersion)
  • Digital Repository at the University of Maryland (University of Maryland College Park)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
obesity, poverty, energy density, energy costs, diet quality, food insecurity, socioeconomic disparities, added sugars, dietary fat, refined grains, food expenditure, fruit and vegetable intake, palatability, health disparities
MeSH terms
Adult, Child, Diet, Educational Status, Energy Metabolism, Female, Food, Humans, Hunger, Male, Obesity, Poverty, Social Class, United States, Body Mass Index

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