Financial belt-tightening could result in a literal belt loosening as hard times force people to adjust their dietary habits, according to a German study of indebtedness and obesity.
The likelihood of being overweight or obese doubled with increasing indebtedness, an association that could not be explained by other socioeconomic or medical factors, according to an article published online in the journal BMC Public Health.
One plausible explanation relates to the potential impact of indebtedness on risk factors for obesity and other chronic diseases.
"These findings are in accordance with international models assuming a link between individual's financial situation and the diversity of access to 'healthy' food," Eva Munster of the University of Mainz and colleagues observed. "An inverse relationship between energy density of food and its costs, combined with the inability to pay, can be a partial reason for the higher risk of overweight or obesity among overindebted subjects."
Some clinicians in the United States expressed doubts about the study and its applicability to the U.S. But others said its statistical rigor made the relationship between debt and waistline an important finding.
One thing there's no doubt about: worldwide economic turmoil has led to a substantial increase in the proportion of overindebted residents in Europe and the U.S. The authors defined overindebtedness as "lack of possible debt redemption in due time due to the relation of income and cost of living after a remarkable cutback in standard of living."
Socioeconomic status has a well-documented association with health, particularly overweight and obesity. However, conventional definitions of socioeconomic status do not account for overindebtedness, the authors continued. As a result, the impact of indebtedness on health remains unknown.
In an effort to clarify relationships, investigators examined results of two population-based surveys in Germany. One from 2003 covered disease risk factors, quality of life, utilization of healthcare and socioeconomic status in the general population, while the other assessed the health status of overindebted individuals. The data involved 8,000 individuals from the health survey and 949 respondents to the debt survey.
Being in Debt Linked to Obesity, Other Ills
Comparison of the two survey cohorts showed that the overindebted group was younger, less educated, and had a lower income. Overindebtedness also was associated with a higher prevalence of depression, overweight, obesity, and tobacco use.
Taking other factors into account, the authors found that overindebtedness was associated a nearly doubled risk of being overweight -- and two and a half times the risk for obesity.
"Overindebtedness affects a series of risk factors for chronic diseases such as leisure time activities, as well as participation in social activities," the authors concluded, adding that diet could also play a role.
"Energy-dense food such as sweets or fatty snacks are often less expensive compared to food with lower energy density, such as fruit or vegetables," they added.
The authors suggested that "low-pricing campaigns" to increase the availability of healthy foods could be an effective public health strategy.
The results got a mixed reaction from U.S. clinicians. Dr. Lewis Kuller of the University of Pittsburgh said the findings suffered from the fact that the data were all collected at once, and not at many points in time.
"Did the individuals gain weight when they lost [their] income [or] job over indebtedness?" he asked. "Or were they already obese, overweight before their economic problems?"
Dr. Tim Byers of the University of Colorado in Denver noted that the results difficult to interpret, limiting the ability to extrapolate to the U.S.
"The new wrinkle here of this measure of indebtedness is hard for me to assess," said Byers. "I am not sure what this really means as a social factor in Germany, as measured. I therefore do not think this study adds valuable new information, especially for those of us in the U.S."
In contrast, New York physician Dr. Emanuela Taioli said study's methods were credible – and that the implications of indebtedness to diet were particularly interesting.
"This result is even more applicable to the U.S., where unhealthy food is currently much cheaper and more affordable than healthty food, and so is water in comparison to sugary drinks," said Taioli of SUNY Downstate Medical Center in Brooklyn. "This will have a large impact on the current U.S. obesity problem, now that the proportion of people with debts is increasing."
This article was produced in collaboration with ABC News.