The Paradox of Nutrition Deficiency and Obesity

The Canadian Observatory on Homelessness
January 31, 2018

A common misconception about people experiencing homelessness is their weight, or lack thereof. While many people experiencing homelessness are on the lower end of the body mass index (BMI) scale (a measure of body fat based on height and weight), a considerable amount of them are overweight or obese. This means many of them have a BMI score between  25-29.9 (overweight) or a score of 30 or higher (obese).

In Carla D'Andreamatteo and Joyce Slater’s study, more than half of their 40 participants—men experiencing homelessness in Canada—were overweight or obese. A study on youth homelessness based in the U.S. showed that over half of its female participants were obese and 41% of its male participants were either overweight or obese. Among a study’s sample of 5632 adults in the U.S, 32.3% were obese, while only 1.6% were underweight.

Nutrition Deficiency

Despite their size, overweight and obese people experiencing homelessness are still at risk for malnutrition, just like their normal-weight and underweight counterparts. Overweight or not, numerous studies have shown nutrition deficiency among those experiencing homelessness. One study found  over 90% of its male participants were deficient in vitamin A and D3, along with calcium and magnesium. On the other hand, 100% of females were deficient in vitamin A, D3 and C, with over 90% of them lacking vitamin E and calcium. A study on youth homelessness based in Toronto found over half of its participants lacked folate, vitamin A and C, zinc and magnesium, and over half of the women surveyed lacked iron and vitamin B-12. Other studies have also shown deficiencies in certain vitamins, minerals and dietary fibre, but overconsumption of sodium, sugar and saturated fat.

Constrained by Living Conditions and Income

Nutrition deficiency and obesity among those experiencing homelessness exist because of the nutritiously poor, yet calorie-dense food they often eat, whether it’s food they’ve purchased or food from charitable services. Fresh fruits and vegetables are often expensive, so they turn to cheaper processed alternatives. One of the youth in the Toronto study relied heavily on Kraft Dinner, a brand of packaged macaroni and cheese dinner, because of its low price. Lack of access to an oven, stove and refrigerator also forces people experiencing homelessness to purchase unhealthy take-out or ready-made, packaged foods found in convenience stores. When making food choices, nutrition is rarely a priority for people experiencing homelessness. They eat just to survive and to satisfy a basic human need. Although many would like to eat healthier, their living conditions and little to no income limit their options and make it extremely difficult.

Soup Kitchens’ Reliance on Food Donations

Many of those experiencing homelessness or poverty rely on meals offered by charitable services, but these meals are also constrained by cost and are not healthier. A study on three American soup kitchens revealed that although eating two meals provided two thirds of the required daily amount of most nutrients, they lacked fibre and were extremely high in calories, saturated fat and sodium. D'Andreamatteo and Slater’s study showed how the participants’ reliance on charitable meal programs in Canada led to low consumption of fruits and vegetables, whole grains, and milk and alternatives, but high consumption of sugary, salty, and fatty foods.

Also, an analysis charitable meal programs in Victoria, Edmonton, Toronto, Quebec City, and Halifax revealed that many of them had limited government funding for food and were highly dependent on food donations, fundraising, and volunteer labour. Most of the programs provided meals made from both purchased and donated foods, but usually more than half of their supply came from donations. These donations included unsellable “leftover” foods from local businesses, and because of the foods’ nearing expiration, errors during manufacturing, or damage from shipping and handling,  programs sometimes received foods that weren’t edible. Although a majority of programs wanted or tried to follow nutrition recommendations, their small budget and reliance on donations determined the quantity and quality of their meals, which were highly variable. 

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Hunger

The obese and overweight population makes the issue of hunger and food deprivation among people experiencing homelessness no less severe. Accessing any food, nutritious or not, is an immense struggle many face. Some have to go to great lengths, such as survival sex, to satisfy their hunger. The analysis of charitable meal programs in Victoria, Edmonton, Toronto, Quebec City, and Halifax also found the number of meals the programs provided wasn’t enough to meet the demand. A quarter of them sometimes had to turn people away or shorten serving times when they ran out of food, and some cut portions in order to feed more people. 

Service times is another barrier people face when accessing meals. Some programs are only open once or twice a week and during certain times of the year; less than half of the programs surveyed in the Canadian cities study served meals five or more times a week and only 35% of them served meals on weekends. Moreover, only 64% were open all year round. The study based on youth homelessness in Toronto showed the unreliability and unpredictability of serving schedules, with certain programs closing on some days, even entire weeks, without warning. Because of the scant and unreliable serving times of charitable meal programs, people who rely on them are prone to hunger, or even worse, chronic food deprivation. In the Toronto youth study, 43% of females and 28% of males reduced their food intake for 10 or more days in one month, sometimes not eating for entire days. In the same study, some males showed muscle atrophy—also known as muscle wasting—a sign of severe food deprivation. 

Multiple Health Risks

Nutrition deficiency, hunger, and growing BMI scores coupled with the stress and hardships of homelessness, put those experiencing it at greater risk for physical and mental illnesses, and worsen existing ones like depression, substance abuse, and various sexually transmitted diseases. Nutrition deficiency can damage health in the long run, such as bone fractures later in life due to calcium deficiency. Obesity comes with its own problems: Type 2 diabetes, heart disease, and hypertension. Dietary fibre, which was low for many participants in the studies discussed, is linked to decreased chances of developing obesity, Type 2 diabetes and gastrointestinal disorders.

Conclusion

The charitable meal programs’ poor funding and dependence on donated, sometimes inedible, foods highlights something very problematic in our society: the “beggars can’t be choosers” belief, that people experiencing poverty and homelessness may be fed with “leftover” foods—even if these foods are nutritionally inadequate. After all, anything is better than nothing. However, as these studies have shown, not only are these foods harming their health, but there’s not enough of these foods to meet the high demand. There needs to be better strategies and policies to address the diets and nutrition of those experiencing homelessness.

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The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.