April 17, 2012: Global (all sites)
The Cost Of Healthy Eating
S has taken the lead in preparing our weeknight meals. It helps us get dinner on the table earlier but he’s also interested in helping us eat more healthfully. He’s invested a great deal of time into learning about healthy food options and healthy substitutes for the richer foods he enjoys. Our daily menu has shifted to include brown rice regularly, lots of salads and vegetables, and lean white meat. Oh, and oatmeal. Lots and lots of oatmeal. The reduced-fat milk is the hardest for me. Although he’s made it clear that I can eat what I want, but since he’s ramped up his efforts to eat well and get in better shape, it seems the right time to make this change together. It means that the days of savory lasagnes and chicken marsala and pesto have been limited to Sunday dinners, which is fine, but I really, really miss whole milk.
The change has made us more aware of what we’re buying, and what it costs to create a healthy meal. It’s hard—and that’s more than just typical whining about having to give up culinary treats. It requires a social and behavioral shift, but is also requires a serious reconsideration of our food budget and means questioning the effectiveness our personal food environment—where you get your foods is as important as what your foods are.
In addition to watching our fat and sodium intake, there’s something else to consider: The distance people are willing to travel for foods appears to be related to their weight and wellness. A recently published study in PLoS One found that among the French, those who shop at the same local supermarkets tend to have a similar body mass index and waist circumference. And while Basile Chaix and colleagues admit there are some challenges with this study, there are some general ideas that can be applied to our overall relationship to food and food procurement.
The study found that the greater the distance a person has to travel to his primary supermarket, the greater the person’s BMI and waist circumference. One possible reason for this may be that because supermarket visits are few and infrequent, the person is relying on canned and less-fresh products and not obtaining the maximum nutritional value from the foods available. Other factors that appear to be associated with a greater BMI and waist circumference include, a lower SES customer base, purchasing specific supermarket brands, and shopping at discount supermarkets.
New York City recognized the challenges residents of lower SES neighborhoods face in obtaining fresh produce and other healthy food options. For example, in both Bedford-Stuyvesant and Central Harlem, bodegas are more common than supermarkets. While they often function as food centers, they are severely limited in their offering:
- While offering convenient locations and hours, bodegas carry a narrower range
of products at higher prices than supermarkets and other stores.
- Bodegas are less likely than supermarkets to carry reduced-fat milk, apples, oranges, bananas, and green vegetables.
- Bodegas are also more likely to have ads for sugary juices, energy drinks, and tobacco.
Fast food is a prevalent option in lower income neighborhoods, as well. Taken together, the available food environment in these neighborhoods offers few options. To combat these limitations, the City launched the Green Cart initiative in 2008, a program that uses food carts as mobile produce stations throughout the five boroughs.
However, the green carts have not been without their own challenges. They must deal with low foot traffic, competition between vendors, finding and purchasing affordable produce, storing their carts, the weather, and fines for breaking the City’s strict rules (like vending too close to an intersection). And green grocers, supermarkets, and even bodegas view these mobile produce stands as competitors, whether they’re down the block or three blocks away, and are less than welcoming. So what’s the bottom line with these carts? Have they been successful in increasing fresh produce intake in lower SES neighborhoods? Results are mixed:
From 2008 to 2010, the percentage of residents in Green Cart communities who reported consuming no fruits or vegetables the previous day increased from 17.1 percent to 18.1 percent, while in non-Green Cart neighborhoods, the same number decreased from 10.7 percent to 9.5 percent. During that same period, the number of residents in Green Cart areas who reported consuming between 1-4 servings decreased by 2 percent. However, residents with Green Carts in their neighborhoods reported consuming five or more servings a day increased 1 percent.
It’s true that change takes time, but Chaix and colleagues offer an observation that may help us understand the slow adoption of the Green Carts: Access alone is not enough to change behavior. If shoppers in Supermarket A were suddenly placed in Supermarket B, their shopping behavior would reflect tendencies rooted in shopping at Supermarket A.
It’s not entirely about access—although that’s definitely part of the issue. The quality of the goods available is questionable, according to Chaix and colleagues:
Another French study published in 2009 reported no systematic difference between low priced and branded products in terms of nutrient content, raw materials, microbiological analysis, or taste. However, in the aforementioned French study, a weak relationship suggested that the overall quality of ingredients increased with the price of foods (within a given food category). Moreover, basic nutritional information and dietary recommendations were less often provided on low priced foods than on branded products. Overall, the published information is scarce and provides only mixed evidence in support of the idea that hard discount supermarkets are obesogenic nutritional environments.
If shoppers will retain their tendencies even if given the option to shop elsewhere, then they are will likely continue to by the non-perishable staples that are familiar to them—especially in the face of sticker shock.
Habits are notoriously difficult to break. For many residents in lower SES neighborhoods, relying on non-perishable goods that can be obtained at little to no cost from food banks and churches and other social centers continues to represent a viable option for feeding their families. Or purchasing goods from bodegas and discount stores that accept food stamps is a more realistic option—though some carts have adopted an electronic machine that would allow them to do this as well.
The amount of money in your pocket really does influence where and what you can eat. And that in turn influences the quality and variety of foods you have access to. Fresh fruits and vegetables start to look like a serious luxury when you realize that you can triple your purchase of canned goods for what you would spend on perishables, which will spoil within the week if not used. Or that a lunchtime salad—in New York City, at least—will cost you almost three times what a slice of pizza and a fountain soda will cost. There is a premium on healthy foods, which of course is not such a new thing: kings and lords have always tended to eat better than commoners. But if we want to break unhealthy food habits at an early age, are we putting those healthy options within reach of children, whose spending money may not match the premiums?
S and I were considering the changes in our personal food environments over the years, reflecting on the degree that our finances determined what we could eat and where we could shop—so that even when we had the means of traveling beyond our local food neighborhoods to green grocers and other specialty stores, we often didn’t (and the truth it, we still don’t). This discussion was spurred by wondering where we could shop to increase our healthy food options and realizing that at an early point in our lives together, our primary supermarket was a discount supermarket with canned goods that were dented and deformed. We shopped there when we needed pantry staples, got our deli meats from a bodega, and were surrounded by fast food options—there were three Chinese take-out places within a 2 block radius of our first apartment. And it’s not that we didn’t have a model of shopping in place: My parents did travel to increase their food options as did S’s parents, but they didn’t do so because they were health conscious, they shopped at different stores to help save. And they did buy fresh produce because it figured heavily in their diets in the first place.
The costs of healthy eating are negotiated by a number of factors: financial means, yes, but also by dietary preference, transportation, availability, and quality. What lengths do you go to to get variety in your diet?
Chaix B, Bean K, Daniel M, Zenk SN, Kestens Y, Charreire H, Leal C, Thomas F, Karusisi N, Weber C, Oppert JM, Simon C, Merlo J, & Pannier B (2012). Associations of Supermarket Characteristics with Weight Status and Body Fat: A Multilevel Analysis of Individuals within Supermarkets (RECORD Study). PloS one, 7 (4) PMID: 22496738
View the complete article at Scientific American