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The Cost of Healthy Eating

The views expressed are those of the author and are not necessarily those of Scientific American.


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How do you spend your food budget? | Photo by Maureen Reilly, CC. Click on image for license and information.

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?

Reference:
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

Krystal D'Costa About the Author: Krystal D'Costa is an anthropologist working in digital media in New York City. You can follow AiP on Facebook. Follow on Twitter @krystaldcosta.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. killgrove 1:49 pm 04/16/2012

    I wonder if the growing trend in urban gardening will change the way we eat in a significant way. We have a role model in the Obama White House, where a big deal was made out of Michelle Obama’s creation and maintenance of a vegetable garden (http://www.nytimes.com/2009/03/20/dining/20garden.html). But I’m not sure anything short of another world war would make victory gardens catch on again, since food production in the US is now quite mechanized and since most people now live in urban or semi-urban areas and don’t necessarily have the land, time, or money needed to grow their own food.

    Have there been any projects to bring green spaces and food-producing gardens to urban areas like NYC? Like, co-op type gardens in places that are food deserts?

    Link to this
  2. 2. em_allways_right 3:59 pm 04/16/2012

    Drinking whole milk is like eating a stick of butter. ick

    Link to this
  3. 3. Hasufin 7:01 pm 04/16/2012

    I note especially the study which found “no systematic difference between low priced and branded products in terms of nutrient content, raw materials, microbiological analysis, or taste.”

    Many of the factors we use to determine our food purchases are subjective. We desire food that is “wholesome”, but what we consider wholesome or flavorful is based on our expectations and to a large part our upbringing. For example, I prefer grade B maple syrup, and will spend quite a bit for it. In theory, it’s a lower quality than grade A, but in my own opinion the flavor is better. On the other hand, my ex gamely tried maple syrup and decided that she did not like it – she vastly preferred the very cheap pancake syrup.
    In addition, consumers are given inaccurate and conflicting information about nutritional content. While it’s correct that unprocessed produce has more nutrients than processed, there’s not necessarily a difference between “organic” and “normal” produce – but that doesn’t stop some suppliers from making outlandish claims!
    And even comparing processed and unprocessed foods, will the nutritional value of the actual food be different? The reason processed foods are less nutritious is because the processing (i.e., cooking) breaks down those chemicals. So, is there for example a nutritional difference between a can of stewed carrots which have been warmed to serving temperature, and organic carrots which were bought and then stewed at home? Probably not!
    But there’s a major perception difference – people who are “serious” about food – foodies – will go to great lengths to get the ingredients they desire. And then, having invested more time and money into acquiring ingredients, will subsequently invest more time and effort into the cooking, too. Assuming competent cooking, that will yield a better product. Is that because of the ingredients, or the technique? (In my own experience, it’s definitely the technique, but don’t tell your guests you’re using cheap ingredients).

    Link to this
  4. 4. Krystal D'Costa in reply to Krystal D'Costa 8:44 pm 04/16/2012

    Hasufin, I agree that the distinction between “organic” and “normal” can be exaggerated. But I think the acceptance of “organic” goes beyond the foodie culture. We’re bombarded from so many different sources about the benefits of taking the time to cook things from scratch that canned goods start to feel like an unmentionable short-cut—whether or not you’re a competent cook! This view allows for a premium on organic goods. But what is it that we’re paying for? Time? That someone was able to grow the produce that we might be able to grow if we had the time, space … or inclination?

    Link to this
  5. 5. Krystal D'Costa in reply to Krystal D'Costa 8:53 pm 04/16/2012

    KK, I doubt we’ll see the return of victory gardens, but yes, here in New York City, green spaces and urban gardens are on the rise. In the City, rooftops are the spaces that are being commandeered for gardens—and they provide the added benefit of helping to regulate building temperatures—perhaps if enough rooftops are used in this way, it can also help cool the City overall during the dog days of summer?

    Here are a few articles about this trend:
    The Rooftop Garden Climbs Down a Wall
    Urban Garden? Check. Now, Chickens.
    Healthier Eating Starts on the Roof

    Where I live currently, I have the space for my own garden … but no time for it. Plus, those house plants I was so tenderly nurturing a few weeks ago have not fared so well.

    Link to this
  6. 6. Hasufin 11:14 pm 04/16/2012

    Krystal, I absolutely agree. I’ve fallen into this trap many times, and I’ll admit it’s sometimes plain snobbishness.
    On the other hand, using processed foods limits your options considerably; I’m often frustrated when cooking at friends’ houses to find that they only have “pancake mix” and “cake mix” and frozen cookie dough, but they don’t have simple flour. That does extend to produce – there’s a great deal more I can do with fresh carrots than with canned carrots
    I think the key is that we shouldn’t fool ourselves. If I cook from fresh ingredients, I am putting more effort into the food, coming up with results that I could not have managed with processed food, and am (hopefully) showcasing that I am a good cook. I am NOT making healthier food than the same thing out of processed food.

    Something to think about, with respect to Victory Gardens today, is what we hope to get from them. It’s a considerable amount of time and effort to make a serious dent in your food budget with home gardening; I recall my grandmother’s yard, which was at times entirely devoted to gardening. My father tells of when he was young, and he and his four siblings would help can jar after jar of string beans. Rooftop gardens and raised beds simply don’t exist on that scale.
    But consider – in the American economy most professionals do skilled, often stressful work that never yields a tangible result. This is, I think, very frustrating for the psyche – the effort and the reward are so abstract that they cannot be emotionally connected. With many people who are in such a situation I am seeing them take up exceptionally anachronistic hobbies: quilting, candle-making, embroidery, crochet, woodworking, and yes, gardening. While they never have the time to devote for these crafts break even on cost, what they get is the comfort of an activity in which effort and results are in direct proportion to one another. Which, incidentally, is one of the draws of cooking from scratch!

    Link to this
  7. 7. SandyDandy77 1:42 am 04/17/2012

    Healthy eating is almost always worth the cost. Believe me, I know. I’ve actually lost over 70lbs in the past year.

    I was so proud of myself I even made a website to share what worked for me (Ok and maybe to brag a little bit:-))

    Check out the new me on my site: http://sandygotsmaller.com

    Link to this
  8. 8. catevictor 2:05 pm 04/18/2012

    My partner and I live in an inner city neighbourhood that is bordered by an upscale granola ‘hood. So our choices are expensive organic specialty stores or overpriced corner and small grocery stores. We don’t even have a discount grocer. The nearest supermarket is over a mile away and not easily accessible by bus. We have struggled with balancing our budget while eating healthy and have made the choice to make it work. The choice part is critical – we had to get to the point where we talked about it and made decisions that we can stick with.

    I’m a full-time student and my partner is an actor, so we aren’t exactly rolling in dough. Thus, we try to spend only $20 a week each on food, with three extras: local eggs, cheese and bread, which adds an additional $10 per week. This has worked surprising well for us and if you’re interested, I’ve posted some menus as well as some thoughts: http://retrench.wordpress.com/category/eats/

    I also garden like crazy, last year producing enough beets, onions and potatoes to last until December. Currently working on my thesis, which looks at community gardening in the inner city, so really appreciate your article and perspective. And the other comments!

    Link to this
  9. 9. ALJenkins 10:25 am 06/7/2012

    The relationship between certain stores and the BMI of their users is interesting, but I’m not sure it’s surprising.  For several subsets of urban consumers (esp. low-income individuals/families, seniors, and even some geographically-constrained middle-class minority groups), the scarcity of healthy food options combines with nutritional misinformation and a lower amount of money, time, and energy to make the “cost” (in more than just a monetary sense) of healthy eating challenging or, for some, really impossible to bear under current conditions.  I would encourage those interested in this topic to take a look at a recent study (2010) by the Chicago Policy Research Team called “Deserted?: A Policy Report on Food Access in Four South Side Chicago Neighborhoods” (http://cprt.uchicago.edu/report2010.shtml).  Through a variety of methods (e.g. mapping, surveys, interviews, focus groups, market basket data), the report shows what circumstances shape food purchasing and preparation tendencies and how people in urban areas struggling with food access concerns think about their options and how they navigate said options.

    Link to this
  10. 10. TobyLongbeach 7:24 am 03/26/2013

    On gardening: Some fresh produce is exorbitantly expensive at the grocery store as compared to growing it at home: tomatoes, fresh herbs except parsely and cilantro, zuccini and summer squash, cucumbers, persimmons, and berries of any sort except table grapes. Other fresh produce is very cheap compared to the inputs, equipment and space you would need to grow at home: regular mushrooms, potatoes, onions, cabbage, apples, yams, carrots, celery and tropical fruit such as bananas, mangos, etc. Growing fresh herbs indoors and growing tomatoes or cherry tomatoes can really make a difference in your budget.

    Health education makes a big difference in shopping habits. The more I learned about the unhealthfulness of canned foods, the more I have bought fresh and frozen. When I lived in upstate NY and was reliant on public transit, I found that frozen was easier to carry than canned and did not melt in the Winter.

    On cooking: Some foods are much tastier, healthier and less expensive to cook from scratch: Eggs, Chicken soup, tomato Pasta sauce, tofu stir-fry, hummous, rice, baked potatoes, quesadillas, salads in general, soups in general and steak. Also, tea and drip coffee. Espresso and espresso drinks at home are not worth the effort and expense IMHO.

    Some foods are better frozen or processed: brownies, popsicles, beans and legumes, chocolate, french fries, emulsion sauces like hollandaise (bring on the guar gum!), salad dressings. I’m not a baker and I think the time and effort that goes into baking, preheating the oven, wasted flour, etc. as well as the cleaning and prep time – baked goods in general I buy.

    Fried foods are actually cheaper at restaurants than doing it at home – there’s an economy of scale there. At home, you’re only using the oil once or twice, at a restaurant, they’re only changing the oil once a day at most (at most places, its more like once a week). Also, cleaning the spattered oil is a mess. Lastly, the oil in a commercial fryer gets hotter than at home and so the food absorbs less of the oil. Fried foods are not good for you but if I’m going to have them, I don’t fuss with making them at home.

    The most expensive things at the grocery store are condiments, meat, “gourmet” ready-to-eat foods, “gourmet” bottled beverages, “exotic” seafood and “exotic” produce. What counts as exotic or gourmet depends on the typical customer at the store. Its usually much cheaper to buy mexican food and produce typical of a Mexican diet at the mexican grocery store. Its usually cheaper to buy fish, seafood and asian food at the asian supermarket. Do not buy “white people food” like peanut butter at the asian or mexican supermarkets because to them, that’s “gourmet” and exotic.

    Restaurants, on the other hand, charge similar prices no matter what you buy.

    Eating healthy is hard – time is a bigger impediment than money, though – especially if you are taking transit and have children or other dependents at home.

    Link to this

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