NewScientist: Food stamps could help US trim obesity epidemic
Re-posted from NewScientist.com.
View the original story, with photos >>
This is the San Francisco that the tourists never see: the Alice Griffith housing project in the neighbourhood of Bayview-Hunters Point is as distressing an example of urban decay as you'll witness anywhere in the US. Housing units are boarded up; broken bottles crunch underfoot; police cars rumble by.
I'm here in the south-east corner of the city with Dana Andrews, who worked as a nutritionist for the local YMCA until a couple of months ago, when multiple sclerosis forced her to quit. Today, like many of her former clients, she has to rely on the federal Supplemental Nutrition Assistance Program (SNAP) for her basic needs. "If I didn't have it, I don't know where I would be," she says.
As the US Congress wrangles over legislation to renew funding for SNAP – generally known as "food stamps" – deep cuts seem likely that will hit these streets especially hard.
Listen to some of the political rhetoric, and you would imagine that the cost of feeding nearly 48 million food-stamp recipients is dragging the US economy into the mire. In fact, research by the US Department of Agriculture (USDA) suggests that SNAP stimulates as much as $9 of economic activity for every $5 it spends – knock-on effects that are especially important in depressed neighbourhoods like Bayview-Hunters Point.
What's more, public health advocates say the current political acrimony has obscured a big opportunity: using SNAP to experiment with solutions to the US's wider problems of poor nutrition and obesity.
Because junk food is cheaper than fruit and vegetables, poverty and obesity tend to go hand-in-hand. But even after controlling for this association, some research suggests that recipients of food stamps are more likely to be obese. In a 2010 analysis, for example, Charles Baum of Middle Tennessee State University in Murfreesboro estimated that, for women, receiving food stamps boosts the prevalence of obesity by 13.5 per cent.
This does not mean that SNAP can be blamed for the US obesity epidemic, which is so huge that any increase linked to food stamps would be hard to detect. But it does indicate that there's scope for experimenting with the way in which benefits are delivered to improve the health of the country's poorest citizens.
One simple idea is to give the benefits every two weeks, rather than monthly. This would smooth out a cycle in which people load up on high-calorie food when the payments come in, then go hungry towards the end of the month – a pattern known to cause weight gain. Such a monthly cycle may explain findings like Baum's.
But most attention is focused on efforts to provide incentives to buy fruit and vegetables, or restrict purchases of junk food. A pilot project delivered promising results last month. Over 14 months to December 2012, 7500 households receiving food stamps in Hampden, Massachusetts, were given an extra 30 cents for every dollar spent on fruit and vegetables. Surveys run four to six months into the study show that their consumption of fruit and vegetables was 25 per cent higher than for people on regular food stamps.
Sanjay Basu of Stanford University in California has studied how changes in food prices affect what people put in their shopping baskets. His work suggests that banning food-stamp purchases of unhealthy foods, or increasing their price, should be even more effective (Medical Decision Making, doi.org/nbf).
But the idea of restricting people's choice is controversial, and influential lobby groups oppose any such change. These include the Food Research and Action Center, the main non-profit group campaigning against hunger in the US, and the Grocery Manufacturers Association, whose members make billions of dollars from purchases made under SNAP. Against this background, the USDA, which backed the Hampden study, has so far denied requests to experiment with restricting purchases of junk food.
Fast food habit
My trip to Bayview-Hunters Point exposed further difficulties. Andrews took me to meet Christine Drummer, who helps run a food pantry in the Alice Griffith Housing Project. She distributes packages of fresh food to local residents – many of them seniors who cannot walk to the nearest supermarket, a mile or so away. Drummer, who lives nearby, is frustrated that more local residents are not making use of the pantry service. "People around here don't know how to cook well," she laments.
That's in large part a consequence of the neighbourhood's long-standing status as a "food desert" – where fast food joints and convenience stores are the main suppliers of food. "If a kid's used to eating fast food, then they're going to adapt to this habit of bad nutrition," Drummer says. Her comments echoed in my mind later as we visited a nearby corner store, when a child who asked Andrews for money to buy a soda turned down her offer of an apple.
Any fundamental changes to SNAP would need careful pilot studies, to ensure that already vulnerable groups are not put at a further disadvantage. Recipients' benefits are loaded onto a debit card that allows them to shop just like anyone else, without being publicly identified. One concern is that people who are told at the checkout that they cannot buy certain products will feel a stigma that will drive them away from taking the benefits.
Yet despite all the obstacles, recipients of food stamps do seem willing to embrace reforms that would nudge them into making healthier choices. In a survey of recipients run in 2012 by researchers at the Harvard School of Public Health, 54 per cent said that they would support removing benefits for sugary drinks (Public Health Nutrition, doi.org/nbg).
Results like that make public health researchers optimistic that SNAP could become a vehicle for testing solutions to the US's collective weight problem. If economic carrots and sticks can be used to improve the diet of some of the country's most disadvantaged citizens, then the stage would be set for using taxes and subsidies to nudge the nation as a whole towards a healthier relationship with food.
"We can solve this," says Hilary Seligman of the University of California, San Francisco, who studies the links between food insecurity and chronic disease. "It only takes political will and resources." Right now, however, those two things seem to be in short supply where it matters most – in the corridors of power in Washington DC.