What Would Make Americans Eat Better? – chicagobooth.edu
This American exceptionalism has a high cost for the US health system. In the US, obesity (which afflicted four in 10 Americans in 2020, according to the CDC’s National Health and Nutrition Examination Survey) costs about $170 billion per year, the CDC estimates.
Some academic research is adding rigorous data to the evidence that demand is, in fact, a crucial piece of this puzzle. In which case, what can policymakers do to improve diets in Riverdale and across the country?
The ultraprocessed problem
Consumers are barraged with mixed messages about food—what is healthy, what isn’t, which fad diet they should follow today (low-carb, low-fat, high-fat, carnivore) and which is no longer in favor. Most nutritionists say there is a place for all foods—including fries, frozen pizza, and ice cream—in any balanced diet. Eating hot dogs and chips at your Fourth of July barbecue is not a problem for most, and no one should be expected to replace a birthday cake with a bowl of kale. Even having nightly dessert after a balanced dinner does not have to pose a problem for your health.
However, most also agree that diets on the whole should lean more toward foods that are fresh, such as raw produce and legumes, or only lightly processed, which can include choices such as canned beans, Greek yogurt, olive oil, and nut butter. And they should lean away from ultraprocessed foods, many of which contain high amounts of artificial flavorings, colorings, sweeteners, and preservatives.
Nutritional value within this category can vary, but the biggest offenders contain “often chemically manipulated cheap ingredients such as modified starches, sugars, oils, fats, and protein isolates, with little if any whole food added,” per an editorial by Carlos A. Monteiro, Eurídice Martínez-Steele, and Geoffrey Cannon from the University of São Paulo, published alongside the BMJ review. Research led by University of Michigan’s Ashley N. Gearhardt and also published in the BMJ finds that items such as chips, cookies, sugary cereals, and packaged rolls might be classified as addictive substances, just like alcohol and cigarettes.
Diets that lean too far toward tasty but bad-for-you foods have a high cost for patients as well as health systems. The BMJ review finds that diets high in ultraprocessed foods are associated with an increased risk of type 2 diabetes, cardiovascular disease, obesity, anxiety, and depression. The researchers note that, broadly, more controlled trials would be needed to better establish causality between this type of diet and outcomes related to these serious health problems, but, says Lane, “setting up trials testing the effect of long-term exposure to diets rich in ultraprocessed foods on hard disease endpoints such as cardiovascular disease or cancer won’t be possible, for obvious ethical reasons.”
This issue of diet is of particular policy concern in poorer communities, both urban and rural, where lack of car ownership, among other factors, can keep people from quality grocery stores. A 2023 study by five American Cancer Society researchers finds that lack of accessibility to healthy foods, in terms of distance and transportation, was associated with lower life expectancies at birth.
Many policymakers have focused on access. The USDA in 2022 partnered with Reinvestment Fund, a mission-driven financial institution, to invest nearly $23 million in improving access to healthy foods—and this April announced another $40 million in grants “to provide financing and technical assistance to food retailers in underserved communities.” Ridding the country of food deserts was also a key part of first lady Michelle Obama’s Let’s Move! initiative. In 2011, speaking at a mayor’s summit in Chicago, she noted, “It’s not that people don’t know or don’t want to do the right thing; they just have to have access to the foods that they know will make their families healthier.”
The importance of demand
But some research casts doubt on this line of thinking. A research team that included Chicago Booth’s Jean-Pierre Dubé studied grocery purchases across 60,000 households and about 35,000 stores throughout the US from 2004 to 2015, when more than 1,000 grocery stores opened in areas meeting the government definition of food deserts. The data confirm what shoppers have previously indicated on self-reported surveys: there is a large nutrition gap between the wealthiest and poorest households.
But placing a supermarket in a food desert did not have a substantial effect on food choices. The researchers cite data from the 2009 National Household Travel Survey to note that people who lived in food deserts still shopped predominantly in supermarkets offering healthy products, even though it required traveling to retailers outside of their area. These residents overall traveled an average of 7 miles, and those in households earning less than $25,000 a year traveled an average of 5 miles each way to buy groceries and other items. Even low-income residents of a food desert without a car traveled an average of 2 miles to shop at a grocery store. (According to the USDA Economic Research Service, of the almost 40 million people living in census tracts defined as low-income and low-access in 2019, just over half of them have did have some access to a food store.)
