Bargaining for Better Health: Chewing on Food, Nutrition, and Cost

From Dr. David L. Katz, Director, Yale University Prevention Research Center and Editor-in-Chief of Childhood Obesity

Along with good use of our feet (being physically active), good use of our forks (eating well) counts as one of the most important determinants of not just weight, but overall health – for children and adults alike. There are, however, challenges to using our forks well – the price of good nutrition notorious among them.

Cost certainly can be a barrier to nutritious food. But confusion about what actually IS nutritious may be an even greater obstacle. Confusion about the relationship between cost and nutrition can be costly to the quality of both diet and health.

The conventional wisdom is that more nutritious food costs more. A 2011 study in Health Affairs showed that those spending the most on food came closest to recommended intake of potassium, fiber, vitamin D and calcium. Those spending the least had the highest intake of saturated fat and added sugar. This has been interpreted to support the prevailing view that more nutritious foods are inevitably more expensive.

But that prevailing view is often wrong.

Like everyone else, I had heard innumerable times that ‘more nutritious food costs more,’ but was never very impressed with the data to support the claim. So my colleagues and I generated some. We designed a simple experiment: we gave a volunteer shopper criteria for more and less nutritious foods, and had her pick examples of both from multiple food categories. We paid the grocery bill, so she didn’t need to worry about prices. We then compared the cost of more and less nutritious foods, category by category, from soup to nuts. We found no difference. In almost every aisle of almost every supermarket, it’s possible to trade up nutrition substantially without spending more money.

This is because higher prices are routinely attached to items that feign superior nutrition, but don’t actually offer it. There are literally thousands of products in the U.S. food supply that sport some front-of-pack message implying better nutrition- fat-reduced, sugar-reduced, lower-salt, multi-grain, etc.- that do not offer better nutrition.

Fat-reduced peanut butter is a one good example. It has a bit of healthy oil removed, the fiber content cut in half, and substantial additions of sugar and salt relative to the ‘regular’ variety. Multi-grain products are another. They often contain vanishingly small quantities of those ‘multiple’ grains, routinely provide less whole grain and fiber than far more humbly packaged alternatives, and invariably charge a premium for the multigrain label. Paying more for LESS nutrition is the literal addition of insult to injury (or vice versa)!

Along with paying a premium for pseudo-nutrition, we seem to have a cultural blind spot to the full spectrum of food choices. Lentils and beans cost much less than meat, while offering outstanding nutrition and an alternative protein source. Water costs less than soda, while offering a far more ‘nutritious’ means of achieving hydration. There are innumerable instances in which the more nutritious choice costs less.

So we don’t have to spend more to eat better. But imagine if we could always spend less! We could directly incentivize more nutritious foods to improve diet and health one better choice at a time. There is every reason to think such a program could save many more disease-care dollars than it spends on food subsidies, so it’s logical for the entity that currently pays those bills- an employer, an insurance company, the government- to ante up.

For now, we can acknowledge that the cost of nutritious food is often higher than it should be, and does act as a barrier to better diet and health. But we can also acknowledge that the cost of confusion about the true relationship between nutrition and price is at least as great- and that’s something we can fix right now, one family at a time- starting with yours! No credit card required.

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