Foods: Healthy Foods are Expensive (cont.)

In 1904, being fat meant that you had the wherewithal to buy plenty of food and didn't need to burn calories in hard labor to earn your daily bread. In 2004, being fat is often an unwanted byproduct of being poor.

"We've known that very rich people are almost always thin, rarely fat, and that the lower you go down the socioeconomic status ladder, people tend to be fat," Castellanos tells WebMD.

It isn't laziness, either. According to the Greater Boston Food Bank, nearly half of all people who receive assistance from food pantries nationwide live in households with at least one working adult, and of the 23 million who receive food assistance in the U.S., 9 million are under age 18.

Workers earning the federal minimum wage of $5.15/hour (the standard in 29 states) gross $206 in a 40-hour week, or at best $412 if they can manage to hold down two full-time jobs. Out of that pay they have to subtract the costs of housing, transportation, utilities, child care, clothing, and food. So how does a family of four at or near the poverty level spend their food budget -- on spaghetti at 3 lbs. for a dollar for a bargain brand, or on 1/6 of a pound of salmon at $6.00 a pound?

"High-fat, energy-dense foods are often the cheapest options for the consumer. As long as a meal of grilled chicken, broccoli, and fresh fruit costs more, and is less convenient, than a burger and fries or a peanut butter sandwich, then the battle against obesity will be lost," write the editors of the UK medical journal The Lancet in the January 31, 2004 issue, in an editorial titled "Who Pays in the Obesity War."

The same editorial notes that the estimated $75 billion dollars spent in the U.S. on medical costs linked to obesity "equates to $175 each year for every U.S. taxpayer, who pays for obesity-related illness including heart disease, cancer, diabetes, and gallbladder disease, via Medicare and Medicaid programs."

"I would love to see more subsidies for fruits and vegetables, making fruits and vegetables more readily available, particularly amongst poor people," says Barbara J. Rolls, PhD, professor of nutrition at Pennsylvania State University in University Park, Pa., in an interview with WebMD. "The produce that's available in poor communities is shocking -- non-existent, or really bad. A lot of poor kids never taste fresh vegetables. A kid in our graduate program went and worked in a poor community in Philadelphia; the children in that community had never even seen a banana."

Rolls, who also presented data at the Harvard School of Public Health symposium, studies how the size of food portions and the content of dishes can contribute to weight gain. She advocates small dietary changes that can be made by people on limited budgets and can help to modestly decrease the energy density of inexpensive common dishes such as macaroni and cheese.

"I'm not thinking dramatic: I'm thinking building toward goals with smaller changes. Take out some fat, and add in some water-rich vegetables, such as celery and onion, and try to do it in a way that isn't going to cost an arm and a leg but is going to have some significant impact," Rolls tells WebMD.

Castellanos tells WebMD that federal agricultural subsidies "have not kept up with the nutritional problems of modern-day America. I think when we started school lunch programs, commodities and a lot of these price supports, we were worried about people getting enough calories. I think we haven't kept up with the science and the current health problems of Americans and made adjustments."

Ultimately, both food producers and their customers need to play a role in changing attitudes about food choices, says Rolls.

"In the end, the problem is that the food industry is giving people what they want. They're very good at figuring out what we want and providing it, and trying to provide it cheaply, because they know that brings people in. So we really have to work on consumers, too. Consumers have to demand better food. If they demanded smaller portions, they would get them. So I think what we need to demand is more choices of portions, and not jacking up the price so much."

Published March 19, 2004.

Adam Drenowski, PhD, Center for Public Health Nutrition, University of Washington, Seattle. Victoria H. Castellanos, PhD, RD, National Policy and Resource Center on Nutrition and Aging, Florida International University, Miami. Barbara J. Rolls, PhD, Pennsylvania State University, University Park, Pa. Greater Boston Food Bank. U.S. Census data. Dept. of Health and Human Services. The Lancet, January 31, 2004, p 339. U.S. Department of Labor Employment Standards Administration Wage and Hour Division.

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