Berkeley Health asked Barbara Laraia, head of the School of Public Health’s program in public health nutrition, to explain how food and nutrition factor into the health equity equation.
What role does food play in the health inequities that we see within the United States?
Food, and access to food, has a large role in the inequity we see in dietary intake. From consumption patterns that the USDA Department of Agriculture looks at, we know, for example, that lower-income households consume a lot more foods that are high in fat and have added sugar—more sodas and more processed foods. And the high fat and high sugar content of these foods really influences chronic disease processes. There is a large differential by household income, and we do see that households with low incomes are heavier, they have higher BMIs, and that obesity prevalence is higher among lower- income households, as is obesity-related chronic disease, diabetes, and cardiovascular disease. Nutrition plays a direct role in the development of those diseases and in the maintenance of those diseases. Middle-and low-income households are more likely to experience food insecurity.This means that several times during the year, they have a shortage of food, they tend to skip meals and skip whole days of food intake. Among these households, women who are pregnant are more likely to have gestational diabetes, and adults in the household are more likely to have diabetes and have a more difficult time maintaining their diabetes. These households experiencing food insecurity have higher BMIs and higher levels of hemoglobin a1c, which is an indicator of poorer blood sugar control.
What does “food environment” mean?
Researchers look at the access and distance to food venues that offer healthy foods versus poorer foods, or they look at a density measure, such as, how densely populated is your neighborhood with food venues that have healthy food offerings versus unhealthy food offerings. Conventional wisdom describes a poor food environment as a lack of food venues that can offer fresh and healthy food such as fruits and vegetables, lean meats, and low-fat dairy products, and an abundance of food venues that offer high-fat, high- sugar, and processed foods. Convenience stores, for example, are venues that have a lot of food offerings that are processed and high in fat.
What are some of the most challenging aspects of the food environment?
I think what we’re learning is that with more than 24,000 new food products in the market every year, it’s very challenging to navigate one’s supermarket, or their neighborhood environment, to make healthy food choices. Because we are making choices every day, and three times a day, about what to eat, so there’s a lot of room for error. There’s a lot of room to give yourself permission to purchase a candy bar or get something on the run. This is challenging for the average individual, and it’s more challenging for lower-income households. Because of their income and what they have access to, they can’t possibly purchase all of the foods that are available for a healthy diet. They also lead hectic lives. They might be working two different jobs and trying to manage daycare and transportation issues. So they have very limited time. And education is really important— education about what to eat and how to prepare those foods, and how to prepare them within a time-limited day to eat a consistent healthy diet day in and day out.
What are some of the ways in which food policy needs to change?
A lot of the research is suggesting that if individuals live in a lower-income neighborhood that has poor access to food, that they might have a higher BMI, and they might have a poorer dietary intake. But if you follow those households over time, it’s really challenging in our statistical model and in our studies to see the direct effect of living in a poor food environment and the effect that has on their weight and their dietary intake. So the answer isn’t an easy one as far as policy and programs.
I think that for the large part, researchers are concluding that it’s not that if you build a supermarket, they’ll come. It’s not a one-size-fits-all silver bullet. So policy makers and program officials need to look at working with the communities to create solutions. It might be that there needs to be better access to fruits and vegetables, for example, but it’s not necessarily in the form of a supermarket. Or if it is in the form of a supermarket, the efforts need to be community-based, so that the community is working alongside policy makers and the supermarket in making sure that that endeavor is successful, that possibly people in the community are hired to work, and that the community has access to foods. This means they assess the price points of those foods, they make sure that the foods are appealing to the community, and that there’s transportation to be able to access food.
What are some of the implications later in life for children who don’t have nutritious diets growing up?
I think there are two. Without learning about food, and having that lived experience of preparing and eating food, and with limited exposure to foods, you’re less likely to eat new foods later in life. You might rely on those same comfort foods. So it’s about experience and access and exposure. And the other thing is, there’s a lot of research that looks at stress and stress- related eating, and there’s this pretty strong literature that shows that eating under stress actually promotes the accumulation of central body fat, which is the unhealthy body fat. And we do see that more in low-income households that are more likely, as I mentioned earlier, to be heavier or be obese. And if it’s true that they’re accumulating central body fat, then they’re much more likely to have a chronic disease later in life, not because they’re heavier, but because of where they gained weight.
What else should people know?
Right now, more than 34 million people are on food stamps, and half of those are children. And over 50 percent of kids, U.S. children, will be on food stamps at some time in their life. So the issue of being low-income and having that influence your diet really affects a lot more people than the average American realizes. It really is a big issue.