Is eating well more expensive?

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When I was a teen, and first discovered nutrients, calories and the inconvenience of looking up foods on endless nutrition charts (no internet, no nutrition label - remember those days?) I would imagine a simpler scheme: If only food could be priced according to caloric content. If each calorie would cost, let's say, 1 cent, a person aiming at 2000 calories a day would keep within his caloric upper limit as long as he spends no more than $20 a day on food.

This is of course a particularly silly idea, as the caloric content of food has absolutely nothing to do with the factors that determine its price, and even in an ideal world it wouldn't be feasible to make 100 calories of black truffles cost the same as 100 calories of canola oil.

It was then that I realized that in the real world an inverse correlation between price and caloric content is all too common.

Obesity and diet related diseases are more prevalent among people with low incomes. There are a few possible explanations, but one of the really troubling questions often asked is whether eating well is more expensive, and whether it's feasible to eat a balanced, healthy diet on a tight budget.

The current issue of the American Journal of Clinical Nutrition devotes two research articles and an editorial to this question. Let's take a look.

Spending more on food is correlated with better nutrition and health

A study led by Adam Bernstein looked at the connection between how much money women spent on food, and the healthfulness of their diet. Diet quality was assessed using the Alternative Healthy Eating Index (AHEI), a scoring method developed by Harvard researchers as an alternative to the US Food Pyramid, that looks at the consumption of foods associated with lower risk of chronic diseases in studies. Basically, the index gives points for eating fruits and veggies, whole grains, prioritizing white meats and fish over red meat and unsaturated fats over saturated ones.

The study included more than 78,000 women and found that spending more money was clearly associated with a better diet.

But here's the interesting part: the researchers divided the participants to quintiles according to their level of spending, and within each spending group there was quite a lot of variation in diet healthfulness. The diet healthfulness index for each spending group varied by as much as 29 index points, and just to put that in perspective, a 20 percent increase in the AHEI score is associated with 25 percent lower risk of heart disease.

The authors suggest that investing in nuts, soy, beans, and whole grains, while reducing purchase of meat and dairy, would improve the overall diet without an increase in spending.

The cheapest foods have lots of calories

Adam Drewnowski examined the cost of various foods compared to their nutritional content. He found that the cheapest foods per calorie or per serving are grains, sugars and fats, while fruit and vegetables are relatively expensive. Drewnowski argues that subsidies to wheat, corn and soy have led to increasingly cheap foods, rich in calories and poor in nutrition, and that "The fact that healthful foods cost more than less healthy options is a formidable real-world challenge for nutrition interventions".

Pricing affects purchase, while educating people is expensive and difficult

In an editorial , Cliona Ni Mhurchu discusses both studies, and concludes that both studies support a substantial body of research showing that eating healthy does indeed cost more. Since the most influential factor affecting food-purchase decisions is price, perhaps it's time to study and test pricing strategies (subsidies for fruits and veggies and/or taxes on unhealthy foods) as a tool to move our collective diets towards healthier foods.

Cheap food's a rip-off

Fruits and vegetables cost more per calorie compared to oils, grains and sugars. I suppose that's been true for a very long time, even before farm bills, subsidies and the invention of foods with an almost eternal shelf-life, and is mainly due to the fact that calorically dense foods are, well, calorically dense.

Buts let's face it; our problem isn't really the price of grain sugar and oil, compared to the price or veggies. The problem is the rift between the price of produce, and that of the highly processed stuff made of grain sugar and oil. The huge competition is between the ready-made extra convenient meal and the raw ingredients that will require know-how, a kitchen and a bit of time to make into a meal.

The absurdity of our times is that highly processed foods cost less than the raw ingredients for preparing a healthy meal. It is mind boggling that a prepared meal at McDonald's costs less than the ingredients to make a meal at home, and that a Twinkie costs less than an apple.

How can complicated food that's made from so many ingredients, and has design, packaging, marketing and advertising costs to it, cost the same - or even less than - raw ingredients? It's beyond the scope of this post to get into that. Michael Pollan explains the industrial food chain beautifully in The Omnivore's Dilemma.

But it's the presence and push of cheap, palatable, convenient, attractive, ready-to-eat ready-to-heat ultra-processed highly advertized foods that really undermines our diets.

It is quite possible to eat well on a budget, but doing so takes knowledge, cooking skills, time and determination. Before the age of highly processed foods people with low incomes would grow their own food, limit the amounts of meat and sugar in their diet, and generally eat less. Nowadays a low budget diet is more often a highly processed, fast-food diet, because nothing is as cheap or convenient as that. That's what we're up against.

Except highly processed foods aren't really a bargain - they're actually a rip-off. It is extremely short sighted, financially, to eat poorly. The consequences of a poor diet are very costly in suffering and also in money. Just think of the costs of treating a large population with cholesterol lowering drugs, or for chronic diet-related diseases such as type 2 diabetes and heart disease, and fresh produce looks like a really good deal.

Dr. Ayala

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