Eat­ing bet­ter for less

To treat the obe­sity epi­demic, why not lower prices on health­ier food

Modern Healthcare - - OPINIONS | COMMENTARY - Roland Sturm and Derek Yach

Since the early 1980s, fed­eral di­etary guide­lines have urged Amer­i­cans to eat more nu­tri­ent-rich foods and cut back on fatty foods and highly pro­cessed “empty calo­rie” snacks such as cook­ies and chips. But those pleas have fallen on deaf ears. It’s time to start think­ing dif­fer­ently about how to en­cour­age Amer­i­cans to make smarter food choices—and a fine place to start would be cut­ting the costs of healthy foods in our su­per­mar­ket aisles.

This is eas­ier said than done. Amer­i­cans don’t en­joy be­ing told to change what they eat. A ma­jor­ity of Amer­i­cans do not eat enough fruits and veg­eta­bles. But we do man­age to gulp down lots of so-called dis­cre­tionary calo­ries, es­pe­cially added sug­ars and solid fats.

So how can we help en­cour­age Amer­i­cans to put down the potato chips and pick up an ap­ple? It turns out that the road to our stom­achs may run through our wal­lets. One im­por­tant new idea for chang­ing what we eat re­volves around chang­ing food pric­ing and it’s be­ing pi­o­neered in South Africa.

Food and agri­cul­ture poli­cies have al­ways ma­nip­u­lated prices. For decades, the U.S. govern­ment has sub­si­dized ef­forts to in­crease agri­cul­tural out­put, no mat­ter what it does to the qual­ity of Amer­i­cans’ di­ets. The last fiveyear farm bill, for in­stance, in­cluded $300 bil­lion in spend­ing—but such spend­ing has never been used as a tool to im­prove the pop­u­la­tion’s nu­tri­tion.

For two decades, sub­si­dies to farm­ers have helped make corn and soy in­creas­ingly cheaper than fruit, veg­eta­bles and whole grains. Food com­pa­nies have built en­tire brands based on th­ese cheaper com­modi­ties, which make up the raw ma­te­rial for a range of un­healthy pro­cessed foods and an­i­mal feed—all at a very real cost to the qual­ity of the calo­ries we con­sume.

We know that peo­ple re­spond to food­price taxes on fat, sugar or other un­healthy in­gre­di­ents. The more that food based on such in­gre­di­ents costs, the less we con­sume.

But pro­pos­als to tax un­healthy foods have been very con­tentious—and, at least in the U.S., not very suc­cess­ful. Such taxes don’t do any­thing about what con­sumers may sub­sti­tute for the newly taxed prod­uct. The im­pact on obe­sity could be min­i­mal. And the mere men­tion of taxes on food­stuffs raises the specter of the “nanny state.”

So if Amer­i­cans don’t want to be forced to pay more for un­healthy foods, per­haps we

If Amer­i­cans don’t want to be forced to pay more for un­healthy foods, per­haps we should flip the logic on its head: Re­duce the cost of healthy foods.

should flip the logic on its head: Re­duce the cost of healthy foods.

Would such a pro­gram work on a large scale—im­prov­ing con­sumers’ di­ets with­out bankrupt­ing farm­ers? For­tu­nately, we have some help­ful and en­cour­ag­ing in­sights from an un­ex­pected place.

For the past four years, South Africa’s largest health in­surer has op­er­ated an in­no­va­tive pro­gram called Healthy Food for its mem­bers. Par­tic­i­pants re­ceive a 25% re­bate on healthy foods (as de­fined by in­ter­na­tional di­etary guide­lines) in 800 supermarkets na­tion­wide. More than 300,000 mid­dlein­come South Africans are par­tic­i­pat­ing.

So far, the re­sults are com­pelling. Low­er­ing the costs of healthy foods in supermarkets not only in­creases the amount of fruits, veg­eta­bles and whole grains that peo­ple eat, but it also seems to re­duce their con­sump­tion of less nu­tri­tion­ally de­sir­able foods.

Us­ing data from the gro­cery clerks’ scan­ners, we es­ti­mate that a 25% re­bate on healthy foods raises the share of health­ier foods that pro­gram par­tic­i­pants buy by 9%, while cut­ting the share of less de­sir­able foods they pur­chase by about 6%.

There’s other good news from the South African ex­per­i­ment. Sur­veys sug­gest that the price changes al­tered be­hav­ior, too: Con­sumers re­ported that they were eat­ing larger amounts of fruits, veg­eta­bles and whole-grain foods, and said that they were eat­ing less pro­cessed meat and foods high in added sug­ars, fats or salt. (Un­for­tu­nately, we have found no ev­i­dence that th­ese new eat­ing pat­terns re­duced obe­sity rates.)

Over­all, the South African pro­gram of­fers en­cour­ag­ing ev­i­dence that low­er­ing the cost of health­ier foods can mo­ti­vate peo­ple to sub­stan­tially im­prove their di­ets. But be­hav­ior changes also seem to be pro­por­tional to price changes. When peo­ple’s ac­tual eat­ing be­hav­iors are far from what nu­tri­tion­ists would rec­om­mend, even a 25% price cut can close only a small frac­tion of the gap.

There is no sin­gle cure for Amer­ica’s obe­sity epi­demic, which has deep roots in the so­cial in­equal­ity that drives poor peo­ple to buy artery-clog­ging fast food. Af­ter all, the least healthy foods are usu­ally the cheap­est, the most ad­ver­tised in poor neigh­bor­hoods, and the most avail­able in in­ner cities—mak­ing it far harder to make healthy food choices.

But our work sug­gests that a com­bi­na­tion of things might well slow the obe­sity epi­demic while also im­prov­ing the Amer­i­can peo­ple’s over­all nu­tri­tional well-be­ing: price in­cen­tives, ini­tia­tives to con­trol por­tion sizes and a longterm cam­paign to sup­port bet­ter food qual­ity.

Na­tions such as South Africa are teach­ing the U.S. and the world a cru­cial les­son: If we can find ways to get past the re­sis­tance to adopt­ing such poli­cies, they could make us all a lot health­ier.

GETTY IM­AGES

Roland Sturm, left, is a se­nior econ­o­mist at the not-for-profit, non­par­ti­san RAND Corp., and Derek Yach is se­nior vice pres­i­dent of the Vi­tal­ity In­sti­tute.

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