The Dinner Divide: How Can We Improve the Diets of All Americans?

The number of Americans eating an optimal diet increased by 50 percent between 1999 and 2012, according to a study published this week in the Journal of the American Medical Association. Over the course of a decade-plus that saw the rise of kale, cold-pressed juice, and veganism as genuine lifestyle trends, the percentage of Americans eating the healthiest diet, per guidelines set by the American Heart Association, increased from 1 to 1.5 percent.

The study, which was based on data from the National Health and Nutrition Examination Survey, may have found a paltry number of people who epitomize healthy eating, but it did show progress—progress that is far from even across demographic groups. As a whole, we’re eating better—more whole grains, fruits, nuts, and yogurt, and less refined starches and sugar-sweetened beverages. But affluent, educated, white Americans have made more of these changes than the rest of the country.

“It’s not as if certain minorities or low-income or low-education Americans aren’t improving—they’re just improving less,” said Dariush Mozaffarian, dean of the Tufts Friedman School of Nutrition Science and Policy and the study’s lead author.

The researchers found that the number of Americans who eat a “poor” diet dropped from 56 percent in 2000 to 46 percent in 2012, while the percentage of people eating an intermediate diet increased from 43 percent to 54 percent. Consumption of whole grains nearly doubled in that time period, and soda consumption declined. For low-income Americans, the diet gains were far smaller, with 38 percent of people earning $30,000 for a family of four eating an intermediate diet in 2012, compared with 62 percent of Americans earning about $69,000 for a family of four. The overall improvement in diet was barely observed for black and Latino Americans.

Mozaffarian said people are quick to point to food costs as the reason why the gap between diets is widening across class and race lines, “but I think that’s a simplistic explanation. It’s a little bit of cost but also opportunity cost,” he said. “The time and knowledge to actually cook isn’t always available to everyone.”

The question of what to do about the gap in improvement isn’t easily answered, however. Mozaffarian said that creating economic incentives and disincentives that encourage healthy eating could be a powerful tool for creating wholesale change in Americans’ diets. “Right now, we’re essentially putting a tax on healthy foods, and we aren’t respecting their true costs,” including the decades-long expense of health care costs and lost productivity, he said. A 10 to 20 percent tax on unhealthy foods to subsidize healthy foods—dropping the price of an apple, say, down to 5 cents—would indeed upend both the food-supply system and the way Americans eat. But the millions of dollars that beverage-industry groups are spending to fight comparatively small soda taxes suggest it’s a less-than-plausible idea.

Sugar-sweetened beverage taxes like the one recently passed in Philadelphia are a step in the right direction, according to Mozaffarian, but he “would like taxes to be broader than soda.” He also pointed to Women, Infants, and Children (WIC)—a federal nutrition program that gives pregnant women and new mothers and their babies benefits they can use to buy certain healthy food items—as a model that could turn the far larger food-stamp program into a benefits system that promotes better diets.

Limiting food stamps—officially known as the Supplemental Nutrition Assistance Program—so that recipients cannot buy unhealthy items such as soda is an idea that gets thrown around a lot, and currently Maine’s Republican Gov. Paul LePage is trying to do it by fiat in his state. Last year, he asked the USDA for permission to block the roughly 200,000 Mainers enrolled in SNAP from using their benefits to buy sugary foods, such as soda and candy—a request the department denied.

“It’s time for the federal government to wake up and smell the energy drinks,” LePage wrote earlier this week in a letter to the USDA responding to the blocked request. “The Obama administration goes to great lengths to police the menus of K–12 cafeterias but looks the other way as billions of taxpayer dollars finance a steady diet of Mars bars and Mountain Dew.”

LePage is now threatening to stop administering SNAP in Maine, and the USDA said it would not be able to handle the program in the state, which would do little to help the diets—or general well-being—of the poor residents that rely on the program. But the USDA looked at the question of SNAP benefits, soda, and sugar consumption as recently as last year, and it concluded that dropping sugar-sweetened beverages from food stamps would not help to reduce consumption.

According to NHANES data (the same data set the recent JAMA study relied on), the majority of low-income adults—between 73 and 83 percent—drink sugar-sweetened beverages on a daily basis. However, after comparing the soda habits of SNAP recipients and other low-income Americans, the USDA researchers concluded, “SNAP participants are no more likely to consume sugar-sweetened beverages than otherwise similar low-income nonparticipants.” Another USDA study of the diets and health of SNAP recipients found that, while people on food stamps eat less of things like fruits and vegetables than other Americans, their nutrient intake is on par with Americans who do not receive nutrition assistance. Despite their diets being a political football, SNAP recipients eat much the same as other Americans—which is to say, not all that well. Still, the obesity rate for people on SNAP is higher—46 percent, compared with 36 percent for U.S. adults on the whole.

Less punitive approaches like market-match programs for SNAP shoppers at farmers markets have showed potential for improving access and lowering the cost of foods like fruits and vegetables. But Mozaffarian believes that more systemic changes will be needed to give all Americans a better shot at eating the diet of the 2 percent.

He cited past debates on public health and government regulation—from cigarettes to laws requiring seat belts, car seats, and helmets for motorcyclists—where the conclusion was eventually reached that health concerns outweighed personal choice.

For food, “outside of safety standards for contaminants, there are little safety standards for health,” Mozaffarian said. “We need to do the same for the food system” that has been done for cigarettes and vehicle safety. “Education alone and dietary guidelines alone aren’t going to be enough.”