Healthy Food Doesn't Come Cheap After All

Back in the day when I was teaching full time in rural Eastern North Carolina, we used to discuss the cost of food.  After all, it appeared to be cheaper to eat out at a fast food restaurant than to go to a grocery store and buy lean proteins, various fruits & vegetables, and some healthy fats. 

It's difficult to argue against a breakfast consisting of an egg & sausage muffin, hash browns, coffee & juice, all for just 99 cents.  Lunch was a double cheeseburger, fries & soft drink for $1.99.  Then $2.99 could get you 3 pieces of fried chicken, cole slaw, mash potatos & gravy, biscuit and another soft drink.  For less than $6/day you could stay full and never experience hunger (much less have to wash dishes!). 

Of course, my nutrition colleagues would rightly point out that while fresh fruits & vegetables might be expensive, a healthy diet could be obtained from canned and/or frozen products.  Canned and/or dry beans are inexpensive sources of fiber & protein.  Breads & other whole grains are also affordable components of a healthy diet.

However, in a cost of living analysis published yesterday in Health Affairs, the authors concluded that, at least for Washington state, it would cost $380 more per year to increase potassium intake as recommended in the latest Dietary Guidelines for Americans, 2010.  This doesn't even take into account increasing fiber, vitamin D & calcium, which were also recommended to improve our overall nutrition & health.  On the other hand, more daily calories obtained from sugar and simple processed carbohydrates was associated with decrease in food costs.

The authors arrived at their conclusions by interviewing 2,000 adults and reviewing the cost & nutritional content of 1,300 who returned a printed questionnaire (which in and of itself could also lead to bias).  Those who spent the most money on food got the closest to meeting DGA2010 recommendations for potassium, fiber, vitamin D & calcium.  Those who spent the least were least likely to achieve the guidelines for all 4 nutrients while consuming the most in terms of added sugars and saturated fats.

As noted above, others have argued that food can be affordable if one doesn't require fresh, picked/harvested-same-day, all-natural, certified organic, pesticide-free, antibiotic-free, locally grown, cold-pressed, steel cut, hand-crafted products.  And while the Mediterranean diet is likely the most studied and healthiest way of eating, it may conflict with ethnic & religious beliefs, not to mention personal palates.  So while we may counsel all we want about healthy nutrition habits, we should also inquire into our patient's social situation as it may reflect upon their ability (and willingness) to eat in a healthy fashion.  Unfortunately, it's already clear that the long-term costs of eating poorly (obesity, heart disease & diabetes) are even more expensive.