National Geographic News
Damon Miller, left, Lana Taylor, center, and Kimberly Trower  check out the fresh tomatoes at the mobile Five Points Community Farm Market behind Trinity Word of Faith Baptist Church on Ballentine Blvd in Norfolk, Va. Saturday morning, Feb. 2, 2013.

The study's authors say that healthy fresh food is tough to come by for low-income Americans.

Photograph by The' N. Pham, The Virginian-Pilot via Associated Press

Tracie McMillan

for National Geographic

Published September 1, 2014

The diets of low-income Americans have worsened in the past decade, even as the diets of the wealthiest Americans have improved, according to a new study that is among the first to measure changes in diet quality over time by socioeconomic status. Overall diet quality in the United States remains poor, said the lead author of the study, published Monday in the Journal of the American Medical Association Internal Medicine.

Although the study found that the diet of all Americans improved on average between 2005 and 2010, the progress masked a decline in diet quality among the poor. The result: a doubling of the gap in diet quality between the wealthiest Americans and the poorest.

The study attributed the change to the higher cost of convenient and healthy meals, as well as limited access to quality supermarkets in some poorer neighborhoods.

Frank Hu, a study author and co-director of the Program in Obesity Epidemiology and Prevention at the Harvard School of Public Health, cautioned against taking the improvements as a sign that Americans eat well. "This is really almost like an American diet report card," Hu said. "This has the good news that there has been some improvement in overall diet quality, but the report card still doesn't look very good."

The report comes at a time when the food choices of low-income households are in the national spotlight. Legislators and advocates have suggested restricting what foods can be bought with the federal Supplemental Nutrition Assistance Program (SNAP, also known as food stamps) in an effort to promote health. First Lady Michelle Obama has made healthy diets a central part of her campaign to end childhood obesity. Today two-thirds of Americans of all classes are overweight or obese, with higher rates among the poor.

Graphic showing diet quality by socioeconomic status.
NG Staff. Source: Dong D. Wang, et al., Harvard University School of Public Health

Even with the improvements, Americans collectively scored under 50 out of 110 on the Alternative Healthy Eating Index, according to the study.

Most of the improvement in the American diet, researchers said, was due to a steady decline in the consumption of trans fats. Consumption of sugar-sweetened beverages also dropped, giving a minor boost to overall diet scores. American diets otherwise stayed consistent, with low scores for fruits, vegetables, and whole grains.

Trans fats have been a target of public policy efforts to improve diet. Last fall the Food and Drug Administration announced it was considering banning the fats in processed foods, a decade after the agency required that trans fats be clearly listed on packaged foods. Federal efforts to promote consumption of fruits, vegetables, and whole grains, meanwhile, have largely been confined to education and public service announcements.

The study has implications for efforts to improve Americans' diets, particularly among the poor, experts said. "It really speaks to the evidence that if you want to change the American diet, you have to change the policy," said Marlene Schwartz, director for the Rudd Center for Food Policy & Obesity at Yale University.

"Education will only get you so far," she said, noting that education is often most successful for those who can afford to pay for it. Improving diet among the poor, she said, requires "improving the food supply so people can eat what's there and not be exposed to so many dangerous things."

Jessica Caouette, a nutrition and cooking instructor with Cooking Matters—a national nonprofit—who works with low-income families, echoed that reaction. "All parents are interested in feeding their families healthy meals," she said, but "price is a concern for low-income families."

A survey of Cooking Matters students from 2012 found that 85 percent said they wanted to eat healthfully but that only half were able to do so. More recently a survey from the food bank umbrella group Feeding America found that nearly 80 percent of its clients bought the cheapest food available even though they knew it wasn't healthy. (Related "Study Sheds Light on Broadening U.S. Hunger Problem.")

The best bet for improving the American diet, Hu said, lies in a broad approach. "Without changing the food environment and food system," he said, "education alone is not going to be very effective."

Follow Tracie McMillan on Twitter.

33 comments
Politi Thinkshop
Politi Thinkshop

Healthy food is not easy to prepare, does not have a very long shelf life, and is more expensive than cheaper canned and mass produced "food" that contains fillers and other ingredients that return adequate profits, facilitate transportation, refrigeration, and distribution.


America's food consumption and health connection problem goes well beyond socioeconomic issues of lack of cash and proximity and access to healthy food.  Our society's economy produces commodities and commodities are distributed based on market forces of supply and demand.  Supply and demand pressures have thus far overpowered the traditional forces on the side of promoting community health.  The loosing forces are:


Social do-gooders


Philanthropy


Public health officials


Conscientious parents


Suburban focused and lead prevention efforts



In short, economic forces have thus far trumped social ideas and groups aiming to undo what are basically the macro and micro consequences of food production and distribution.


Any successful efforts in this area will have to have for-profit corporations at the table with philanthropy and government officials providing public policy leadership and incentives that appeal to corporate America's economic interests and social responsibility (good corporate citizen) commitments.


Politi Thinkshop
Politi Thinkshop

Healthy food is not easy to prepare, does not have a very long shelf life, and is more expensive the cheaper canned and mass produced "food" that contains fillers and other ingredients that facilitate transportation, refrigeration, and so on.


So the problem goes well beyond socioeconomic issues of cash and proximity to food.  Our societies economy produces commodities and commodities are distributed based on market forces of supply and demand.  Supply and demand pressures have thus far overpowered the traditional forces on the side of promoting community health.  The loosing forces are:


Social do-gooders


Philanthropy


Public health officials


Conscientious parents


Suburban focused Prevention efforts



In short, economic forces always trump social ideas and groups aiming to undo what are basically the macro and micro consequences of food production and distribution.


Any successful efforts in this area will have to have for profit corporations at the table with philanthropy and government officials providing public policy leadership and incentives that appeal to corporate America's economic interests and social responsibility (good corporate citizen) commitments.






Kathy Fullmer
Kathy Fullmer

I do agree that the food system needs a change, but I have not seen a concerted effort to educate the public about healthy diet either. Back to the system change, there is a movement afoot to develop an alternative food supply system. These systems could use more advertisement and public support. Most people could use more access to them. The food buying clubs remain too inconvenient for the majority of Americans. Also I find access to truly whole grain foods both in groceries and in restaurants to be nil to non existent. I end up carrying healthy choices with me where ever I go. You enter a kind of desert that squelches good health when you leave the door of your own home, especially along the roadways and highways, where convenience becomes the primary valued quality. My point here is that healthy for us food could be made more conveniently available. Public policy and private investment could take some interest in this concept. A nation that invests in healthy eating saves a lot on medical expenses. This is not rocket science folks.

John C.
John C.

Michelle Obama gave it a try; kid's threw the healthy food in the garbage and parents demanded "normal" food for their rotundo offspring. Most Americans have awful diets. Too much bread, fat, sugar. If it tastes good eat it, then eat even more, as much as you can stuff into yourself. 


The reason there are fewer supermarkets selling healthier foods in poorer neighborhoods - as opposed to liquor stores and KFC, no shortage there - is simple market demand. However, rice, dried beans, grains, fruit (apples, bananas, peaches), vegetables, chicken are cheap and healthy sources of nutrition available to every American in every neighborhood, affordable by way of food stamps for the low income. It's just a matter of what you chose to put in your mouth. As with smoking, people have to ultimately take responsibility for themselves.

Andrew Booth
Andrew Booth

I'm British and I spent three months in the US in 1991. OK, that's a few years ago but it doesn't seem too much has changed. 

I had a wonderful time in the US northeast - but the food was awful! Most restaurants seemed to offer very limited selections that revolved around giant burgers and fries, steak, fries and onion rings or huge pizzas with a vast array of toppings! One 'restaurant' sold nothing but doughnuts! All portions were huge and I noticed everyone - including children - cleared their plates! 

I didn't eat my first burger until I was 17 or my first pizza until I was in my 20s and the only 'takeaway food' we had here was fish and chips. Yet it seems that every American child grows up on a diet of junk such as burgers, pizza, waffles, doughnuts etc. I saw very little in the way of fresh vegetables on menus or in stores I visited. I ended up so tired of the monotonous fried and fatty menus and I  craved fresh vegetables and fruit. Much as I loved my stay in the US I've never wondered since then why the US has such an obesity problem.  

That's why the US has such a problem - too much fried and fatty foods and too much junk. The US diet should introduce plenty of fresh fruit and vegetables, discourage sales and advertising of junk food (like certain US burger chains) and serve much smaller portions.


Jiangtao Qiu
Jiangtao Qiu

It is hard to image this problem. In China, peoples can easily find vegetable market in close proximity to home. Families prefer like to buy fresh vegegable and meat and cook foods by themself. Why does US, the strongest country in the world, still worry about healthy foods ?

cs strath
cs strath

Unfortunately, we have many barriers within our country that prevent families from choosing healthy food options.  Many of our poorest live in cities that serve as "food deserts", meaning that these residents don't have access to healthy food options.  Imagine that you are barely making ends meet - you and your spouse each have a job or maybe 2, but you struggle to pay rent, utilities and medical bills. The amount of money that you have left is for food and your options within close proximity to your home or job are McDonalds, corner stores and other such venues. Your family uses public transportation to get to school and work because you don't have a vehicle of your own. The only places to purchase fresh produce are in the wealthier side of town, which would take half a day to get to because of buses, walking, etc.  With your job(s) and responsibilities to your family members, you just don't have the time to travel for fresh food.

Some people are not even aware that McDs dollar menu items are unhealthy. Honestly.  Fast food restaurants and junk food products are promoted on more billboards and signage in low income neighborhoods than in the wealthier areas of town...so unless you are educated about the benefits of fresh food, and given an EQUAL opportunity to acquire that food, you will choose the default food items - cheaper, unhealthy, processed meals.  This is a reality for many many Americans.  :(

Carter Fox Jr.
Carter Fox Jr.

How can the richest nation on earth have so many homeless and hungry citizens?


Answer: It's not profitable.........

2. Somebody can't count money

3. If you believe this, you have been misinformed.....

Austin Kelly
Austin Kelly

I'm not an American and I have never visited, so maybe someone can help me out here, but I have difficulty swallowing the points of this article.

I cant accept that poorer people are inhibited by the expense or distribution of healthier ingredients.

Its not like Tomatoes, Zucchini's, Carrots, Apples, Oranges or Banana's are precious commodities. There cheap. There is no rule that you need an Italian sports car to shop at a farmers market of a fruit and veg shop. Anyone can easily find and afford those things. So what is the problem?

The study suggests that "education will only get you so far" but I don't agree. Education should be enough. The will is not there I get the feeling.


Jean B.
Jean B.

There is a terrific free PDF cookbook called  "Good and Cheap" that features inexpensive, accessible, affordable recipes.  Take a look. It's attractive and the food is marvelous.  I say accessible, though some can NOT access anything but a convenience store.  However, wth the price of foods lately, almost anyone could benefit from it.

There has not been any increase in taxes.  Perhaps no decrease.  But there is no excuse for prices to be higher of late..

Gerard Van der Leun
Gerard Van der Leun

Oh bring out the crying towel, Tracie. Go out and bring one of the poor into your home and support them,

Justin Smith
Justin Smith

Here is a news flash for you. Increase the cost of business with one of the highest corporate taxes, increase the cost of fuel with taxes, increase the cost of electricity with taxes. Raise the minimum wage and guess what? The price of EVERYTHING goes up, including food. 


Facepalm. 


Now they want to have a CO2 tax to raise costs even farther.


Double Facepalm.

Jeffrey S.
Jeffrey S.

@Politi Thinkshop Good day. As is said, "Money is the root of all evil", seems Politics is a close second these days.

I know I'm not stating anything new here, but part of the problem is that, "Corporate" America still holds too much influence over Congress through, "(un-)Special Interests" and the almighty dollar.

To truly address the issues that will ultimately have the greatest impact on Society and to serve Society's best interest, this tie must be broken. To that end we need to change our, "Political Contribution" laws, (we've been rethinking that one for decades and although some laws have changed in this regard, there are so many loop-holes in the current laws pertaining to such, all we seem to have accomplished is to make the issue more convoluted). Unfortunately, as with many of the issues we face, we can't seem to get by, "Thinking" about it and move on to, "Doing" something substantial about it.

Be Well

Jeffrey S.
Jeffrey S.

@Andrew Booth  Hi Mr. Booth, while what you say rings true, many are getting more health conscious, exercising more and eating smarter. We still have a ways to go.The saddest part is the children, who start off life with poor eating habits and obese, it's generally a curse that follows one the rest of their life. It impacts every part of their lives, self esteem, socially, physically and mentally. Sometimes I wonder, what are the parents thinking?

John C.
John C.

@Jiangtao Qiu 


Guilt-free overindulgence is a big part of American culture, with food and many other things.

Jeffrey S.
Jeffrey S.

@Jiangtao Qiu  Hello Mr. Qiu, It's a matter of culture. Also, we Americans aren't exactly known for our, "Healthy" life styles, in general, but that seems to be changing.

Be Well

cs strath
cs strath

There are many organizations trying to help make a change, but more people need to get on board.  Community, urban and school gardens are great ways to help all people have access to fresh produce during a portion of the year. Adding fresh or frozen produce at corner stores that are available for purchase with WIC or food stamps also help accessibility.  Schools that increase servings of produce throughout the day also help youth have a healthier diet.

Jeffrey S.
Jeffrey S.

@Austin Kelly  You can only educate those who are willing. It's as the saying goes, "You can lead a horse to water, but you can't make it drink". Many, (not all) of the poor in this country are uneducated and have no real desire to be so. It's an issue that we have not found the answer to.

Justin Smith
Justin Smith

@Austin Kelly  The problem is that people make choices out of desires not out of what is necessary. They desire to buy that dozen donuts instead of a dozen carrots. 


Here in the US we already have the Political Correctness Police and the No Religion Anywhere Police,  all we need now is the Food and Thought Police and the US will be every liberals dream place to live. 

Oden Hughes
Oden Hughes

@Austin Kelly It's a little more complicated than just having the will. Many poorer areas do not have close proximity to grocery stores much less a farmer's market, instead dependent upon convenience type stores which typically don't have much in way of fruit/veg. Prepackage/processed foods are easier to stock, have longer shelf lives and are often discounted/couponed, making them readily available and cheaper. And then there are things like having time/knowledge/skill to cook.

If your options are a 10min walk for a .20 box of mac-n-cheese or having to find a ride and gas money for the 30min drive to the farmer's market....

Jeffrey S.
Jeffrey S.

@Gerard Van der Leun  More, "Sour Grapes" from a, "disgruntled" former employee? Never anything constructive or substantial, just sarcasm & denigration.

By the way, many Americans do exactly that, give of themselves to help the less fortunate, obviously you aren't one of them.

Jean B.
Jean B.

@Gerard Van der Leun Reporting facts on the state of the poverty stricken does not amount to pandering.  Your comment simply does not follow.

Jeffrey S.
Jeffrey S.

@Justin Smith Little understanding of economics, here's a News Flash for you; The prices of products and services do not go up because of an increase in the minimum wage, you have it bass akwards, the minimum wage goes up in response to the rise in cost of living. Notoriously, by the time minimum wage is raised, it's not sufficient. Would you rather we go back to a sweatshop mentality?

"Everything goes up?" Not hardly, many prices have been dropping. E.G., cars, housing, electronics, clothing and precious metals, to name a few.

Many states offer corporations significant tax advantages to lure them in, so in many cases Corporate taxes are going down as well. Your own state of Texas is known for this, but apparently not by you.

Your statements, for the most part, are based on your skewed perceptions and are not grounded in fact. You should really get your facts straight and then maybe you'll have something constructive to add instead of the constant diet of rhetoric you supply. You might even come to appreciate the Country you live in. Just the fact that you can express your derogatory attitudes speaks volumes to the, "Freedoms" you have, but evidently do not appreciate. In some other Countries you'd be locked up, or worse, just for speaking your mind.

Billy Belcaro
Billy Belcaro

@Jeffrey S.  Recent data concludes 1 in 5 US preschoolers is obese.  Unfortuneately (for the reasons you've stated) obesity may carry with them for their entire life.

Too many parents allow young children to survive on a diet of fried chicken tenders, hot dogs, mash potatoes, pizza and fried potatoes.  Then add the soda and/or sweetened drinks all day long.

Yes, what are they thinking???

To those outside the US:  It's true, but hard to believe, that these junk foods are cheaper than whole food produce.  And not much effort needed to buy/ prepare. 

Jeffrey S.
Jeffrey S.

@cs strath For those who are working and responsible, as the scenario you describe above, which I agree does exist, should be able to live somewhat comfortably. However, I'm not so sure, I may be wrong, that many many families that have 2 working parents and living responsibly find themselves in such desperate need. There is something to be said for living within one's means and that includes, dare I say it, the number of children a couple decides to have.

Jeffrey S.
Jeffrey S.

@Justin Smith @Austin Kelly  Where do you come up with this dribble? We enjoy more Freedom than anywhere else in the World.

The Asinine Police will be showing up at your door any day now.

As to your comment below; If you do not want to pay tax, MOVE to another country, (suggestion, Saudi Arabia, they only pay 3%, or there abouts). In the list of developed countries, we in the USA pay less than most of our contemporaries. The ones who pay less than us, for the most part, have a substantially lower standard of living and do not enjoy the opportunities, freedom or security that we do. Part of what each citizen's responsibility is to support government by paying their fare share and obviously you have a problem with that. "Freedom" isn't free!

The CO2 tax is aimed at INDUSTRY to give them incentive to clean up the emissions they produce,(don't hold your breath waiting on corporate America to take action on their own, as proven time and again). Regardless of your ignorant views on "Global warming", still the right thing to do, a cleaner environment is always a good idea, at least to most thoughtful people.

Your rhetoric is getting old.

Jeffrey S.
Jeffrey S.

@Oden Hughes @Austin Kelly  I do not disagree with what you have to say, I would like to add the following, as unpopular an OPINION as it may be, (I say opinion because the problem is so complicated, as you point out, and I am far from knowledgeable enough on the subject to make a statement set in stone):

"Where has the concept of personal responsibility gone to in this country"? Although I believe in Social programs to help the, "truly" needy, That concept has turned into, "entitlements and a free ride". In a general sense it seems many of us have gotten complacent, fat and lazy and always looking for the easy way out. We are on our way to becoming a Welfare state in every sense of the word. Instead of grabbing the bull by the horns and making some significant changes in our Social attitude and Programs, we toss some coin at it and hope it will go away. Time to show some, "tough love", get rid of the, "handouts" to those whom are capable and get them to work earning a decent living and provide their children a safe, educational  environment while they do so, (infrastructure repair immediately comes to mind), reestablish the concept of, "Personal responsibility", which in turn instills, "Social responsibility". That is what made this Country great to begin with and the lack of which is why we find ourselves dealing with many of the problems we face.

Be Well

Jeffrey S.
Jeffrey S.

@Billy Belcaro  If memory serves, (when one gets older can be a mite, "Dain Bread" from time to time), I have read articles that claim certain fats and processed sugar and alike can actually be addicting and the younger one is overindulging the stronger the addiction becomes.

And don't forget about the sugar in a bowl, which is touted as cereal, many children start their day off with.

One of the true blessings in my life was to have Parents who understood the importance of a good diet and Healthy habits.  As a child, along with my siblings, we sometimes stamped our feet over it. "Tough Love", it's a dying concept.

cs strath
cs strath

@Jeffrey S. Sadly, it is not the case. Through my professional career and my personal community outreach efforts, I find more people in the above scenario than I would like to admit. Empowering residents to make changes by partnerships with organizations, schools and local government can really work (faith communities, nonprofits such as YMCAs, community foundations, etc).  We have seen change in our community by increasing food access as i have mentioned above.  But we have a long way to go to educate all of the public.

Austin Kelly
Austin Kelly

@Jeffrey S. Thanks for your response. You may be misinterpreting my questions as hostility, when they were asked solely out of curiosity. Neither post are "dribble". Justin Smith is just answering my question. If your have a difference opinion, I'd love to hear it.

Jeffrey S.
Jeffrey S.

@cs strath @Jeffrey S.  I wouldn't argue with you as I just do not know what the stats are. Having, "Hands on" experience as you state, puts you in the position of seeing clearer. I have lived my life in, "Rural" America and see a somewhat different picture in Suburbia, than that you paint of the inner city. That being said, I have no qualms about helping those who truly need it and not just looking for a "handout".

Be Well

Jeffrey S.
Jeffrey S.

@Austin Kelly @Jeffrey S.  I did not take your questions as hostile. My response to you, was not presented as such.

As to my response to Mr.Smith's comment, his depiction of America as being a, "Police state" is dribble, that was the kindest response I could think of for such nonsense.

Be Well

Share

Feed the World

See blogs, stories, photos, and news »

Latest From Nat Geo

See more photos »