The following originally appeared on The Upshot (copyright 2016, The New York Times Company)
Often, when I discuss the obesity crisis in the United States, especially when I’m pointing out another failed effort to help people change their eating habits, it’s as if there’s nothing we can do.
But sometimes it’s actually more that there’s nothing we will do. There’s a difference.
The Supplemental Nutrition Assistance Program (SNAP), colloquially known as food stamps, provides aid to poor families in the United States so that they can buy food. More than 44 million Americans are in the program, with the average household receiving about $255 a month.
Oddly, food insecurity is linked to obesity. This could be because calorie-dense food is cheaper than nutrient-dense food, so poor people find it harder to eat healthily. Simply providing money for food won’t change this. In studies, people who receive SNAP tend to be more obese than those who don’t.
This has led some to call for a reduction in benefits, arguing that the program is causing obesity. It’s more likely that we need to change the behavioral economics of food, not the aid we supply.
A very recent study adds credence to this hypothesis. Researchers gathered adults in the Minneapolis-St. Paul area who were earning no more than 200 percent of the federal poverty line and who were not already enrolled in the SNAP program.
All received a debit card with money for food, much like in SNAP. But then they were randomized to one of four groups. The first received a 30 percent financial incentive to buy fruits and vegetables; the second was prohibited from buying sugar-sweetened beverages, candy or sweet baked goods; the third got both the incentives of the first group and the prohibitions of the second; the fourth got none of these, and served as a control.
Researchers followed these groups for three months. They found that, compared with the control group, those in Group 3 (incentives plus prohibitions) consumed about 96 fewer calories per day, 64 of which were “discretionary” calories (from added sugars, solid fats and alcohol above moderate consumption). The third group also ate less of the prohibited foods and more fruit.
Interestingly, those in the incentive-only and prohibition-only groups didn’t see significant differences. It seems that a combined approach was needed.
The good news is that there seems to be something we can do about obesity. The bad news is that we probably won’t do it.
There have been many, many, many calls for the food stamp program to promote more healthful diets. Many states have requested waivers allowing for restrictions on what benefits can buy (some items, like alcohol, tobacco and household supplies, are already prohibited). Further restrictions have been rejected by the Department of Agriculture, which administers this welfare program.
Its reasons for doing so are not hard to understand. The U.S.D.A. harbors legitimate concerns that such restrictions could increase the stigma and embarrassment already associated with food stamps, driving away potential beneficiaries, some of whom are children. The agriculture department favors incentives, rather than exclusions, though this research shows incentives alone don’t seem to work. Most important, the department may be concerned that such changes would unfairly target poor people.
That concern is not entirely unreasonable. Sometimes the people calling for restrictions on food stamp purchases are the same people trying to reduce benefits over all. Such calls are often also fueled by anecdotal accounts of people abusing the program to buy luxury items like lobster, filet mignon and crab legs. When we move beyond anecdotes, data show that food stamp recipients are not favoring shellfish or steaks over ground beef.
But not all pushes come from those who seek to punish the poor. New York City, which tried to limit soft drink sales for everyone, also asked the U.S.D.A. for permission to restrict purchases of sugary beverages from food stamps as part of a two-year experiment and was denied.
The department’s concerns seem odd when we look at other federal programs. The program for Women, Infants and Children (WIC) provides food to poor women during and after pregnancy and to their infants and children. That program’s restrictions on food are quite thorough. The School Lunch Program helps provide meals to more than 31 million children each school day. The regulations that govern what’s allowed under that program are complex and vast.
The authors of the new study say that this is the first experiment to look at whether restricting certain foods on SNAP might lead to better health. It might be worthwhile for the Department of Agriculture to extend the experiment a bit more.
