As policymakers and health officials sound the alarm on the nation’s obesity epidemic, a team of researchers want to improve health outcomes among the most vulnerable Americans by overhauling the federal food assistance program.
In articles published as a supplement Wednesday in the American Journal of Preventive Medicine, more than a dozen researchers called for changes in the Supplemental Nutrition Assistance Program (SNAP) to align the initiative more closely with the nation’s 2015-2020 Dietary Guidelines for Americans. The report found SNAP recipients consume less healthy foods on average than Americans overall and, due to their low-income status, face a higher risk of developing diabetes and hypertension. People receiving the benefits, formerly called food stamps, told the researchers that nutrition could be improved by increasing incentives to purchase healthy foods and excluding sugary drinks.
Researchers also proposed limiting the types of food available for purchase through the program to four categories, incentivizing retailers to stock nutritious food. They will submit the material in the journal as a proposal to the Department of Agriculture, which oversees the SNAP program.
The supplement was sponsored by the Physicians Committee for Responsible Medicine, a nonprofit group dedicated to vegetarian and vegan diets, eliminating animal testing and promoting a greater role for nutrition in medicine.
Susan Levin, the director of nutrition education at the group and an author of one of the papers in the supplement, said the findings reflect the government’s responsibility to help SNAP beneficiaries make healthful choices concerning their diets. She advocates for restricting SNAP benefits to cover only healthy foods, but said the guidelines are not about taking away choice.
“My argument is that government shouldn’t be funding the perpetuation of illness,” she said.
SNAP provides food assistance to more than 43 million Americans living below 130 percent of the federal poverty level (about $15,400 for an individual). Recipients access their benefits at the beginning of the month through an Electronic Benefits Transfer, or EBT card. On average, a SNAP beneficiary receives $126.83 per month, according to the physicians group.
Half of the program’s recipients are children and adolescents.
“SNAP has succeeded in terms of filling the stomachs of Americans and alleviating hunger,” said Neal Barnard, president of the Physicians’ Committee for Responsible Medicine. “The problem is it provides calories, not healthy food.”
Opponents say restrictions on SNAP reflect a paternalism from the federal government because it implicitly undermines the recipients’ ability to make their own food options. Nancy Farrell, a registered dietitian nutritionist and spokesperson for the Academy of Nutrition and Dietetics, said the government must tread lightly in placing restrictions on individual choice, as it could bear fruit to unintended consequences.
“Nobody likes government mandates,” Farrell said. “They’re not necessarily favorable. I think you have to explore this cautiously.”
As the food supplement program evolved, so did the recipients’ palettes. According to one of the studies, in 1965, low-income blacks maintained the most healthful diet and affluent white Americans consumed the unhealthiest foods. By the 1990s, however, that had reversed as rich white Americans improved their diets while for many of the nation’s poor, nutrition suffered.
Today, the eating habits of SNAP recipients reflect the economic divide in dietary choices. In 2011, 55 percent of SNAP benefits were used to purchase meats and less healthy food such as sweetened drinks and candy, according to the physicians group’s analysis based on USDA data. In contrast, less than a quarter of the SNAP aid was used to purchase fruits and vegetables.
As a result of poor diets, SNAP recipients also face a higher risk of developing chronic conditions. According to the research presented in the journal, low-income Americans face a 70 percent higher odds of developing Type 2 diabetes than higher-income populations. Their odds of developing high blood pressure are nearly 20 percent higher than wealthier individuals. And, when compared to other people who would be eligible for SNAP but don’t participate, recipients face higher rates of obesity.
“In this country, we’re not dying of typhoid,” Levin said. “We’re dying of things that we can prevent.”
To combat poorer health outcomes, the researchers proposed an overhaul called “Healthy Staples.” The program would restrict SNAP purchases to four food categories — grains, vegetables, legumes and fruits — and vitamin supplements. It would exclude meats. It would also require SNAP-eligible stores to stock a minimum variety of products in certain food groups. The review said the plan could provide a SNAP recipient 1,800 calories plus a multivitamin daily for $121.02 per month, $73 less than the most comprehensive SNAP benefit package. Researchers calculated the change could ultimately save the program $26 billion each year.
“Our view is that we could provide better nutrition for less money for more people,” said Barnard.
The program seeks to align with the 2015-2020 Dietary Guidelines for Americans, which promotes five key recommendations including maintaining a healthy diet for a lifetime, focusing on variety, nutrient density and amount; and limiting caloric intake from sugars, saturated fats and sodium.
Researchers and policymakers in recent years have proposed several reforms to alter the SNAP program. Some have advocated for the program to become a block grant given to states. The move would give states more discretion in how to administer benefits and provide more financial stability. Others have pushed to make some food ineligible for SNAP coverage based on nutritional value. Sugary drinks in particular have stirred controversy due to their strong link to obesity and diabetes. Advocates of restriction have pushed for SNAP to model the Women, Infants and Children (WIC) program, a federal assistance program for pregnant women, infants and children that limits the type of food available for purchase to more healthful options.
Diane Schanzenbach, a senior fellow at Brookings Institution, said both proposed reforms are problematic. Changing the program into a block grant would alter the program’s ability to respond to economic downturns, she added. Limiting food options removes the recipients’ ability to purchase foods they prefer, and the conversation surrounding healthier options should be framed as a national issue rather than a problem affecting only low-income Americans, she said.
“I think that some nice public heath campaigns would be a good thing, but I don’t see why targeting that to people who are using the safety net makes any sense,” said Schanzenbach. “This should be a broader conversation in the United States about healthy choices.”