Carole Farina's grocery cart used to include heads of lettuce, tomatoes, and cucumbers for homemade salads. Not anymore. Shopping at a Family Dollar store in Somerville, Massachusetts, the unemployed 47-year-old recently saw her monthly food stamp benefits reduced from $94 to $68 due to income adjustments from her disability payments. Now, Farina told me, she can only afford to buy "the cheapest stuff," like 5 for $1 instant ramen Cup Noodles -- those dorm-room staples made of refined carbohydrates, fat, sodium, and polysyllabic chemical additives.
Farina still occasionally splurges on cucumbers, but only when they are on sale for 2 for $1 at her local supermarket. Already overweight, she recognizes that her diet is unhealthy, but her diminished food budget portends a future of more Cup Noodles and fewer salads.
Like Farina, millions of food stamp recipients may soon see their monthly benefits trimmed and their nutrition compromised. But unlike Farina, these changes may occur regardless of changes in their personal income. That's because in two weeks the full House floor is slated to vote on the GOP-controlled Agriculture Committee's omnibus farm bill, which includes unprecedented cuts to the food stamp program, now called the Supplemental Nutrition Assistance Program (SNAP). The Agriculture Committee's reductions to SNAP would total $20.5 billion over 10 years and is even more austere than last year's stalled House farm bill, which sought a $16 billion reduction to SNAP. Such draconian cuts to SNAP may exacerbate the obesity epidemic and ultimately raise health care costs associated with treating obesity and related conditions like type 2 diabetes, heart disease, and stroke, particularly among low-income Americans.
According to the CDC, nearly 36 percent of U.S. adults and 17 percent of children are obese. High as these rates are, the proportion of obese Americans has finally plateaued in the last few years after having escalated since 1980. But obesity rates may climb again if the House Agriculture Committee's farm bill passes and results in benefit reductions for the 47.8 million Americans currently on SNAP. (An estimated 2 million households will lose their SNAP benefits altogether.)
SNAP recipients are already means-tested for poverty and scraping by on meager allowances. Under current eligibility guidelines, households qualifying for SNAP can earn no more than 130 percent of the poverty line, or $30,615 for a family of four. (Eighty-three percent of SNAP recipients earn less than 100 percent of the poverty line, or $23,550 for a household of four.) The U.S. Department of Agriculture's figures from 2012 indicate that monthly SNAP benefits average about $133 per person, or $4.43 per day. Had last year's House farm bill been enacted, half a million households would have seen their monthly SNAP benefits slashed by $90 per month, according to the hunger relief organization Feeding America. Given that this year's House farm bill calls for an additional $4 billion in cuts to SNAP, poor Americans would feel even greater hunger pangs if the Agriculture Committee's current farm bill passes.
Households affected by these SNAP cuts will have to contend with desperately tight grocery budgets that will constrain their ability to buy healthy food, making it easier for them to become obese. Having less money to spend on food could prompt SNAP recipients to buy more calorie-dense, nutrient-poor foods that contribute to both weight gain and malnourishment. With the exception of a few items like beans and potatoes, many of the cheapest grocery offerings are highly processed foods packed with health advocates' maligned trinity of salt, sugar and fat.
Calorie for calorie, unhealthy processed foods and sodas are also often significantly more economical than healthier alternatives. In their widely cited survey of supermarket prices in Seattle, University of Washington epidemiologist Adam Drewnowski and his colleague S.E. Specter at UCLA found that one dollar bought 1200 calories worth of cookies or potato chips, but only 250 calories of carrots. For cash-strapped, hungry Americans, the choice seems obvious. And indeed, Drewnowski and Specter's research suggests that consumers on tight budgets decide what foods to buy based not on nutritional considerations, but on the cost and palatability of foods.
In spite of the challenges of eating healthfully on current SNAP allowances, it may still be possible to prepare relatively nutritious meals with scrupulous planning, culinary resourcefulness, and the type of fanatical frugality exhibited by "extreme couponers." The New York Times's Mark Bittman, for example, insists that simple home-prepared meals such as rice and beans are even cheaper than fast food. (Bittman, of course, presumes that working Americans have the time and energy to cook every day, and that they have endless appetites for Spartan dishes like rice and beans.)
A case can also be made that current SNAP funding levels enable recipients to buy a select number of healthy, pricier foods like fresh vegetables, as long as they balance those "luxury" purchases with more cost-efficient processed items like boxed macaroni and cheese. But if SNAP households' benefits are cut, even by a few dollars a week, their food choices may be driven even more by cost and palatability at the expense of nutrition.
This phenomenon was illustrated in 2007, when New York City councilman Eric Gioia attempted to live on a SNAP budget for a week. According to the New York Daily News, Gioia's $28 worth of grocery purchases for that week included a combination of reasonably healthy fare like canned tuna and a "handful" of vegetables, along with inexpensive carbohydrates such as white bread, pasta, and ramen noodles -- items that were filling but not particularly nutritious.
Gioia repeated his week-long SNAP experiment a year later, when food prices had risen about 25 percent and he had effectively six fewer dollars in purchasing power. In order to stretch his food budget this time, Gioia had to eliminate a number of provisions that were within his budget in 2007, but not in 2008. These included "four bananas, three ears of corn, two cucumbers and two packets of pasta." If a highly educated and nutrition-conscious Gioia had to jettison the healthier items from his grocery cart when faced with a shrunken food budget, it is not difficult to imagine that SNAP recipients would have to do the same if Congress approves the House Agriculture Committee's cuts to the program.
Reductions to SNAP may also promote obesity in other ways. Paradoxically, by causing food insecurity (a term used to describe limited or uncertain access to food) reducing SNAP benefits may actually trigger food behaviors associated with obesity, such as binge eating and hoarding. Most SNAP households are unable to stretch their benefits through the month as it is, let alone if their assistance is cut. Feeding America reports that 90 percent of current monthly SNAP benefits are redeemed by the third week. (Gioia's 2007 seven-day food stamp experiment yielded him 5 days' worth of food in 2007 and only 3 days in 2008.)
None of this would not surprise William S. Simon, the chief executive of Walmart's U.S. operations. In a 2010 Goldman Sachs conference, Simon described how SNAP recipients stormed Walmart stores all across the country to load their grocery carts immediately before midnight at the first of every month. Eager to refill their empty cupboards and refrigerators, these midnight shoppers were too hungry to wait until the following day to buy provisions.
Such patterns of food insecurity can lead to lifelong habits of overeating and hoarding. Cornell University nutrition researchers Christine M. Olson, Caron F. Bove, and Emily O. Miller have shown that when food does become available in food-insecure households - such as at the first of every month when SNAP benefits are redeemed - individuals may go on eating binges, overcompensating for the hunger they experienced during periods of privation. The children who grow up in these homes may become obsessed with ensuring that they have enough to eat, and derive emotional comfort from consuming unlimited quantities of food and maintaining fully stocked kitchens. It is no wonder then, that researchers Drewnowski and Specter have also found that women living in food-insecure households are more likely to be overweight than those for which access to foods has never been an issue.
Overall, low-income Americans, particularly if they are white children or women regardless of race, are also considerably more likely to be obese than their higher-income counterparts. Among white women, for example, 39.2 percent of those at or below 130 percent of the poverty line are obese, while only 27.5 percent of those with incomes at or above 350 percent of the poverty line are obese (figures from the CDC, 2010). If SNAP benefits are slashed and the number of low-income obese women and children increases, there will be even greater disparities in obesity rates across income levels.
Apart from raising concerns about health inequities, such an outcome would also undermine Congress's own efforts to combat childhood obesity through the Healthy, Hunger-Free Kids Act of 2010. The law, which imposed new nutrition standards for school lunches, was intended to promote healthy eating at schools. But if Congress passes the House Agriculture Committee's farm bill, many of these same children may soon be eating more poorly at home and obesity rates will rise again.