Why we focus on food deserts and not food swamps

Most people have heard the term food desert. A food desert is a place where people live and do not have reasonable access to whole foods, or fresh produce. Often this is measured by some distance to a grocery store. For example, in some places people live close to convenience stores and fast food restaurants, but would have to travel several miles, sometimes 10 or 20, to get to a grocery store. In these same areas, there may be high rates of obesity - however, there are high rates of overweight and obesity across the USA. Some speculate that not living close to a grocery store where one can access produce is a 'cause' of obesity (i.e., they associate food deserts with obesity). And it is not just availability, it's affordability, too. If the fresh produce costs more than processed foods, they are less accessible. If children have to try foods several times to like them, and a parent is on budget, it makes it hard to buy more expensive items that might not be eaten.

Access and affordability are things that public health advocates work to change AND that the electorate/society supports. Right? Of course we should make sure everyone has access to nutritious foods that are often low in calories. YAY! Let's do it.

Research has not always supported the intuitive, however, and sometimes people who have access to fruits and vegetables still don't purchase or consume them. Why not? Well, my educated/informed opinion is because a good many people live in food swamps. I am not sure where I first heard or read the phrase, but I describe a food swamp as an area where high calorie foods - often low in nutrients - are in abundance, are cheap, easy to locate, highly advertised, branded (e.g., KFC, Doritos, Pepsi) and popular among children, adolescents and adults. Actually, these foods and their promotions (e.g., all you can eat buffets, $1 hamburgers, 3 for 1 honeybuns, 32 ounce sodas) are hard to avoid.  

As noted above, the popular strategy for dealing with a food desert is to bring more fresh foods in - build a grocery store or a farmers market, add produce to the convenience store checkout, send in a mobile produce truck - and hope people will purchase, prepare wisely and eat more nutritious foods. Oh and here is the most important part... eat them instead of the high calorie non-nutritious foods they have been eating. Every one agrees, yes - those are all good strategies... yay, lets fund them! [They don't work so well, but they seem smart and non-paternalistic, therefore, it must be right.]

The strategy for food swamps (which is as unpopular as the food desert strategy is popular) is policy and regulation. I believe that food swamps are the bigger problem and that regulation and policy are our best bet at trying to reduce over consumption of calories (often occurring passively, i.e., not intentionally eating extra calories). Examples include, limiting the number of fast food/quick casual restaurants that can surround neighborhoods, schools, and worksites (zoning laws), putting a sales tax on high calorie, low nutrient items, like sugar sweetened beverages (specifically I say a sales tax because consumers are more likely to notice a sales tax than an excise tax and sales taxes cannot be 'eaten' by the manufacturer unless they literally lower the prices of their products), putting calorie counts out in front on everything, everywhere (menu boards, front of packages, sodas) and educating people on what is considered a 'high' amount of calories (e.g, a dinner entree over 500 calories is high, if it is part of a days worth of meals), portion caps - like suggested in NYC might work, and limiting ads for high calorie foods or ad space (e.g., TV, public transit, magazines, websites, social media). I think our grocery stores should have makeovers as well. The cheap, high calorie foods should not get prominence and promotion. This is one of the main reasons I believe that strategies to add fruits and vegetables to neighborhood stores or whole grocery stores to neighborhoods, fail. It is hard to get through the mire of junk - physically, emotionally, socially, parentally - to the better for you items. 

And before anyone points out that the food swamp policies I mentioned are regressive (i.e., they will have a bigger impact on persons of lower income) I say YES, and obesity and its related disease conditions is also regressive and has a greater impact on persons of lower income. 

My point is, that though it might sound good (especially politically) to make fruits and vegetables and other nutritious foods available and accessible, what we really need is to make low nutrient (junk) foods and drinks LESS available and accessible (less cheap, less popular, less in our face).  And as that annoying prince on the TV show Outlander says, "mark me" I am right about this.

The additive effect of SUGAR - or SSBs

I only have four or five items set aside for tomorrow's Odds and Ends post, so I checked out some trusted websites in search of something easy to post tonight (to conserve my brain).

I went to the RUDD Center for Food Policy and Obesity   where I emailed someone to find out what they heck is going on with the FDA final rule on menu and vending labeling, and then I ventured over to a website in LA County, CA.  
The LA cite has a sugar sweetened beverage calculator.   Here you enter the number of drinks of each type that you consume and it calculates several different measures.  For instance, the packets and pounds of sugar you consume in a week, month and year and how much you might be spending on these beverages.  

I do not drink SSBs (I even make my sports drink with a sugar substitute)- so I made believe I was someone else.  Startling results!

BTW - I do eat sugary snacks (real sugar) but I only have about one a day.

Oh I almost forgot - here is the website and calculator where LA County suggests that you ChooseHealth.  AMEN.

If you can't tax it - ban it

I am thrilled to attach the current newsletter from the Harvard School of Public Health.  It announces a policy change for the city of Boston. 
All new beverage contracts, for city owned properties, will include only low calorie beverages and NO SODA or sugar sweetened beverages (SSB)i.e sports drinks .  Diet soda will be allowed, but there is a limit on the proportion of diet soda to non diet drinks per total vending machine, or canteen menu.  If you click on one of the side links, you will see the report on diet drinks. In short, they are not considered the best alternative, but perhaps a step down from full sugar to no sugar beverages.  In that article,  some research is cited that indicates that having the sweetness without the calories confuses the brain.  The signals for satiety do not get sent and people over consume.  I drink a diet soda every day with a small snack and I am the least overweight person I know.  [this may be related to the fact that I am not drinking the soda to trick myself into thinking that I ate, but because I enjoy the taste. Also, I am consuming a low calorie snack at the same time - so I feel full AND have calories]

 Another research example they gave involved rats.  I am just thinking - rat studies - for calorie consumption - do not make a lot of sense because rats do not eat for all the reasons that people eat.  Much of our eating has to do with social pressure, happiness, sadness, etc - where as, I assume rats eat because they are hungry.

So back to the BAN.  Boston is also going to utilize my favorite Go Slow Whoa labeling  - Green means go -  water would be green, fruit juice (100% and small serving) would be yellow, and soda or whole milk would be red.  OK truth is that I did not open their traffic light guide, but I think I know this stuff well enough to guess correctly.  But that reminds me, though they will allow fruit juice, the serving size cannot be more than 8 ounces.  They are allowing low fat/no fat milk too - but again, in limited sizes.

I am so excited about this initiative that I emailed one of my professors to see how I could make something like this happen on my campus :)  I told him I would dedicate my summer to it.  I will keep you posted.

I also emailed it to the obesity coalition of which I am a part - perhaps we could influence my city :)

You are more than welcome to pass it on yourselves.  Here it is.  (I still think taxing or price differentials are good strategies too)  In this article, my hero, Walter Willett (MD) equates soda consumption with the greatest single cause of our obesity epidemic.  It was said that many people consume 200 calories a day in soda or SSB - well the average person.  That is only about one soda a day - I know many who drink several cans/bottles a day. 

EBT Cards and Soda

The big debate these days is whether or not NYC has the right to prevent people from buying soda or any other food or beverage with their food stamps. (In case you didn't know, most states do not actually use stamps anymore. People who receive this needs based stipend actually get an electronic benefit transfer card - or EBT)

The problem with soda and the attempts to do something about it policy wise have been discussed in past posts. One notes a PSA from NYC and another is in regard to the NYC Health Commissioners attempt to raise the tax on soda. This same health commissioner is working with Mayor Bloomberg in the current soda initiative.

The USDA has to approve restrictions on food stamp purchases. Some people are concerned that this might set a precedent but I am hopeful that it will!
I knew that people on foods stamps could not buy non food items, or alcohol or tobacco, but I hadn't realized that there are NO nutrition restrictions.

Many popular press articles are discussing this NYC proposal so I won't rehash them here. I will say that Bloomberg and Farley are wise to suggest that this is a temporary intervention that can be evaluated and revisited in the future. When I read that the that 75 to 135 million dollars was spent (in NYC from EBT) on sugary drinks in one year, I realized that we could track all items purchased with these cards and THAT is some data I would like to get my "teeth" into :)

BTW - this was also discussed on Science Friday today and my public health hero, Walter Willett was a guest :) We must thank Lee Ann for the call that got me away from my studies to turn on the radio - kisses....

Big Soda

Seriously - I was stunned. It was break time during one of my classes and I noticed a sign in the lobby area of the 4th floor of the Science Building. The plaque said, Mountain Dew Lounge.

I pointed this out to one of my peers and then another told me that all the floors have a "soda" named lobby. So I am pretty sure that it would be safe to say that Pepsi helped pay for the building.

Now I do drink a diet Mountain Dew just about every other day (a diet coke on the others) but I consider it one of the less healthy things that I do. Soda probably isn't good for you even without sugar.

I think it is shameful to have soda themed rooms, but at least it wasn't one of the Public Health or Nutrition buildings.

And this is NC - so yes Pepsi rules the south - but what you usually see are buildings and rooms named after RJReynolds or their cigarette brands.

ABA - Soda Strategy

Very busy day today - no time to study or track things down, but alas, a little news story from this morning gives me points to pontificate

A public service announcement that is being broadcast on You Tube is grossing some people out. The PSA is meant to discourage people from drinking soda. The video is being used in New York which is usually on the cutting edge with these types of things. They were aggressive about smoking bans, getting TFAs out of foods, ordering calorie content charts and now - confronting the beverage industry. Much of what happens in NY trickles down, so I am optimistic.

The video shows a kid drinking a soda and gobs of wet sugar run out of his mouth and down his face. I can't remember the important health message that followed - something like soda or sugar makes you fat.

The American Beverage Association, a trade group for soda makers, is upset about this commercial. They say that it is true that sugary beverages are not without disadvantages, but that they also offer low and no calorie choices. They propose a less offensive means of suggesting people limit their intake of soda. Then they point out that ALL of their products are fat free.

Yup, that is the part that got me. Hello? Not having fat doesn't change a thing. And comparing sugar to fat is ridiculous. There is no "good sugar bad sugar" debate, it is ALL bad sugar. We have healthy promoting, in fact, life sustaining, good fats, but there is no amount of sugar that the body needs. [not referring to that which occurs naturally in fruits and vegetables].