Thursday, March 07, 2013

Nutrition, Obesity, Cost

In a recent online exchange, a poster commented on how extraordinary it was that poor people in our society are fatter than not-poor people. I am not sure the claim is literally true, but I believe it is true that obesity in the U.S. is at least as common among the poor as in the general population, and perhaps more common.

Someone responded that the reason was that more nutritious food was more expensive. She did not go into details, but my guess is that she was thinking of fast food—I have seen other people make the argument in that form. I responded by offering home made bread and lentils as examples of inexpensive but nutritious foods. Another poster responded to that with the claim that home made bread, while tasty and nutritious, was more expensive than "the cheap and nasty supermarket bread."

So I did some price comparisons, getting my price and nutrition information off the web.

Flour, the main ingredient in home made bread, costs about $.50/lb and has about 2000 calories/lb, so about $.25/1000 calories.

Wonder Bread, the classic example of supermarket bread, has 1100 calories/loaf and cost $1.99/loaf on sale at Walgreens, normally more. So about $1.80/1000 calories, or seven times as expensive.

Comparing lentils to fast food, 1 kilo of lentils has about 3500 calories and costs a little over $2. So about $.60/1000 calories

A McDonalds Quarter Pounder with cheese has 520 calories and costs $3.10.  So about $6.00/1000 calories. For that comparison, fast food costs about ten times as much per calorie.

Not only are the claims wrong, both are wrong by close to an order of magnitude.

I should add that I bake bread, as does my wife. My version is a sourdough bread, so does not require yeast. The only ingredients are flour, water, sourdough, salt, and raisins, so if I did a non-raisin version the only significant cost would be the flour. It does require an oven, but most Americans, including most poor Americans, have access to one.

My recipe does require some time, although not a lot--perhaps half an hour per pound of flour, counting only time spent actually doing things, not time waiting for bread to rise or bake. But there is a very low work recipe I sometimes use for a yeast bread, based on the recipes in Artisan Bread in Five Minutes a Day, that takes substantially less time than that.

35 Comments:

At 9:34 AM, March 07, 2013, Blogger John said...

I think that Orwell's quote below from The Road to Wigna Pier goes a long way to explain why low income people tend to have worse eating habits. When you're busy working at a stressful job and don't have the time/money for productive leisure, it's easy to find tasty food as a substitute. Candy, Quarter Pounders, and so on are all quite cheap, even for people with a limited income:

"Now compare this list with the unemployed miner's budget that I gave earlier. The miner's family spend only tenpence a week on green vegetables and tenpence half-penny on milk (remember that one of them is a child less than three years old), and nothing on fruit; but they spend one and nine on sugar (about eight pounds of sugar, that is) and a shilling on tea. The half-crown spent on meat might represent a small joint and the materials for a stew; probably as often as not it would represent four or five tins of bully beef. The basis of their diet, therefore, is white bread and margarine, corned beef, sugared tea, and potatoes--an appalling diet. Would it not be better if they spent more money on wholesome things like oranges and wholemeal bread or if they even, like the writer of the letter to the New Statesman, saved on fuel and ate their carrots raw? Yes, it would, but the point is that no ordinary human being is ever going to do such a thing. The ordinary human being would sooner starve than live on brown bread and raw carrots. And the peculiar evil is this, that the less money you have, the less inclined you feel to spend it on wholesome food. A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man doesn't. Here the tendency of which I spoke at the end of the last chapter comes into play. When you are unemployed, which is to say when you are underfed, harassed, bored, and miserable, you don't want to eat dull wholesome food. You want something a little bit 'tasty'. There is always some cheaply pleasant thing to tempt you. Let's have three pennorth of chips! Run out and buy us a twopenny ice-cream! Put the kettle on and we'll all have a nice cup of tea! That is how your mind works when you are at the P.A.C. level. White bread-and-marg and sugared tea don't nourish you to any extent, but they are nicer (at least most people think so) than brown bread-and-dripping and cold water. Unemployment is an endless misery that has got to be constantly palliated, and especially with tea, the English-man's opium. A cup of tea or even an aspirin is much better as a temporary stimulant than a crust of brown bread."

 
At 9:38 AM, March 07, 2013, Blogger Ryan Long said...

This post is amazing! I have heard the claim that poor people are obese for nutritional reasons, and I fully believed it. I never took the time to work it out, though. You've managed to shatter a belief I've held for a good 10 years or more.

I realize now that I should think about this more carefully. Thank you for that! :)

 
At 9:43 AM, March 07, 2013, Blogger David Friedman said...

"When you're busy working at a stressful job and don't have the time/money for productive leisure, it's easy to find tasty food as a substitute."

If that is the explanation, then the working poor should be fat and the welfare poor thin. Do you think that's the case?

 
At 9:47 AM, March 07, 2013, Blogger August said...

I don't think eating homemade bread and lentils would materially improve anyone's health. I have had great success with the Paleo diet and actually look back on these types of foods as the mistakes that derailed my previous efforts.
I used to make my own bread too, and it became pretty obvious it was responsible for my acne outbreaks.
Now, I also don't happen to believe that fast food is necessarily cheaper than good food; it is just takes a lot more work to find good, cheap food. You either have to throw more money at the problem, or more time.
Anyone who realizes this should gain a higher level of respect for the natural division of labor found within marriage previous to the delusions of the 20th century.

 
At 9:55 AM, March 07, 2013, Blogger Max said...

Many people believe that fast food is cheap; and while it's certainly cheaper than fancy restaurant food, it's not cheap food. The lower income people I've known don't eat fast food nearly as often as people seem to believe.

It's also true that some meats, fruits and vegetables are incredibly expensive, and I think the claim that nutritious food is expensive is based on that fact. Yes, it's true that lower income people aren't buying arugula, avocados, kiwi, veal, etc. But they can afford chicken and less exotic fruits and vegetables.

Fundamentally, the definition of poor or low income in America is actually pretty high by world standards. I happen to know that Brazil defines poor as "unable to purchase food each month" (note that definition doesn't include other living costs). I believe the US defines poor as "makes less than an inflation-adjusted number that was chosen in the '60s." In non-industrialized countries it is still possible for the poor to starve to death. If you asked them about the rates of obesity among their poor you would get some very strange looks.

 
At 9:59 AM, March 07, 2013, Blogger gandeez said...

While I agree with your analysis, Dr. Friedman, I think the argument is also based loosely on the principle of least effort, although my memory of Zipf's model is a little rusty. The basic principle is that individuals in any social system are always working to economize their effort, in this case the marginal mental and physical effort needed to do the job themselves.

I don't know if it's possible to do a good quantitative analysis that takes into account value both in terms of money and in terms of human effort, since quantifying marginal effort in economic terms seems like a highly subjective task.

 
At 10:18 AM, March 07, 2013, Blogger Joseph Miller said...

I second David Friedman's remark about overweight of working poor vs welfare poor.

The argument that poor people are overweight by eating too much unhealthy food because they can't afford healthy food is a contradiction. If you're fat, eating fewer empty calories would be healthier and cheaper.

Likewise, not smoking would be healthier and cheaper.

Let's just acknowledge that there are other reasons why some people would choose to eat candy or smoke cigarettes at the expense of their health.

 
At 10:38 AM, March 07, 2013, Blogger praguestepchild said...

I held a friendly challenge a couple years back in order to examine this from a paleo diet perspective to try and debunk the idea that a paleo-type diet has to be expensive.

General roundup
http://praguestepchild.blogspot.com/search/label/7-day-challenge

To quote myself:

So what is the average person's weekly food budget?

I've seen different numbers so I decided to calculate it for myself. I took the numbers from this ERS/USDA report for 2009. Americans spent 607,422 million dollars on food-at-home and 574,541 million dollars on food away from home for an annual total of 1.18 billion dollars for 300 million people or $75.77/person per week. Note: I didn't include money spent on booze (167,028 million dollars).


It's quite possible to eat a diet of reasonable meats, eggs and fresh veggies, chock full of nutrients, for around $30/week/person (or at least it was a couple years ago), less than half the national average.

The average monthly allotment for SNAP benefits is $160 or $40/week/person with the max being $200/week.

Another way to look at this is the Stigler approach of linear programming which I touched on briefly here:

http://praguestepchild.blogspot.com/2011/01/ruminations-on-paleo-stigler-diet.html

Keep in mind I know zilch about linear programming. It's an interesting problem but since the optimal (not barely necessary) amount of nutrients are not very well known and the subject in general is heavily politicized WRT things like SFAs and macronutrient ratios this is more of a theoretical rather than practical problem.

 
At 10:40 AM, March 07, 2013, Anonymous Anonymous said...

Can the observation that the poor tend to have a much higher time preference explain the American fast food / obesity problem?

One can purchase a whole chicken for ~$4-5, plus any side vegetables for a rather cheap, nutritious, and delicious meal for a small family, but of course this costs a few hours of time and effort to produce and cleanup.

Frequent fast food purchasers (poor or rich) simply demonstrate that they value near instant meals over the costs and benefits of a homecooked meal.


 
At 1:25 PM, March 07, 2013, Blogger DR said...

I remember seeing a study somewhere, but am unable to find it, showing that poor people had higher preference for sweet tasting foods. The rich in contrast preferred bitter foods to a greater degree.

For example coffee (particularly straight black coffee) is consumed to at a much higher rate among the rich than poor. The corollary is that desert type foods, candy, simple carbs (which tend to be less bitter than vegetables) would be consumed more by the poor.

 
At 5:10 PM, March 07, 2013, Blogger John David Galt said...

Nutritious food, at least some kinds in the raw, is quite cheap in terms of money, but it may be expensive in terms of opportunity cost, especially for the disabled and the working poor. When a simple trip to a grocery store must be made by bus and takes an hour or more each way, one can't blame those people for choosing the food that requires the least preparation time. Drive fast food places out of town, and the poor will eat Cup o'Noodles or SpaghettiOs.

I can't help but agree with the view expressed here that the "health" campaigns against convenient food, like those against smoking and other "vices", are motivated by hatred of the poor rather than merely having the inadvertent effect of screwing them.

 
At 8:09 PM, March 07, 2013, Anonymous joeftansey said...

They forgot that the cheapest low-calorie food is no food.

 
At 1:25 AM, March 08, 2013, Blogger Charles Collom said...

Even without Professor Friedman's analysis, and granting the premise that the poor are fat because fast food is cheap, what economic barrier is keeping the poor from eating smaller portions fast food?

 
At 1:46 AM, March 08, 2013, Anonymous Rebecca Friedman said...

Re: Charles Collom

Hunger.

Eating smaller portions may well leave one hungry, even if the food is high-calorie - at least, judging from personal experience. I can get quite respectably full eating broccoli, which is relatively low-calorie, or eating chicken, which is much higher. I admit it's very subjective, but I don't think I notice myself getting full much more quickly when I'm eating a chicken stirfry than a vegetable one. Though I could be wrong - I haven't run any strict experiments.

Also, fast food tends to be offered in units that are more cost-efficient for larger quantities - again, at least in my experience; I haven't done a proper study.

 
At 6:07 AM, March 08, 2013, Anonymous Alexx Kay said...

You're leaving out lots of externalities in your analysis of the cost of home-made bread. Some have already been mentioned, but I'll include them anyways:
* Sufficient cash-flow to buy ingredients in bulk, well ahead of projected need.
* Secure enough food storage that you can be reasonably sure vermin won't get at those bulk supplies or cooling fresh bread. [I have personally lived in places where this was a serious consideration.]
* Time to make the bread.
* A kitchen with a working stove (or dedicated bread-making device).
* Mixing bowls and other kitchen implements used to prepare the dough.
* Training in how to bake bread. (That Five Minutes a Day book cost money to buy and time to read.)
* Pursuant to that last point, knowledge that home-made bread is a thing that can be done! It seems obvious to you and me, but there are many people who simply don't know this sort of thing.

I'll grant that it would still be possible for most people to eat healthier than they do, but there is more in the way than you have accounted for.

 
At 7:01 AM, March 08, 2013, Anonymous Andersson said...

I remember a chat I had with a guy who ran a convenience store in a poor neighborhood in Australia.

He described how people would come to the counter with their carts loaded with everything from cigarettes and soda to milk and cereal for their kids' breakfast. Then they'd discover they didn't have enough cash. They'd beg him (the store owner) for credit and he'd refuse. They would start taking things out, eventually leaving only the cigarettes, candy and soda. The kids' breakfast went back on the shelf.

The store owner was happy, by the way, as he got his biggest margins on cigarettes.

 
At 10:23 AM, March 08, 2013, Blogger David Friedman said...

Alex:

1. "Externality" is a technical term in economics, and it doesn't mean what you are talking about.

2. Most Americans have access to a stove, and it doesn't take much space to make bread. One large bowl and some loaf pans add only a tiny amount to the per loaf cost. The training is something that people can, and routinely do, do for each other, and books are available in libraries if one wants to learn that way. It does take time, but many poor people, most obviously the unemployed, have lots of that, although not all.

 
At 10:25 AM, March 08, 2013, Anonymous RKN said...

Echoing one of JDG's points, lack of practical access to fresh fruits 'n vegetables was cited as a big reason why the poor substitute fast and cheap processed food instead, as reported by a study in the Cleveland area when I lived there ('05-'10). If I recall correctly, food merchants interviewed said they were reluctant to locate stores in those neighborhoods over concerns for the safety of their employees, and theft.

Recently, I heard a story on NPR where one person made the point that the food industry in this country has become very efficient at creating & marketing less than nutritious packaged and processed foods which dominate store shelves. It was cited as one big reason why many Americans are overweight, not just the poor.

 
At 6:03 PM, March 08, 2013, Blogger Peter McCluskey said...

I often pay more in order to get food that is more nutritious. Eggs from pasture-raised chickens cost 3 times those fed an unhealthy diet of seeds. Salmon costs more than most grain-based products.

But if I only wanted good enough nutrition to avoid obesity, eating mostly sweet potatoes would be adequate and cheap. See also Soylent.

 
At 7:41 PM, March 08, 2013, Anonymous Brandon Berg said...

Joseph:
Let's just acknowledge that there are other reasons why some people would choose to eat candy or smoke cigarettes at the expense of their health.

No can do. If we acknowledge that poor people are prone to obesity because they make poor dietary choices, then it's just a small step to acknowledging that poor people are poor because they make other poor choices. And next thing you know it you're questioning the foundations of welfare statism.

Ergo it's obvious that the high rates of obesity among the first-world poor are in no way related to any alleged tendency to make bad dietary choices.

 
At 6:08 AM, March 09, 2013, Anonymous Andersson said...

The vermin problem I recognize... from slummy student housing in Sweden and more recently (with ants) in Italy. My solution is to put my flour and other things (sugar, salt, muesli, rice...) in glass jars with screw tops. I use jars that crushed tomatoes are sold in, so they cost me nothing extra. Actually, there are no ants where I'm now, but I keep doing it out of habit.

 
At 10:14 PM, March 09, 2013, Blogger Raquel said...

All of us could live better if we put in the effort. Accusing poor people of being lazy is not groundbreaking. I guess I should write an article about stupid it is to live in a slum. All it takes to build a better home is some woodworking skills and motivation.

 
At 1:51 PM, March 10, 2013, Anonymous Andersson said...

Raquel, I think the thing is that it's not necessarily stupid to live in a slum. It may be the best option available to someone.

So the question why poor people eat nutrionally inferior food when healthier food is actually cheaper is more interesting -- it's a seemingly irrational choice.

Explanations could perhaps be along the lines of

"It's irrational, and caused by universal human cognitive and physiological biases..."

"It's irrational, and due to circumstances particular to the situation of poor people..."

"It's rational, given the resources available to the individuals in question and their tastes..."

or possibly some combination of the above.

 
At 9:49 AM, March 11, 2013, Blogger Michelangelo Landgrave said...

As John makes mention of, the issue is likely more about the value of time. The time to prepare healthy foods is significant and tends to be outweighed to the time needed to order fast food.

Consider fruit. In my household there is a large bowl of fruit in the kitchen, but its rarely touched since we're all too busy to actually cut it up to eat.

 
At 9:09 PM, March 11, 2013, Blogger Hume said...

On a diet, I eat Lean Cuisines for lunch and dinner. Oatmeal for breakfast. I dont know about long-term consequences, but I lost 40 lbs. Cheap and quick. There is nothing anyone can say that will ever convince of this argument (with the exception for those who do not have access to a freezer and microwave or similar heating device).

 
At 10:45 PM, March 11, 2013, Blogger Simon said...

The Gary Taubes theory on why we get fat perfectly explains greater obesity among the poor. Slimming diets, namely meat, fish and green vegetables are much more expensive both to buy and to maintain and prepare. High sugar and high carb foods are cheap, quick and easy.
If you believe high sugars and carbs is the reason for obesity you would expect to see it increase amongst the poor. I'm not sure but I imagine this is the case.

 
At 12:29 PM, March 12, 2013, Blogger Jim Oliver said...

1. Poor people in other countries manage to make their own bread or tortillas.
2. Carrots are cheap and do not need cooking.
3. Greens are cheap and are known a food of the poor.
4. Eggs are cheap and require very little cooking.

The obesity is due to too much access to food not too little.

 
At 6:33 PM, March 12, 2013, Anonymous Eccdogg said...

It is just plain false that a healthy diet is expensive.

Legumes are incredibly cheap and store forever.
Canned Tuna is also cheap.

Frozen and canned vegetables are also very cheap and really are not that different from fresh.

And carrots cabbage kale collards onions can generally be bought year round at a good price.

Frozen berries can be bought cheap. As can fresh apples and bananas. Canned fruit is also a decent option.

Grains are all cheap. Whole grain rice, whole grain flour, corn meal, oats. Potatoes are also a cheap starch. Chapatis are an even easier bread than your recipe

Canola oil is a cheap fat that is pretty healthy.

Other fresh fruits an veggies can be bought or grown cheaply in season.

Every night soak some dried beans then cook legumes plus starch for dinner about an hour. Season with onions salt pepper an oil. Fill half you plate with legumes and starch the other half with veg and fruit for dessert. Save leftovers for lunch with an apple. Banana plus oats or grits for breakfast with milk.

You can easily get in under $5 per day per person on that meal plan and be very healthy.

You can eat on less tha

 
At 1:03 PM, March 13, 2013, Anonymous Nightrunner said...

Yes, most of the poverty is in the head - witness economic success of the immigrants.
No, we cannot just say that it is all their own fault and wash our hands. It would be both inhumane and very short-sighted, since the societal cohesion cannot be kept by the bayonets for any extended period of time.

 
At 12:14 PM, March 14, 2013, Blogger Arthur B. said...

Nitpicking:

Sourdough contains yeast. It differs from specially cultivated yeast which are more active than the wild yeasts caught in your sourdough and tend to outcompete every other bacteria, but still, it's yeast.

 
At 2:00 PM, March 14, 2013, Blogger Travis said...

What about the chemicals they use to preserve most prossest foods that have been proven to be habit forming if not plan addicting and the fact that people just don't get enough exercise

 
At 7:12 PM, March 14, 2013, Blogger David Friedman said...

Arthur B writes, about sourdough, "it's yeast."

So I once thought, but I was wrong. Sourdough contains yeast, but it also contains lactobacilli, a different micro-organism, and the combination is important to how it functions. For more details see:
http://en.wikipedia.org/wiki/Sourdough

 
At 4:32 PM, March 17, 2013, Anonymous Melissa said...

It's sad when the government has to set in to change things so people don't eat bad foods and get fat. People have lost track of the most important thing in their life. Their health.

 
At 10:20 PM, March 20, 2013, Anonymous js290 said...

"Nutritious food" would imply whole, unprocessed foods. How is it possible that additional processing can make something cheaper?

Some resources regarding obesity problem:

http://www.bodybyscience.net/home.html/?p=266
http://www.fathead-movie.com/index.php/2013/01/22/new-year-new-fat-head-dvd/
http://www.gnolls.org/3310/video-of-my-ahs-2012-presentation-what-is-hunger-and-why-are-we-hungry-j-stanton/
http://www.dietdoctor.com/why-calorie-counters-are-confused

 
At 5:48 AM, March 21, 2013, Anonymous Anonymous said...

Interesting. I was just thinking about the efficiency of making the bread earlier (no joke).

The only issue I raise with this is that making bread is not a common practice and thus some might not really think of doing it.

 

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