Welcome to eating season.
The unofficial food Olympics — with Thanksgiving serving as opening ceremony and New Year’s Eve as closing bell — marks a national stretch of belly-busting indulgence, when healthy bites seem to surrender to calorie-crammed binges.
Among many Americans of modest means, however, a gluttonous feast is just a fantasy, and good nutrition is an expensive luxury — whether it’s a holiday or a Thursday. In those kitchens, a balanced budget may trump a balanced diet. And fast food is often what's for dinner.
But now, science is challenging that unhealthy reality. Several recent studies co-authored by investigators at Fred Hutchinson Cancer Research Center have found that buying, cooking and eating nutrient-rich meals at affordable prices is entirely doable.
“It is possible to eat better for less,” said Dr. Adam Drewnowski, a public health researcher at Fred Hutch.
In fact, some people are doing it already.
Nutrition ‘resilience’ on a budget
Lower-income consumers who prioritized nutrition over convenience and taste when food shopping had significantly better diets than their fellow shoppers, according to a recently published study co-authored by Drewnowski.
The findings are based on a national health survey of nearly 9,000 U.S. adults. To gauge the participants’ diet choices, researchers used the Healthy Eating Index, or HEI, which measures adherence to dietary guidelines on a scale of zero to 100. People who placed importance on nutrition while buying groceries posted HEI scores that were eight points higher than those who didn’t carry that mindset, the study found.
Surprisingly, that association held true for all income levels — including those with far less to spend. And that finding led Drewnowski and colleagues to coin a new phrase, “nutrition resilience,” which describes people who have good diets despite bad economic odds. The study was published in June in the journal Preventive Medicine.
“You can eat well if you have at least two of these three things: first, some education, which includes nutritional education and cooking skills; second, some resources, whether that’s money or social capital; and third, you need to have time,” said Drewnowski, who is also an epidemiology professor at the University of Washington School of Public Health and director of the school’s Nutritional Sciences Program.
“If you have two out of three, say education and time, you can cook at home. If you have education and money, you can select good foods when you go out. If you have time and money, you can have no problem whatsoever. The problem is when you’re zero for three. That becomes an issue,” Drewnowski said. “Then, you’re pretty much at the mercy of whatever the food industry puts in front of you.”
In the eastern Washington town of Sunnyside, the team is now studying the grocery-buying patterns of lower-income Latino women — where they shop, what they purchase and the cost and diet quality of those food choices. Their research goal: “Figure out what is it that makes people eat well on a budget despite economic constraints,” Drewnowski said.
Food baskets promote follow-through
Scientists already know part of answer: Education helps, but teaching alone may not be sufficient to improve diets for people with little to spend.
Some studies exploring health disparities among low-income people offer cooking demonstrations to help change habits. Participants attend eager for tips on adding more nutrients to family meals. They watch. They listen.
“But many times, everything stops there,” said Dr. Linda Ko, a public health researcher and behavioral scientist at Fred Hutch. “They go home with nothing other than what they learned, which is asking a lot from people. When they go home, that’s when they need more help.”
Ko led a study, published in the October issue of the Journal of Nutrition Education and Behavior, that took things a step further. Participants got nutrition education and food baskets to practice new recipes they learned in the seminars. As a result, they increased their fruit and vegetable consumption.
“They use the food baskets as an extension of what they’ve learned,” Ko said. “This makes learning become more real.”
The study involved 40 volunteers, 39 of them women, all from the Seattle area. Nearly half had annual household incomes of less than $20,000, and 38 of the participants were originally from Mexico, South America or Central America. They enrolled in an eight-week community program on nutrition education. And they received food baskets containing items used in the cooking classes, including fresh salmon, kale, pasta, cranberry jelly and Dijon mustard. Each basket cost $12 to $14 and had enough food to feed a family of four.
Before the intervention, participants consumed a mean of about five daily fruit servings as well as about three daily vegetable servings. After the intervention, the participants reported increasing those to a mean of nearly six daily fruit servings plus nearly four daily vegetable servings, researchers found.
“The salmon was very delicious,” one participant later said in focus group for the study. “I prepared the salmon as taught in the class; my husband doesn’t eat salmon, and he didn’t want to eat it. He said, no thanks. I said, try it and you will like it. … And he tried it and he left a clean plate.”
Said Ko: “Besides changing behaviors themselves, they also became the educators of their own families.”
Cheap and healthy food hacks
Another recent study used community workshops (again, with cooking demos) to teach 50 Latino women how to get the healthiest bang for their buck.
Fred Hutch public health researchers used an Office of Disease Prevention and Health Promotion program called Eat Healthy, Be Active — or Coma Saludable, Manténgase Activa — to create a series of interactive workshops, bookending each with a nutrition, activity and health awareness survey.
Community health educators in Sunnyside, known as promotores, shared a slew of healthy food hacks in each six-week session, from using weekly advertising circulars to put together nutritious, low-cost meals to swapping fat- and salt-laden ingredients for their healthier cousins when making traditional recipes.
Other hacks (some of which might come in handy for your Thanksgiving dinner) include:
- Trading out full-fat milk and cheese for low-fat offerings
- Baking, broiling and grilling meats and other foods instead of frying
- Cutting back on processed and prepared foods, which contain more salt and fat
- Using brown rice instead of white rice
- Switching to whole-grain breads instead of white breads
- Cutting back on sugary drinks like soda
- Buying lean cuts of meat
- Using spices instead of salt to add flavor
Researchers also showed participants how to decipher nutrition labels and offered tips on folding extra activity (think walking, gardening simple strength training) into their daily lives. Healthy eating and regular activity are particularly important for Latinos, who are often at risk for obesity and its related diseases.
“People didn’t know that nutrition labels gave information for only one serving,” said Kathy Briant of the Hutch’s Office of Community Outreach and Engagement (formerly the Health Disparities Research Center), who oversaw the program. “They didn’t know that if something was five servings, they had to multiple everything by five.”
Briant is currently working with her team to analyze the data, but said the response to the workshop was very positive.
“People really liked coming together,” she said. “They had a chance to socialize while learning something. And the cooking demonstrations were also well-received. When people get to eat food together, they’re happy.”
More than just eating and socializing though, participants picked up new food wisdom. Some reported they hadn’t known previous to the workshop that too much salt was bad for their health. Others were excited about using different spices and recipes.
Briant said a “quick and dirty” preliminary analysis showed fruit and vegetable consumption went up; use of refined grains and sugary drinks went down and participants exercised more. They also became more food label literate.
“It’s another tool that we have in our toolkit,” Briant said, “particularly for this particular population, most of whom have lower levels of education and income.”
Healthy food is good medicine
“Take two zucchini and call me in the morning.”
That sounds like a joke, but the Fresh Bucks Rx program, launched last summer by the City of Seattle, encourages health care providers to “prescribe” fruits and vegetables as a way to fend off diet-related diseases in their low-income patients.
It’s built on the successful Fresh Bucks food access initiative, which helps people using the Supplemental Nutrition Assistance Program, or SNAP, also known as food stamps, to double their spending power at certain farmers markets.
Fresh Bucks Rx promotes the idea of food as medicine. Participating physicians at Harborview Medical Center and the Odessa Brown Children’s Clinic give patients cash vouchers that they can redeem for fresh fruits and vegetables at Seattle farmers markets and farm stands.
The program gives doctors a chance to talk to their patients about how a healthy diet can hip check common diseases and chat with them about their daily diets. It gives patients on a budget regular access to fresh produce, a luxury for many.
The federally funded pilot program’s aim is to cut back on “food insecurity” and “food hardship” — or lack of access to adequate affordable, nutritious food — an issue that’s more common in Hispanic, black, multiracial and Native American and Alaska Native households. These communities also tend to suffer higher rates of obesity, which can lead to heart disease, diabetes, high blood pressure and cancer.
Advocates praise the program’s practical approach, saying it’s fulfilling a critical need in the community. Ko, the Fred Hutch public health researcher, agrees and adds that she’d like to see the idea expanded to include community food banks.
“I think it’s wonderful,” she said. “[And] that’s another avenue for us to collaborate, if we can. I would like to see that being implemented for obesity, as well. Obesity is a serious problem linked to so many other diseases, especially for children.”
Again, these healthy food hacks aren’t just for those on a tight budget; Ko and her colleagues regularly use the recipes and tips they’ve been testing out on others. Nor are they limited to summer, when fresh produce is cheaper and more abundant.
Rather, think of them as a year-round strategy to help you go for the nutritional gold during the calorie-laden food Olympics and well beyond.
Bill Briggs was a former Fred Hutch News Service staff writer as well as a contributing writer for NBCNews.com and TODAY.com. As a staff writer for The Denver Post, he was part of the newspaper's team that earned the Pulitzer Prize for coverage of the Columbine High School massacre. He authored two books, including "The Third Miracle: An Ordinary Man, a Medical Mystery, and a Trial of Faith."
Diane Mapes is a staff writer at Fred Hutch. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she blogs at doublewhammied.com and tweets @double_whammied. Email her at dmapes@fredhutch.org.
