Friday, June 21, 2013

Consider Equity In Targeting Obesity

There is no doubt that reducing empty calorie consumption is a necessary component for eradicating the obesity epidemic.  In recent years, several approaches have been promoted as means of targeting large numbers of the American people who are either currently obese or at risk of becoming obese.  Some of these measures include restricting advertisement of junk foods to children, requiring calorie labeling on menus and restricting the size of sugar-sweetened beverages that are sold.  While there is not universal agreement on the appropriateness of these approaches, we can safely say that measures targeted towards promoting health and preventing obesity can and should be equally applied to all Americans regardless of their economic status. 

That is not the case with promoting the restriction of purchasing sugar-sweetened beverages with food stamps.  In order to qualify for SNAP benefits, individuals must have income that falls below 130% of the Federal Poverty Line; however, the income can go as high as 200% of the Federal Poverty Line for families receiving non-cash TANF services.  

As the argument goes, obesity is an epidemic that costs the healthcare system millions of dollars and a significant amount of federal dollars are being diverted from other important programs to underwrite treating this epidemic.  Therefore, the government should have greater discretion as to what it does and doesn’t subsidize within its food programs as a way to impact the obesity epidemic and bend the health care cost curve.   

It is not clear that restricting food purchase choices in a way that targets poor people will result in changed behaviors related to food choices and healthy eating.  However, if we accept the premise that targeting groups of individuals who receive federal dollars to purchase food is an effective way to decrease obesity, why stop at SNAP benefits?  There are more than 2 million federal employees and a growing number of elderly who use federal dollars to buy food for themselves and their families every day.  Both of these groups of individuals would benefit from decreased consumption of sugar-sweetened beverages and the potential savings accrued from their improved health would contribute additional health care savings.  These examples underscore the point that our perceptions of acceptable and reasonable restrictions on groups of individuals, especially if they are poor, are subjective.

One approach we at the Baltimore City Health Department have chosen to take to promote healthy food purchase and eating is evidenced through our Virtual Supermarket Program in which healthier food choices are incentivized at point of purchase.  The VSP is a program that is designed to improve food access for SNAP recipients who live in food deserts. Individuals get $10 health bucks every fourth order they make with the Virtual Supermarket to purchase fruits, vegetables, whole grains, and low-fat dairy products.

Ultimately, our approach respects an individual’s agency around health and wellness decisions and provides greater opportunities for sustainable behavioral change that can help turn the tide on obesity.

I'm curious to hear your take on the situation, Baltimore.  How are you impacted by this issue? Please share your comments below.

Take care, B’more.

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