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How Restricting Food Stamp Choices

Can Fight Obesity
Aaron E. Carroll

THE NEW HEALTH CARE SEPT. 22, 2016

Often, when people discuss the obesity crisis in the United States, and another
failed effort to help people change their eating habits, it’s as if there’s nothing
we can do.

But sometimes it’s actually more that there’s nothing we will do. There’s a
difference.

The Supplemental Nutrition Assistance Program (SNAP), colloquially

known as food stamps, provides aid to poor families in the United States so
that they can buy food. More than 44 million Americans are in the program,
with the average household receiving about $255 a month.

Oddly, food insecurity is linked to obesity. This could be because calorie-

dense food is cheaper than nutrient-dense food, so poor people find it harder
to eat healthfully. Simply providing money for food won’t change this. In
studies, people who receive SNAP tend to be more obese than those who don’t.

This has led some to call for a reduction in benefits, arguing that the
program is causing obesity. It’s more likely that we need to change the
behavioral economics of food, not the aid we supply.

A recent study adds credence to this hypothesis. Researchers gathered

adults in the Minneapolis-St. Paul area who were earning no more than 200
percent of the federal poverty line and who were not already enrolled in the
SNAP program.

All received a debit card with money for food, much like in SNAP. But
then they were randomized to one of four groups. The first received a 30
percent financial incentive to buy fruits and vegetables; the second was
prohibited from buying sugar-sweetened beverages, candy or sweet baked
goods; the third got both the incentives of the first group and the prohibitions
of the second; the fourth got none of these, and served as a control.

Researchers followed these groups for three months. They found that,
compared with the control group, the third group (incentives plus
prohibitions) consumed about 96 fewer calories per day, 64 of which were
“discretionary” calories (from added sugars, solid fats and alcohol above
moderate consumption). The third group also ate less of the prohibited foods
and more fruit.

Interestingly, those in the incentive-only and prohibition-only groups

didn’t see significant differences. It seems that a combined approach was
needed.

The good news is that there seems to be something we can do about

obesity. The bad news is that we probably won’t do it.

There have been many, many, many calls for the food stamp program to
promote more healthful diets. Many states have requested waivers allowing for
restrictions on what benefits can buy (some items, like alcohol, tobacco and
household supplies, are already prohibited). Further restrictions have been
rejected by the Department of Agriculture, which administers this welfare
program.

Its reasons for doing so are not hard to understand. The U.S.D.A. harbors
legitimate concerns that such restrictions could increase the stigma and
embarrassment already associated with food stamps, driving away potential
beneficiaries, some of whom are children. The agriculture department favors
incentives, rather than exclusions, though this research shows incentives alone
don’t seem to work. Most important, the department may be concerned that
such changes would unfairly target poor people.

That concern is not entirely unreasonable. Sometimes the people calling

for restrictions on food stamp purchases are the same people trying to reduce
benefits over all. Such calls are often also fueled by anecdotal accounts of
people who abuse the program to buy luxury items like lobster, filet mignon
and crab legs. When we move beyond anecdotes, data show that food stamp
recipients are not favoring shellfish or steaks over ground beef.

But not all pushes come from those who seek to punish the poor. New
York City, which tried to limit soft drink sales for everyone, also asked the
U.S.D.A. for permission to restrict purchases of sugary beverages from food
stamps as part of a two-year experiment and was denied.

The department’s concerns seem odd when we look at other federal

programs. The program for Women, Infants and Children (WIC) provides food
to poor women during and after pregnancy and to their infants and children.
That program’s restrictions on food are quite thorough. The national school
lunch program helps provide meals to more than 31 million children each
school day. The regulations that govern what’s allowed under that program are
complex and vast.

The authors of the new study say that this is the first experiment to look at
 whether restricting certain foods on SNAP might lead to better health. It might
be worthwhile for the Department of Agriculture to extend the experiment a
bit more.

Aaron E. Carroll is a professor of pediatrics at Indiana University School of

Medicine who blogs on health research and policy at The Incidental Economist
and makes videos at Healthcare Triage. Follow him on Twitter at @aaronecarroll.

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A version of this article appears in print on September 27, 2016, on Page A3 of the New York
edition with the headline: Limiting Food Stamp Choices May Help Fight Obesity.

© 2016 The New York Times Company