In a well-timed article in the New York Times last month, Aaron Carroll discusses the implications SNAP restrictions can have on the obesity levels of its participants. Whether due to the higher costs of nutrient-dense food or other factors, obesity has been linked to food insecurity.2 This relates back to SNAP, as much of the concern surrounding restrictions for SNAP participants involves the stigma and embarrassment such a policy could cause. However, a strategy to encourage SNAP participants to eat healthier must be implemented in some way or another. Carroll looks at a recent study in which Harnack et al. evaluated the effects of incentive and restrictions on the obesity levels of SNAP participants. 279 low-income participants, who were not currently enrolled in SNAP, were utilized in this randomized control trial and placed into one of four different study groups. The first group, incentives, provided a 30% financial incentive for participants who purchased fruits and vegetables. The second group, restrictions, did not receive any incentives and were not allowed to purchase SSB’s, baked goods, or candy using their food benefits. The third group, incentives plus restrictions, were given the 30% financial incentive for fruits and vegetables but also had the same purchasing restriction as group two. Finally, group four was the control group, on which no incentives or restrictions were placed.3
With outcome measurements of energy intake, discretionary calories, and overall quality of diet, the researchers found that the third group (incentives plus restrictions) was significantly improved compared to the control group.3 However, although group three had reduced energy, discretionary calorie, and sugared food intake as well as increased fruit intake, the study did not have obesity as an outcome measurement. Carroll concludes that Harnack et al.’s study has found a solution to the link between obesity and SNAP participants; yet the study does not itself conclude that incentives and restrictions for a SNAP program will lead to a reduction in overall obesity.1 Yes, the participants eating habits became healthier, but this is only one contributing factor to obesity. Carroll does make a valid point however that although this study seems to demonstrate a strategy to improve the healthful diets of SNAP participants, actually instituting these polices is a long ways away.1 I also agree that Carroll makes a valid point by referencing the restrictions placed on other federal food benefit programs, such as WIC and the national school lunch program. If restrictions for healthy eating can be implemented with these programs, finding an agreeable solution for SNAP hopefully shouldn’t be so far off.
1Carroll, A. (2016, September 22). How Restricting Food Stamp Choices Can Fight Obesity. Retrieved October 23, 2016 from http://www.nytimes.com/2016/09/23/upshot/restrictions-on-food-stamp-purchases-can-improve-diets.html?_r=0.
2Dinour, L., Bergen, D., & Yeh, M. (2007, November). The Food Insecurity–Obesity Paradox: A Review of the … Retrieved October 23, 2016, from http://www.andjrnl.org/article/S0002-8223(07)01616-1/fulltext.
3Harnack, L., Oakes, JM., Elbel, B., et al. (2016, September 19). Effects of subsidies and prohibitions on nutrition in a food benefit program. JAMA Internal Medicine. Retrieved October 23, 2016 from http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2553293
My goodness, do I have a lot of opinions on this topic! I am a bit biased because I have talked to and know so many people on SNAP benefits so I do not believe that restricting food purchasing for food stamps would be ideal, nor do I believe that there is anyway to do this without adding a stigma onto the people who have to use food stamps. In addition to that, this particular study only saw about 100 kcal difference in providing incentives and restrictions vs. the control, and we really need to ask if this is clinically significant. Also, we know that when people are self-reporting dietary data that they tend to underreport. Perhaps that is what is happening here. Another concern about this study is that it makes sense that restrictions and incentives will lead to more fruits and vegetables being purchased, but how much of this food was actually consumed? Many people do not have the education on how to prepare or eat certain fruits and vegetables, so did a majority of these items go waste? I definitely think education is solution, so people can make their own smart choices without being treated like children and prevented from purchasing their choice of foods.
I do not understand how the study failed to include obesity an an outcome measure when that looked like it was the objective of the study. Did the address this discrepancy? Did the study reveal the results of the other groups? Were the results significant at any level? I feel like so much was left out of the results of this study.
I however, do think that this is worth further investigation. There should be studies where obesity is actually included as an outcome measure. As someone who worked at a gas station and regularly served SNAP recipients, I think restrictions is step forward in a way. I saw a lot of SNAP recipients choosing to shop for food for the their children at a gas station where the food is high in calories and sugar than at a grocery store right down the street with more options. Restrictions may be useful here because it would limit the kinds of food they would be getting at a gas station. This may hopefully lead them to a grocery store which a good first step.
I thought this was a very interesting article. I can understand the theory behind the restrictions but I don’t know that it is the perfect answer. I definitely like the incentive portion of their idea experiment. I think it is important for those on SNAP benefits, be able to make decisions on what they want their family to eat. The incentive idea would help those while grocery shopping to make better food decisions without limiting them, while at the same time increasing the amount of benefits they receive. I definitely agree with the idea that there is more work to be done to figure out a solution. I would be curious to see others thoughts and opinions on my idea, which would be to maybe look at the total purchase and place a general limit of foods/drinks that are considered “unhealthy”. For example, limiting SNAP participants to 25% of their total purchase being able to be “unhealthy” while the other 75% needs to be considered healthy. Therefore placing a limitation, but still allowing them to make their own decisions.