Nutritional Pearls: More Evidence That Healthier Is Not More Expensive

John is a 10-year-old boy who is overweight. In the past, you have suggested that John’s parents try to incorporate more whole foods into his diet, and attempt to limit processed foods. However, John’s parents have commented that whole foods tend to be more expensive to buy, and it is therefore easier to continue buying processed, prepackaged foods.

How do you advise your patient?
(Answer and discussion on next page)

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Answer: Simple changes, like switching from white to whole grain pasta, can improve overall health without increasing costs.

People often believe that eating healthier costs more than eating the processed foods available in the supermarket or even buying fast food. The problem, however, is how "cost" and "healthier" is defined: is it cost per calorie? Cost per some unit of energy density? What about macro- and micro-nutrients such as carbohydrates, protein, vitamins, and minerals? Depending on the definitions, research is mixed as to whether it's more expensive to eat healthy. I have found that per serving, making your own home made version of processed foods like Hamburger Helper© is both cheaper and you get more to eat by volume.
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Yet the myth persists, and in an effort to combat this myth, a team of researchers from the National Institutes of Health (NIH) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development designed a study to evaluate whether families could eat healthier without spending more money, choosing to define "healthier" as having higher adherence to the Healthy Eating Index 2005 (HEI-2005), which measures how well an individual matches the recommendations in the 2005 Dietary Guidelines for Americans. This is measured on a scale of 1 to 100, with 100 being perfect adherence.

The Research

The authors recruited 136 adolescent men and women with type 1 diabetes between the ages of 8 and 16 (and their families) to participate in the 18-month-long study. At the start of the study, half of the families received multiple counseling sessions designed to help them improve their overall diets which focused on improving their intake of whole plant foods, including whole fruits, vegetables, whole grains, legumes, nuts, and seeds. The other half of the families served as controls and did not receive the counseling. Over the following 18 months, all of the adolescent participants completed detailed 3-day diet records every 3 months for the first year, and again at the end of the study. One of each of the adolescents' parents completed 3-day diet records every 6 months.

At the end of the study, the authors assessed the participants' diets and assigned them each a score on the Healthy Eating Index scale as well as a score measuring the amount of whole plant foods the participants consumed.

Using information from applicable restaurants (when the participants reported eating out) as well as pricing from online national grocery stores with brick-and-mortar locations in the region, the authors were able to total the estimated costs of all foods the participants consumed and then estimate the daily diet cost by averaging the cost of food over the number of days in the study.

The Results

After taking variables such as age, income, education, and race/ethnicity into account, the authors found that those who received the dietary counseling improved their HEI-2005 scores by an average of 7 points, while the average daily cost of their diet did not change in any statistically significant way.

What’s the “Take-Home”?

I like this study because it deals in the real-world issues of buying food. After all, people don't go to the grocery store to buy calories or carbohydrates or monounsaturated fats—they buy food.

Similarly, evaluating the participants' diet as a whole makes far more sense than evaluating caloric density or specific micronutrients or macronutrients. Encourage your patients to make small changes in their diet, like switching to whole grain pasta from white pasta, or eating a handful of nuts instead of something from the vending machine. These are simple, real-world changes they can make to their diet that won't cost more, but will improve their overall diet and their health.

Reference:
Nansel TR, Lipsky LM, Eisenberg MH, et al. Can families eat better without spending more? Improving diet quality does not increase diet cost in a randomized clinical trial among youth with type 1 diabetes and their parents. J Acad Nutr Diet. 2016;116:1751-1759