The People's Perspective on Medicine

Better Diet for Poor Americans Is Not a SNAP

The last fifteen years have seen some increases in diet quality for most Americans, but not for poor people on SNAP assistance. Disparities in diet quality are increasing.

Poor diet may underly a wide range of undesirable health problems, from obesity to diabetes and heart disease. The Supplemental Nutrition Assistance Program (SNAP) was designed to help very low-income Americans afford a better diet. Scientists wondered how well this program is working to improve nutrition in poor families. They examined data from the National Health and Nutrition Examination Survey from 1999 to 2014, and discovered increasing dietary disparities between SNAP participants and the rest of the population.

Determining What People Are Eating:

The research included 38,696 participants who filled out either one or two detailed dietary questionnaires (JAMA Network Open, June 15, 2018). To determine diet quality, the researchers created a diet score based on recommendations of the American Heart Association. They calculated consumption of eight dietary components: fruits and vegetables; fish and shellfish; whole grains; nuts, seeds and legumes (all of which presumably counted positively); and sodium; sugar-sweetened beverages; processed meats; and saturated fat (which must have lowered the overall scores). They then estimated how many people were eating a poor diet, an intermediate diet or an ideal diet.

SNAP Diets Did Not Improve Noticeably:

Between 2003 and 2014, the mean diet score for Americans in general improved significantly, while the diets of people receiving SNAP assistance did not change. Higher-income individuals in particular started eating better during that time, although they still have a lot of room for improvement. The proportion following an ideal diet went from 1.4 percent to 2.6 percent, while the figures for intermediate diet scores increased from 59 percent to 69 percent.

In contrast, there were no significant changes in dietary scores for people with lower incomes, whether or not they participated in SNAP. In particular, people on SNAP drank more sugar-sweetened beverages and ate more added sugars and less fish, shellfish, nuts and seeds than those who were not participating in the program.

The authors conclude:

“our findings underscore the need for robust new strategies to improve diet quality and reduce dietary disparities in the United States.”

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I grew up urban poor with families around us not having food at the end of the month. Luckily, we always had enough to eat and did not use food stamps. But we were just one step away from that. One of the things that may be overlooked is what is needed for food preparation. For instance, dry beans may not be an option if one has no stove. Also, if the gas/electricity gets turned off, that’s a problem. Remember to add in the costs of cooking food like dry beans or cooking from scratch. Crockpots, for instance are not inexpensive as advertised, if you do the math. So, lots of cooking may be out of reach for many folks, who also may be working more than one job. Also, going to the supermarket multiple times a week may not be an option. Food that doesn’t spoil quickly is often not healthy food. All things to consider for some folks. Jelly for peanut butter and jelly sandwiches may not be healthy, but it is something that is viable in terms of not taking a lot of money, time, preparation, etc.

I am a SNAP recipient. There is just no way that I can stretch my SNAP $ to buy healthy food. Healthy food is EXPENSIVE! SNAP $ have decreased over the years, so SNAP recipients are forced to buy cheaper less healthy food, if they want to eat all month.

I try to buy the most healthy food I can, but run out each month. I would love to buy organic fruits and veggies like raspberries, blueberries, and wild salmon, but if I did, I would run out of SNAP $ very fast! The solution is to increase the amount of SNAP we get each month, which of course the Trump administration is trying to do just the opposite.

An economist some years ago examined the types of food as they are arranged in grocery stores, their nutritional value, and their cost. Around the edges were vegetables, fruits, dairy, and meats and were all more expensive than those in the center, which were largely processed food and heavy in corn sugars and cheap. It is no wonder poor people are not healthy. Our economic system influences their choices.

This might be of interest to some readers here…the pdf to the cookbook is free. I love the story of it.

her website:

This cookbook, Good and Cheap, by Leanne Brown is bases on her master’s thesis. It was written to help ANYONE live and eat well on a SNAP budget, and it is available online for FREE.

It has nutritious, delicious, varied, and attractive dishes as well as ideas for substitutions, tips & work-arounds for life challenges, and educational information sprinkled throughout.

Bon apetit!

I have lived in a poor SNAP community. “Good food” is expensive when or if available. Lack of transportation to a quality grocery store(s). You are pretty limited in where you can shop. Too often the local store is the corner gas station. Farmer markets don’t take SNAP. Food banks give out way too much junk and white bread. And yes poor choices, but it is out of ignorance on nutrition and health. It would shock you to know that there are people who still think diabetes is like the flu. A disease that will go away once you get a shot in the emergency room. Heart disease/ high blood pressure? There’s a pill for all that. Alcohol and self-medication is also a problem. It clouds good judgment on food choices. It would be nice if doctors/nurses would go directly into these communities and educate from there.

You can make quite a lot of vegetable soup with misc. fresh veggies that are on sale, and a can of tomatoes, plus any meat bits (even leftover). A bag of frozen mixed veggies is cheap and nutritious, too Make a huge batch and freeze it in portions. Not expensive.
Soda has NO nutritional value at all. Nothing with 0 nutritional value should be eligible.

I receive a very small amount of SNAP benefits($82/mo). I am completely disabled and on SSDI. I am trying to eat healthier and my food bill has really gone up as a result. Things like fresh fruits and vegetables, nuts, whole grain products, lean meats and shellfish are pretty expensive. It is cheaper to just buy two dollar frozen meals like I used to. I try my best but am out of SNAP money by the middle of the month. It would be easier to just eat poorly again.

Why are taxpayers subsidizing sweet beverages, candy, sweetened cereals, and junk food? If SNAP were limited to quality proteins, fruits, and vegetables, maybe there would be an improvement in the diets.

The government can not mandate people’s diet. Yes, we all should eat a healthy diet, but there is a fast food spot on almost every corner, and the remaining corners have a candy or donut shop. If you work long hours, are not inclined to cook, or don’t have much cash, you’re not going to eat well. It is always cheaper to eat well if you are willing to cook. You can eat steak that you cook for the price of a fast food burger. (Vegetarians should take that figuratively.) For people that buy cheap Mac’n’cheese packages, a bag of pasta, a block cheese, and some milk will be cheaper. You do need a stove, a refrigerator, and a pan.

Many folks who use SNAP also use local food pantries. I volunteer at one that offers fresh produce, dairy products, and sandwiches from local grocers, food outlets like Starbucks and Quik Trip, etc. The vendors get a tax credit and the food does not go to waste. However, I am appalled by the cakes, cookies, candy, and doughnuts that are donated and offered to those who use our pantry. We are contributing to poor choices and while our single little pantry might simply throw out such cakes instead of making it an option, it doesn’t address the root of the problem. What about not allowing non-nutritious food to be donated for tax credits?

Just through anecdotal observation at the grocery store check out, SNAP users eat a terrible diet! More nutritional education needs to be required for them because you can eat fairly well if you know how. Knowledge is a great thing!

Perhaps instead of providing cards with restrictions (no paper goods, alcohol, tobacco products, etc.), SNAP participants could be provided with food boxes that contain nutritionally sound foods AND a card for personal tastes in groceries, meats, and dairy that would specifically exclude sugary drinks.
The boxes could be available at either local grocers or predetermined distribution points.
The box contents could include dry foods (beans, rice, pasta, flour, powdered milk, etc.) as well as locally-available fresh fruits and veggies with quantities based on family size.
SNAP participants could be required to attend nutrition and cooking classes to improve their family’s nutrition.
Diabetes and obesity are national problems for both SNAP and non-SNAP participants.

I live in a part of Dallas, Texas that is a refugee resettlement area and a low to moderate income area with 37 languages represented in our elementary school. We also have a large share of the over-65 population, many of which qualify for minimal food stamps (SNAP ). I am 75 and lead two very active community organizations, one of which is devoted to the welfare of our senior citizens. My husband is 79 and while he still drives (I don’t), we are in need of much better public transportation.

All this to say that I am aware that our older people do not eat well. Sometimes we find that they do not eat much at all. Meals on Wheels is active in our neighborhoods, but the food is not palatable to many people. And I find myself joining the ranks of older people who just don’t enjoy cooking anymore, especially not of fresh foods that I have to wash, chop, prepare, season, etc. making one meal take an hour or more to prepare. We can afford to eat out more often than some of our neighbors, but that’s not such a good answer either.

I see our working moms and dads come home after, often, working two jobs to keep up their household, and they will stop at McDonalds or other and pick up a quick meal for themselves and the kids. Our schools feed the children three meals a day, but those meals are not always eaten because sometimes the food is just not very tasty to the kids.

No one is eating the right things here. We are surrounded by urban gardens that sell to the public as well as supply food banks. But when I buy fresh vegetables and even fruit, it languishes in the refrigerator and much of it gets thrown out. That is not good for us, but I have MS and seldom feel like cooking. Plus my teeth are in bad shape and the lowest price I have been quoted to fix them is $19,000, which I cannot afford. So I can’t chew fresh foods very well, even when cooked.

My neighbors and I think that these things contribute to the lack of positive use of SNAP, to poor nutrition overall, to lack of general good health. Two other things stand out as well.

Fresh foods at local markets are prohibitively expensive. And a lot of both elderly and young people simply do not know how to cook fresh foods, season them for taste, etc.

Public assistance can be used to educate people with regard to good eating habits. This may sound unAmerican, i.e., not allowing people to choose their food, but SNAP should not be used to support the soft-drink or sugar industries. The government agency could put restrictions on the specific items eligible for purchase via SNAP. In the long run, we all pay for healthcare provided to people suffering from diabetes that could have been prevented.

In 2010 My husband of almost 20 yrs said goodbye so I went from $118,000adj gross income to approx $8,000 and a little SNAP benefits I have chronic illness am very health conscious I can assure you It is IMPOSSIBLE to eat healthy these days if you’re poor espec if you get SNAP benefits I even live in Midwest prices are lower I dont eat processed foods I dont like fish even if I did I couldn’t afford edible fresh decent fish Unless you live it you cant know

SNAP allocations are not much. When considering the price of fresh food, SNAP benefits are NOT ENOUGH to afford a good diet, so many people don’t bother.

Purchasing only some fresh produce can take up over half the SNAP benefit. This is especially hard on the elderly who live on a fixed income or people who are ill and cannot work.

Not all the SNAP rules should apply to everyone across the board. The only consideration the elderly get are they don’t have to get a job (who would hire an 80 year old).

It only makes since that if the people who need it the most, the people who are most vulnerable, receive better nutrition, the sickness rate would be less and, therefore, hospitalization costs and Medicare costs would be less.

As long as there are food deserts in areas with low income populations this will continue to be a problem. Many people living in low income areas do not have access to fresh fruits and veggies.

I have had stomach issues for years and other chronic conditions such as Candida & Fibromyalgia. I was indicriminently prescribed-antibiotics for years ago. Eventually, a holistic physician treated me with vitamin b, c, & b12, Which improved my health 70%.

I always take vitamins and know they have helped in my situation. I eat a healthy diet, which most Americans don’t. Between agricultural practices and processing, are we really getting all the nutrients we need in our diet!!

Our farm accepts SNAP vouchers at local farmers markets. Recipients become angry when they are not allowed to purchase eggs, jelly, and other farm processed foods that we offer. They do not want to buy vegetables or fruits. Exceptions are apples and potatoes. They also want to spend all of their vouchers in one trip, which is too much food for one senior or WIC parent. Buying such a large amount of produce in one visit must result in a lot of wasted food.

We encourage them to spend one voucher each on several weekly trips to market (we also offer to deliver locally), usually to no avail. Therefore, education on simple ways to prepare produce must be a part of the voucher program. We usually offer recipes for the produce we are selling that week.

I receive SNAP benefits. I am elderly, disabled and live on a small SSRI income. My monthly expenditure for groceries is $125 (the amount of my food stamps.)

I would love to eat healthier … fresh vegetables and fruits but given a choice and my budget I will always choose what I can afford. Compare a pound of pasta for $1.00 or a tomato for $1.00, which would you choose? How about a loaf of bread and a jar of peanut butter compared to 3 pounds of apples? Both cost about the same.

I can buy a cheap jar of spaghetti sauce for $1.00 and with my pasta feed myself for about 3-4 days. I could go on and on but fresh fruits and veggies are not on the top of my list for obvious reasons. I would be really hungry eating a third of a tomato for supper for 3 days.

People buy all kinds of junk food and pop with food stamps. There are no laws against this.

Our government dollars is funding obesity but that keeps the doctors and pharmaceutical companies very happy making billions off of diabetes, high cholesterol and obesity complications.

The USDA website on SNAP has a section on eligible and ineligible foods and no food items. It cites the challenges of restricting “junk” foods including the prohibitive cost and lack of clear nutrition criteria to restrict certain foods. It also notes the vast number of food items added to the marketplace. Changes would require Congressional approval.

SNAP recipients can benefit from nutrition education and, over time, may choose to make certain dietary changes. The key is to communicate this information in a meaningful way.

I was on food stamps long before it was SNAP. I easily fed my family a healthy diet. There were nutrition guidelines available although they didn’t tell me anything I didn’t already know. Of course a lot of those guidelines have changed over the years. I was recently on SNAP for a few months. I ate very healthy then, too. It’s possible. But education is key.

I see this in my local walmart, all the time. In my opinion, certain things should be allowed for purchase, with SNAP, and others not allowable. Soda should not be on the allowed list. Rots teeth, among many other things. Junk food should not be allowed. And now, I’m seeing some fast food chains are accepting SNAP. I think that kind of defeats the whole purpose of the program. People are also selling their benefits, for drugs, alcohol. The whole program needs revamping. JMO

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