What Prevents People From Eating a Healthier Diet?

I’ve been wondering what it is that so irritating about a certain type of food and health writer, the sort that moralises and pontificates about the food that the population should be eating. Media-hyped examples would be Gillian McKeith and her Abundant Foods list that includes vinegars and Tamari (who considers them to be food rather than ingredients?), or Patrick Holford and his low GL recommendations that can involve about £9 worth of berries per person, per day. Holford claims that people who are optimally nourished don’t become ill and don’t need medicine.

McKeith and Holford both stress that people should eat organic fruit, vegetables, meat or eggs.  Given that they target a comparatively affluent market demographic and recommend a diet that is studded with supplements, it is possibly irrelevant to them that this is neither affordable nor sustainable for much of the population.

Jay Rayner had a tart but on-point observation about the proselytising efforts of Hugh Fearnley-Whittingstall.

[He] has attempted to turn what are basically a bunch of lifestyle choices for the affluent – ones I buy into – into part of a wider debate on public nutrition, which they are not.

I thought much of his attack on the chicken industry was naive, and found the sight of him lecturing people on benefits on how much they spend on a bird distasteful.

Indeed, too often the campaigning programmes for Channel 4 have felt to me like the co-opting of an ethical position into a set of brand values. Or, to put it another way…it didn’t hurt him one bit that lecturing people who couldn’t afford it on their shopping habits only increased his appeal to those who could. It’s probably fair to say that the eight-week-old River Cottage Canteen…is aimed firmly at the latter group. This is a business for people who can afford their ethics.

Beyond that even, is the stark reality depicted in Eating Our Way to Better Health.

[A vignette in Food Inc. shows] a Latino family of four struggling to make good and affordable food choices. They discuss how their school and work schedules leave little time to prepare meals at home. They compare the cost of buying dinner at the drive-thru (cheap) to buying produce at the grocery store (expensive). And most memorably, they share that the costs of prescriptions to treat the father’s diabetes severely limit their food budget.

There are no easy solutions to this family’s problems. Nor are their problems unique…

[A] patient struggling to manage his diabetes…works long hours and returned at night to an unsafe neighborhood where the only food sources were convenience and liquor stores. The patient’s doctor concludes that this environment not only contributed to his poor health, but was likely to thwart his efforts to manage it.

At its heart, it feels like this is what is amiss with so much of the writing about nutrition – it can’t be a useful public health message because it is divorced from the daily realities of the many people whom these nutritionists or food evangelists lecture. Dr Ben Goldacre sums it up well:

And that’s the most sinister feature of the whole nutritionist project…it’s a manifesto of rightwing individualism – you are what you eat, and people die young because they deserve it. They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see 78. You deserve it. Not like them.

It probably is possible to eat a healthy, balanced diet on a tight budget if you already own a freezer, stock pot and other useful items and you don’t have to incur large upfront costs for more unusual ingredients. For all the “Simple suppers for 4 in 30 minutes”, cooking on a budget is time consuming and it may be impractical or infeasible for some groups. Over the next few weeks HolfordWatch is going to examine the practicalities of eating well on a budget.

Any suggestions as to what the budget should be?

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31 Comments

Filed under GL diet, nutrition, patrick holford

31 responses to “What Prevents People From Eating a Healthier Diet?

  1. Wulfstan

    Jamie Oliver had a reasonable crack at the issue with his programmes but it seemed as if what was really needed was a combination of him, Martin Lewis and a revison of town planning and social policies.

    My food spend is ridiculously high. I spend a lot on convenience food because I’m vision impaired (or whatever this month’s euphemism is) and it is easier this way – easier to shop, cook (microwaves are essential for some of us), clean up and recycle (really, it is harder than you might think). There are some blind people who return from work and spend happy hours using gadgets to measure levels in pans, listening for the robot voice of their thermometer above the extractor fan to tell them when their meat/fish is done to their liking – I admire them, but I’m not one of them.

    Isn’t the official government figure something like £15 per head per week and that’s what they use to justify the level of benefit awards?

    • I’m ashamed to say that I hadn’t considered particular problems relating to sight or other issues that might interfere with food preparation.

      If this is an intrusive/offensive question please ignore it but how do you know how long to microwave meals for? I know that not everyone uses Braille but it’s not as if there are Braille instructions on the packing.

      I had a quick trawl through the ONS and Consumer Price Index but so far I haven’t found the government assumptions behind how much we spend on food in a week.

      • Wulfstan

        I’m such a stereotype but I always buy the same meals so I know that they take roughly the same amount of time (3-4 mins plus standing time). Shepherd’s Pie, various stews, casseroles, pasta dishes and fish pies. I never buy meals with separate parts that need to be microwaved for different amounts of time or removed and stirred in later.

        I buy porridge in individual portions in the winter, things like that I will microwave for a minute then in 10s bursts.

        I get a home delivery from the supermarket so I have sometimes had a couple of surprises/ruined meals when they’ve made substitutions. I stopped buying fruit from them because I could never tell when it hit the tiny window of being ripe enough to eat and ended up throwing it out.

        I try and buy a vegetable soup for lunch at work and maybe a fruit salad. I eat out at the weekend so I think I eat a reasonable diet even if it is full of convenience food – to be honest, I doubt it meets many guidelines but it is manageable and that matters to me.

  2. Karen Cooke

    If you are looking at cooking cheaply you might find this interesting: http://www.cookforgood.com/

    It’s US based so not everything translates easily but it does show how to eat a fairly decent diet that can be paid for on food stamps (lots of beans).

    • Thanks, I’ll take a look. I am interested in whether it is possible to afford to eat within recommended nutritional guidelines – both the micronutrients (calcium, iron intake etc.) as well as the macronutrients.

  3. Very interesting.

    Though I don’t tend to like mixing my professional work with blogging, this is somewhat relevant to my PhD work, and very relevant to the work of one of my colleagues (my second supervisor, in fact).

    http://www.geog.qmul.ac.uk/staff/cumminss.html

    Here are some good starting points in the academic literature:
    http://www.bmj.com/cgi/content/short/325/7361/436
    http://ije.oxfordjournals.org/cgi/content/extract/35/1/100

    • Thank you for these. A couple of weeks ago the Guardian asked readers to produce recipes and costs for an 2 course evening meal for 2 and it is extraordinary how much food prices vary throughout the UK (as revealed in the comments). I live in an urban area with lots of supermarkets and no independent food shops. Although it would seem as if there would be lots of choice and competition because there are so many supermarkets my food costs are quite high and I don’t have access to the same range of products as other people that I know.

      I will follow up on the references.

  4. Claire

    I’ve had this recommended to me by some usually sensible friends – the whole book is available free online. I haven’t vetted it thoroughly & she can be a bit sanctimonious and makes the odd sweeping statement about aspartame (she doesn’t like fizzy drinks!) but the recipes and instructions seem generally ok & there is a weekly menu planning section (family of four) coming in at under £30 p/w. However it’s based on shopping at a supermarket so perhaps not so helpful in the inner city food desert. And I’m not sure how up to date the prices are.

    • I was overcome with inadequacy when I saw the £30 but that seems to be evening meals rather than all of the meals in a week (Week 1 has a shopping list of @£24 but it is hard to see how that provides enough left-overs to feed people for lunch and the weekend as well as breakfast)? But it looks good so thank you.

      I’m going to run some of the recipes through a diet analyser and see how the nutrition stacks up in a week (I’m sure it’s excellent but it would be good to know) and if I can, I’ll update the prices with one of the supermarket aggregators.

  5. pamwest

    Your article is definitely ‘food for thought’. It’s not easy putting food on the table when money is short and working hours are long. When I’m stressed the first thing I want to eat is always the wrong thing but there is also an element of what food is known to us, the food our parents fed to us. I had the benefit of a Mother who cooked and passed the skills on to her children, showing us how to stretch out a budget and still have good food.
    Now, not only do I have some of the skill she had but also have a passion for growing my own food. I realise that I am one of the lucky people who have a garden in which to do that, many don’t have them and if they do don’t have time or maybe knowledge of how to use it to the best advantage.
    Reading the comment from Wulfstan makes me feel so upset because we should be able to buy ready made meals that are good and healthy; the companies who make these meals should be able to source good ingredients more cheaply in bulk so that the product cost is reasonable and also profitable.
    In schools the time is short and cookery not a priority, school dinners may be attempting to be healthier but can the pupils reproduce the same, it is a very difficult problem to solve.

    • Wulfstan

      There are probably some better ready-meals than the ones that I eat but they need a lot more attention in the microwave or are better done on the stove-top or oven. One niggling regret is that some vegetables just don’t come out well in microwave meals, the sauces can be gloopy and there is a lot of salt. Some of that is the reality of trying to do that sort of one-pot recipe in a microwave.

      I find the portion sizes a bit mean for the cost – particularly for pasta dishes where the ingredients probably cost less than 20p but I’m paying £3.50 or so.

      Overall, convenience food does simplify my life enormously and I suppose there is a premium to pay for that.

  6. I believe the nhs has a leaflet and info on eating heathily on a budget. My suggested budget is a food spend of £40 per week for a family of four. Plus an entry on using vouchers, own-brand foods, the merits of canned and frozen fruit and veg, …

    • Thank you – I shall look out for that leaflet. I must say that I am very interested to see if it is possible to eat within nutritional guidelines on a reasonable budget.

      £40 per week for 4? Is that adults or 2 adults and 2 children? That includes everything such as breakfast, lunch, snacks etc.? OK – £40 looks tight but a reasonable challenge.

  7. Firstly, thanks for the link back to my post on Disruptive Women in Health Care. The two stories I shared were eye-openers for me. Both put the problem into an entirely different context for me. As you note, a lot of the discussion about healthier eating presumes that people are either ignorant or lazy. Too often we forget about the obstacles in our way to make the right choices.

    Thanks for expanding the conversation on this topic. Looking forward to reading ideas for eating well on a budget.

    • Yours is such an interesting post and I shall look out for the film. I don’t know about US but in the UK there is a lot of finger-wagging and guilt that goes along with criticisms that people don’t cook, or if they do cook then they are cooking ‘the wrong things’. For some of us, it’s amazing that we can cook for a family at all when there are such different schedules and skill levels in the home (some can cater for 200, others struggle to boil the proverbial egg) and different food preferences.

      I recently started baking bread because one of my neighbours has been late diagnosed with Coeliac’s Disease. I find that my biggest problem is being around when the bread has proved. It’s all edible and much nicer than the bread she could buy in the shops or on prescription (some aren’t suitable because she also has a problem with soy and a lot of the pre-mixes have soy flour) but it’s a surprise to me how difficult it is at present. Perhaps it will become easier as I adapt it into my schedule better than I am now.

  8. My impression of Hugh Fearnley-Whittingstall’s campaign was that it was aimed more at the supermarkets than at the individual consumers, trying to convince them to stock chickens (in particular) which had been raised in a reasonable environment. The point of appealing to consumers to alter their purchasing habits was to apply pressure on the shops to change their habits in turn.

    The one person I recall him being particularly upset about was the lady who had visited an intensive battery farm, exhibited extreme distress on behalf of the chickens and promised him faithfully that she would not succumb to the massively-reduced “two for a fiver” deal again even though it would mean changing her cooking arrangements…and then promptly back-tracked when her family complained about the changes.

    I am by no means a vegetarian (although my wife is, and still harbours an ambition to convert me ;-) but I have adjusted my eating and purchasing habits so that I eat far less meat, but all of it is free-range or organic. This means that I spend the same (or less) money as I might if I wanted to eat meat every night, but I’m not buying meat that has come from the kind of conditions that Hugh and others have highlighted.

    I am sorry that people criticise campaigns to improve the living conditions of animals bred to eat, and fail to understand some of that criticism. How is it “naive” to want to stop chickens being raised in the appalling conditions shown on those programmes?

    • To be fair to Jay Rayner, I don’t think he is at all opposed to HFW or his message, it was the scene of him lecturing people on benefits and telling them that they should only buy high-end chicken that was Rayner’s issue.

      There is a strong argument that UK farms are strongly controlled by animal welfare legislation which the UK population supports in theory – but not in practice at the checkout where they may well buy pork, chicken etc. that was raised in countries that don’t have anything like the UK welfare standards and can sell their products for a much lower price.

      • He wasn’t saying they should buy “only high-end chicken”, he was saying they shouldn’t buy the “two for a fiver” bargains which are obviously so cheap that welfare standards could not possibly have been applied economically.

        I don’t know about you, but I don’t care nearly so much about how baked beans or pasta are treated as chickens…anything more than the most basic where those are concerned is luxury. The most “basic” chicken is simply beyond the pale as far as I am concerned.

  9. Psychedelia Smith

    Hmm, last time I was on the dole – a year ago – I got about £40 a week in Jobseeker’s Allowance. And I live in Hackney, which has more fried chicken shops than Colonel Saunders could ever possibly dream.

    Anyway, how about setting a target of £5 a day? Should just about fit within the JSA.

    • OK, the way this is going there may well be several budget plans because I get the argument that it can be more expensive for 1 person to eat than for two or more who can split costs.

      I would hope it is possible to eat well for £5 a day or things are badly out of control with food prices.

      ETA: however, as this is Carrie’s project it is not for me to say.

  10. I am reminded of a recent lunch. I bought a large tuna and salad roll – delicious, chock-full of fresh salad vegetables, no nasty mayo glue, and whole grain bread. I had tap water to drink, in my own bottle. Cost $AU 8. From the neighbouring burger place, I could have got a burger, chips and sugary soft drink for $AU 5… I am so virtuous. Or financially well off, or something.

    • Cath, you might enjoy this cartoon.

      The fast-food companies provide most calories per dollar. The NYT tried an article on most nutrition per dollar but it was not particularly convincing.

      Ignoring fuel costs etc. for the moment, I can see that it would be much cheaper to put together a low food budget by filling up on carbs and fat but I particularly want to see if it is possible to eat, say, 7-9 portions of fruit and vegetable per day and still not rack up a large bill.

      As per the NYT article, one of the things that niggles at me is pronouncements such as this:

      According to the Economic Research Service of the United States Department of Agriculture, low-income women who work full time spend just over 40 minutes a day on meal preparation. With a little planning, another 20 or 30 minutes can provide healthy, economical fare.

      That is probably true – but if they are time-strapped, that time might have to come from elsewhere or their sleep. I’m also aware that if people haven’t cooked particular recipes or use particular techniques, then the first couple of times it might take a lot longer than that.

      Still, I can fret about the budget for now. And I’ll try to avoid anything that needs careful tending for hours.

      • Claire

        And those low-income, full-time working women might just be dog-tired from long days of manual work. I recall from my student jobs – chambermaiding, waitressing, hospital cleaning – being utterly exhausted at the end of a working day. So ‘another 20 or 30 minutes’ might sound reasonable to someone sitting behind a desk but less so if you’ve been on your feet all day.

        • Yes – there’s a heaping amount of guilt that’s being served up as a side-dish to this well-intended guidance. That 20-30 minutes a day really means that pretty much the whole of a weekend day is given up to cooking for the week. This might suit some people, others who can’t find anyone to look after children or other dependent relatives might find it infeasible.

          Is it just me or does it seem that the people who issue this guidance have an image of low-income, f/t working people coming back home, ordering a takeaway and shoving their feet up in front of the much-caricatured plasma TV rather than the reality of seeing to homework, serving dinner, checking lunches, sorting schedules/appointments for everyone?

          One restriction at a time – I’m going for the budget for now.

  11. Claire

    I’ve just remembered that an aquaintance who moved back to the US was (maybe still is) involved in Cornell University’s Community Nutrition Program . I’ll see if I can get her contact details – they might have helpful insights. I know they do outreach programs into low-income neighbourhoods in New York. If I can’t contact her, perhaps you could contact the Community Nutrition program directly.

  12. Excellent idea, thanks!

    I live with four young adults, we are all either students or on JSA (~£50/week for under-25s). £10-15 on buying food per person per week here, often less if it’s been a good week for skipping [‘dumpster diving’]. I don’t find this massively difficult to do, & it keeps me healthy enough to run marathons.

    Communal cooking is usually vegetarian & often vegan, we’ve basic but mostly-adequate kitchen equipment, and three of us are good confident cooks. We used to get a veg-box delivered (£4 / person / week, enough for making veggie dinner each day & more potatoes than we could eat) but that stopped, have market & large supermarket within a bicycle ride. Tend to live on lentils & flapjack unless particularly inspired.

  13. I think vegans/vegetarians are probably well covered on the ‘eating for low cost’ front, particularly if lentils and flapjack are staples :)

    What’s notable about the fact that you run marathons is that 2 of the people whom I cook for on a regular basis (but shan’t include in the ‘meals for 4’ calculation) are keen tri-athletes and eat somewhere between 5,500 to 8,500 calories per day, depending on the state of their training or competitions. They will quite happily eat half of a bread pudding that I had intended to portion into 6 servings and consider it a snack.

    I can easily see how to fill people up on carbohydrates – and understand how refined flours/cereals can add quite a lot to people’s nutritional intake but it is awkward to supply 7-9 fruit and vegetables in a way that is affordable and filling. Eg, my local Tesco had some ripe plums that were so fragrant that I smelled them as soon as I walked through the door. They were 50p each – if I’d wanted to buy 2 or 3 for each person (2 medium plums is a recommended serving for 5-A-Day and these were small-to-medium), then that would have been far more money than was appropriate to spend on a budget.

    It seems a shame to pass up the seasonal treats such as fresh, wonderfully ripe plums, but those were too costly. I should mention that I needed to visit somewhere yesterday that I knew to have an Aldi store (I don’t have one locally). Aldi currently has a 50p promotion on several fruit and vegetables including a punnet of plums, so I bought one. Nowhere near as fragrant or perfect but still decent plums and far from the cricket balls that are available elsewhere.

    For the purposes of this project, I’m not going to resort to ‘stickies’ or very unusual bargains that are unlikely to be available more widely as that doesn’t feel entirely fair. However, it seems sensible to take advantage of various promotions that are widely available such as the above, when I can.

    • Our local market (which is held on the High Street on Tuesdays, so not difficult to get to even from work) includes a fruit stall. They sell a bowlful of fruit or veg for £1 and it’s all good quality, you can get right in there and look. It’s sourced as locally as possible, too, and they’re always happy to discuss where their produce has come from.

      Maybe you have something similar in your area?

      • Me – no. We used to have a local market (not that I could have got there during work hours during the week but certainly at w/ends) but that has pretty much closed down. afaik, our local market didn’t specialise in local produce, it was by no means a Farmers’ Market.

  14. Carrie,

    I noticed that you discussed the film Food Inc. on your blog and I wanted to let you know about a film called Our Daily Bread which I think you would find fascinating. It’s similar to Food Inc. in how it illuminates the horrific reality of industrial agriculture, however; Our Daily Bread is not an advocacy film in the traditional sense. The film communicates its messages using provocative images of places where food is produced by going deep inside the world of high-tech agriculture. Our Daily Bread touches on animal husbandry, labor issues, and the shocking reality of food production with a very distinctive style.

    I appreciate you taking the time to read this. We are an independent company with limited resources, so if our film interests you, I would appreciate it if you could mention it in an upcoming post. If you have any questions about Our Daily Bread or Icarus Films, please don’t hesitate to contact me.

  15. Hello!

    This is fascinating. I have for the last year been part of a project attempting to find the cheapest diet in the UK from a major UK supermarkey which fulfills all the correct RDAs or vitamins minerals and so on. The best I can do at the moment is 80p per person per day (assuming a typical family of 4) this is cheaper if all parties are adults. I will be very interested to read if your results are similar to ours. I’m not sure if I am welcome to post links to what we’ve found?

    All the best in your interesting quest!

    Louise

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