Diet influences health and poor diets drive up healthcare costs for individuals and society as a whole. Multiple governmental programs in the US have aimed to educate citizens about diet choices, resulting in documented successes, as well as, unintended consequences such as increased food waste. Here we examine some of the relationships between healthy diets, food prices, and wealth by drawing parallels between the diffusion of technological innovation and healthy food diets. We introduce a simple modeling framework to estimate the adoption rates of healthy diets based on income and food prices, and describe the implications of the modeling results for the food industry and for government.
Introduction
In recent decades, obesity rates in the US have increased substantially1. Obesity has multiple negative health effects, including type II diabetes, hypertension, cardiovascular disease, and some cancers2. In 2012, Cawley and Meyerhoefer (1) estimated the health issues arising for obese persons increase medical costs by $2.7 k per year compared to a non-obese person. Over the entire US population, this leads to an estimated 6–10% of US health expenditures spent on diseases influenced by obesity (2). According to the US Centers for Disease Control and Prevention (CDC), adult obesity rates continue to climb: 39.8% of adults were considered obese in 2015–20163. The term “obesity epidemic” has been used to describe the prevalence of obesity and its negative influence on human health.
A variety of factors are thought to drive the obesity epidemic, including increased caloric intake, reduced physical exercise, women entering the workforce at increasing rates (reducing the time spent preparing healthy meals at home), and consumer preference for convenient—and not necessarily healthy—meal options (2–5). Bleich et al. (2) studied eating habits in developed countries and discovered higher caloric intake is the driving force behind the obesity epidemic. While obesity is prevalent across all income levels in the US, low-income citizens are more likely to be obese than high-income citizens (6). The increased cost of healthy foods may also contribute to unhealthy eating habits.
Americans appear to be increasingly aware of the importance of a healthy, well-balanced diet4. Public schools in the US teach content developed by the United States Department of Agriculture (USDA), based on the USDA dietary guidelines, which specify recommended types and quantities of food to eat, and which are reviewed and updated every 5 years5. However, education does not always result in changes in behavior, and large parts of the US population continue to have unhealthy eating habits as defined by the USDA guidelines. Multiple factors beyond education influence eating habits, and in this work, we focus on food consumption patterns—specifically on healthy eating habits and the relationships between diet, food prices, and wealth.
Government Programs to Measure and Encourage Healthy Eating
The prevalence and cost of obesity has led the US government to take steps to address the epidemic. This includes understanding how Americans eat6, promulgating legislation to encourage better food choices7, requiring schools to offering healthier foods for breakfast and lunches8, and providing nutrition education (7). These measures have had mixed results. The following paragraphs describe what has been done, as well as, research done after implementation to realize their effectiveness.
Quantifying the “healthiness” of a diet can provide insight on the causes of obesity. When the USDA releases their dietary guidelines, the organization tracks Americans' eating habits to monitor how well they are eating based on these recommendations. This comparison produces a number called the Healthy Eating Index (HEI). The USDA is using the HEI to monitor eating habits, and while many Americans are not meeting the required diet, the overall trend since the turn of the century is one of increasing HEI4. Although HEI scores increased from 49.1 to 59.0% from 1999 to 2012, only a small majority of Americans are eating as recommended, and this has major impacts on public health and healthcare costs.
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