Editor’s Note: This article is a part of an Op-Ed series, “Second Opinion,” where patient experts and health writers share their take on current research, news, and trends in health and medicine. The views expressed in this article do not reflect the opinions or views of HealthCentral.com.
I’m a fruit and vegetable-aholic. I eat massive amounts of vegetables daily — I’m not kidding — and at least three servings of fruit. I take for granted my access to delicious, in-season produce, knowing that now I can afford to have a delightful selection year-round. But when I talk to people about healthy food, I find they often require some education in order to make the healthiest selections, especially when it comes to grains, fats, meats, fish, and dairy products. Although fruits and vegetables are easy to navigate health-wise — with each choice oferring a unique nutrient payoff — not everyone likes fruits and vegetables and not everyone can afford them on a regular basis.
So if we made this food category more affordable, would it spur people to buy more?
Common barriers to eating fruits and vegetables include:
- Cost and affordability
- Access to variety and in-season produce
- Education to understand the health payoff of regularly consuming produce
- Taste: Many food preferences are developed early in life
- Familiarity: Many fruits and vegetables can appear alien to people who have not been exposed to produce early in life
- Preparation: Some fruits and vegetables are not sold ready to eat
- Local culture: Many neighborhoods across America subsist on processed foods
At least two studies have examined whether offering significant discounts on produce increases fruit and vegetable purchases among people who generally cannot afford to buy fresh produce.
One study, published January 2017 in the journal The Lancet Public Health, looked at the impact of price discounts and consumer education on food and beverage purchases in a remote, primarily indigenous, region of Australia. Twenty communities in the region received a 20 percent discount on fruits, vegetables, water, and artificially sweetened drinks. Half of the stores participating in the discounts were given additional nutrition education along with the discount, while the others just received the discount. The study lasted for 24 weeks, and weekly purchasing data was collected.
Price discount alone generated a 12.7 percent increase in the purchase of fruits and vegetables compared to purchase tallies in the 24 weeks before the study began. The group that received consumer education generated an additional 7.6 percent increase in the purchase of fruits and vegetables, especially fruits. Communities also continued purchasing produce at a higher rate after the study was over.
The researchers felt that because indigenous Australian communities are among the most socioeconomically disadvantaged groups worldwide, the study results were significant.
Another study, published in June 2017 in the journal Obesity, assessed the impact of a 50 percent discount on fruit and vegetable purchases in a group of local supermarkets in New York City. The 16-week study included a four-week baseline to establish purchasing habits, an eight-week intervention with the 50 percent discount, and a four-week observation and follow-up period. Shoppers who were identified as overweight or obese were randomly assigned to either get the discount or no discount on their store rewards card. Data was collected based on 24-hour recalls, and psychosocial evaluation measures were obtained during each phase of the study.
The researchers found that the discount boosted purchases of fruits and vegetables threefold and led to a 50 percent increase in consumption (actually eating produce). The increased consumption of produce was sustained to some degree after the eight-week discount phase of the study. The researchers noted the profound impact that the discount had on self-efficacy (being able to choose produce and afford the purchases) and on sustained behavioral change (buying and eating patterns). Yet, the researchers acknowledged that the discounts would need to be permanent in order to sustain the increased purchasing levels of fruits and vegetables.
Discounts and subsidies on healthy food would seem to be one viable way to get people to embrace healthier food habits. But, I think it’s worth mentioning another study that looked at willpower.
If you have a bowl of apples sitting next to a jar of cookies, which would you choose? You could draw a parallel to another life circumstance of having only a set amount of dollars to spend on food each week. Do you buy cheap, processed foods to stretch your budget, or do you try to buy healthier foods, albeit possibly in smaller amounts? It’s the battle of buying what you want to eat (justified by cheap prices many times) versus buying what you should eat. It’s complicated.
In a July 2017 paper published in the journal Psychological Science, researchers examined what happens when people are presented with two foods — one healthy and one unhealthy — in the seconds before choosing one of the foods. Participants were seated in front of a computer screen and told that at the end of the experiment they would be given a sample of one of the foods they chose. They were then instructed to move the cursor to choose food items flashed on the screen that “meet their health and fitness goals.” So regardless of “temptation factors,” the subjects knew the goal was to choose healthier selections.
Some of the subjects initially moved the computer cursor toward images of unhealthy food but ultimately selected the healthy foods that flashed on the screen. When these subjects were offered different foods after the experiment, most chose an unhealthy food (a candy bar). Researchers think these participants’ subtle movements during the study indicated the “level of struggle” they experienced before finally choosing the healthier photos.
Other participants in the study immediately honed-in on healthy choices. Not surprisingly, these participants chose the healthier option (an apple) when they were offered food after the experiment. Researchers presume these subjects had high levels of self-control and little conflict in making food selections that met the mandated goal. The researchers noted that there appears to be very real conflict right from the start when some people face food choices. In some cases, willpower is strong enough to ultimately force a healthier choice, but many people will give in to temptation.
Personally, I think that the more exposure to treat foods (highly processed, refined foods), especially early in life, the harder it is to have the willpower needed to fight the desire for those tasty and often addictive foods. An apple will be hard pressed to win over a candy bar when the two are offered to someone at the same time. When shopping at the supermarket, people often impulsively grabtreats as they meander down aisles, even when they’re using a shopping list. We know that stress and going to the supermarket hungry can tremendously undermine willpower. We also know that, like using a muscle, working your willpower on a regular basis likely strengthens it.
If you are financially stressed and facing the choice between cheap and tasty versus healthy and more expensive foods, willpower may not even factor into the discussion. It is, however, encouraging to know that discounts on healthier foods may be one way to nudge people toward healthier food choices.
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Known as The HealthGal, expert contributor Amy Hendel is a popular medical and lifestyle reporter, nutrition and fitness expert, columnist, and brand ambassador, as well as a health coach. Trained as a physician assistant, she maintains a health coach private practice in New York and Los Angeles. Author of The Four Habits of Healthy Families, you can find her on Twitter @HealthGal1103 and on Facebook at TheHealthGal. Her personal mantra is “Fix it first with food, fitness, and lifestyle.”