Examining the Causes and Effects of 
Unhealthy Diets among Low Income Households in the U.S.
Intro to Poverty Studies | January 2021
As the old adage goes, we are indeed what we eat. Though overly simplified, this reductionist approach proffers some truth about the importance of a healthy diet. As many know, not all food is created equally with respect to its nutritious qualities. Sticking to a healthy diet is hard enough for most Americans, but it proves to be even harder for low income households and individuals. Though it has been long assumed that lower income households eat worse than others due to less purchasing power, relevant research indicates that income is not the sole factor in determining a nutritious diet. Unhealthy diets among low income households are the result of inner biobehavioral responses to a strained lack of nonfinancial resources and external pressures that arise from the instability of being poor in the U.S. 
First of all, a nutrient rich diet is one of the strongest pillars of good health and wellbeing. The importance of having a healthy diet should not be overlooked when assessing the hardships that low income households face. According to the Food Research and Action Center, poor diets are associated with increased instances of being sick, longer recovery times, worse educational performance, and increased behavioral problems among children. Similarly, chronic illnesses such as hypertension, cardiovascular disease, obesity, Type 2 diabetes, and osteoporosis can be triggered by nutritionally poor diets. Though typical Americans across all income groups fail to abide by national dietary guidelines, health care costs caused by poor nutrition impose a larger burden to those who are already financially vulnerable. Studies have estimated that $1,863 more is spent by food insecure households on health care each year. Essentially, eating healthily can be seen as a critical preventative measure against future chronic illnesses. 
With that in mind, let’s examine why low income households don’t or can’t eat with their best health in mind. Historically, the main argument as to why the poor don’t eat as health-consciously as the wealthy is because they simply can’t afford to do so. Interestingly enough, research conducted by the USDA has shown that as the amount of money spent on food increases, the categories of food expenditures remain roughly the same. Therefore, additional income does not significantly increase the amount of healthy fruits and vegetables purchased at the grocery store and ultimately consumed at home.
Compared to higher income households, low-income households typically spend more on beverages with high sugar content (i.e. soda, fruit juice), and less on fresh produce (fruits, vegetables). In a study conducted by BMC Public Health, analysing the food purchases from 202 urban households of varying incomes concluded that, “...The overall nutritional quality of foods and beverages purchased was significantly lower among lower income households compared with higher income households”. By using the Healthy Eating Index score, the study also showed that there weren’t significant differences between low income and middle income households. The purchase categories that differed the most among income groups were vegetables, dairy and frozen desserts; low income households bought more frozen desserts and higher income households bought more vegetables and dairy products. Several studies have observed that low income households purchase less whole or unprocessed foods. These foods make up diets higher in saturated fat, sugar, and sodium. In looking at the spending patterns of four-person, low income households, the USDA found that the largest percentage of spending was devoted to prepared and frozen meals, canned foods, snacks, and nonalcoholic beverages. 
Evidently, there seems to be a fundamental predilection for processed and convenient foods among low income households. There are several possible explanations for these consumption patterns. A biobehavioral level of analysis explains why low income households gravitate towards the processed-food friendly inner aisles of the supermarket over the produce-filled outskirts. 
Living with limited resources can result in high levels of stress, depression, anxiety, worse sleeping habits, and an overall diminished state of mind. Specifically, the stress hormone response administered by the body can influence hunger and appetite which dictates one’s consumption behavior. Stress hormones guide us to tasty treats, which tend to be high in calories but low in nutrients. Emotional and uncontrolled eating are also byproducts of increased stress levels. In addition to what we eat, how we eat also plays a supporting role in our physical and mental wellbeing. The specific mechanism that underlies this response is an activation of the hypothalamic-pituitary-adrenal axis. Simply put, stress-related hormones have a huge say in what, how, and when we eat. According to the American Psychological Association, higher stress levels were observed among low-income households and particularly among women. Unsurprisingly, single-woman led households experience the highest rates of food insecurity, which only puts them in a worse position to maintain a healthy diet.
Moreover, it takes more time to prepare fresh, healthy recipes composed of produce than it does to microwave a filling, but nutrient-poor starch based meal. When stressed or pressed for time, heads of households must develop strategies to get food on the table for their kids. The convenience of pre-prepared and processed foods saves valuable time and energy. More than that, frozen foods and foods high in preservatives have longer shelf lives than that of fresh produce, making them more cost effective for many households that can’t afford to risk food expiration. Typically, a household will prioritize price and quantity of food over its quality. On one hand, these decisions are time savvy and budget friendly. On the other, they are ultimately damaging from an aerial perspective. Being time poor is just as influential as being financially poor when it comes to making decisions about food.  
Among the time-constrained are the low income working class. Irregular and inflexible work hours (i.e. working night shifts) are common among low income workers. Often, the lowest paying jobs also have the most atypical hours. Studies have shown that workers with irregular schedules have less healthy diets and eating habits, consuming more refined carbohydrates and eating at unpredictable times.
Often followed by irregular working schedules are poor sleeping schedules, too. Sleeping habits heavily influence our personal dietary behavior. According to national survey data, “...Individuals earning less than $20,000 annually are more likely to get less than 5 hours of sleep compared with individuals who earn more than $75,000 per year”. Little sleep is associated with increased levels of ghrelin, the appetite-regulating hormone that makes us feel hungry, resulting in compulsive overeating and weight gain. By decreasing glucose tolerance, insulin response, and increasing cortisol response, too, poor sleep can exacerbate the effects of an unhealthy, nutrient poor diet. 
In addition to lacking both financial and time resources, some low income households also lack the culinary resources necessary to prepare palatable, nutritious meals. For example, having a working kitchen with functional appliances and cooking equipment matters. Storing fresh fruits and vegetables typically requires refrigeration, which some households clearly can’t afford. However, access to these resources varies among low income families. According to a SNAP publication, “In a study of housing quality among 186 Latino farm-worker families in six North Carolina counties, Gentry and colleagues (2007) found that many lacked functional appliances, including ovens (27 percent), refrigerators (8 percent), and stoves (5 percent). By contrast, in a study of SNAP applicants in three Oklahoma counties (rural, suburban, and urban), Landers and Shults (2008) found that more than 97 percent of homes surveyed had adequate equipment for cooking”. Though cooking resources vary regionally, it can be said that without those resources, households will opt for less nutritious foods. 
Continuing down the line of external factors, access to supermarkets also contributes to poor diet quality. In 2009, it was estimated that 23.5 million Americans who lived in low income areas also lived more than one mile away from a supermarket or large grocery store. (It is worth noting that higher income areas have to travel similar distances for groceries, but have much better access to transportation.) This poses an issue because a large body of research has discovered a positive relationship between greater access to supermarkets and healthier diets. The main alternatives to supermarkets are convenience stores, where produce is less abundant. Consequently, this issue is really one of transportation; many low income households can’t afford a personal vehicle to travel the extra distance to a supermarket if it’s located out of their way. The ease of access to supermarkets is yet another barrier that low income households must overcome to purchase healthier foods. 
While the ability to choose what to eat is entirely up to the individual, there are several external and internal factors that predispose them to eating the way they do. It is important to emphasize that most Americans consume far too much fat, sugar, and sodium and far too few fruits, vegetables, and whole grains. However, a low income family already coping with adversity and instability are only made more disadvantaged by adverse diet-related health consequences. Zoomed in, diets shape how we think, act, and feel. Zoomed out, diets can greatly affect future susceptibility to chronic illnesses and ultimately, life expectancy. Thus, poor diets and eating habits can limit a household’s ability to improve their economic status and quality of life. 
Because research has shown that eating low quality, high calorie food is a coping mechanism to maximize one’s dollar, minimize time in the kitchen, and deal with the stress of being poor, this issue should be seen as a symptom of low economic status. To reduce the mentality of scarcity, uncertainty and instability must also be reduced. As previously mentioned, an increase in income does not significantly increase the amount of healthy food purchased. The innate biobehavioral responses to stress do guide our consumption, and they are thrown off-kilter by the overall physical and mental strain caused by housing, food, and employment insecurities. Designing evidence-based interventions to improving dietary quality among the poor should be given more attention.
 One preexisting solution is to incentivize and enable healthier eating habits through education based programs, some of which have been successful in changing the habits of participants. For instance, the Expanded Food and Nutrition Education Program (EFNEP) teaches participants ways to purchase and prepare food with higher nutritional value even with limited resources. But, this intervention doesn’t fully counteract the effects of other internal and external factors. Ultimately, reducing the chronic stress and lack of resources associated with living in a low income household should encourage healthier diets and better nutritional intake. 
Because poor nutrition in the U.S. isn’t a black and white issue, it is important to keep researching its causes and effects to paint a fuller, technicolor picture. Properly identifying the underlying causes of consumption habits at both the micro and macro levels can help low income households reduce future healthcare costs and enjoy better lives. Since we are indeed what we eat, we should be eating the best quality of food we can come by. That applies to all people, but especially to the vulnerable. 
Works Cited
“Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences.” U.S. Department of Agriculture, June 2009. 
Committee on Examination of the Adequacy of Food Resources and SNAP Allotments; Food and Nutrition Board; Committee on National Statistics; Institute of Medicine; National Research Council; Caswell JA, Yaktine AL, editors. Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy. Washington (DC): National Academies Press (US); 2013 Apr 23. 4, Individual, Household, and Environmental Factors Affecting Food Choices and Access. Available from: https://www.ncbi.nlm.nih.gov/books/NBK206912/
Drewnowski, Adam, and Petra Eichelsdoerfer. “Can Low-Income Americans Afford a Healthy Diet?.” Nutrition today vol. 44,6 (2010): 246-249. doi:10.1097/NT.0b013e3181c29f79
Frazao, Elizabeth, et al. “Can Food Stamps Do More to Improve Food Choices? An Economic Perspective-Food Spending Patterns of Low-Income Households: Will Increasing Purchasing Power Result in Healthier Food Choices?” US Department of Agriculture, Sept. 2009. 
French, S.A., Tangney, C.C., Crane, M.M. et al. Nutrition quality of food purchases varies by household income: the SHoPPER study. BMC Public Health 19, 231 (2019). https://doi.org/10.1186/s12889-019-6546-2 
“Frequency of Food Insecurity.” USDA ERS - Frequency of Food Insecurity, www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/frequency-of-food-insecurity/. 
Gregory, Christian A, and Alisha Coleman-Jensen. “Food Insecurity, Chronic Disease, and Health Among Working-Age Adults.” Economic Research Service, July 2017.
Laraia, Barbara A et al. “Biobehavioral Factors That Shape Nutrition in Low-Income Populations: A Narrative Review.” American journal of preventive medicine vol. 52,2S2 (2017): S118-S126. doi:10.1016/j.amepre.2016.08.003  
Morales, Mary E, and Seth A Berkowitz. “The Relationship between Food Insecurity, Dietary Patterns, and Obesity.” Current nutrition reports vol. 5,1 (2016): 54-60. doi:10.1007/s13668-016-0153-y
Secretary, HHS Office of the, and Fitness & Nutrition President’s Council on Sports. “Facts & Statistics.” HHS.gov, US Department of Health and Human Services, 26 Jan. 2017, www.hhs.gov/fitness/resource-center/facts-and-statistics/index.html#:~:text=Americans%20eat%20less%20than%20the,%2C%20dairy%20products%2C%20and%20oils.&text=About%2090%25%20of%20Americans%20eat,recommended%20for%20a%20healthy%20diet. 
“The Impact of Poverty, Food Insecurity, and Poor Nutrition on Health and Well-Being.” Food Research and Action Center. 

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