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Dr. Ayala

Dr. Ayala
Philadelphia, Pennsylvania, USA
V.P. Product Development
Herbal Water
I’m a physician (Pediatrics and Medical Genetics), artist, and mother of 3 school age active kids. I recently co-founded Herbal Water Inc. (www.herbalwater.com) with my husband, Albert. I am a serious home cook, and love to entertain. My expertise is vegetarian food (I have been a vegetarian all my life). I strongly believe that eating healthy and enjoying good food go hand in hand. My main interests are science, nutrition and art, and I am overall a very curious person that tries to learn something new every day. Dr. Ayala (Ayala Laufer-Cahana M.D.)


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OCTOBER 5, 2011 7:46AM

Junk food is cheaper

Rate: 19 Flag

In his recent New York Times article titled Is Junk Food Really Cheaper, Mark Bittman asserts:

 “In fact it isn’t cheaper to eat highly processed food: a typical order for a family of four — for example, two Big Macs, a cheeseburger, six chicken McNuggets, two medium and two small fries, and two medium and two small sodas — costs, at the McDonald’s a hundred steps from where I write, about $28… In general, despite extensive government subsidies, hyperprocessed food remains more expensive than food cooked at home. You can serve a roasted chicken with vegetables along with a simple salad and milk for about $14, and feed four or even six people. If that’s too much money, substitute a meal of rice and canned beans with bacon, green peppers and onions; it’s easily enough for four people and costs about $9.”

It’s the wrong comparison, though.  Jogging is a cheaper pastime than sitting on the couch and watching TV (cable packages don’t come cheap), yet our affinity for leisure and convenience comes into play when we choose how to use our free time.  The food cost question should more fairly be: Is a junk food ready-to-eat meal cheaper than a healthier made-by-someone-else meal?  The answer to that is unquestionably yes!

Is healthier food more expensive?

A new study led by Colin Rehm in the American Journal of Clinical Nutrition addresses this questionThe study looked at the diet of almost 5000 participants, calculating the cost of their daily food and assessing its nutritional quality.  Diet healthfulness was scored taking into account foods and nutrients such as sodium, saturated fats, fruits and vegetables, total vs. whole grains and empty calories (SoFAS: solid fat and added sugar).

The study found a significant positive association between diet cost and diet healthfulness, and this was true for the entire study population, and especially strong for women.  But here’s an interesting finding: older adults, women and Hispanics had lower cost diets that were nutritionally higher quality when compared to other population groups.

Another recent study led by Adam Bernstein and including more than 78,000 women came to the same conclusion: It found that spending more money was clearly associated with a better diet.  Diet quality was assessed using the Alternative Healthy Eating Index (AHEI) -- a scoring method developed by Harvard researchers as an alternative to the US Food Pyramid -- that looks at the consumption of foods associated with lower risk of chronic diseases. Basically, the index gives points for eating fruits and veggies, whole grains, selecting white meats and fish over red meat and unsaturated fats over saturated ones.

But when the researchers divided the participants to quintiles according to their level of spending, they found that within each spending group there was quite a lot of variation in diet healthfulness. The diet healthfulness index for each spending group varied by as much as 29 index points, and just to put that number in perspective, a 20 percent increase in the AHEI score is associated with 25 percent lower risk of heart disease.

So this study, too, finds that there are ways to improve diet without adding cost: adding nuts, soy, beans, and whole grains, while reducing meat and dairy would improve the overall diet without increasing spending.

In another recent article Adam Drewnowski examined the cost of various foods compared to their nutritional content. He found that the cheapest foods per calorie or per serving are grains, sugars and fats, while fruit and vegetables are relatively expensive. Drewnowski argues that subsidies to wheat, corn and soy have led to increasingly cheap foods, rich in calories and poor in nutrition, and that “The fact that healthful foods cost more than less healthy options is a formidable real-world challenge for nutrition interventions”.

Unhealthy food’s lure

The raw ingredients that make a healthy diet are more expensive than those that make a less healthy one.

Experts overall agree that what’s most lacking in the average American diet is fruits and vegetables and foods with low caloric density.  By definition, and also just as a matter of fact, these kinds of foods have a higher cost per calorie than grains, fats and sugar, and since people living on tight budgets look also for foods that satiate (i.e. food with calories a-plenty), they’ll opt against fresh produce (full of water and fiber) in favor for calorically dense food.

But that’s not the main problem.  The bigger problem is that highly processed foods are weirdly inexpensive, and when affordable meets palatable, convenient, attractive, ready-to-eat ready-to-heat and highly advertised – the product becomes almost irresistible.

It’s possible to eat well on a budget.  Not all vegies and fruit are expensive and you can do quite well shopping for carrots, oranges, potatoes and beans.  Slow Food USA is proving through its $5 challenge that you can cook real food for $5 per person.   But doing so requires organization, cooking skills, time and determination. Before the age of highly processed foods people with low incomes would often grow their own food, eat very little meat and add very little sugar – sugar used to be expensive. Nowadays a low budget diet is more often a highly processed, fast-food diet, because nothing combines cheap with convenient and desirable as seamlessly.

Changing the culture

Bittman describes our relationship with fast-food as an addiction; we view home cooking, on the other hand, as “work”.  So how do we move from the quick fix offered in every corner to a culture that promotes simple, no-nonsense everyday cooking?  We need to convince people, especially kids, that fast-food isn’t food, isn’t cool, and we need to celebrate real food and have some fun cooking.  I’ll end with Bittman’s resounding words:

“To make changes like this more widespread we need action both cultural and political. The cultural lies in celebrating real food; raising our children in homes that don’t program them for fast-produced, eaten-on-the-run, high-calorie, low-nutrition junk; giving them the gift of appreciating the pleasures of nourishing one another and enjoying that nourishment together.

Political action would mean agitating to limit the marketing of junk; forcing its makers to pay the true costs of production; recognizing that advertising for fast food is not the exercise of free speech but behavior manipulation of addictive substances; and making certain that real food is affordable and available to everyone. The political challenge is the more difficult one, but it cannot be ignored.”

Dr. Ayala

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Although I live in a farming community, fruit and veggies are expensive, however since I have stopped eating meat, I am not spending that money. I have not noticed a demonstrable difference in spending, it comes out about the same. However, I never eat fast food and when my children were young we could not afford it vs. cooking at home. Good article. Fish right now is very expensive and avoidable for other reasons.
I'm a very good cook. I love to cook. I believe that most my meals are more expensive than McDonald's. And they can be just as fatty if I do it right.

I'm 20 pounds overweight because I am not walking everyday or exercising as I am suposed to. I keep wanting to change this.

But I refuse to give up my pasta, my olive oil, my salmon, my brown rice, my fingerling potatoes, my braised brussel spouts, my refried beans, my blue cheese, my claret...

Anyway, I'm on that downward spiral at 50 years of age where we start to gain 2-4 pounds a year. Fast food isn't my problem, food isn't really my problem.

My problem is that all the athleticism that fueled my eating habits for years is fading away on athritic feet, back pain, neck pain and simple fatigue. A day at the office wears me out.

I'm going to get back on the walking and exercising, I swear. No, really.
Thanks for presenting this research and offering a valuable perspective.
A super piece, right to a hard-edged point. You got it so right here.
Keep us fat, lazy, stupid, and working, and we won't protest against you. That's their plan.

I refer to this in my post "Poor Choices." If the healthy food is only available to the rich, then how do we ever plan to dig ourselves out of the mess we're in?

@jane smithy: Basic cooking lessons have become part of some schools’ nutrition education, and complement an edible garden program, where it exists – I wish these lessons about food were taught to every kid.

My advice to any beginner cook, and even for those who have no interest in cooking -- is to start with mastering the vegetable salad. If you make a delicious salad, mix a simple vinaigrette, and improvise on it, you’ll be adding a lot of health to your diet. I'm pretty sure any salad made at home -- fresh -- tastes better than most bought equivalents.
@jramelle: The true cost of cheap food is, of course, not reflected in the price we pay for it at the store. Cheap food is extremely expensive in the long run – you pay for it with your health and the health of the environment. That’s what I remind myself when I look at the price tags.
Fast food and "convenience food" are two different things. And the expense of fresh veggies and fruits may depend on the time of year and where you live, too. Great points, thought provoking piece!
Good post. It is very difficult to get good fresh food at reasonable prices. We are once again forced by budget and corporate food czars to chose what they would have us eat, that is what we can afford. If you go to a grocery store chain, the fresh food is very high priced, as well as fresh baked goods, which are not really fresh as their batters are made elsewhere. There are very few actual bakeries which make real fresh batter and hence authentic fresh baked goods. The whole thing is a vicious corporate bite.
We need a way of distinguishing the healthy processed foods from the unhealthy. Spaghetti sauce is pretty cheap and spaghetti with bought sauce is easy to make. However, so many spaghetti sauces have way too much sugar and to find the ones that aren't, requires reading a lot of labels. I typically have to read at least 5 labels before finding something that I'll buy. This was not true 20 years ago, when I last lived in the States.

Weaning people off fast food will be easier if we help them find the healthier items in the grocery store shelves. And that doesn't mean allowing companies to stick a few atoms of bran in a sickly sweet tomato syrup and call it healthy spaghetti sauce.
If you plan to have roast chicken and you run late or hit traffic, dinner will be quite late, and you will be in for an hour of listening to our kids whine because they are hungry. Very relaxing.

If you stop at McD's on the way home from work, you will not have to listen to any whining.

If you plan roast chicken and don't cook it, you have to cook it tomorrow or it will go bad. So, you can't get stuck in traffic two days in a row.
It's a free country. People are free to make their choices and makers of food are free to price as they wish. If people don't want it, they don't have to buy it. Go ahead, boycott a company, but please keep all nanny-staters away from marketing to limit the advertising of junk food. Most of us are not idiots. We really can decide how to eat and feed our kids ourselves. I grew up poor and, although it is not meant that way I'm sure, find it a bit "rude", if not arrogant, that other people think that means, in a sense, that my parents were idiots who didn't know how or couldn't manage to feed their kids. It just wasn't so.
I am unsure why anyone would want to defend marketing junk food to kids. Yes, it is a free market, but with obesity and diabetes rates in children on the rise, we face an epidemic or unhealthy adults.

It's no accident that our infant survival rate is below most other developed countries and our cancer and heart disease levels lead as well.

Adults are not making healthy choices by a long shot. Regulations on marketing are directed at full disclosure of the nutritional facts of both packaged and store prepared foods. This can't be a bad thing!
Excellent article. Thank you.

I have discovered, in my quest to find healthy ways to eat, that trying to rely on price is never the answer to sustainability. I end up being very selective on what I buy, and quite often that means being less selective on how much I pay. After awhile, you start to figure out where to buy the things that are healthiest at the best price. But that takes time and effort.
There is the whole issue of time. People’s schedules are so jam-packed today. Many feel they just don’t have enough time in the day to cook a meal, sit leisurely at the dinner table while they slowly masticate high-fiber/fresh ingredients, and imbibe in the spiritual conviviality of a wholesome meal. Fast food is delivered fast and consumed fast. It is so refined and processed (and devoid of fiber) it can be wolfed-down in one fell-mumbled-swoop.
CrazyKball wrote, "I am unsure why anyone would want to defend marketing junk food to kids."

Actually I didn't defend marketing to KIDS. I defended free marketing - in the sense of not trying to regulate food advertising as cigarettes, beer, wine, and such are regulated. And I said I'd like to see nanny-staters (not, obviously by force it is a request) stay away from limiting the advertising of junk food. If you don't want to buy it, don't. And let parents make those decisions for their kids.

CrazyKball added, "Yes, it is a free market, but with obesity and diabetes rates in children on the rise, we face an epidemic or unhealthy adults."

They have the information - by the way I'm not sure it IS an epidemic we are facing - they are free to make their choices. How I eat is not anyone else's business. I don't belong to you and you don't belong to me. Also, no meanness intended, but I am a free individual and am not part of a "we". I'm really not.

She or he also wrote, "It's no accident that our infant survival rate is below most other developed countries and our cancer and heart disease levels lead as well."

Actually, you might want to look at how those stats are arrived at - they are very misleading. I can get you a name and site if you like. But even were they true, it is not up to the government to regulate how I eat via any schemes. Sorry, I AM an adult and my children do not belong to the state.

She/he wrote as well: "Adults are not making healthy choices by a long shot."

That's your opinion and it may be right. But, happily, it is not your business or mine to coerce via any government scheme people into making better choices. If someone wants to be a busybody or the neighborhood scold, they can be. But keep my tax dollars out of it.

He/she wrote: "Regulations on marketing are directed at full disclosure of the nutritional facts of both packaged and store prepared foods. This can't be a bad thing!"

I agree, full disclosure is a good thing. And, that really, is about all we can do or, I'd submit, should require. BTW, when was the last time any of you bought packaged food WITHOUT such "full disclosure"??
At some point, we have to take personal responsibility for our health. We can blame marketing, junk food companies, etc, however, it is an individual's choice to decide what one decides to put in one's mouth. Healthcare costs will go down, people will live healthier lives if better
choices are made. I, personally, have taken a lot of time & effort seeking out healthy resources & have adjusted my budget & time accordingly. I work full time & go to school, eat primarily organic & cook everything from scratch. It is something I am very passionate about.
I read the Bittman article over the weekend and found it very compelling. Your clarification, however, is truly important: we must be sure to compare apples to apples.

Quoting Bittman's passage at the end, then, gives more power to the overall message: our culture is diseased, and it is reflected in our eating habits. The implications extend far beyond our physical well-being. Our relationships with our families and our enjoyment of life are costly casualties.

Thank you for this post.
Anyone who adopts the word "nanny state" can't be reached with logic.

BTW: the only regulations being seriously considered all deal with disclosure. Also, some common packaged foods are intentionally misleading. Some of the proposed regulations deal with elminating such things as alternative descriptions for high fructose corn syrup and monosodium glutimate. Others deal with requiring that the serving size for nutrient information be the actual size people will eat (for instance, not having the serving size be half a bag of a single serving chip bag).

I know someone may argue that adults can figure this out for themselves, but that isn't true. There is a reason why a plastic bag typically states clearly that it is not a toy! Most people lack the common sense needed to raise a child to adulthood unharmed.
Thank you for writing the article I never got around to writing! To spell it out in another way, there is the cost of our time, energy, effort, in addition to monetary costs spent on food. For a low income family with parents each working multiple jobs, fast food seems like a much lower "cost" relative to the less expensive rice and beans, for instance.

As for filling the belly when money is short and there is food insecurity, a candy bar at 60 cents and 250 calories meets the need better than an apple for the same price (or higher).

Bittman did a lovely job, like all good journalists, of pulling out the numbers in a limited way to prove his point.
Great post.
Lori Lieberman, RD,CDE, MPH, LDN
And to the commenter who wrote that adults are not making healthy choices, I would add, and I mean nothing rude to you, but what is it about the word "choice" you don't understand?
I read the comments and all I can think is that most of you do not know the average high school educated lower wage worker in America. I don't mean any offense to Barbara Joanne but she hit the nail right on the head. They are going to do what they want and they do not want some educated fool telling them that they are doing it wrong. A lot of them get that their lifestyle is ruining their life and they don't care. A few do change but they run a real risk of being shunned by friends and family because they are becoming "too snooty". So the problem isn't just the cost or convenience. You are asking these people to risk ostracism in a world where friends and family rule.

Full disclosure, I come from that world and have reached the point where I'm going to be healthy. They aren't going to take me in if I'm not.
Unfortunately more than 50% of the people dont have a choice.
Nice post.
I believe that Phyllis is on to something that Barbara falls to see. I live there too. My peers are actually hostile to my eating healthy, they ridicule me at every turn. And the thing is. . .those poorly educated people are steadfast in their resolve that (as Sarah Palin so lovingly pointed out) no one is allowed to tell them how to eat. What gets me though is that they then turn around and complain about how heavy they are getting. They say that what they eat doesn't matter. How dumb.
Junk food AND fruits and veggies are all more expensive. Being poor myself, I struggle to find nutritious foods. But really, I can make a homemade pizza (all homemade, fresh ingredients) in only slightly more time than baking a frozen on. Mac and cheese can be made in the microwave with whole grain noodles and real cheese similarly. It's not rocket science to be able to mix flour and water together or cheese and pasta.
But you know what? My parents WERE STUPID. They didn't feed me anything but meat and starch my whole growing up. And their parents raised them on fresh produce from their own gardens. It is the fault of marketing and gov't intervention--subsidizing corn and so forth--that got us in the mess. If they want to provide big corp with money and help them sell it to my kids, then they can help ME by restricting advertising to my child about fast food and by teaching her healthy habits in school (instead of the opposite, such as getting rid of home ec to keep the cost down).
To those who worry that poor people don't know HOW to eat well. Well, Phyllis, I too come from that world and I have never known there to be more dumb people that are poor than dumb people that are rich, nor are poor people necessarily less educated than others.

We live in a free country. Even the poor are free to do what they like and eat as they like and raise their kids as they like and make their choices.

And the patronizing on the part of the Left is really an insult.

Shannon, if you can't feed yourself as you wish without your friends getting upset, maybe you need new friends, but please keep your "we're from the Left and we're here to help" attitude away from the rest of us.

The government, or the good doctor here, is not a replacement for your parents. Sorry you didn't get the ones you may have wanted in terms of smarts, but life is not perfect and some of us prefer the messiness of freedom from do-gooders to the even messier road to utopia in the dining room.
I am always surprised at who spends what on food. I have a friend on food stamps and buys fresh direct. I find whole foods and fresh direct really expensive! I think you CAN eat healthy on the cheap. I have lived alone since I was a teen and have developed a few tricks! First get your local supermarket circular and buy what you like that is on sale. Here in the east village, its key food, or associated.Key food does circulars online, for the more artisinal breads, I go to trader joes. I buy what is on sale that week and semi-stock up. pasta rice, toilet tissue etc.. this basic life tool can be applied to everything you buy. I spend about 35-50 dollars a week on food and I cook about 3 times a week.Eat out about 2 times a week, the rest is easy , fast at home to prepare food, leftovers etc. last nights chicken breast is taco meat too. Fruit and veg. buy what's in season and what you need.
I have known many people who tragically maintain that only the rich can eat healthy food. The rest of us are doomed to obesity. Part of the problem, is that we only eat food that tastes good, when we should want to eat food that is good for us. This takes a little education. Food manufacturers are clever at designing packages that convince us that what we have bought is healthy and nutritious. Probably the only way to acquire a healthy diet is to refuse to eat anything with a label on it. If you can't cook, eat it raw.
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If your idea of eating cheaply is to buy the most inexpensive version of the same things you'd buy if you had money, then you're going to end up eating a lot of empty calories. If you want to eat both cheaply and healthy, it's going to take a significant behavioral change. But cabbage, beans, rice, potatoes, and onions aren't all *THAT* expensive, and they'll make a pretty big dent in your dietary needs, between them.