Will requiring food stamp retailers to sell more healthy food make it easier for SNAP recipients to eat better?

Getting healthy foods on shelves is only part of the solution. Lynn Friedman/Flickr, CC BY-NC-ND

The federal Supplemental Nutrition Assistance Program (SNAP) serves an important role in our nation’s fight against hunger. Formerly known as food stamps, SNAP helps 45 million low-income Americans – nearly half of whom are children – put food on the table each month.

On average, SNAP recipients receive just US$126.37 per month, per person and most live well below the poverty line. Low-income areas are also more likely to be so-called food deserts, where residents often rely on convenience stores to buy groceries. It can be a real challenge for many SNAP recipients to find healthy food that’s affordable – and nearby.

To help solve this problem, the USDA has proposed a rule that would require SNAP retailers to offer a broad variety of healthy food. The public comment period for the SNAP rule is open until April 16, 2016.

But does making healthy food accessible actually affect what people purchase and what they eat? The answer is a little more complicated than you might think.

Food deserts are everywhere

In the U.S., more than one in three adults and nearly one in five children are obese. The obesity rate is higher among SNAP recipients. According to a USDA study on diet quality, 40 percent of recipients are obese.

In response, some states have tried to pass laws that ban SNAP recipients from purchasing junk food with their SNAP dollars, but this approach has been hotly debated.

SNAP recipients have low incomes, and low-income neighborhoods are often food deserts. That means many SNAP recipients may wind up buying their food at local convenience stores, which aren’t exactly known for carrying healthy food.

The USDA’s proposed rule would increase the variety of healthy foods that SNAP retailers, including convenience stores, are required to stock. Retailers would have to stock healthy foods (including perishable foods) from four staple food groups: dairy products; breads and cereals; meat, poultry and fish; and fruits and vegetables. At least six different types of food from each category would need to be available at any given time.

All in all, a SNAP retailer would need to have a total of 168 items available at any given time. For a large grocery store, this isn’t a problem, but it could be a challenge for a smaller convenience store to follow.

Does requiring stores that accept SNAP benefits to sell healthy food make sense? U.S. Department of Agriculture/Flickr, CC BY-ND

Putting healthy food in stores is only part of the solution

Realizing that the food environment plays a key role in consumers’ food choices, researchers at Johns Hopkins Bloomberg School of Public Health have initiated several interventions to improve food access in Baltimore City’s urban food deserts.

One of them, the Baltimore Healthy Stores program, led by Dr. Joel Gittelsohn, was aimed at finding ways to increase the supply of healthy foods in stores, and to build consumer demand.

The project began as a store intervention trial in nine corner stores in the food desert of East Baltimore, where the population is 91 percent African American and the median household income is $17,000 per year.

Store owners in the area lamented that consumers don’t purchase healthy food when they stock it. No small shop owner wants to take the financial hit that would come with stocking the shelves with fresh, healthy foods that rot away while customers ignore them.

Consumers, on the other hand, complained that when stores stocked healthy food, it was often too expensive or of poor quality.

Offering healthy food in neighborhood stores isn’t enough to change eating behaviors on its own. People have to want to buy and eat the food, too. Living in a poor urban neighborhood may mean that you don’t have a refrigerator, stove, pots or pans to cook with, so food choices need to reflect what people’s circumstances realistically allow them to prepare.

Stocking healthy foods isn’t enough. You have to build consumer demand for them, too. Lynn Friedman/Flickr, CC BY-NC-ND

The products were chosen after extensive research that included comprehensive reports of food and beverages commonly eaten in the community and workshops in which residents identified healthy, affordable and culturally appropriate foods to replace unhealthy foods.

The promoted foods included fresh fruits, whole wheat breads, high-fiber and low-sugar cereals, lowfat milk, cooking spray, baked/lowfat chips, low-salt crackers, diet beverages, and 100 percent fruit juice. This careful food selection was one of the keys to the program’s success.

Also on the supply side, price incentives and nutrition classes were offered to store owners to increase the stocking of healthy foods.

Researchers used multiple strategies to build consumer demand for healthy food. Taste tests, interactive nutrition classes and recipe cards helped expose people to healthier foods. Other strategies, like reduced prices, coupons, advertising, outreach events and shelf labels, posters, and fliers were all used to encourage people to purchase healthier foods.

The project was successful in stocking and increasing the sales of promoted foods. While the researchers noted that including a range of approaches was key to the success of the intervention, not all the approaches were equally successful.

Surprisingly, coupons were ineffective – because store owners didn’t pass them out to customers. The most successful components were interactive taste testing and the visual materials. Ultimately, providing access to healthy food is only part of the solution.

What will it take to get it to work?

Requiring SNAP retailers to sell healthy food might work, but the Healthy Stores Project shows that conscious efforts to build consumer demand to buy these products are important as well. Small stores that are already on the cusp of survival might not last long if they are required to sell foods that customers don’t buy.

Regarding the proposed SNAP rule, Dr. Gittelsohn voiced concern that:

You’ll end up with food environments in which many of these stores are closed. So there’s a danger that if these efforts to change the food environment are not implemented correctly, it could actually worsen the food environment.

What can be done to help those small corner stores succeed? Gittelsohn offered some suggestions: store owners need help identifying specific foods that not only meet the SNAP requirements, but also are available from local wholesalers. Basic infrastructure, such as small refrigerators, would also help stores meet the perishable food requirements.

If the new SNAP proposal goes into effect, store owners will have ample motivation to sell healthy foods. But, retailers will need help selecting affordable, quality, nutritious and culturally appropriate foods that their customers want to buy. And a range of approaches are needed to help consumers select the newly available healthy foods.

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