Cost comparison: American Heart Association poll spotlights need to make healthy food accessible

12 Jun 2024 --- A new national poll of public attitudes on food and nutrition has found that the cost and lack of access to nutritious food is a significant concern to US consumers. The report, released this week by Deloitte, the American Heart Association (AHA) and the non-profit research advocacy alliance Research!America details the challenges to integrating nutritious food into the healthcare system to prevent and treat chronic illness.

“Cost is noted as the largest barrier to healthy eating, while one in five respondents report having experienced hunger,” a spokesperson at AHA, tells Nutrition Insight. “These results demonstrate that prevention and treatment of disease requires addressing barriers to healthy eating by building on the ecosystem of stakeholders to create sustainable food and health care systems to ensure nutritious foods are accessible to all communities nationwide in ways to improve public health.”

Roughly seven out of 10 poll respondents acknowledged healthy eating habits as an essential factor in extending healthspan and lifespan. However, 53% of respondents say the US has not done enough to make nutritious food accessible and affordable.

About 77% of respondents said they would eat a healthier diet, citing barriers to that being the cost of healthy food (60%), stress eating (42%), lack of food preparation time (33%) and lack of knowledge (32%).

“The impact of food insecurity is felt disproportionately in rural and southern US counties, but food and nutrition insecurity exist across the US. Factors including consumer preferences, cultural norms and unhealthy food marketing, compounded by social inequities and food and nutrition insecurity, impede access to healthy foods,” says James Cascone, sustainability, climate and equity partner at Deloitte.

UPF narrative
Meanwhile, a new report released by the WHO Regional Office for Europe today links the tobacco, UPFs, fossil fuels and alcohol industries to around 19 million deaths a year globally or 34% of all deaths. The report observes that these industries drive ill-health and premature death in Europe and Central Asia while stunting the prevention of non-communicable diseases (NCDs). 

In response to these findings, Rebeca Fernández, science director at FoodDrinkEurope, tells Nutrition Insight: “To connect the consumption of processed foods with the tobacco and fossil fuel industries is irresponsible and outrageously misleading. We all need food — and we all need processed food.”

“Unfortunately the WHO report does not acknowledge that there is no agreed definition of what UPFs are, let alone their impact on health, which is why last year the UK Scientific Advisory Committee on Nutrition and the Nordic Nutrition Guidelines concluded, respectively, that the evidence was insufficient to use UPF terminology to define public health guidelines and that it detracts from well-established food classifications and dietary recommendations.”

Fernández underscores that well-established food nutrition science is the best way to tackle obesity and NCDs and that the industry should focus on the nutrition content of regularly consumed food in conjunction with lifestyle choices.

“That’s why food and drink makers here in Europe are playing their part by reformulating products to cut salt, fat and sugars while boosting fiber and micronutrients, all the while providing more nutritious offerings that deliver health benefits,” says Fernández.

Fostering nutrition securityExperts are calling for collaborative efforts to stem the tide against rising NCDs and obesity.
The poll results have been published in an expert analysis of the US Health and the Future of Food report, which outlines the challenges to improving nutrition security caused by systemic factors making it difficult for people to access healthy food.

“The poll provides important insights that help guide efforts to make healthy foods more accessible and affordable to everyone. The results show that people in America are very concerned about health issues and appear eager to make changes with improved access to healthier food,” says the AHA spokesperson. 

“Understanding patient and consumer perspectives throughout their life course is especially important when developing effective research interventions.”

The report spotlights food and nutrition insecurity, UPFs and the lack of resilient and adaptive food and agricultural systems as major contributors to poor diets. Approximately one in seven people, about 44 million, in the region faced food insecurity in 2022, including 13 million children.

“Efforts led by the American Heart Association have cut death rates from heart disease by half in the past 100 years, but as we look to our second century of existence, the trends are ominous,” said Nancy Brown, chief executive officer of the AHA. “We are committed to averting a crisis of unparalleled health and economic burdens due to cardiovascular disease and obesity in the coming decades.”

In addition, the AHA published stark projections in the peer-reviewed journal Circulation, showing that left unaddressed obesity will be a significant driver of rising cardiovascular disease. About 61% of US adults are expected to have a form of cardiovascular disease by 2050, double the current figure.

Left unchecked, obesity rates in adults will increase by nearly 40% in adults and by more than 60% in adults. The highest growth rate is expected in adults between 20 and 44 years or 45–64. High growth rates are expected in all age groups of children.

Barriers to healthy eating
At the rate the situation is progressing, more than 150 million people in the US will have a poor diet, a catalyst for diseases such as hypertension, obesity and diabetes. According to the public opinion survey, obesity is a major factor in the public’s perceptions of health in the US, with 94% believing it is “either a somewhat” or “very serious concern.”

In addition, 66% of Asian American and 68% of Hispanic respondents said the cost of healthy food was their biggest barrier to healthy eating. Black respondents were more likely to cite gaps in knowledge and difficulty accessing stores with nutrient-dense foods as barriers.

Statistics cited in the report show that up to 60% of the US diet consists of UPFs high in refined grains, calories, sodium, sugar and saturated fat. These are the kinds of foods that consumers often select over nutritional alternatives. The report calls on healthcare professionals, the food industry and policymakers to drive innovation that creates a healthier system. 

“Healthy, nutritious food not only leads to better overall health – it can be a critical tool to treat, manage and prevent chronic disease,” says Dr. Kevin Volpp, scientific lead for the AHA’s Health Care by Food initiative.

“Cross-sector collaboration and research-backed innovation in public and private sector programs are needed to stem the combined tidal wave of obesity and nutrition insecurity, threatening the health of millions of people in the US now and for decades to come.”

The Health Care by Food initiative is investing in research, advocacy and education to integrate cost-effective food-is-medicine approaches into the healthcare system. The AHA, in collaboration with the Periodic Table of Food Initiative, is also driving a greater understanding of the components of specific foods and their role in human health.

Direct-to-patient registry
The association is set to launch a longitudinal direct-to-patient registry of individuals living with overweight and obesity and people who have been prescribed treatment for weight management. Additional health and nutrition solutions are needed to prevent projected cardiovascular disease incidence and cost increases.

“We must make bold moves to change the troubling trajectory of cardiovascular disease,” says Brown. “Building on our decades of experience in patient registries and inspired by the Framingham Heart Study, this registry will provide seminal research to improve understanding of the causes and treatments for obesity and how obesity is managed by healthcare professionals.” 

The initiative will help shape public health guidelines related to nutrition and obesity. 

“Collaborative efforts from public and private entities are imperative to advance health and nutrition approaches that could shape the course of public health in the next century,” Brown concludes. 

By Inga de Jong