Photo by Flickr user Daniel Oines

Should food stamps be used for sugary drinks? Researchers find new evidence to support a ban

For years, researchers at Harvard and the University of California have found that people who receive food stamp benefits from the Supplemental Nutrition Assistance Program, known as SNAP, were suffering from diabetes, heart disease and obesity at higher rates than people even in the same tax brackets who were not receiving food stamps.

Health AffairsThese findings were so alarming that in 2013, 18 mayors of major U.S. cities including Boston, Los Angeles and notably New York’s former Mayor Michael Bloomberg wrote to Rep. Nancy Pelosi and Speaker of the House John Boehner pushing to ban the use of food stamps to purchase sugar-laden drinks. The American Beverage Association fought the ban stating that sugared beverages were being targeted and were not the only causes for obesity.

But a new study released by Health Affairs on Monday in its June issue shows that a proposed ban on sugar sweetened beverages purchased with SNAP benefits would significantly reduce obesity in adults ages 18-65. And a subsidy for fruits and vegetables would more than double federal vegetable and fruit consumption guidelines for SNAP beneficiaries.

Dr. Sanjay Basu, an assistant professor of medicine at the Stanford University School of Medicine in California and a team of researchers conducted the study to find out how much these proposed policies could affect the SNAP population’s level of risk for these diseases.

Basu and his team used what is called the National Health and Nutritional Exam Survey, used to assess the nutritional status of adults and children by the CDC, and combined it with current information on SNAP to see how this would affect people’s dietary risk and how people would substitute sugary beverages for other products.

Two models simulating the proposed reforms, one for the ban on sugary beverages (excluding 100 percent fruit juice) and another portraying an incentive for SNAP participants to receive a 30 cent credit per dollar on fruit and vegetable purchases used different factors such as metabolism rates, demographics such as race, age, and gender, and income to test the effects of the proposed measures.

What they found was that SNAP participants averaged about 157 calories per person per day from sugary beverages such as soda. (By comparison, one can of regular carbonated soda contains an average of 138 calories.) With the simulated ban, a person would reduce their amount by 24 calories per day, a 15.4 percent decline in calorie consumption from sugar-sweetened beverages, according to the model.

Obesity and type 2 diabetes also saw decreases. After the simulated ban, obesity decreased 2.4 percent from current SNAP obesity rates. Type 2 diabetes decreased by 1.7 percent (240,000 people). The simulated subsidy, did not, however, have a significant impact on overall diabetes and obesity.

Before the simulated subsidy on fruits and vegetables, SNAP participants averaged 1/4 of a cup per day. With the simulation, that amount nearly doubled fruit and vegetable consumption to up to 3 cups per day.

Basu says that the key here is that an increased diet of fruits and vegetables is not enough to simply reduce diabetes and obesity risk on a national scale.

“There would also have to be further reforms to also reduce the consumption of sugary beverages,” Basu said.

So what does all of this mean? Should we start these reforms?

Not everyone thinks so, in early May, SNAP Decisions, a study released by The Illinois Public Health Institute that addressed a proposed ban in Illinois, found that even if sugared beverages were banned, SNAP participants would still purchase the beverages with their own money.

But, argues Basu, the economic model his team used to simulate the two policies did account for SNAP beneficiaries’ outside income and whether or not participants would have a propensity to buy banned items with their own money.

“It’s more just an opinion of a group. There are no calculations or data associated with that study,” Basu said. “[Our study] accounts for purchasing power and normalizes for that. Otherwise you would reduce obesity by half so this model accounts for that.”

For Basu, his encounters with his own patients give him a positive outlook that his study’s results would actually make a difference.

“A large number of my patients are SNAP participants and so in addition to talking with them and the more formal focus groups about how they feel about these proposed changes, the responses have been pretty universally consistent,” Basu said. “In general they are quite worried about the risk of type 2 diabetes but feel like they can’t afford healthier foods.”

Basu says the next steps for this study is to actually take this to the people. SNAP participants taking a lead role in a controlled study instead of a simulation model.

“We often do randomized controlled trials to study drugs or new therapies and similarly when we’re spending 76 billion dollars a year on a massive nutrition program and spend a very small amounts of money to do a randomized trials to make sure our program is running as smooth as possible.” Basu said.

A study to look into heart disease is on the next agenda for Basu’s team.