The Economics of Eating

As the U.S. recession nears its 18th month, government officials are parsing economic data and trying to guess whether the repercussions will begin to decline in a matter of months, or sometime further down the line. Dr. Mitchell Roslin, chief of obesity surgery at New York's Lenox Hill Hospital, is watching another recession metric—people's waistlines—and seeing a very far off impact indeed.

Lean times lead to bad diets. Bad diets lead to obesity. And obesity leads to diabetes, heart disease and other chronic illnesses—not now, but sometime later in life, when today's recession is a memory but Medicare, Medicaid and private insurers are still groaning under its weight. "People are eating cheaper, more fattening foods; care is more difficult to find; and as a result we're going to have more and more people presenting at a later stage of the disease process," says Roslin. "If you're concerned about paying your rent and making ends meet, it's very hard to think about the future implications of diabetes and other illnesses."

Bad economic times affect Americans' health in a number of ways. Most obviously, people who lose their jobs can lose their health insurance, if they are unable to find coverage under a spouse's plan, if COBRA extensions expire before another job can be found or if Medicaid benefits are unavailable. Even Americans who do have health insurance avoid or delay getting care during a recession, especially if co-pays become unaffordable or receiving time off of work to visit a doctor is an impossibility.

But one of the most insidious health effects of a downturn is in the area of diet. Eating healthily can be expensive and time-consuming—two qualities Americans currently have little appetite for. Hitting up the drive-through is cheap, no-hassle and easy to rationalize; those off-the-charts levels of fat, sodium and sugar feel like they can be dealt with in better days. Owing in part to psychology like this (lower fuel costs helped too), McDonald's Corp. this week announced that it has defied the worldwide economic downturn, posting a first-quarter profit of $980 million, up 4 percent from last year. Burger King's most recent U.S. sales figures were also up 1.6 percent, according to the chain.

"There's a certain ratio," says Roslin. "If you and I went to Hale and Hearty [a New York chain] to have soup and salad, it would take us $30 to be filled. If you go to McDonald's, we're going to be full for $6 each. The bottom line is that cheaper food sources are making people more full, and until we change that ratio we're not going to do anything about this problem."

Already at 35 percent (according to the Centers for Disease Control), obesity rates in the United States are likely to climb even higher. It's enough to make health researchers retch. The effects of poor eating and exercise habits, if left unchecked, are likely to outlast the current recession by years and even decades. "So often, making the healthy choice is the difficult choice. It's imperative that we make it the easy choice," says Harold Goldstein, the executive director of the California Center for Public Health Advocacy, which studies the state's obesity epidemic and advocates for measures like mandatory menu labeling to better inform consumers about what they're ordering.

"The restaurant industry wants that information hidden in complicated brochures," Goldstein says. "What we know is that if you put that information up there on the menu board, consumers have calorie sticker shock." A spokesman for the National Restaurant Association says the group supports federal legislation known as the LEAN Act, under which "our customers will have access to that information prior to purchase in an easy and convenient manner." Critics of the bill, like the New York Times editorial board, say it would allow restaurants to continue to bury calorie information in brochures. Goldstein's organization also calls for transportation stimulus money to be spent on making urban communities more walkable, with better-lit sidewalks and safer parks, so that more people are able to get simple exercise.

"This is a pretty bad recession, worse than the more minor ones we've had recently. All these effects you might think about existing between health and employment will be stronger this time around," says Brad Herring, a professor of health policy and management at The Johns Hopkins University. Men and women are affected differently. A 2003 study by two Cornell researchers, John Cawley and Kosali I. Simon, found a stronger correlation between unemployment and lack of insurance for men than for women and children, who are more likely to be caught by the safety net of Medicaid. Without health insurance, men are likely to avoid well checkups that might detect early indicators of diabetes, or symptoms that can exacerbate the disease, like high blood pressure.

Nutrition experts say there are no easy solutions. Some ideas are creative, but controversial. Earlier this month, New York CityMayor Michael Bloomberg—who successfully banned smoking from bars and trans fats from restaurants—reiterated his support for a tax on nondiet sodas, to theoretically reduce demand by 10 percent.

Don't expect menus to change soon: Manhattan has a lot more soda guzzlers than cigarette smokers. "That's the whip," says Roslin. "I don't think a whip strategy will ever, ever, ever work. You have to subsidize the salad bar, not make the french fries more expensive."

© 2009