Like many people, Clarke Square resident Vernita Daniel doesn’t read nutritional labels at the grocery store.
“My daughter is telling me ‘momma you’ve got to watch your calories, you’ve got to watch this;’ I ain’t got to watch nothing, all I’ve got to do is buy it, cook it, and eat it. But maybe I’ve got the wrong attitude.”
Daniel’s attitude is not unusual; we eat what we like. But nutritionists such as Lisa Stark, the director of the Dietetic Internship Program at Mount Mary College, know that this approach toward food is contributing to obesity and poor nutrition.
We like what we’re familiar with, Stark pointed out. “For example, some people may never eat brown rice [a healthier alternative to white rice]; their parents never ate it. It is a newer food. It has become more common in the last decade when we have been talking about whole grains.”
Nutrition has become a greater concern in the U.S. as the epidemic of obesity continues to spread. Experts say that a critical key to better health is access to nutritious food.
Milwaukee Neighborhood News Service examined access to healthy food in Milwaukee’s central city by surveying availability and prices of a “healthy food basket” at eight grocery stores in Lindsay Heights on the north side, and Clarke Square and Layton Boulevard West (Burnham Park, Layton Park and Silver City) on the south side.
None of the communities is a “food desert,” based on the U.S. Department of Agriculture definition—a low-income metropolitan area at least a mile from a supermarket. While all five are low income, each is within a mile of a supermarket. The price of healthy food in these neighborhoods did not vary widely from a comparable grocery store in a more affluent neighborhood.
Participants in Wisconsin’s FoodShare program for low-income residents can buy breads and cereals; fruits and vegetables; meat, fish and poultry; and dairy products; all items represented in the NNS healthy food basket.
Sarah O’Connor, project director of the Milwaukee Childhood Obesity Prevention Project, or MCOPP, was surprised by the NNS survey results because in her experience, easy access to healthy food in Milwaukee’s struggling neighborhoods is not the norm.
Nevertheless, the NNS data raise a challenging question: If healthy food is nominally available, why is obesity such a big problem in minority and low-income neighborhoods? Experts, community organizers and researchers have a variety of answers.
The similarity in the basket price across neighborhood grocery stores suggests that prices for nutritious food are not prohibitively high. Nevertheless, price does factor into individual shopping decisions and habits, especially for low-income consumers. “People with lower incomes can’t always take advantage of bulk pricing, like at a Sam’s Club,” Stark said. “If you can purchase in large quantity, it’s a way to get those items at a lower cost that you may not get otherwise.”
Some consumers also may not be able to take advantage of sales because they can’t afford or lack access to convenient transportation. North side resident Emma Graves, interviewed outside of the Clarke Square Pick N’ Save, 1818 W. National Ave., takes advantage of sale prices. “I shop all the time; if it’s high here, I’ll go where it’s on sale.”
But other shoppers, for a variety of reasons, may not be able to shop at multiple stores. Asked why she shops at the Pick N’ Save on National, Clarke Square resident Olga Vana answered, “It’s the closest one that I have.” She does the majority of her shopping there.
Even after shoppers walk into the supermarket, meeting federal nutrition guidelines can be challenging. Researchers in King County, Wash., recently found that it would cost the average consumer an additional $380 per year to meet federal guidelines for potassium, a nutrient necessary for the proper functioning of the heart, kidneys, muscles, nerves and digestive system. The study also found that the greater the percentage of consumers’ calorie intake coming from saturated fat and sugar, the less expensive their diet.
A related study by University of Washington researchers found that the most energy-dense (high-calorie) foods, such as oils, peanut butter and potato chips, are far less expensive than the least energy-dense foods, which often have the most nutrients. The least energy-dense foods, such as lettuce, tomato, peppers and other vegetables, cost $18.16 per 1,000 calories, whereas the most energy-dense foods cost $1.76 per 1,000 calories.
These findings have serious implications for shoppers with tight food budgets; it can cost much less to satisfy hunger with energy-dense foods, but these foods often lack nutritional value. Asked whether she and her family eat fruits and vegetables every day, Nannette Hopper, a Clarke Square resident, said, “Not every day.” She added, “Most of the time we don’t have money to buy that stuff.”
“Access to food can only explain one part of the obesity problem,” said dietitian Lisa Stark, and price doesn’t account for the rest. Personal habits and upbringing also contribute. Many eating habits are passed down through families and are part of a shopper’s culture. “Like I told my daughter,” south side resident Vernita Daniel said, “When my mother was living, she went shopping, she bought what we want to have the taste for to eat, and that’s what I do.”
Often, healthy eating habits are not passed down. “Now we have lots of people who haven’t been taught to cook from their parents or grandparents,” said Stark. “People don’t know where foods come from.” Healthy foods can be unfamiliar to people, putting them at a nutritional disadvantage. “People aren’t familiar with the food, so they’re not going to eat it,” Stark added. “You have to introduce people to how to prepare foods that they’re not familiar with.”
In addition, location and access to transportation can limit people to corner stores, which often lack fresh produce and are more expensive. “A lot of people go to corner stores quite a bit for a number of items,” Stark said. “The prices for fresh produce are much higher, and the availability is lower.”
Asked whether she shops at corner stores, shopper Emma Graves said she goes “only if it’s an emergency. It has to be a milk, bread emergency. Other than that, no never. It’s too expensive.”
Studies have confirmed that residents of low-income, minority communities are the most at risk for obesity-related health issues, and often have the most difficulty obtaining nutritious food.
The Center for Urban Population Health and the City of Milwaukee Health Department analyzed health trends for groups of Milwaukee zip codes based on socioeconomic status. In the lowest group, which included Lindsay Heights, Clarke Square and Layton Boulevard West, the obesity rate was 31.1 percent, compared to 24 percent for the high socioeconomic group and 29.6 percent for Milwaukee as a whole.
The data also show that 70.1 percent in the low socioeconomic group reported inadequate fruit and vegetable consumption, defined as the percentage of the population who report eating less than five servings of fruit and/or vegetables per day. This compares to 61.9 percent of the highest group.
Eating junk food and consuming calorie-filled beverages are learned behaviors that have become the norm for many people. The problem is magnified, however, in low-income communities with limited access to grocery stores, and where insufficient safe parks and outdoor spaces hinder physical activity. “Nutrition is so difficult, and poverty is always a part of it,” said O’Connor, of MCOPP.
O’Connor attributes nutrition and obesity-related problems to the physical and cultural environment of Milwaukee’s neighborhoods. “My take is that the obesity challenges are much more related to environment than they are to individual behavior,” she said. “People who live in places that don’t promote health are less likely to be healthy, and those places tend to be poorer areas where there is more crime and less access to healthy foods.”
Cultural behaviors also have contributed to obesity-related problems. “Activity levels are different today than they were,” Stark remarked. “We have automated machines, and remote controls for everything under the sun.” She added that tempting options such as chips or a bottle of soda are easily available, and it takes a concerted effort to reject them in favor of healthy food.
What is being done?
Organizations such as MCOPP, a program of United Neighborhood Centers of Milwaukee (UNCOM), are spearheading efforts to combat obesity in Milwaukee communities. MCOPP recently began initiatives targeting four specific areas related to childhood obesity: providing nutritious food in vending machines, improving nutrition at community food providers, promoting active living and improving land use around community centers.
MCOPP is focused on changing the physical and cultural environments in the neighborhoods it serves. “When people are regularly going to a community center and seeing healthy food available, it helps to change the norm in their life,” O’Connor said. Her hope is that these changes will “radiate out to the communities,” and make healthy, active living the prevailing norm.
These initiatives face multiple challenges, however. For example, MCOPP recently tried to substitute healthy food into the vending machines at the Agape Community Center in the Thurston Woods neighborhood, but vending machine operators weren’t interested because they believed healthy food wouldn’t sell, O’Connor said. More broadly, healthy food and active living messages can be drowned out by the large marketing budgets of fast food companies.
O’Connor recognizes that MCOPP faces an uphill battle. “What I’ve learned about policy and environment change is that it’s slow, and you don’t see the fruits of your labor overnight,” she said. But she is starting to see a shift nationally toward addressing childhood obesity. “There is a lot more awareness in general, and that is the key to me,” she said.
In June, the United States Department of Agriculture launched MyPlate, a visual representation of recommended healthy foods that replaces the food pyramid system of dietary guidelines. In particular, MyPlate calls attention to the importance of eating more fruits and vegetables. First Lady Michelle Obama’s recent “Let’s Move” initiative also addresses one of the main causes of childhood obesity.
Increased national awareness is one step toward reducing the problem, but it takes people on the ground to achieve change, O’Connor said. She added that residents, working with healthy food advocates and those trying to create safe places to exercise and play, can foster an environment that promotes better health.
“People still make choices, and often they are unhealthy choices,” O’Connor admitted. “But if you live in a place where healthy food and exercise are not the norm, I think it is a lot harder to be healthy.”