Friday, August 31, 2007

Poor Diet and The Poor

The current received wisdom is that healthy food is beyond the reach of America's poor, hence their rising obesity and related poor health. My experience suggests this is simply wrong.
Healthy food is still much cheaper than garbage-food--fast food, convenience food, snacks, soft drinks and all the other stalwarts of the standard American diet "enjoyed" by rich and poor alike.

Obesity Rates Show No Decline in US:

"Another factor in obesity rates is poverty. The five poorest states were all in the top 10 when it came to obesity rates. An exception to that rule was the District of Columbia and New Mexico. Both had high poverty rates, but also one of the lower obesity rates among adults.

Poverty can lead to less safe neighborhoods, which deter children from playing. It can lead to fewer grocery stores offering fruits and vegetables, and it can lead to greater reliance on fast food, officials said. "It seems the cheapest foods are the worst ones for you," Marks said."

A Crisis of Great Magnitude by Nayer Khazeni, M.D.

"Today, cutting across all income groups, obesity remains a dangerous medical condition and a national public health crisis, costing Americans $100 billion in health care expenditures and more than 400,000 premature deaths each year. A number of studies have now demonstrated links between obesity and a host of medical conditions, including depression, gastroesophageal reflux, sleep apnea, gout, osteoarthritis, gallbladder disease, kidney disease, diabetes, high blood pressure, high cholesterol, coronary artery disease, heart failure, atrial fibrillation, stroke, pulmonary hypertension, blood clots, dementia and several cancers (endometrial, breast, pancreas, kidney, esophageal, multiple myeloma, lymphoma, prostate, liver and colon).

A July 2007 study from the Johns Hopkins Bloomberg School of Public Health estimates that 75 percent of American adults and 24 percent of American children will be overweight or obese by 2015. During my residency, patients weighing more than 325 pounds used to be transferred from the hospital to local zoo scanners for imaging."

Granted, poor neighborhoods are inherently unsafe for many reasons. But the inaccessibility of healthy food is not one of them.

The cliche is that the poor have little access to groceries. That too is simply wrong. We shop in low-income, gritty neighborhoods which are home to "poor" people, i.e. those living on less than middle-class incomes. The fact is that the cheapest groceries are in "poor" neighborhoods.

Yes, if you insist on doing your grocery shopping at the corner liquor store, you may not find inexpensive, healthy foods. But if you walked a block down to the Hispanic/Mexican market, you would find vine-ripened tomatoes, 3 pounds for a dollar, 4 ears of corn for a dollar, a huge bag of beans for a couple bucks, and fresh bakery rolls for less than a dollar.

Yes, these are tough neighborhoods. That's where the "poor" can afford to live. That's why the ethnic grocery stores are located there rather than in some high-rent yuppie paradise.

I should note here that based on my taxable income, I am not exactly rolling in moolah either ($22K gross income, $14K taxable income). Why aren't I rich? Because I'm an idiot!

Be that as it may, we eat very well and we do it by shopping in "poor" neighborhoods at ethnic stores which cater to "poor" people and cooking our own meals.

Every cliche about how difficult and impossible it is to eat well if you're poor in America is simply wrong. The poor don't have cars, so they can't go to a grocery store. My wife takes a bus to Chinatown; every major shopping district in the Hispanic neighborhoods, every Indian or Pakistani or Iranian store or Halal is on a major bus line. I can be at the local bulk foods store (owned by southeast Asians) or the Mexican market in 10 minutes on my bicycle.

Do the poor have no time to cook? Based on surveys, Americans of all incomes watch horrendous amounts of useless, mind-numbing television. I am sorry to pop all the balloons about how awful and difficult it is to eat well in America on a limited income, but the solution is not difficult at all: buy real food at bargain prices in ethnic grocery stores, and cook this real food into real meals instead of watching hopelessly moronic TV shows (including those cuisine-porno shows on Food Network).

In the half-hour some "poor" citizen sat on their duff watching a useless TV show, they could have cooked a delicious and nutritious chicken-green bean dish in an Indian style or Chinese style. I know, because even "poor" me pulls this off, with a recipe you can download for free at any public library or copy off a cookbook from that library. I am no cooking-show wizard, just an average person who can read a recipe.

But what about all those fancy pans and appliances you see the TV chefs use? All you really need is one decent knife and a wok or equivalent pan. That's what hundreds of millions of Chinese and other Asian families use to cook an immense variety of dishes.

All this flies in the face of what's considered "affordable." A friend's teenager was just enthusing over the meals at a fast-food chain called Nations--huge portions, she reported, fries and a soda, all for only $6. Six bucks for one garbage, high-fat, high sucrose meal? I walked out of the Mexican market on International Blvd. last week with a full grocery bag of real food for $5.45. That is the truth: tomatoes, much better tasting than the plastic-fantastic found at Safeway, potatoes, garlic, veggies, fresh corn, some bread rolls, even a piece of bread pudding for dessert (a low-fat, low-sugar one at that), large enough for two of us--yes, for less than $6.

"But meat is so expensive." Well, how about eating less of it? It's not good for you anyway to consume vast quantities of meat. The lower you eat on the food chain, the better it is for the planet and the better for your health. One piece of chicken or pork makes a darned fine stir-fry which serves four.

Or how about scanning those free shopping flyers everyone gets in the mail from the local supermarket chain? If you sign up for Safeway's "club card", you can often get 2-for-1 sales on all kinds of meat. I recently bought a roast on an advertised sale, sliced it myself in about 15 minutes and the resulting plate of low-fat, high-quality steak served six people, with leftovers for lunch. All for about the same cost as two "cheap" fast-food meals.

And Safeway is on the bus line, too.

Don't have a membership at Costco, or can't get to Sam's Club? How hard is it to find a co-worker or neighbor who goes to one of these big-box stores? Would they be willing to buy you some paper towels and bulk flour? Probably.

"Food is so expensive." Yes, some of it is. But it is cheaper at the ethnic groceries, and the quality is often better than you'll find at the chain supermarkets. Our close friends operate an Indian market, and they are at the regional produce wholesalers open market at 4 a.m., buying the best quality vegetables and fruits available. Cultures which have a much greater focus on food and cooking than the mainstream America portrayed in ads and the media--Indian-Americans, Iranian-Americans, Korean-Americans, Chinese-Americans, Hispanic Americans, to mention but a few types of Americans who support small groceries in cities large and small, and neighborhoods rough and upscale alike--care about the quality and price of their food, and the markets cater to their desire for excellent quality at the lowest possible prices.

If you eat rice, you can buy huge 25-pound bags at your local Halal or Korean market for less than $10. Basmati, long-grain, brown, you name it--it's all insanely cheap. Ditto for 25 pounds of pinto beans and 10 or 25-pound bags of flour. If you travel overseas, check out the food prices in Europe, Japan or elsewhere. Food in the U.S. is still relatively cheap.

I understand that this is mostly urban-America-related--but rural Americans have the luxury of growing their own food at least a third of the year. Even on a very small garden plot which is surrounded by 3-story buildings, we grow more veggies than we can consume ourselves: lettuce, green beans, etc. And the soil is clay, not great by any means; the sun is limited by the neighboring structures, and the climate is often foggy/overcast, even in summer. Yet we still managed to bake 14 pies from the bounty of our one peach tree. And it wasn't even a very good yield this year. (We gave away/shared most of the pies, but kept a few in the freezer.)

And even small-town America is now often served by a Halal, Hispanic, Asian or Indian grocery store. Hey, you may be the only Caucasian or African-American customer at any given moment, but check out the freshness and the prices.

The problem isn't being poor--it's being ignorant of basic nutrition, shopping and cooking, and being unmotivated to do something about it. We as a nation are far more interested in watching the Food Network (cable or satellite TV being another waste of $60/month that even "poor" people seem to manage) than in actually cooking.

Has our educational system completely failed to educate our young about nutrition, household management and cooking? Yes, absolutely. And so now we get to throw up our hands and blame some bureaucracy, or budget cuts, or an uncaring Federal government?

I am especially tired of hearing about how "busy" Americans are and as a result they have no time to cook. It takes literally two minutes to combine rolled oats (59 cents/pound), raisins and some honey and make a decent breakfast. It takes literally five minutes to mix up some pancake batter from scratch--come on, folks, there's only five ingredients. You can make a giant pot of pasta sauce from scratch in less than an hour--which is literally one-sixth of the daily average time Americans watch TV. And that pasta sauce will last 2-3 meals, even if there's 6 people in your household.

These are all meals with costs of about 25-50 cents per serving, or even less.

How to find time to cook? Easy--stop watching TV or other "entertainment." Not watching TV supposedly makes you a snob, but really, who has that much time to waste? I don't. Like you, I get up at 5:30 or 6 a.m. and have to get cracking. (The fact that I write books no one wants to publish or read makes me stupid, granted, but it does take a lot of time, as does this site.)

Hey, we're all busy. But is it really so impossible to cook or get any exercise? Yes, if you live in a real ghetto, it's dangerous to go walking around outside. But probably less than 5% of Americans live in such hard-core bullets-flying ghettos. Yes, in harsh winter conditions, going outside isn't that healthy, either. But on the other hand, all you need for a home gym is enough room to swing your arms around--six feet by six feet.

Rambling on about cooking real, unprocessed food into real meals--I know it sounds like a health nut or food-snob rant, but it's simpler than that: I have high blood pressure, and so everything with empty calories, high fructose and/or high salt is out. That means essentially everything in the standard American diet is off the menu: packaged food, frozen dinners, canned soups, juices (mostly sugars and empty calories), Jamba Juice and Frappucino calorie-fests, chips and other high-salt snacks, cookies, doughnuts, all fast food and most ethnic-restaurant food--out. Cutting out all the high-salt, high-fat, high-sugar stuff (other than what we bake at home, where we can control the salt, butter and sugar) has lowered my blood pressure appreciably.

It's a simple choice that many who are recovering from cancer, heart disease, etc. make-- living healthy means eating healthy, which means standard American convenience food/fast-food/snacks /drinks are rarely on the table.

The mainstream media seems extremely interested in offering up excuses: for people signing up for obviously bad-deal mortgages, for people buying expensive fat and sugar-loaded garbage food instead of real food, for people watching 6 hours of TV or MySpace a day but being unable to muster the time or energy to actually prepare a real meal--and so "being poor" is now the catch-all excuse for poor health. Never mind that middle-class people are roughly equal in obesity and poor health--so what's their excuse?

Where do all these excuses lead us? What do we as a society and as individuals get out of all the excuses? "Permission to wallow in self-pity"? Is that really the best path? It is simply fact that modestly careful shopping and preparing real food is not beyond most Americans, who spend inordinate amounts of time sitting in brain-dead torpor in front of the television or other "entertainment" device.

If that's how we choose to spend our lives, fine. But let's not make excuses about how we as a society are in such poor health because we're too busy to be healthy or too poor to buy and prepare real food.

Thank you, Jim V., ($20) for your much-appreciated donation to this humble site. I am greatly honored by your support and readership. All contributors are listed below in acknowledgement of my gratitude.

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