In the United States, many low income individuals and families are eligible to participate in the Supplemental Nutrition Assistance Program (SNAP) to offset the cost of food. In recent years, there has been a discussion about how to improve SNAP to address issues of obesity and chronic disease in recipients. Some suggest incentivizing participants to purchase healthier foods may improve their behavior. Others believe that limiting the foods that can be purchased using SNAP benefits, a protocol similar to that of Women Infants and Children (WIC), may be the answer. Currently, little research exists to support either of these claims.
The September issue of the Journal of the American Medical Association featured a study conducted by Harnack et al. that took a closer look at some of these proposed addendums to SNAP. Previously, it has been very difficult to experimentally test these propositions with current SNAP recipients, as it would drastically interfere with the efficiency of the delivery system. For this study, the researchers recruited families who were near eligible for SNAP or those that qualify for SNAP, but were not enrolled. “Near eligible” was defined as having a household income less than or equal to 200% of the poverty line. Participants were given a debit card to be used solely for the purchase of approved foods. Money proportionate to family size was added to the card every four weeks for a 12-week period.
Participants were split into one of four groups: incentive, restriction, incentive plus restriction, or control. The incentive group was credited 30% of the purchase price on fruits and vegetables. This did not include items packaged in syrup or sauce, pickled vegetable, or white potatoes. The restriction group was not allowed to purchase sugar sweetened beverages, candies, or sweet baked goods using the debit card. The incentive plus restriction group received both the 30% incentive on fruit and vegetable purchases as well as the restriction on sweets. The control group followed the same guidelines as current SNAP recipients. Demographic information and three, unannounced 24-hour dietary recalls were taken from participants at baseline and follow up.
Several differences between the groups were observed at follow up. Those in the restriction group had the greatest decrease in overall energy intake. Participants in the incentive plus restriction group had a greater reduction in overall discretionary calorie intake and the percentage of total energy coming from discretionary calories. “Discretionary calories” refers to calories coming from foods that are low in nutrient value. They also showed the greatest increase in Healthy Eating Index (HEI) score. The incentive plus restriction group and the incentive group both showed improvements in the amount of solid fruit consumed and a reduction in sugar sweetened beverage consumption. All study participants showed a significant increase in food security, regardless of group.
Based on the findings of this study, it is difficult to say which design would be the most effective for improving the diet quality of SNAP participants as each experimental group demonstrated different strengths. In addition, data was only collected from the primary food purchaser in the household. These results, therefore, are not reflective of the effects the program may or may not have had on the family. They also failed to take into consideration the additional burden that food purchasing restrictions may place on already disadvantaged populations. The primary intent of programs like SNAP is to provide low income populations with the means to feed their families and themselves. The ethics of narrowing the types of foods they are able to purchase should be more closely examined in future research and policy.
Source:
Haranack, L., Oakes, J. M., Elbel, B., Beatty, T., Rydell, S., & French, S. (2016). Effects of subsidies and prohibitions on nutrition in a food benefit program: A randomized clinical trial. JAMA internal medicine.