Proponents of SNAP bans tend to link obesity directly to the poor choices of SNAP recipients. However, scholarship in public health and nutrition suggest that there is a much more complex set of variables discouraging healthy eating, including higher costs of healthy foods, preparation time, knowledge, transportation, and cultural practices.66 Food insecurity shapes not
only the amount of food individuals can afford, but also the kinds of food they can afford. Today
66 See Chung and Freedman on food price disparities in low-income neighborhoods, Coveny on transportation as a barrier to healthy foods, Gordon on black, low-income areas tending to have healthy foods available but far
outnumbered by unhealthy options. Walker’s 2012 review of food deserts literature highlights the range of problems beyond geographic location, including the aforementioned barriers. Chanjin Chung and Samuel L Myers, "Do the Poor Pay More for Food? An Analysis of Grocery Store Availability and Food Price Disparities," Journal of
ConsumerAaffairs 33, no. 2 (1999); John Coveney and Lisel A O’Dwyer, "Effects of Mobility and Location on Food Access," Health & place 15, no. 1 (2009); Cynthia Gordon et al., "Measuring Food Deserts in New York City's Low-Income Neighborhoods," ibid. 17, no. 2 (2011); Renee E Walker, Christopher R Keane, and Jessica G Burke, "Disparities and Access to Healthy Food in the United States: A Review of Food Deserts Literature," ibid.16, no. 5 (2010).
$1 can purchase almost five times as many calories of cookies or potato chips as of carrots.67 As
a result, high-fat, energy-dense diets are less expensive than diets based on lean meats, fish, and fresh fruits and vegetables. Adults experiencing food insecurity often reduce the variety of foods in their diet to include a few low-cost, energy dense yet nutritionally poor foods in order
maintain their caloric intake. 68 Doctors Hilary Seligman and Dean Schillinger, writing in The New England Journal of Medicine have argued that these kinds of compensatory behaviors “have enormous implications for the prevention and management of chronic disease.”69 Research has also found that food insecurity is associated with lower diet quality and a higher risk of being overweight.70
The negative health outcomes associated with food insecurity are made worse by the insufficiency of SNAP benefits, especially for low-income individuals with diabetes. This insufficiency is particularly true near the end of the month, when many families have exhausted their monthly SNAP benefits. A recent California study found that hospital admissions for hypoglycemia – episodes of low-blood sugar accompanied by complications ranging from dizziness to stroke – spike in the last week of each month among low-income individuals.71 Similarly, risk for hospital admissions due to hypoglycemia increased by 27 percent in the last week of the month among the low-income population. The study found no variation in the high- income population, suggesting that exhaustion of food budgets can be a significant source of
67 A. Drewnowski and S.E. Specter, "Poverty and Obesity: The Role of Energy Density and Energy Costs," American Journal of Clinical Nutrition 79, no. 1 (2004): 9.
68 Ibid.
69 Hilary K. Seligman and Dean Schillinger, "Hunger and Socioecnomic Disparities in Chronic Disease," The New
England Journal of Medicine 363 (2010): 6.
70 P Peter Basiotis and Mark Lino, "Food Insufficiency and Prevalence of Overweight among Adult Women," Nutrition insights; 26 (2002).
71 Hilary K. Seligman et al., "Exhaustion of Food Budgets at Month's End and Hospital Admissions for Hypoglycemia," Health Affairs 33, no. 1 (2014).
health inequities. Previous studies have found that adults with diabetes who experience food insecurity have five more physician visits per year than those with adequate food.72
A biological view of obesity does not seem to be the source for the failure to recognize structural causes of poor health among those facing food insecurity. Though proponents of SNAP bans often cite health problems associated with obesity, they tend to focus on poor
decision-making by SNAP recipients as causes, where a biological view might focus on a genetic predisposition to weight gain. Thus, as in the case of drug use, health is explicitly invoked, but not a narrowly biological view of health. Instead, individuals are held responsible for their own poor health with recognition of neither structural nor biological causes to relieve them of blame and disapproval. For the marginalized, the current tendency toward individualizing health and rendering it a personal responsibility can be particularly harsh.
In light of this finding, SNAP programs focused on making healthy foods more
accessible to SNAP recipients seem particularly promising. Going beyond the assumption that SNAP recipients desire too much soda, the programs acknowledge that fresh produce can be more expensive, more difficult to find, or impossible to afford on a SNAP budget. Many of the incentive programs also do work to demedicalize weight by advocating better nutrition in lace of medication or surgery. Of course these alternatives are not perfect. Critics of medicalization might worry about programs like FVRx, which involve medical professionals in the distribution of food assistance, and encourage them to “prescribe” fruits and vegetables.73
72 K. Nelson et al., "Is Food Insufficiency Associated with Health Status and Health Care Utilization among Adults with Diabetes? ," Journal of General Internal Medicine 16 (2001): 408-409.
73 As discussed above, as part of a 2010 incentive program, doctors at three health centers in Massachusetts began writing vegetable “prescriptions” to be filled at farmers markets and providing low-income families with farmer’s market coupons amounting to $1 a day per family member.
Attempts to combat obesity among the poor also highlight significant disparities in experiences of biomedalization. In SNAP bans and (to some extent) farmer’s market programs, the structural problems of food insecurity and, more broadly, poverty are individualized with no reference to biological views of health, and with no effort to increase consumption of medical care. At the same time, government-funded researchers study the genetics of weight gain, and the weight-loss industry promotes expensive weight loss treatments, invasive gastric bypass surgery, and genetic testing for risk of weight gain.74 Gonido, a for-profit company, offers “obesity management and nutrigenomics” services to help individuals overcome “genetic barriers” to weight and determine whether they might benefit from appetite suppressant medication.75 The poor are both punished by SNAP bans and overlooked by biomedicine, confirming arguments about its stratification and exclusionary/disciplining tendencies.