Psychologists are working with colleagues in nutrition, public health, and other disciplines to help overhaul the food system—designing food-labeling programs for food banks and food pantries, creating a framework for early childhood well-being that includes nutrition, and studying the effects of nutrition policies like school lunches and taxation of sugary drinks on people’s health.
In fact, psychologists and other public health researchers and advocates have spent decades trying to curb the obesity epidemic by educating the public about good nutrition and taking actions to improve the quality and amount of food that people consume.
But obesity rates remain stubbornly high: 43% of adults and 19% of children, compared with 13% and 5%, respectively, in the early 1960s, with numbers higher among people with low incomes than those with high incomes, according to the Centers for Disease Control and Prevention (CDC). That is not surprising, given a consumer environment that continues to peddle poor-quality foods and makes it difficult for people with lower incomes to access healthy options, said psychologist Christina Roberto, PhD, associate director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania.
“Unhealthy, ultra-processed food is so accessible, so cheap, and is designed in ways that make it so tantalizing, that we are really out of whack in terms of what an actual healthy food environment looks like,” she said.
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Large-scale policy solutions that employ creativity and interdisciplinary teamwork are needed to move the country into a healthier place, Roberto and others say.
“If we really want to tackle this problem at a population level, we have to focus on government and institutional policies that can fundamentally change the food environment,” Roberto said.
Improving nutrition in food pantries
Psychologist Marlene Schwartz, PhD, who directs the Rudd Center for Food Policy and Health at the University of Connecticut, has worked for decades to improve children’s diets and health in the context of K–12 schools. Recently, she has turned her attention to food banks—large-scale warehouses stocked with donations from the government and other sources—and food pantries—community-based agencies that serve their neighborhoods and receive their supplies from the food banks. The charitable food system is an important source for many low-income Americans, including those who do not qualify for the Supplemental Nutrition Assistance Program (SNAP) but still struggle to pay for groceries. In all, there are some 200 food banks and 45,000 food pantries across the country that feed more than 46 million Americans at no cost.
Because of the network’s scale, Schwartz sees it as a prime venue for studying and improving on the nutritional quality of food for low-income people; the system is largely unregulated when it comes to nutrition, so food pantry offerings are extremely variable. “It’s a great system to work in, because 100% of your efforts are going to the people who need it the most,” she said.
To better understand what food banks and pantries donate and offer, she and colleagues developed a color-coded food-rating system—green for most nutritious, yellow for moderately nutritious, and red for least nutritious—that she deployed in a series of studies with food pantries in Connecticut. The research showed that when the food pantries designed their shelves using versions of the system, consumers made healthier choices, findings detailed in a 2021 report to Feeding America, the national network of food banks.
Schwartz and others are now working to implement these findings on a national scale. In 2019, Schwartz cochaired a panel on nutrition and food banks funded by the Robert Wood Johnson Foundation’s Healthy Eating Research (HER) program. The panel worked for a year to create a universal nutrition-ranking system called the HER Nutrition Guidelines and issued a report in 2020. Key players in the food bank space, including the CDC, Feeding America, and the nonprofit Partnership for a Healthier America (created in conjunction with the Let’s Move! effort of former first lady Michelle Obama) have endorsed the system, which in turn spread the word to food banks and pantries.
Schwartz and others are now providing food banks with training and technical assistance to help them better understand and implement the HER Nutrition Guidelines, such as creating a searchable online database of common foods using the nutrition rankings. Meanwhile, food banks and pantries are using the nutrition coding system in creative ways: Some food banks, for instance, are setting goals of having a certain percentage of available food in the “green” category, while others are sharing reports of their inventory with donors to encourage them to provide healthier options.
“Donors understand the diet-related health risks faced by low-income Americans, so they’ll usually say, “Yeah, OK. Maybe we shouldn’t be giving you all our soda or cakes,” said Schwartz.
Targeting the entire food bank system, from government and corporate donors all the way to consumers, is what has made these changes as successful as they’ve been, Schwartz believes. “The idea is to improve communication about nutrition at every juncture, with the aim of systematically improving the quality of what’s in the entire system.”
Giving kids a healthy start
To bolster a healthier nutrition environment on a global scale, pediatric psychologist Maureen Black, PhD, a distinguished fellow at RTI International who studies childhood development and nutrition, has worked to create an international framework intended to help all children grow and thrive, including nutritionally.
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Known as the Nurturing Care Frameworkopens in new window, the initiative maintains that children need five interconnected components to do well in life: health, nutrition, opportunities to learn, responsive caregiving, and security and protection. In terms of nutrition, the framework spells out not only the kinds of foods that children need at different stages but also the ecology of children’s food environments, including when, where, and how much to eat, said Black. Parental recommendations include allowing children to touch and learn about food, responding to children when they are hungry and letting them stop eating when they are full, and providing and modeling healthy food choices, for example.
Black and other researchers spelled out the scientific rationale for this approach in a series of articles in The Lancet (Vol. 389, No. 10064, 2017) called “Advancing Early Childhood Development: From Science to Scaleopens in new window.” The World Health Assembly adopted the framework in 2018, and it has since been championed by the World Health Organization (WHO), UNICEF, the World Bank, the Inter-American Development Bank, and governments around the world.
Now, Black and colleagues are helping communities, health care systems, and countries implement this system. To aid in the effort, in February the WHO launched a population-level method that Black helped design called the Global Scales for Early Developmentopens in new window (GSED). Free and available to the public, the scale employs an easy-to-use metric based on children’s emerging skills and behaviors in cognitive, motor, language, and social-emotional domains. Fieldworkers in different countries are now using the scale to collect population-level data on kids’ development (Cavallera, V., et al., BMJ Open, Vol. 13, No. 1, 2023opens in new window).
“The aim is to help governments assess which areas need more community services so that all young children have the ingredients to reach their developmental potential,” said Black.
Studying public health interventions
Other psychologists are studying the potential health benefits of these large-scale policies and interventions. One focus is the impact of taxes on sodas and other sugary drinks, now in effect in eight U.S. cities, including Philadelphia, San Francisco, Seattle, and Washington, D.C. Like taxes on alcohol and tobacco, public health advocates argue that these taxes will help to reduce overconsumption of a substance linked to health risks, including obesity, Type 2 diabetes, tooth decay, and heart disease. The policies are not without controversy: For one thing, there is significant blowback from beverage manufacturers, who argue that the taxes hurt the economy, though researchers have refuted this claim (Crosbie, E., et al., American Journal of Public Health, Vol. 111, No. 4, 2021opens in new window).
That said, studies are finding that these taxes do reduce purchases of sugary beverages; they are also finding that fewer purchases are linked to better health outcomes. (Typically, these taxes are levied on distributors of the beverages, who pass along the extra cost to consumers.)
Roberto and colleagues found that when Philadelphia instituted a tax on sugary and diet drinks in 2017, it led to a 38% decrease in purchases of these beverages a year later (JAMA, Vol. 321, No. 18, 2019opens in new window). The team next focused on potential long-term health consequences of the policy, looking at dental disease, one of the ill effects of too many sugary drinks. In analyzing dental records of 83,260 patients living in Philadelphia and control areas between 2014 and 2019, Joshua Petimar, ScD, of Harvard Medical School, Roberto, and colleagues found a significant reduction in cavities and other dental problems among low-income Philadelphia residents 2 years after the tax was implemented. The same was not true for the general Philadelphia population, suggesting that these interventions might especially benefit underserved populations, the team noted (American Journal of Preventive Medicine, Vol. 65, No. 2, 2023opens in new window).
In a similar study, health economist Justin S. White, PhD, of the University of California, San Francisco, and colleagues found that compared with purchases of sugary drinks in nearby cities without a soda tax, purchases of sugary drinks in Oakland, California, dropped 26.8% from the time a tax went into effect in 2017 until 2019 when the team finished its analysis (PLOS Medicine, online, April 18, 2023opens in new window). The researchers estimated that if this decrease continued over 10 years, people’s quality of life would increase significantly, and the city would save more than $100,000 per 10,000 residents in health care costs. Still another study in Berkeley, California, saw a 52% drop in self-reported consumption of sugary drinks 3 years after a tax went into effect in 2014 (Lee, M. M., et al., American Journal of Public Health, Vol. 109, No. 4, 2019opens in new window).
These policy moves can do more than just improve physical health, Roberto added. The income generated from the Philadelphia tax is being used to expand access to free, high-quality pre-K for children in low-income families in the city. Berkeley is putting its extra revenue into school-based nutrition education and gardening programs.
“If you design these taxes well and you use the revenue by reinvesting it back into the community, it can be a really progressive policy,” Roberto said.
In another look at the effects of large-scale nutrition policies, social and behavioral scientist Erica Kenney, MPH, ScD, an assistant professor of public health nutrition at the Harvard T. H. Chan School of Public Health, and colleagues have analyzed the long-term health impact of the 2010 Healthy, Hunger-Free Kids Act among children receiving the program in public schools. The law, implemented in 2012, sought to bring school lunches, breakfasts, and snacks in line with dietary guidelines for Americans in general, including more whole grains, more fruits and vegetables, lower levels of sodium, and smaller portion sizes.
Examining national estimates of childhood obesity among 173,013 children between 2003 and 2018, the team found that before the changes were implemented, the percentage of children in poverty with obesity was trending steadily higher with each passing year; after implementation, those numbers began and continued to fall. The team estimated that in 2018, the law prevented about 500,000 cases of obesity nationally (Health Affairs, Vol. 39, No. 7, 2020opens in new window).
Like Roberto’s findings in Philadelphia, there were no changes in the obesity rates of children overall, suggesting that these programs made the biggest difference for low-income kids, Kenney added. Other researchers have since drawn similar conclusions using different data sets, and some have found that children in public schools are eating more healthily in general than they were before the law was passed (see Richardson, A. S., et al., JAMA Network Open, Vol. 5, No. 5, 2022opens in new window; Kinderknecht, K., et al., JAMA, Vol. 324, No. 4, 2020opens in new window).
“When you put it all together, it looks like the law had a significant impact in terms of improving the diet for all kids who are eating school lunch, and potentially in helping to prevent obesity for kids who might be at most risk for that,” Kenney said.
