A study on the eating habits of the UK’s lower-income groups has caused surprise among health professionals for claiming that nutrition and diets are not worse in poorer families. However, questions remain about the report and there is some concern that its findings could undermine the huge efforts underway aiming to improve the health of the UK population. Ben Cooper reports.
Research published by the UK’s Food Standards Agency (FSA) at the weekend presents policymakers, food and health advocacy organisations and charities with a dilemma, as it flies in the face of the widely held view that lower income groups have substantially worse diets than the better off.
The FSA’s Low Income Diet and Nutrition Survey (LIDNS) examined the diets of some 3,728 people from 2,477 households identified as being “approximately” in the bottom 15% of the population in terms of material deprivation. The study concluded that dietary patterns of people on low incomes are similar to those of the general population, though in some respects they are “slightly less healthy”.
According to the FSA, diet-related problems affecting low-income groups are the same as those facing the general population, such as not eating enough fruit and vegetables, not eating enough oily fish, and consuming too much saturated fat and sugar. Levels of obesity were found to be very high – 62% of men, 63% of women, 35% of boys and 34% of girls were overweight or obese – but the FSA said this mirrors the high levels within the general UK population. The FSA report suggests low earners are not compelled to eat unhealthily by their income, access to shops or cooking skills.
“The encouraging news from this research is that the gap between the diets of people on low incomes and those of the rest of the population is not as big as some had feared,” said Rosemary Hignett, the FSA’s head of nutrition. “It is also positive that most people in this group say they feel confident about their cooking skills, have reasonable kitchen facilities and access to large supermarkets. However, the bad news is that this group – like the general population – are not eating as healthily as they could.”
Understandably, industry representatives greeted the findings with enthusiasm. The British Retail Consortium (BRC) said the research was an indication that people are not priced out of eating healthily, and that its retail members are doing well in supplying healthy food options to all consumers. “This report confirms that British retailers have made healthy food accessible to families of all incomes,” said BRC director general Kevin Hawkins. “Customers have a bigger food choice, including more healthy options than ever. Educating consumers about what to do with that choice is now the key to improving the nation’s diet.”
However, the report does not really constitute good news. If the findings are accurate – and as they seem to go against much previous research this will be seen as a significant assumption by many – they only serve to confirm the prevailing unhealthy dietary trends among the general population, suggesting that the poor do not eat substantially less healthy diets than anyone else.
But the FSA’s focus on the narrowness of the gap between rich and poor may cause problems for groups working to improve diets among poorer households, not least The Department of Health. Among many of its initiatives, the department runs a scheme called Healthy Start aimed at increasing consumption of fresh foods among low-income households. Such schemes are predicated on the idea that poorer people have poorer diets and are therefore in need of such interventions. The FSA’s findings arguably present a conflicting message.
Indeed, one insider suggested the FSA’s findings and the spin that was put on them would have caused consternation among some at the Department of Health who are working hard to respond to the particular challenges associated with improving diet among lower-income groups. The important point here is that even if the diets of poorer families are only “slightly less healthy” than the better off, different solutions are required to combat this from those that might work with other socio-economic groups.
Hugh Thornbury of NCH, the children’s charity, said that poor diet among vulnerable and excluded families was “not a matter of choice”, and that “anything that obscures the fact that there is a problem will be a real concern”.
Moreover, in spite of the GBP5m (US$10m) budget for the research there is a strong possibility that it does not accurately reflect dietary differences between rich and poor.
Ed Randall, lecturer in social policy at Goldsmiths College, University of London, and the author of a number of books and papers on the politics of food and health, believes that the methodology used may have biased the result.
The research looked at the diets of a large group of people over relatively short time periods, but Randall believes a more in-depth examination of the dietary habits of smaller but representative samples would have yielded a more accurate picture. “I would have more confidence in work focused on a smaller sample of relatively poor and relatively well off households, followed over a longer period and investigated in ways that are specifically aimed at ensuring comparability,” Randall said.
Randall also contends that a bias is often created by the self-assessment of diets. When research subjects know roughly what the research is looking for there is a tendency to try to give desirable answers and in this case this may result in reporting a healthier diet than is actually the case.
Above all, Randall believes that focusing and possibly overstating the notion that the gap between richer and poorer is narrower than once thought is a distraction from the challenge of improving diets across the board. In particular, it represents a distraction from improving the diets of lower-income groups, who are known to be more difficult to reach through public education messages.
Interestingly, the FSA report does mention this challenge, although it was not one of the most highly publicised aspects of the report. The report states: “While some of the issues mentioned may already be targeted for action in the general population, different approaches might be required to achieve effective changes in the low-income population.”
“The researchers may have picked up on the main issue that if everyone is eating badly the task is to find a way to reach them,” Randall said. “We need to think particularly hard about how we get information on adequate nutrition over to people who have least control over the lives.”
In this respect, the FSA report does make an important observation about the challenge of improving diet among lower-income groups. But in focusing on the suggestion that the gap between the diets of the poor and the rest of the population is narrower than previously thought, the FSA has given rise to a misinterpretation that the situation is better than previously perceived, which is definitely erroneous.
At the very best, diets are equally bad across the board, and the task of changing dietary patterns among the lower-income groups will still require specialist and targeted intervention.