In the Fall of 2017, I was invited to give the keynote address at a conference titled “Food Justice: Exploring Our Cultures’ Complexity.” In return, my generous hosts at the University of Rochester gave me an embarrassing number of gift cards to the family of restaurants that includes Olive Garden, Longhorn Steakhouse, and Bahama Breeze. By now, those cards have become a running joke in my house, and not just because chain restaurants are so antithetical to most people’s image of “food justice.” It’s because we can’t bring ourselves to use them.
We’ll have booked a babysitter but failed to make any further plans, and as we’re pulling out of the driveway at peak restaurant wait time on a weekend evening, one of us will say, “Is this the night we finally go to Olive Garden?” Then we laugh and go somewhere else to eat, usually a familiar brewpub or diner, but sometimes the kind of aspirational chef-driven restaurant that serves from-scratch cooking highlighting fresh, locally sourced ingredients. In other words, they serve the food most people do associate with food justice because they believe it is better for the planet, for the people raising and cooking the food, and for their health.
The thing is, we actually like Olive Garden. I’m a fan of the minestrone soup and garden salad, and who doesn’t like their garlic bread sticks? Together, these compose a vegetarian meal that even many omnivores will find satisfying, and provided you don’t go too crazy with the breadsticks, most people would probably consider it reasonably healthy as well. My spouse swears that their calamari appetizer is the best he’s ever had. Nonetheless, I can’t get him, or most of my friends, to eat there with me.
We might sound like snobs, but a better read is that we’re idiots. We’ve now passed up dozens of opportunities to eat food we know we like. Instead, we’ve paid handsomely for food we sometimes don’t — five-spice duck that tasted like burnt cinnamon, unpleasantly acidic salads, sodden fried fish and empanadas, and woefully undersalted dishes at restaurants arrogant enough to leave their diners without salt on the table. We persist in eating this unpalatable and expensive food because we, like almost everyone of our social class, have largely succumbed to the cultural forces that have anointed some foods—fresh, local, organic, and slow—and demonized others—processed, mass-produced, conventional, and fast. By these standards, Olive Garden’s food is bad even if it tastes good and is good for you, and even if it is effectively free.
It’s embarrassing to admit how much that dichotomy still influences how I eat, because I wrote an entire book on the problems with foodie culture called Discriminating Taste: How Class Anxiety Created the American Food Revolution. My book seeks to explain why middle- and upper-class people began to fixate on gourmet food, weight-loss dieting, natural foods, and ethnic cuisines back in the 1980s, just at the moment that income inequality began to spiral. Much of this shift in attitudes toward food was undertaken in the name of health and the environment. But its primary function, in my analysis, has been to enable people of a certain social class to distinguish themselves from the unwashed masses during a period of elite hoarding of wealth and opportunity that started with the Reagan years and continues today.
“Food justice” developed as a direct response to both the industrial food system and the “alternative food movement,” which, whatever else one might say about it, has always been overwhelmingly comprised of the white and rich. But in practice, there’s never been much difference between what “food justice” and “alternative food” efforts look like on the ground, which is almost always uncritical boosterism about community gardens, farmers markets, and subscription vegetable boxes. The main difference is that when branded as “food justice,” such markets might give people double the dollar value for their Supplemental Nutrition Assistance Program1 benefits if they shop at this inconvenient, once-a-week produce vending system where you can’t buy paper towels or toothpaste.
These well-intentioned efforts ostensibly give working people of color access to the same sorts of amenities that many upper-middle-class white people take for granted — fresh, locally grown produce, meat and eggs from pastured pigs and chickens, and the opportunity to ask whether organic-approved pesticides are actually worse for beneficial insects than synthetics.2 Or whatever else they like to make small talk with farmers about. However, it’s not clear what concept of justice any of it actually serves.
Democratic presidential candidate Beto O’Rourke was recently taken to task for the tone-deaf elitism of his answer to poor nutrition in impoverished communities: more farm-to-table restaurants. However, if you add “urban” before “farm” and substitute “food pantry” for “restaurant,” that’s literally what most food justice organizations3 propose as the solution to our present health and environmental inequities. The critique that Beto’s idea is unacceptably elitist and totally inadequate to the nature and scale of the problem it seeks to address isn’t wrong; it’s simply equally true of most food justice organizations.
That, ultimately, is the problem with food justice as it’s presently defined.4 It mostly seeks to expand access to and inclusion in a food culture whose basic claims and premises it has failed to question. As a result, demands for food justice are too often based on assumptions about health, sustainability, and equity that actually reinforce inequality while doing little to meaningfully improve health outcomes for low-income communities of color or reduce damage to the environment. A food justice movement that takes seriously the problems of equity, health, and sustainability will need to start asking harder questions about what counts as good food, and who should get to define what counts as goodness and justice when it comes to food for low-income communities of color.
One reason we should be careful about how we define what it means to be good or just when it comes to our food system is that food is one of the languages we use to inhabit and interpret social identities such as class. For as long as there have been social classes, the poor have been a repository for whatever the richer classes are most anxious about and wish to distance themselves from. In the Victorian era, when the rich proved their status largely by not having to work, they despised labor and the traits associated with it, like a muscular body and tanned skin. Instead, the Victorian elite idealized thinness, especially in women. Teenage girls on both sides of the Atlantic wanted to be slender and pale because those traits were associated with infirmity, delicacy, and an artistic or intellectual temperament. This stood in contrast to the rude health, strength, and lack of sophistication associated with the robust laboring bodies of the peasant and working classes and their voracious appetites.
The modern restaurant was born when some clever entrepreneurs in early nineteenth-century Paris started opening shops to sell foods thought to be appropriate for sick people. In contrast to existing eating establishments like inns or caterers, where you essentially purchased the right to a plate of whatever was being served that day, restaurants offered a consistent menu of options that were medical treatment as much as food. The word restaurant derives from the same root as restore and referred to these establishments’ most standard offering: the therapeutic or restorative broths that invalids were supposed to sip in place of solid food. Part of the popularity of this new institution was that it gave the rich a public arena in which to perform their susceptibility to illness.
Today, thinness is still associated with wealth, but now it’s predominantly seen as a sign of good health. The poor, meanwhile, are strongly associated with fatness and the other stigmatized characteristics popularly linked to it, including ignorance, laziness, apathy, and a lack of willpower. The stigma though, is just that. The strength of the popular association between poor people and fatness is not well supported by the available data.
According to the 2005–2008 National Health and Nutrition Examination Survey (NHANES), which measured the actual height and weight of participants (as opposed to self-reporting data), the relationship between body mass index (BMI) and income isn’t strong, consistent, or linear. Obesity rates are 13 percent lower for women in the richest group than the poorest. But when you break that out by race, the trend is only statistically significant for white women. There’s no relationship between income and BMI for men overall, and for black and Mexican American men, the relationship is the opposite of the popular assumption. Obesity rates among the wealthiest group of black and Mexican American men are 9–16 percent higher than they are for the poorer groups.
Nor is it the case that poor people eat more fast food than richer people. In a 2017 study, economists Jay Zagorsky and Patricia Smith found little difference in fast-food consumption across income and wealth categories. To the extent that there was a pattern, it looked like an inverted U — highest in the middle, and lowest among the rich and poor.5 This finding is pretty typical. Depending on how researchers code the data (mainly how they treat the income variable), other studies have found modestly positive or negative correlations.6 But whatever the true association, it’s not a strong one. People up and down the income distribution eat fast food, some of them perhaps too much of it. But poor people don’t eat much more than rich people, if they eat any more at all.
Neither are poor people less likely to cook meals at home. In fact, they generally do more of it. According to 2012 survey research commissioned by the anti-hunger organization Share Our Strength, people with household incomes lower than 185 percent of the poverty line eat dinner cooked at home 5.5 times per week, compared with 5.2 times per week for those above that threshold. Additionally, poorer families were slightly more likely to cook “from scratch,” which they defined as not relying on prepared or convenience foods.
It shouldn’t surprise anyone that poor people don’t eat more fast food than the middle class or that they cook meals at home a bit more often. Dining out is expensive. Full-service restaurants cost more, about $15 for the average meal versus $8 at a fast-food restaurant. But $8 per meal is still a lot of money for low-income people, more than many can afford (at least very often). For comparison, the cost of an average meal at home for a single male adult, according to the US Department of Agriculture (USDA) food plans used to determine SNAP allowances for 2019, ranged from approximately $2 on the thrifty plan to $4 on the liberal plan. It’s even less for women, children, the elderly, and larger families.7 The poorest 15 percent of Americans can’t even afford $2 per person per meal without government assistance, let alone $8.
So perhaps the first question that the food justice movement ought to be asking the alternative food movement is, How have so many people become convinced that poor people are fatter and eat more fast food than anyone else, when they aren’t and don’t? Or why do we think that eating an average of just over one fast-food meal per week (which is about what everybody, rich and poor, healthy and unhealthy, does) is too much? Also, why do the solutions imagined by both the alternative food movement and the food justice movement seem to depend on the myth that the biggest barrier to an equitable food system for low-income communities of color is how much fast food they consume?
The tendency to displace undesirable behaviors and characteristics onto the poor and non-white other is matched by the valorization of behaviors favored by the elite: hence, the fetishization of fresh, local produce. There is ample evidence that locally grown food isn’t always (or even typically) better for the environment. The evidence isn’t much better for the supposed health benefits of eating more fruits and vegetables, the one dietary suggestion that virtually all contemporary nutritional ideologies endorse.8
For instance, the Nurses’ Health Study and Health Professionals’ Follow-Up Study has periodically assessed the diets of almost 110,000 medical caregivers since 1976 and tracked their cardiovascular events, cancer diagnoses, and deaths. There is a wide range in how many servings of fruits and vegetables people in the study population say they consume,9 with people in the highest quintile eating eight or more servings a day and those in the lowest quintile eating 1.5 servings or fewer. Nonetheless, the study has so far found no statistically significant relationship between consumption of fruits and vegetables and cancer, chronic illness, or overall mortality.
The only condition that appears to be correlated in a statistically significant way with fruit and vegetable consumption is cardiovascular disease, but the association so far is small: a 28 percent reduction in heart disease risk for people eating nearly twice the USDA recommended intake for fruits and vegetables compared with those eating less than 1.5 per day, that is, virtually none.
While the Harvard School of Public Health website lists this finding as an example of the “compelling evidence that a diet rich in fruits and vegetables can lower the risk of heart disease and stroke,” a 28 percent relative risk reduction is actually minuscule for a large epidemiological data set.10 This becomes clear if you look at the actual risk reduction instead. The rate of heart disease for the entire study population is low, around 3.5 percent. A 30 percent reduction from such a low base rate gives us 2.5 percent. So someone who habitually eats fewer than two servings of fruits and vegetables — what you’d get from the sauce and toppings on a couple of slices of pizza and half a cup of guacamole — could start eating an additional six-and-a-half servings of massaged kale salad every day and, based on this data set, reduce their risk of having heart disease from roughly 35 in 1000 to 25 in 1000. Emphasizing relative risks to inflate tiny actual risks is the kind of tactic I expect from journalists, but it’s dismaying to see it used so often by researchers and institutions widely perceived to be credible and honest.
A 2017 meta-analysis of 95 studies of fruit and vegetable intake, which included up to 2.1 million participants, reached a similar conclusion. After controlling for weight, smoking habits, and physical activity levels, eating more fruits and vegetables was associated with a small reduction in the risk of chronic disease. Compared with people who ate between 0 g and 40 g per day (less than one serving), eating 800 g of fruits and vegetables per day (about 10 servings) was associated with a reduction in absolute risk of chronic disease of around 1 percent. That is a real difference, and if it is caused by the difference in fruit and vegetable consumption, then getting people who eat very little of those things to make a radical dietary change might modestly reduce, or at least delay, the onset of some chronic disease. But even the most optimistic estimation of the potential public health benefits, at least based on these studies, should still be small.
Studies that assess biomarkers instead of disease outcomes, which might give an earlier indication of future problems, typically haven’t found significant differences in health risks across different levels of fruit and vegetable consumption either. One study using NHANES data collected between 1999 and 2006 compared fruit and vegetable intake with disease risk biomarkers like C-reactive protein and fasting plasma glucose but found no associations. The authors concluded, “We reject our hypothesis that individuals who consume more fruits and vegetables will have reduced chronic disease risk because of the healthful benefits of these foods.” Nonetheless, they still recommended the consumption of fruits and vegetables to displace “energy-dense foods” in the name of weight maintenance. In other words, their advice amounted to: We don’t know whether eating fruits and vegetables will make you healthier, but we think it should make you thinner,11 which we think is healthier, so do it anyway.
However, studies attempting to assess whether eating more fruits and vegetables really reduces the risk of obesity, even in populations like children (who are sometimes seen as more susceptible to the benefits of dietary change), rarely find much of an effect. One study of nearly 15,000 children and adolescents found no relationship between their intake of fruits, fruit juices, or vegetables and changes in their BMI over a three-year period. “Consumption of fruits and vegetables may be well founded,” the study concluded, “but should not be based on a beneficial effect on weight regulation”— exactly the opposite advice of the biomarker study cited above. Looking at these studies, I sometimes wonder what, if anything, would convince people that eating fruits and vegetables isn’t a nutritional panacea.
As with things like fast-food consumption and home cooking, it shouldn’t surprise anyone that fruit and vegetable consumption isn’t very well correlated with health outcomes. Most people — rich and poor, healthy and unhealthy — get most of their nutrition (in terms of calories or grams of protein, fats, and carbohydrates, minerals and vitamins) from foods such as grains, animal proteins, legumes, and nuts, not from fruits and vegetables.12 The idea that foods that are costly and labor-intensive in relation to the nutrition they provide and don’t account for much of anyone’s overall food intake are driving major differences in health outcomes defies logic as well as the data from large epidemiological studies.
I suspect that the idea that fruits and vegetables are nutritious and that fast food and junk food are not has less to do with evidence than with the notion that pleasure is morally hazardous, so things that aren’t quite as easy to love, like bland or bitter vegetables, must therefore be virtuous. Advertising your affinity for kale on a T-shirt or reusable shopping bag marks you as a denizen of the alternative food movement in part because kale takes so much work to love. There’s nothing special about liking French fries.
This particular construction of vice and virtue has typically held a greater appeal for elites, for whom the elective asceticism of saying “No” to the unhealthy indulgences they associate with the poor may in part serve to alleviate guilty or conflicted feelings about their own forms of overconsumption and excess. It wouldn’t be a problem if the only result were elites fetishizing bitter greens, but this ego-gratifying, status-jockeying ideology has been allowed to blinker the movement that claims to seek food justice.
If the evidence that eating more fruits and vegetables is healthier is weak, support for the notion that freshness equates with better health or environmental outcomes is nonexistent, in large part because freshness is less a biological fact than a shifting and contradictory cultural construct. As anthropologist Suzanne Freidberg points out in Fresh: A Perishable History, freshness means different things in different foods. Pasteurized juice cannot be legally labeled “fresh,” though pasteurized milk can. Pasteurization is the same process in both products and used for the same reason — to kill off dangerous pathogens. However, people expect fresh milk to be pasteurized (perhaps because it’s illegal to sell raw milk for human consumption), but they do not expect fresh juice to be.
Not only do beliefs vary from item to item, but they have also varied over time and space. Today, packages instruct people to refrigerate foods to “maintain freshness,” but in the late nineteenth century, as the cold supply-chain developed in the US, consumers initially saw refrigeration as antithetical to freshness or a kind of unnatural way of prolonging it. There were demands for labels to distinguish between genuinely fresh foods and refrigerated ones, which would make no sense at all to consumers today.
Not long before that, as the historian Rachel Laudan reminds us, freshness itself was typically considered nasty and dangerous. “Fresh meat was rank and tough; fresh milk warm and unmistakably a bodily excretion; fresh fruits (dates and grapes being rare exceptions outside the tropics) were inedibly sour, fresh vegetables bitter…. Natural was unreliable. Fresh fish began to stink. Fresh milk soured, eggs went rotten.” People survived by learning to transform foods from their perishable, natural forms into life-sustaining and pleasurable cuisine.
While it’s true that some of the ways we process food reduce the content or availability of some nutrients or add carcinogens or other toxins, much food processing reduces the risk of contamination, enables people to extract more nutrients, or concentrates and preserves nutrients that would otherwise degrade. Foods like frozen peas and berries, canned tomatoes and pumpkin, yogurt, sauerkraut, and oil-packed sardines and oysters sometimes contain more beneficial nutrients than their fresh equivalents. Meanwhile, fresh foods are often associated with higher greenhouse gas emissions owing to the energy required to keep them cold and transport them quickly enough to get to consumers before they spoil. Our failure to do so consistently is responsible for the lion’s share of food waste.
So why did freshness become such a desirable characteristic? Freidberg argues that it largely has to do with status. Historically, only elites had access to land and could hire or conscript labor to grow and process food. “The conspicuous consumption of freshness didn’t just reflect social hierarchies, it could also help keep them intact,” Friedberg writes. “The ubiquity of more-or-less fresh foods has simply driven the standards higher. The most status goes to whoever can afford the absolute freshest product, however fresh is currently defined.” In other words, the idealization and pursuit of fresh foods helps reinforce social hierarchies, and the obsession with it is a better measure of people’s need for the status it confers than any real health benefits.
If people in low-income communities want fresh food, however they define it and whatever benefits might or might not be associated with it, they should have access to it if at all possible. But it’s worth at least asking why food justice organizations that aspire to more equitable health and environmental outcomes would prioritize this particular goal. Keeping food fresh and then making it edible and palatable frequently requires more energy, time, money, and labor — in many cases, by people who really don’t have those things to spare — and reinforces myths about superior taste and nutrition that mostly serve to help the middle classes distance themselves from the poor.
Food justice organizations are far from alone in holding ideas about nutrition and sustainability that don’t have much of a relationship to the evidence about how food affects actual health outcomes and environmental impacts. But organizations that claim to represent the interests of low-income communities ought to be more careful and self-reflective about interrogating their own assumptions, especially when they bear such an uncanny resemblance to the preferences and behaviors of rich white consumers.
What the epidemiological evidence really suggests is that people who generally eat more fruits and vegetables (and perhaps a tiny bit less fast food) tend to be healthier because they also tend to be wealthier. These behaviors, in other words, are not likely a meaningful cause of their healthfulness but rather markers of wealth and status, which are the real drivers of disparate health outcomes.
Consider that where the associations between income, BMI, fast-food consumption, and health outcomes are weak or nonexistent, the associations between income and chronic disease risk are robust. In the Atherosclerosis Risk in Communities sample, which followed almost 16,000 subjects between the ages of 45–64 for 11 years, the lowest-income category was associated with an approximate 300 percent greater risk of coronary heart disease than the highest income category. In the New Haven cohort of the Established Populations for the Epidemiological Studies of the Elderly, the lowest socioeconomic status was associated with a 200 percent greater risk of stroke.
Although when it comes to cancer the picture is more complicated, one analysis found that people with family incomes lower than $12,500 have a 170 percent higher risk of lung cancer than those with family incomes greater than $50,000, a 59–88 percent higher risk of melanoma, and a 430 percent greater risk of cervical cancer. The Americans’ Changing Lives survey, based on a nationally representative sample of about 3,600 adults, found the risk of mortality was 322 percent higher for the lowest-income group. Even after controlling for smoking, alcohol consumption, sedentary lifestyle, and BMI, the risk was still 277 percent higher.
These studies all show mere associations that cannot on their own prove a causal relationship between poverty and poor health outcomes. Some very small part of the difference might even be due to how many servings of fruits and vegetables rich and poor people eat on average. But whatever is going with social class and health, it appears to have much larger effects than any dietary behavior we can measure.
Before the rise of “food justice,” concerns about food in low-income communities of color were organized primarily around the issue of hunger. In the 1980s, the growing obsession with obesity and people eating “too much” eclipsed the focus on those with too little eat. By the 1990s, when people first started using “food justice” to refer to grassroots food reform or to improving health in low-income communities of color, the dominant assumption was that poor people in low-income neighborhoods can get enough food, just not the right kind.
However, maybe the problem for low-income communities is not that there are too many fast-food joints and not enough supermarkets, but that the poor don’t have enough time or money to eat or shop at either, or anywhere else for that matter. In other words, maybe instead of focusing so intently on what poor people choose to eat, the food justice movement would do better to focus on ensuring that poor people can eat as they choose.
Perhaps for some communities, what would help the most to bring their meals closer to their collective ideals would be to increase the chance that people with meaningful relationships can eat together on a regular basis. The most significant barriers to that vision might include mass incarceration, the unpredictable work schedules of service-sector jobs, and the lack of affordable housing where the densest concentrations of those jobs are located. What would better serve the goal of food justice for these communities are criminal justice reforms: ending cash bail, eliminating mandatory minimum sentences, or working toward prison abolition. It is possible that supporting unionization efforts in the service industry and the fight for minimum wage increases and laws to protect workers’ rights (e.g., mandating that work schedules be posted a minimum number of days in advance) would serve that community’s needs better than community gardens or more produce in corner stores.
For communities that would benefit from having more safe, green spaces where people can gather and eat, it might not be enough to plant a garden if the barriers include gun violence and high rates of substance abuse disorder. Funding gun violence prevention and conflict resolution programs and improving access to clean needles, safer injection sites, medication-assisted treatment for addiction, and mental health support would all do a lot more than selecting the best compact, high-yielding cultivars for urban container gardens. And were we able to establish those safe, green urban spaces, my concept of justice requires that people would be made to feel welcome to share food there whether it came from the garden itself, a local farmers market, or a KFC.
What would probably do the most to address disparities in health outcomes between rich and poor, white and non-white, would be decent universal health care. After all, the diets of rich and poor aren’t appreciably different nutritionally, nor are their rates of obesity. And yet health outcomes associated with obesity are much worse for poor, non-white populations.13 Whether those health problems are the result of dietary deficiencies or not, they’re far more likely to be manageable if you have money and health care. They are deadlier, or at least will kill you faster, if you don’t.
The pursuit of justice throughout the food system might also focus more on the food that middle- and upper-class people eat. Terrible injustice abounds in the food system. Most of the labor of agricultural production, slaughtering and processing our food, cooking and serving it, and dealing with the many messes created throughout that process is performed by immigrants, both documented and not. Food system workers are paid sub-poverty wages, made to work in unsafe conditions, given inadequate treatment when sickened or injured on the job, and in the case of undocumented and mixed-status families, deprived of rights such as driving legally and voting in the country where they live, work, and pay taxes.
Every day, thousands of women working in the food system will go back to the farm fields, slaughterhouses, and restaurants, where they are routinely threatened with or subjected to sexual violence because that’s how they pay the rent. Millions of Americans who work full time, including at food companies like Smithfield Foods, Walmart, McDonald’s, and Applebee’s that post quarterly and annual profits in the millions, earn so little money that the federal government believes they need assistance to afford $2 per person per meal.
If you are concerned about justice, there is no shortage of work to be done. Growing food inefficiently in soils you have to either laboriously amend or truck in from somewhere else is a fine hobby, especially if it beautifies a neighborhood and provides some delicious tomatoes in August. But it’s simply not an adequate response to the scale of the problems people are facing connected with food. No matter how well-intentioned, a movement based on such an impoverished moral imagination about what is worth wanting when it comes to food will never deliver anything worthy of the name justice.
SNAP, also known as the Food Stamp Program.
Many pesticides approved for use on certified organic farms are less effective and have worse environmental impacts, including killing off beneficial insects.
For example, Growing Power, Inc.; Just Food, NYC; Food Security; and Community Service Unlimited.
Here is the definition offered by Just Food (this organization was founded in 1995 to provide training, technical support, and education to help people in New York City start community-supported agriculture programs, urban agriculture–based farmers markets, and farm-to-food-pantry programs): “Communities exercising their right to grow, sell, and eat healthy food. Healthy food is fresh, nutritious, affordable, culturally-appropriate, and grown locally with care for the well-being of the land, workers, and animals.”
The data set they used is from the National Longitudinal Survey of Youth 1979, which recruited a nationally representative sample of over 8,000 Americans born between the years 1957 and 1964 to take surveys every year or two. Three times, in 2008, 2010, and 2012, the survey included the question: “In the past seven days, how many times did you eat food from a fast-food restaurant such as McDonald’s, Kentucky Fried Chicken, Pizza Hut, or Taco Bell?” The highest rates were in the middle of the income and wealth distribution, at around 84–85 percent; slightly lower for the poorest quintile, around 81–82 percent; and a little lower still for the richest, about 75 percent in the top quintile. The differences are tiny, so the real story appears to be that about 80 percent of Americans eat fast food in a given three-week period regardless of their wealth and income. The number of fast-food meals follows roughly the same pattern, with the vast majority from the 20th to the 70th percentile claiming to eat just over four fast-food meals in three weeks, the poorest quintile of income earners eating three and a half, and the richest 10 percent eating around three. Most Americans, regardless of class status, eat fast food about once a week.
Of 17 studies published on the subject, six found no statistically significant association between fast-food consumption and income, only two reported a negative association, six found a positive association, and three found this same inverted U pattern with the highest consumption in the middle. Notably, many of these studies are working with the same data sets, which seem to have no bearing on what they found. Some ways of slicing the data from the July 2013 Gallup Poll yield a positive association, and some yield an inverted U. The 1994–1996 Continuing Survey of Food Intakes by Individuals has been used to show a range of results: no association, a negative association, a positive association, and an inverted U.
These plans are based on model diets designed to reflect American consumption patterns in terms of the proportions composed of different food groups, and adjusted monthly based on the Consumer Price Index.
Whole grains, which are officially encouraged by organizations like the USDA and the Harvard School of Public Health, are expressly forbidden in most Paleo diets, including the Perfect Health Diet developed by Shou-Ching Shih Jaminet, a molecular biologist on the faculty at Harvard Medical School, and Paul Jaminet, a former Harvard astrophysicist and editor-in-chief of the Journal of Evolution and Health. Unlike some Paleo diets and all low-carb or intentionally ketogenic ones, the Perfect Health Diet allows up to one pound per day of what the Drs. Jaminet call “safe starches” like rice, potatoes, plantains, and tapioca, but specifically not brown rice because they think there’s reason to believe the fiber in cereal grains is harmful. The Perfect Health Diet also forbids beans, peanuts, and milk, which are considered healthful by the USDA, while promoting the consumption of fermented or fatty dairy products like butter, sour cream, cheese, and yogurt and the consumption of saturated fats — even in large quantities — which the Harvard School of Public Health and USDA say should be restricted. In contrast, milk is specifically encouraged by the USDA, depicted in the glass in the dairy portion of the MyPlate graphic. Both the USDA and the Harvard School of Public Health specifically discourage the consumption of red meat and encourage the consumption of legumes. The one thing anyone can say for certain about the healthfulness of staple foods like whole grains, red meat, milk, cheese, and beans is that some Harvard faculty who’ve staked their professional reputations on it are wrong, so you should add your own healthy portion of scepticism.
NHANES uses semiquantitative food frequency questionnaires, which basically torpedo the entire project of inferring meaningful relationships between its dietary data and health outcomes. But these are the data the Harvard School of Public Health uses, so I’ll let them answer for its methodological shortcomings. A 2013 review of 39 years of NHANES data on food intake concluded that data on “a majority of respondents (67.3 percent of women and 58.7 percent of men) were not physiologically plausible” based on historical values for reported energy intake, total energy expenditure, and basal metabolic rate.
Epidemiologists interviewed by Science magazine for a 1995 special report on risk factors said they would not take seriously an association with smaller than a 300–400 percent difference in the health outcome of interest. For risk factors with a clear causal link to particular diseases, the association is typically much larger. For example, people who smoke are 15–30 times more likely to get lung cancer than people who do not smoke, a 1,500–3,000 percent increase in relative risk.
There are not many randomized controlled trials on fruit and vegetable consumption and its relation to weight change, but one 2014 review and meta-analysis of seven studies found no effect.
Aside from starchy roots and tubers, which are also an exception to the rule about fruits and vegetables being considered universally healthy. Potatoes and cassava are treated by most nutritional ideologies more like grains, which makes sense because they fill a similar nutritional and culinary role.
As has been covered in this journal, “While disparities in obesity rates have narrowed, those in health outcomes associated with obesity have grown. One study found that the gap in diabetes-related mortality across education levels widened from 1989 to 2005. The authors argue that while progress in diabetes care has helped people of all education levels, it has been ‘of greater benefit to those with higher education.’ Given improving treatment of diseases for which obesity is a risk factor and the very weak relationship between garden variety obesity and health outcomes among middle- and upper-income Americans, it is not even clear that obesity represents a particularly serious health risk, much less a public health crisis, for much of the American population.”