The Impact of Biology, Economics, Geography, and Social Interactions on Food Choices and Health

The food environment and personal choices both play a role in determining one's health. Food choices are influenced by a combination of biology, behavior, and the built environment, as well as community structure. While it is well known that lower-income families tend to have lower-quality diets, it is also important to note that diet quality can vary within small neighborhoods due to factors such as transportation, access to healthy foods, attitudes, beliefs, and social interactions. The findings of the Seattle Obesity Study (SOS II) can be applied to the diverse urban environment of New York City. The Kavli Human Project (KHP) is well-suited to further investigate the root causes of health disparities by examining the various factors that influence food decision-making. Through the collection of location-specific data on food shopping, consumption, health behaviors, diet quality, and biomarkers, the KHP will create a comprehensive atlas of diet quality and health in New York City, incorporating bio-behavioral, economic, and cultural factors.

Background:

In his 1936 publication, Food, Health, and Incomes, John Boyd-Orr brought attention to the issue of malnutrition affecting impoverished individuals in Great Britain during the depression. He was one of the first to examine the correlation between socioeconomic status and the quality of one's diet, connecting it to the cost of food and utilizing his discoveries in the development of public policies. As the initial Director-General of the Food and Agriculture Organization (FAO) under the United Nations, he advocated for a fair and accessible global food supply.

In present-day New York City, we can observe similar patterns of diet quality and health disparities based on socioeconomic factors. However, the nature of malnutrition has undergone a shift. The consumption of excessive empty calories with little nutritional value is now linked to increased rates of overweight, obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS). The distribution of these diet-related diseases can be accurately traced in different neighborhoods across New York City.

The Seattle Obesity Study (SOS) has utilized innovative GIS and GPS methods to highlight the disparities in diets and health at the neighborhood level. According to the study, obesity rates differed significantly across various neighborhoods in Seattle, with a difference of up to five times. This range was much higher than the variations observed based on ethnicity or income levels. The analysis of data from over 59,000 individuals with insurance from a local HMO revealed that the likelihood of obesity among women was influenced by the prices of houses at both tax parcel and neighborhood levels.

In both Seattle and the entire country, individuals from minority and lower-income communities tend to have poorer diets and experience higher levels of obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS). These disparities in diet quality can also be observed among different neighborhoods. Other research has shown that the socioeconomic differences in diets and health can be attributed to the cost of food in retail stores and the overall expense of following a healthy diet. Overall, these findings suggest that various factors, both economic and non-economic, play a significant role in food decision-making, ultimately impacting the quality of one's diet and long-term health outcomes.

The main factors contributing to the current issue of obesity seem to be an overconsumption of processed grains, added sugars, and fats. These types of food are known to be flavorful (and some argue addictive), high in calories, affordable, culturally accepted, and easily obtained. However, certain groups within the population have shown signs of what is known as nutrition resilience, meaning they can create diets that are both nutrient-dense, cost-effective, and appealing. The influence of biology, psychology, or economics on nutrition resilience is still unknown.

The relationship between diet, disease, and mental well-being is extremely intricate. To improve public health policies and efforts, it is important to conduct research on the local food environment and the behavioral economics of food selection when designing dietary interventions. Numerous choices regarding food are made daily, and these choices may be affected by neurobiology, economics, cultural factors, and the overall food environment. Additionally, these decisions are influenced by social interactions and can differ across different neighborhoods.

The precise mechanisms that drive food buying behaviors and ultimately impact both dietary quality and health are not always readily apparent. There exist intricate connections between social status, food, constructed surroundings, measures of dietary quality, and rates of obesity. A more comprehensive comprehension is also necessary of the specific factors that influence food choices within the local community setting. The subsequent stage of investigation into food-related decision-making will demand the collaboration of neuroscientists, nutritionists, epidemiologists, geographers, and urban planners.

Several questions should be addressed across various fields:

1. Economic Question: Is there a higher cost associated with healthier diets?

Based on empirical evidence, it can be concluded that there is a positive correlation between the quality of a diet and its cost. This conclusion is supported by recent reviews and meta-analyses, which suggest that a healthier diet can cost an additional $1.50 per person per day on average. However, this is not always the case, as different food-related choices can impact the cost of a diet. Some studies have shown that certain individuals and minority groups, like Mexican Americans, can maintain a healthy diet at a lower cost. This is known as nutrition resilience, where individuals make optimal decisions about their diet despite facing economic challenges. However, more research is needed to understand the cultural acceptance of affordable and nutritious foods and the avoidance of high-calorie packaged foods.

The issue of economic challenges also applies to the decision-making process of individuals receiving food assistance. A crucial inquiry is whether those receiving benefits from the Supplemental Nutrition Assistance Program (SNAP) tend to experience a "payday effect," wherein they opt for lower-quality food towards the end of the month when their funds run low. An examination of hospital admissions in California revealed a 27% increase in hypoglycemia cases during the last week of the month among low-income patients with diabetes, compared to the first week. This trend was not observed among individuals with higher incomes. As mosincomest government payments are received at the beginning of the month, revising the system to provide more frequent payments may aid recipients in managing their consumption patterns and making healthier food choices. These payments may include Social Security, SNAP, and Temporary Assistance for Needy Families (TANF). Furthermore, further research is necessary to understand the potential impact of regular food insecurity on stress levels and overall health.

Is it still appropriate to measure the availability of nutritious foods based on physical proximity in terms of environmental factors?

The distribution of food in metropolitan areas like New York City is a pressing concern. The central inquiry is whether individuals living in low-income or minority neighborhoods in New York City have access to lower-quality food options. Studies reveal that the food options available in a particular neighborhood are heavily influenced by the financial capacity of its residents. The ability to purchase healthy foods is primarily determined by economic factors rather than physical proximity. Simply constructing new supermarkets in low-income neighborhoods may not effectively improve the nutritional well-being of the residents without implementing economic measures. Merely building it does not guarantee that they will come.

One important area of study within the KHP focuses on gaining a deeper understanding of the shopping habits of low-income residents and the trade-offs they make. This is relevant to the significance of "food deserts." According to the SOS, individuals do not necessarily shop at the nearest supermarket but instead opt for one that fits their budget. It is suggested that food accessibility should be evaluated based on economic accessibility. In a city like New York, transportation plays a crucial role, as many people do not own cars and cannot fit a week's worth of groceries into their trunks.

Q3. Dine at home or dine out?

A commonly held belief is that individuals with low incomes are forced to rely on prepackaged meals or fast food due to a lack of time. Studies conducted in Seattle have found a correlation between the frequency of home-cooked meals, the time spent on food preparation, cooking, and cleaning, and the quality of one's diet. Young working adults and single-parent families are more likely to eat out due to their prioritization of time and convenience. Preliminary analyses of the National Health and Nutrition Examination Survey (NHANES) indicate that larger families, Latinos, and individuals with lower education and incomes are more likely to cook at home. Ethnicity and culture may also play a role in food decisions, with the traditional Mexican American diet being relatively inexpensive and varying food preparation traditions among different social groups. The family unit also plays a significant role, as households with multiple generations living under one roof or nearby may share food preparation responsibilities. In such cases, older family members may help alleviate the workload for younger working members.

Question 4: Psychological Impact: Are attitudes towards nutrition considered important?

A crucial and unanswered matter is whether individuals with low socioeconomic status (SES) are more vulnerable to advertising claims on packaged unhealthy foods labeled as "organic" or "gluten-free." Generally, those with high SES are more likely to be "label savvy," understanding and acting on consumer information. Another inquiry is the extent to which individuals with chronic illnesses like diabetes and obesity make health-conscious choices when shopping, opting for zero-calorie or lower-calorie beverages and diet foods. Additionally, it is intriguing to explore how SES plays a role in this relationship. The significance of the KHP is evident in this aspect, as there is limited data available on this subject. In the SOS, survey questions based on the NHANES consumer module revealed that having positive attitudes towards nutrition leads to an improvement in diet quality. It is worth noting that this trend was observed across all levels of education and income, indicating that it may not contribute to diet quality inequality. However, this is a significant question in its own right and remains poorly understood.

Question 5. Biological: What are the indicators of behavior in terms of biomarkers?

The use of KHP will enable the examination of the biological pathways that link SES and health results. Previous studies have primarily concentrated on stress and the body's reaction to it. Stressors can arise from personal factors or environmental factors such as traffic noise, pollution, and crime. The biomarkers that have been investigated include cortisol levels and inflammatory markers like C-reactive protein. Some of these biomarkers have been associated with SES. Telomeres, which are used as an indicator of accelerated aging, have also been linked to SES, stress, and poor dietary habits.

A vital method for comprehending the aforementioned processes will be a socioeconomic and bio-behavioral diet and health map for New York City. By combining biomarker data with geographic localization techniques, the KHP will be able to produce a unique atlas. In this regard, the KHP can utilize the insights discovered in the SOS. As mentioned, the SOS investigated connections between various aspects of neighborhoods, such as socioeconomic status, social capital, physical and economic access to food sources, opportunities for physical activity, and rates of obesity. The neighborhood variables were evaluated using both objective methods (GPS/GIS) and subjective methods (self-reported questionnaires). The SOS contributed to the advancement of obesity research by converting geographical and economic data into individual-level variables for use in studies on diet, health, and weight. Of significance, it differentiated between physical access to food sources, measured by distance, and economic access to food, measured by food prices and diet expenses. Perceived physical access was assessed by perceived distance and/or travel time to key food sources, such as supermarkets, convenience stores, and fast-food outlets. Economic access was evaluated by perceived weekly food expenses at various shopping and dining locations. The SOS team has developed techniques to calculate the cost of a market basket across different supermarket chains, as well as innovative methods to estimate actual and perceived diet expenses. The accuracy of perceived expenses was confirmed by comparing them to actual expenses supported by receipts from two weeks for all food consumed at home and outside the home.

The SOS had a significant focus on the choices people make when it comes to food retail and shopping. It was found that individuals who were obese tended to frequent lower-priced grocery stores, and the prevalence of obesity was found to vary greatly depending on the type of store. Those who shopped at lower-priced stores consumed fewer fruits and vegetables compared to those who shopped at higher-priced stores, and they were also more likely to be classified as obese (with a body mass index greater than 30 kg/m2). Not many individuals choose to shop for food in their neighborhood or census tract. In Seattle, the distance to the food destination varied based on factors such as race or ethnicity, income, and education. It was observed that Caucasians tended to shop at the closest supermarket, which was approximately 1.5 miles away, while African Americans had the largest difference between the closest supermarket and the actual one, which was around 3 miles away.

KHP Implementation

The investigation of factors that influence food choices can be conducted with the help of various KHP datasets. These include (a) the collection of dietary data through regular food diaries, supplemented by analyzing food purchases made through financial records such as credit cards, debit cards, and checks. (b) Geo-location data from smartphones and activity trackers can be used to determine decisions to eat at home or dine out, as well as the physical proximity to different food sources. This data can then be mapped onto GIS. (c) Information on financial status and participation in government assistance programs like SNAP, Social Security, and TANF can be obtained through a combination of automated methods and surveys. (d) Attitudes towards healthy food can be evaluated through questionnaires administered on smartphones or tablets. (e) Levels of "life stress" can be measured through self-administered psychological questionnaires on digital devices, with cortisol levels in saliva being measured every three years starting from the beginning of the study. (f) Demographic and race/ethnicity data can be collected through the KHP questionnaire at the start of the study.

The effects of food choices on well-being will be assessed by examining various KHP datasets, including: (a) medical data on participants' health will be obtained from their medical records, such as EMRs, doctors' notes, hospital records, and dental records. Prescription information will be collected from the New York State Prescription Database. This data will be supplemented by the KHP's N tests, including blood tests (for metals, vitamins, lipids, glucose, and other biomarkers), urine tests, and hair tests (for smoking, alcohol, and substance use) every three years. (b) Genetic variations at both the individual and family levels will be gathered through whole genome sequencing of blood samples from adults and saliva from children at the start of the study. Additionally, data on variations in epigenetics will be collected through triennial assays. (c) Cognitive function will be assessed by self-administered psychology questionnaires and tests on smartphones and tablets at the beginning of the study and periodically thereafter.

Summary

The significance of decision-making procedures in choosing food holds great importance. The quality of one's diet and the decisions made in purchasing food are influenced by various environmental factors, some of which can be changed while others cannot. It is crucial to examine all these factors within their immediate surroundings. Understanding the primary biological, economic, and environmental factors that affect these intricate processes is crucial for promoting public health.