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SNAP participants do not meet many healthful diet goals

In nearly all dietary components, participants of the Supplemental Nutrition Assistance Program, or SNAP, did not meet the recommendations for a healthful diet, according to findings recently published in JAMA Network Open.

“Among different dietary programs for low-income households, SNAP is by far the largest and most important safety-net program, providing monthly benefits to approximately 1 in 7 U.S. individuals and representing more than half of the annual budget of the U.S. Department of Agriculture,” Fang Fang Zhang, MD, PhD, of the Friedman School of Nutrition Science and Policy at Tufts University, and colleagues wrote.

“Participants in SNAP experience significantly higher all-cause, cardiovascular and diabetes mortality compared with other American adults. Prior studies have shown that disparities exist in diet quality between SNAP participants and higher-income individuals. However, potential trends in these dietary disparities over time remain unclear,” they added.

Researchers analyzed National Health and Nutrition Examination Survey data during the eight cycles from 1999 to 2014, from 38,696 participants aged at least 20 years. Of this total, 25,842 were higher-income individuals, 6,692 were income eligible but did not participate in SNAP, and the remainder were SNAP participants.

Zhang and colleagues found when data from 2003 and 2004 were compared with that of 2013 and 2014, SNAP participants had less improvement in American Heart Association diet scores than both of the other groups (change in mean score = 0.57; 95% CI, –2.18 to 0.33). These differences continued for most nutrients and foods, and scores were even lower for nuts and seeds, added sugars and processed meats, according to researchers.

Also, from 2013 to 2014, more SNAP participants had intermediate diet scores and poor diet scores vs. the other groups (P < .001 for both differences). The proportion of participants with ideal diet scores was low in all three groups (P = .26 for difference), and SNAP participants also consumed more sugar-sweetened beverages than the other groups analyzed.

“Our findings should not be interpreted as a causal effect of participating in SNAP, however. It is possible that dietary trends in this group could have been even worse without participation in SNAP,” Zhang and colleagues wrote. “Nevertheless, our findings underscore the need for robust new strategies to improve diet quality and reduce dietary disparities in the United States.”

That last sentiment was shared in a related editorial by Edgar R. Miller III, PhD, MD, and Deidra C. Crews, MD, ScM, of the Johns Hopkins University School of Medicine. These researchers wrote that attempts to engage SNAP participants in healthier eating have often been nixed by federal lawmakers and agencies.

“Periodically there are proposals to restrict SNAP purchases of various categories of food, such as junk food, sugar-sweetened beverages or foods considered luxury items. However, Congress and the U.S. Department of Agriculture have repeatedly rejected these proposals based on both the administrative burden that restrictions may add and the perception that control of purchases would violate the right to make personal choices,” Miller and Crews wrote.

They added that the current executive branch and SNAP participants seem willing to try and make changes, but barriers remain.

“In 2018 the Trump administration launched a new proposal they believe would reduce taxpayer costs to run the program and improve the nutritional content of purchases for SNAP. The proposed Harvest Box program, in which recipients would receive a selection of healthy foods while lowering the dollar amount for individual purchases of foods, has been criticized as paternalistic toward an economically vulnerable population. However, there are indications that an approach to modifying the program to promote healthy choices would be welcomed by recipients,” Miller and Crews wrote. – by Janel Miller

Disclosures: Crews, Miller and Zhang report no relevant financial disclosures. Please see the studies for all other authors’ relevant financial disclosures.