Cheap groceries may carry a hidden health cost, study finds
Living near a traditional grocery store was associated with lower rates of obesity, diabetes and high blood pressure in a new nationwide study.
- Living near a traditional grocery store was associated with lower rates of obesity, diabetes and high blood pressure in a new nationwide study.
- Living near dollar stores showed the opposite pattern, with higher rates of the same health problems even after researchers accounted for neighborhood social and economic vulnerability.
- The findings suggest that simply having a food store nearby isn't enough — what the store sells may matter just as much.
A dollar store may look like a bargain when grocery prices are straining the household budget. But new research suggests there can be another cost that's harder to see at the checkout counter.
Communities with better access to traditional supermarkets and grocery stores generally had lower rates of obesity, diabetes and high blood pressure, while communities with greater access to dollar stores tended to have higher rates of those conditions, according to a study published in BMC Public Health.
The findings don't prove that shopping at a dollar store causes diabetes or obesity. But they raise an important question about the way researchers and policymakers think about access to food.
A store nearby isn't necessarily the same thing as healthy food nearby.
“Healthy food offerings such as fresh produce, whole grains, and lean proteins largely differ between traditional grocery stores and dollar stores,” the researchers wrote.
That distinction may be increasingly important as families squeezed by food prices turn to discount retailers to stretch their grocery dollars.
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Not all grocery stores are alike
Researchers Ryan Bruellman, Jessica Finlay, Ilana Bennett and Chandra Reynolds examined food-store access across metropolitan areas in the contiguous United States.
They classified traditional grocery stores as “standard quality” food sources and dollar stores as “low quality” sources because of differences in the availability of foods such as fresh produce, whole grains and lean proteins.
The researchers then compared access to those stores with neighborhood-level estimates of obesity, diabetes and high blood pressure from the Centers for Disease Control and Prevention's 500 Cities Project.
They also adjusted their analysis using the CDC's Social Vulnerability Index, which incorporates socioeconomic factors that could otherwise help explain differences in health.
The pattern was striking.
Across the country and within most regions, greater proximity to traditional grocery stores was associated with lower levels of adverse health outcomes.
Greater proximity to dollar stores was associated with higher levels of all of the health outcomes examined, even after researchers adjusted for social vulnerability.
For preliminary work underlying the study, Bruellman geocoded more than 370,000 food-source locations from 2016 through 2020 and examined access within roughly a 10-minute drive in metropolitan census tracts.
A problem with the idea of a 'food desert'
For years, policymakers have worried about “food deserts” — neighborhoods where residents lack convenient access to supermarkets or other sources of fresh, nutritious food.
But the new study suggests that measuring distance to the nearest food seller may not tell the whole story.
A neighborhood containing several dollar stores could technically have plenty of places selling groceries while residents still have limited access to fresh produce, whole grains and other foods associated with a healthier diet.
The researchers say dollar stores have often been omitted from traditional food-environment research altogether.
That is increasingly difficult to justify as discount chains have expanded their grocery offerings and become important food sources for many households. (Springer)
The distinction also matters when governments decide which neighborhoods need help attracting supermarkets or improving food access.
If policymakers simply count stores, a community with several retailers selling mostly packaged and highly processed foods could appear adequately served.
The study suggests researchers should be asking another question: What kind of food can residents actually buy there?
Cheap food can still be expensive
That's where the research intersects with the household grocery budget.
Dollar stores can be extremely useful for consumers trying to stretch limited incomes. They sell canned foods, staples, snacks and household goods at prices that can be attractive, particularly when the alternative supermarket is several miles away.
But low price alone doesn't necessarily make a food a good value.
Highly processed foods can provide lots of calories inexpensively while supplying less fiber and fewer of the nutrients found in fruits, vegetables, whole grains and other minimally processed foods.
And over the long term, diets dominated by those foods have been associated with chronic illnesses that can be extraordinarily expensive to manage.
That doesn't mean consumers need to abandon dollar stores — or spend heavily at premium supermarkets.
Many inexpensive foods are also highly nutritious.
Beans, lentils, oats, brown rice, canned fish, peanut butter, frozen vegetables and canned vegetables can all provide substantial nutritional value without the price tags attached to specialty “health foods.”
The larger issue is whether consumers have meaningful choices nearby.
Association isn't causation
There is an important limitation to the findings.
This was an observational, neighborhood-level study. It cannot show that the presence of a dollar store caused residents to become obese or develop diabetes or hypertension.
Many factors influence those conditions, including income, genetics, exercise, health care access and individual eating habits.
People also don't necessarily shop at the store closest to their homes.
The researchers attempted to account for socioeconomic differences through the Social Vulnerability Index, but no statistical adjustment can eliminate every potential explanation.
The study nevertheless found the contrasting associations between store types across much of the country, which the authors say makes food quality an important factor for future research and public policy.
What this means for consumers
The research offers a useful rule of thumb for grocery shopping:
Don't measure value solely by the price of the package.
A $2 food that supplies several servings of protein, fiber and other nutrients may ultimately be a better value than a $1 snack that provides mostly calories.
Consumers shopping at dollar stores can also improve the nutritional quality of their carts by looking for foods such as beans, canned tuna, oats, nuts, peanut butter, brown rice and canned or frozen fruits and vegetables when they're available.
And there's a broader lesson.
Having a grocery store nearby doesn't necessarily mean a neighborhood has good access to healthy food.
The researchers argue that future food policy should take account not merely of how far people have to travel for groceries, but what they'll find when they get there.
