Food Supply and Dietary Changes

Changes in diet have been implied in the rising obesity and diabetes rates. One intriguing theory focuses on the economics of food supply, noting that the price for foods with higher energy density is much lower than that of less energy-dense foods in terms of price per calorie and that maintaining energy balance is more difficult with foods that have

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Fig. 12. Price indices.

higher energy density (29,30). An alternative theory to the energy-density argument centers around the glycemic index (a measure of the insulin response to ingested carbohydrate) of food. A diet with a high glycemic index encourages higher total caloric intake

Figure 12 shows how prices for different types of foods changed differentially over the past two decades. The price index for fruits and vegetables (foods that have both low energy density and low glycemic loads) has increased much faster than the consumer price index, or general rate of inflation. In contrast, sugars, sweets, and soft drinks, foods either with high energy density or high glycemic index, have become relatively cheaper.

Figure 13 shows how macronutrients changed in the American diet. Whereas fat and protein stayed fairly constant, since the early 1980s there has been a steady increase in the consumption of carbohydrates, and in particular caloric sweeteners (Fig. 14).

If the price per unit of energy for energy-dense products and for sweetened products is much lower than that for food such as fresh produce, lean meats, and fish, a differential dietary pattern would develop between income groups if people of low income are more sensitive to the price of food (29). The evidence is unclear, although low-income families are less likely to purchase fresh produce and they spend less money on it (34). The secular decline of prices for energy-denser foods and sugars relative to produce or fish would suggest widening gaps in obesity and related chronic conditions (such as diabetes) between populations of different socioeconomic status, but there is no strong evidence for such an effect. Nevertheless, these economic effects point to differential challenges in managing diabetes across socioeconomic groups. We do see that children, even at an early age, in communities with higher relative prices for produce gain more weight, and the effect appears to be more pronounced for children in low-income households (35).

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Fig. 12. Price indices.

Fig. 13. US food supply for macronutrients.

Fig. 14. US production of caloric sweeteners.

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Fig. 14. US production of caloric sweeteners.

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