I am stretching my boundaries with this post, and apologize in advance for deciphering the opaque, impenetrable language of economics into something more comprehensible. This is something I have been thinking about for several months now and I needed to get it out of my system. @DrTomSherman
There is a wonderful scene towards the end of my favorite documentary on the American corporate food system, Food, Inc., where Joel Salatin, the insightful, media-friendly face of Polyface Farms, states:
“Imagine what it would be if, as a national policy, we said we would only be successful if we had fewer people going to the hospital next year than last year. How about that for success? The idea then would be to have such nutritionally dense unadulterated food that people who ate it actually felt better, had more energy, and weren’t sick as much. Now see, that’s a noble goal.”
Of course, you will only identify with this statement if you believe there are inherent pleasures to be found eating “nutritionally dense unadulterated food.” I would have said this was obvious if I did not already know there are those who believe otherwise, that there are people who believe that the real pleasures are contained within foods at your local fast food outlet, that significant pain and suffering will be associated with giving up these junk foods, and that the cost of this pain and suffering – or lost pleasure, if you will – has been estimated to be in the range of five billion dollars! It may or may not surprise you that these people are our friends at the FDA.
The Affordable Care Act of 2010 includes a provision that requires that chain restaurants and certain retail food establishments provide calorie and other nutrition information for standard menu items. The FDA conducted an analysis of benefits and costs for this provision and published these findings in a Final Regulatory Impact Analysis entitled Food Labeling: Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments in November of 2014. At 133 pages, this detailed impact analysis is not for the casual reader, but it contains many items of interest, including this gem first recognized by public health advocates and publicized in a Reuters article:
(Reuters) – U.S. health regulators estimate that consumers will suffer up to $5.27 billion in “lost pleasure” over 20 years when calorie counts on restaurant menus discourage people from ordering french fries, brownies and other high-calorie favorites.
If your reaction to this is anywhere close to mine, you had to pick your jaw off the floor!
Marion Nestle discussed this topic briefly in December of 2014 in her excellent Food Politics blog, and correctly noted that Reuters was somewhat imaginative with their “lost pleasure” label; the terms used in the Final Regulatory Impact Analysis are “consumer welfare” and “consumer surplus.”
page 92: The main purpose of this final rule is to make nutrition information for certain foods available to consumers in a direct and accessible manner to enable consumers to make informed dietary choices. If consumers respond to this information by reducing consumption there will be a loss in consumer welfare associated with substitution away from certain food. As a result, we adjust the gross estimates downward to account for this loss in welfare.
The FDA goes on to equate consumer welfare with the term “consumer surplus” defined in an, as yet, unpublished “working paper” entitled “What Would We Eat if We Knew More: The Implications of a Large-Scale Change in Nutrition Labeling” by Jason Abaluck, an Assistant Professor of Economics at Yale University. It is probably fair to state that economists share a writing style with attorneys that can only be described as opaque. Still, I thought this paper was very interesting and thoughtful, and … especially challenging. Challenging because he is trying to assign a dollar value to something almost ethereal: the loss or gain of pleasure or comfort. A growing number of economists will argue, however, that if something has value, even if it is a value on a very personal or quality of life level, than one way to quantitate that level is to assign a financial value to it. What is the value, in dollars, for a diverse ecosystem, a community’s open space, a thriving coral reef or clean air? Conservationists, preservationists, city planners, and others see utility in factoring the calculated value of a lost resource or amenity when determining the total costs of a proposed development. Such economic calculations go by different names, including natural capital, opportunity costs, contingent valuation, ecological economics, or, somewhat confusingly in Dr. Abaluck’s research, consumer surplus.
I say confusingly because it is my understanding that the term, consumer surplus, is classically defined as “an economic measure of consumer satisfaction, which is calculated by analyzing the difference between what consumers are willing to pay for a good or service relative to its market price. A consumer surplus occurs when the consumer is willing to pay more for a given product than the current market price.” [see ref] A classic example of consumer surplus would be if a shopper were willing to pay $75 for a pair of shoes, but found the ideal pair for only $60; the consumer surplus would be $15.
How does one go about attaching the concept of consumer surplus to economic decisions involving foods in the context of restaurant labeling? Again, the arguments are fairly opaque, but with my apologies to Dr. Abaluck, I would frame it like this. A customer of a restaurant weighs several factors while making a selection for lunch: how hungry is she, how appetizing is each possible item, how expensive is each desired item, etc. If each menu choice is now accompanied with calorie information, and perhaps even fat and sugar content data, the ultimate desirability of each item is now increased or decreased by the knowledge that consuming that item might positively or negatively affect their health, or weight, or blood pressure. The FDA is arguing that when a consumer makes a selection for a less desirable food because of health or weight concerns, that represents a loss of pleasure for which there needs to be a financial cost.
I am not in a position to quibble with Dr. Abaluck’s findings. I am, however, inclined to critique the application of his findings by the FDA to legislation on menu labeling. Firstly, and importantly, the choice to include a “cost of lost pleasure” calculation to the impact analysis strikes me as a concession to conservatives and corporations opposed to the legislation. This tactic decreases the financial benefits the rule might be expected to generate, and increases the strength of a corporate argument that the legislation is too expensive for such modest gains.
Secondly, I will argue that the pleasures of eating junk food are exaggerated, and that the consumer surplus calculations are unnecessarily pessimistic, focus too narrowly on the transition to healthy eating rather than the practice of healthy eating, and fail to acknowledge an extensive literature extolling, and quantitating, the pleasures of eating healthy food. Let me address these four items in order:
The exaggerated pleasures of fast food: Studies have shown that otherwise healthy volunteers, when stressed or sleep deprived, consume more junk foods – foods high in sugar and fat – compared to non-stressed or well rested controls in a buffet setting. Michael Moss, in his depressingly illuminating book, Salt, Sugar, Fat: How the Food Giants Hooked Us, makes very clear that food companies carefully engineer processed and fast foods to be maximally addictive. I will argue that the influences of stress, sleep deprivation, addiction, or even marketing, characterize the lost pleasures of eating fast food to be more like withdrawal symptoms or failures to cope. As the unattributed quote above accurately describes, the pleasures of eating a fast food meal are in the convenience and purchasing, not in the actual consumption. Mr. Salatin said it best: “to have such nutritionally dense unadulterated food that people who ate it actually felt better, had more energy, and weren’t sick as much.” That is how people describe themselves after a fast food meal.
Pessimism: the consumer surplus argument is grounded on the apparently accepted canard that healthy food does not taste good, and is less pleasurable than processed and fast foods. Perhaps this speaks to the experiences of the authors of the impact analysis, and if so, this is sad. In part, I blame this perception on the low fat movement of the past 40 years, where consumers were inundated with marketing messages of so-called healthy foods that shared no reality with the nutritionally dense, unadulterated whole foods of which Mr. Salatin speaks with such passion. Peopled learned that healthy food was unpalatable because what they purchased or were served as healthy was unpalatable: bran muffins, low calorie salad dressings, salads comprised of iceberg lettuce and plastic cherry tomatoes, granola bars that were little more than gritty candy bars, and unripe honeydew melon fruit cups. Fresh, well prepared food is a revelation.
The learning curve to healthy eating: when I argue that the impact analysis focuses too narrowly on the transition to healthy eating, rather than the practice of healthy eating, I am simply acknowledging the difficulties in moving from one habit to another, or in learning something new. When a child is learning to read and write, do we calculate the financial price of the lost pleasures involved – of learning new words and engaging in repetitive practice sessions and spelling lessons, and then add these costs to the tuition? They surely are less pleasurable than watching television. Or, instead, do we assign the joys of reading and the utility of writing to the quality of a child’s life and consider it an investment in our society? Thus, after a learning curve, people will learn that the occasional burger with fries is, in fact, the best tasting burger and fries, and that there are greater joys to be found in a Salade Niçoise than had been previously imagined, certainly when compared to a chef’s salad with sliced lunchmeats, processed cheese and low fat dressing.
Quantitating the pleasures of healthy eating: There are countless observational studies and clinical trials exploring the negative and positive impacts on our health of eating certain foods or engaging in certain diets. But it might surprise you that there is also a growing literature on the impact of eating on our psychological wellbeing, happiness, curiosity and sense of meaning.
A few of these studies I find to be remarkably well designed and surprisingly statistically powered, including a study published in 2013 in the journal Social Indicators Research entitled: Is Psychological Well-Being Linked to the Consumption of Fruit and Vegetables? Two of the three authors are economists, and the third is in public health. Their study uses the data available from three surveys for which dietary variables are available: the Welsh Health Survey of 2007–2010, the Scottish Health Survey of 2008, and the Health Survey of England in 2008. These data sets total ~80,000 randomly selected adults. In estimating regression equations on these cross-sectional data, with the dependent variable being a measure of subjective well-being or mental health, the researchers were able to demonstrate that:
“happiness and mental health rise in an approximately dose–response way with the number of daily portions of fruit and vegetables. Well-being peaks at approximately 7 portions per day.”
This was a wonderful, and surprisingly robust, finding. Plus, from the 2008 Health Survey of England dataset on ~14,000 adults, in which more food intake information was recorded:
“the existence of a fruit-and-vegetable gradient in mental well-being is unaffected by the inclusion of variables for the consumption of fish, meat and alcohol. For example … those consuming 6–7 portions of fruit and vegetables have the best mental health. … The meat and fish dummy variables are not as strong in a well-being equation as might have been anticipated. Eating no fish whatsoever, however, is associated with worse mental well-being. We tried various specifications, and all of them left the fruit-and-vegetable gradient essentially unaffected.”
This sounds to me like an endorsement of a Mediterranean diet!
As with all observational data, the primary conclusion to take from these analyses is to call for a clinical trial where the connection between fruit and vegetable consumption and happiness can be tested in a randomized, controlled environment. This is unlikely to happen … ever. In the absence of this, it seems prudent for policy makers to embrace the 5-servings of fruits and vegetables recommendations in today’s USDA guidelines as a true minimum and to encourage more.
On the opposite end of the study size spectrum are a nice series of small studies conducted by professor Tamlin S. Conner at the University of Otago in New Zealand. What is so nice about these studies is her apparent acceptance that the literature has well demonstrated the association of fruit and vegetable consumption with markers of well-being such as happiness and life satisfaction. Her studies take it further to test whether fruit and vegetable intake is “associated with greater eudaemonic well-being – a state of flourishing characterized by feelings of engagement, meaning, and purpose in life.”
In one recent study, 405 young adults completed an online daily diary for nearly two weeks, recording not only the foods they ate – specifically fruit, vegetables, sweets, and chips – and their eudaemonic well-being – curiosity, creativity, positive and negative affects:
“Young adults who ate more FV (ie, fruit and vegetables) reported higher average eudaemonic well-being, more intense feelings of curiosity, and greater creativity compared to young adults who ate less FV. On days when young adults ate more FV, they reported greater eudaemonic well-being, curiosity, and creativity compared to days when they ate less FV. FV consumption also predicted higher positive affect, which mostly did not account for the associations between FV and the other well-being variables.”
Similarly, another small study found that eating fruits and vegetables promoted emotional well-being among otherwise healthy young people.
Taken together, it would appear that the literature supports the thesis that a healthy diet that includes a generous amount of fruits and vegetables not only decreases the risks of heart disease, diabetes and many cancers, but also supports a greater sense of well-being, happiness and curiosity. These latter effects are not consistent with a loss of pleasure or with significant hardships – quite the opposite. This should, I would argue, represent a plus column in the benefits equation that increases the total expected benefits of food and menu labeling while decreasing the expenditures associated with instituting such a system. Therefore, I offer this alternative to Table 14 on page 92 of the Final Regulatory Impact Analysis, in which I substitute a hypothetical Eudaemonic Score for consumer surplus: