Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis

By M. Rao, A. Afshin, G. Singh, D. Mozaffarian. BMJ Open, 2013

723 citations recorded by the source corpus.

Objective To conduct a systematic review and meta-analysis of prices of healthier versus less healthy foods/diet patterns while accounting for key sources of heterogeneity. Data sources MEDLINE (2000–2011), supplemented with expert consultations and hand reviews of reference lists and related citations. Design Studies reviewed independently and in duplicate were included if reporting mean retail price of foods or diet patterns stratified by healthfulness. We extracted, in duplicate, mean prices and their uncertainties of healthier and less healthy foods/diet patterns and rated the intensity of health differences for each comparison (range 1–10). Prices were adjusted for inflation and the World Bank purchasing power parity, and standardised to the international dollar (defined as US$1) in 2011. Using random effects models, we quantified price differences of healthier versus less healthy options for specific food types, diet patterns and units of price (serving, day and calorie). Statistical heterogeneity was quantified using I2 statistics. Results 27 studies from 10 countries met the inclusion criteria. Among food groups, meats/protein had largest price differences: healthier options cost $0.29/serving (95% CI $0.19 to $0.40) and $0.47/200 kcal ($0.42 to $0.53) more than less healthy options. Price differences per serving for healthier versus less healthy foods were smaller among grains ($0.03), dairy (−$0.004), snacks/sweets ($0.12) and fats/oils ($0.02; p<0.05 each) and not significant for soda/juice ($0.11, p=0.64). Comparing extremes (top vs bottom quantile) of food-based diet patterns, healthier diets cost $1.48/day ($1.01 to $1.95) and $1.54/2000 kcal ($1.15 to $1.94) more. Comparing nutrient-based patterns, price per day was not significantly different (top vs bottom quantile: $0.04; p=0.916), whereas price per 2000 kcal was $1.56 ($0.61 to $2.51) more. Adjustment for intensity of differences in healthfulness yielded similar results. Conclusions This meta-analysis provides the best evidence until today of price differences of healthier vs less healthy foods/diet patterns, highlighting the challenges and opportunities for reducing financial barriers to healthy eating.

Subfields: Public Health, Environmental and Occupational Health

View Paper: https://www.semanticscholar.org/paper/2cffadaa9f006547121f7553d45fc01beca4d1f0

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Citations in the corpus

• The Impacts of Dietary Change on Greenhouse Gas Emissions, Land Use, Water Use, and Health: A Systematic Review (2016, background): “In HICs, healthy foods are often more expensive than unhealthy ones [97], and rebalancing these relative prices will be critical to help steer consumers towards more sustainable choices [98].”
• Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis (2015, background): “5 (average for 10 different countries) between the healthiest dietary patterns and the least healthy ones.(36)”
• A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial) (2017, background): “that eating a more healthful diet is more expensive than a less healthful diet [45], our detailed modelling of the costs”
• The global burden of disease attributable to high body mass index in 195 countries and territories, 1990–2017: An analysis of the Global Burden of Disease Study (2020, background): “In contrast, high-income countries have adequate financial resources to launch programs and initiatives aimed at promoting healthy food (which is generally more expensive than “junk food”) [29].”
• Reducing meat consumption in developed and transition countries to counter climate change and biodiversity loss: a review of influence factors (2017, background): “Rao et al. (2013) and Jones et al. (2014) stress that these relationships are too convoluted and underresearched for definitive conclusions to be drawn but should not be disregarded.”