This article was first published on July 20, 2023. It was last reviewed/ updated on July 23, 2023.
We should guide patients toward “healthier eating”
Too many of my patients have overweight and obesity. Unhealthy eating habits, using food to cope with depression/ anxiety, problems with impulse control, and, last but not least, the effect of many of the medications I prescribe, all contribute to this.
So, I feel strongly that helping my patients to move towards healthier eating is part of my job. I talk to them about healthier eating and physical activity just like I talk to them about sleep, sexual functioning, and so on. Not all of these topics in the same visit, obviously.
Over time, I have come to use the term “healthier eating” to refer to what all of us are trying to do. This avoids the word “diet”, which has negative associations. I also don’t want to call it “healthy eating”, which seems like an ideal goal that will be too hard to achieve. I welcome your thoughts and suggestions about this.
Is healthier eating possible when money is tight?
Anyway, when I was discussing healthier eating with one of my patients, he said that, yes, he would like to eat healthier food more often but this was not possible for him at this time because he has a low income and healthy food is expensive. He said that healthier eating would have to wait until he got a higher-paying job.
Yes, fancy pre-made salads, avocados, blueberries, and many other foods are expensive. But we can guide our patients towards healthier eating at lower cost by giving them specific tips about:
1. Where to shop for food items?
2. What kinds of food items to buy?
3. Which specific healthier food items are more affordable?
Where to shop
Those whose food shopping is constrained by a need to cut costs can save significant amounts compared to conventional grocery stores by shopping for fruits and vegetables at the following places (in no particular order):
1. Farmers’ markets
2. Wholesale clubs like (alphabetically) BJ’s, Costco, Sam’s Club, etc. These are good places to shop for frozen food items or those that don’t go bad soon.
Caution! With fresh fruits and vegetables, shoppers must be careful because if significant portions of their bulk purchases go to waste, then shopping for those items at wholesale clubs is not cost-efficient.
3. Ethnic food stores (for example, Indian or Asian grocery stores)
What kinds of food items?
Frozen or canned food items cost less and last longer, which means less wastage (Mayo Clinic, 2022; CDC, 2022). But, at this time, while we recommend frozen food items, we need to be cautious about canned food items.
Frozen food items (fruits, vegetables, etc), especially those with resealable packaging (CDC, 2022) can be great ways of reducing the cost of healthier eating. We should encourage their use and address a common misconception about them. (Note: Here, we are not talking about ready-to-eat frozen meals.)
But shouldn’t we be encouraging patients to eat fresh fruits and vegetables instead of frozen ones? Doesn’t freezing fruits and vegetables degrade their nutritional value? It is a common misconception that commercially-frozen food items should be avoided because they have lost much of their nutritional value while in the freezer. This is not true. Fruits and vegetables are typically frozen soon after they are picked, which preserves their nutritional value for longer (Mayo Clinic, 2022).
Just as examples, it has been shown that commercially-frozen apricots (Adkison et al., 2018) and broccoli (González-Hidalgo et al., 2019) retain most of their antioxidant compounds, vitamin C, etc.
But one thing to watch out for with frozen foods is that shoppers should avoid products with added ingredients that are high in fat, salt, etc (Cleveland Clinic, 2022). Instead, they should buy plain food items and add other ingredients themselves if needed (Cleveland Clinic, 2022).
Store-brand food items cost less than their corresponding brand-name items.
Whole (NOT pre-cut) fruits and vegetables. The price difference between a fruit that we ourselves cut and the same product pre-cut and ready-to-eat is huge.
Warn patients about these potential problems with canned food
Many reputable sources have encouraged the use of canned food items by thrifty food shoppers. But there are several potential problems with using canned food items that we should be ready to tell our patients about.
Problem: Canned vegetables may have high salt content.
– Shoppers should look for ones marked “low-sodium” or “no salt added” (Cleveland Clinic, 2022).
– Another simple measure that is feasible for some but not all canned food items is to rinse the product before consuming it. For example, if canned chickpeas (Garbanzo beans) are used, it is simple enough to pour out the contents into a colander and rinse them with water before using them.
Problem: Canned fruit in “heavy syrup” should be avoided since it contains a lot of sugar (Cleveland Clinic, 2022).
Possible solution: Look for canned fruit marked as being “in its own juice” or in “light syrup” (Cleveland Clinic, 2022).
3. Bisphenol A (BPA)?
Problem: Although many manufacturers have eliminated it from the inside lining of cans for food items, the linings of some cans for food items continue to contain BPA (bisphenol A; Cao et al., 2023).
BPA is a synthetic chemical that has been suspected to cause many different health concerns though low levels of exposure to it may not be dangerous (Della Rocca et al., 2023). In another article on this website, we may discuss what BPA is, whether and to what extent it really is a problem, how to reduce exposure to it, etc.
Possible solution: Some cans are marked by the manufacturer to indicate that they do not contain BPA. For example, see the image below of a can of tomatoes from my home.
Suggest these specific healthier but affordable food items
Here are some examples of food items that are relatively healthy AND inexpensive. When bought by weight, they cost no more than $1.5 per pound (lb).
Can you suggest more that should be added to the list?
Eggs—about $2 per dozen
Oats, whole grain—about $1.5/lb (for store brand)
Low-fat (1%) milk—about $2.6/gallon
Brown rice (uncooked)—about $0.70/lb
Whole-grain pasta (uncooked)—about $1.5/lb
Pulses (beans, peas, lentils)
Beans (pinto beans, black beans, dark red kidney beans), uncooked—about $1/lb
Chickpeas (also called Garbanzo beans), uncooked—about $1/lb
Chickpeas (also called Garbanzo beans), canned (ready-to-eat)—about $1.30/lb
Broccoli florets—about $1.4/lb
Sweet potatoes, fresh—about $1.3/lb
Sweet potatoes, canned—about $1.1/lb
Canned tomatoes—about $0.8/lb
Carrots, whole—about $0.8/lb
Baby carrots—about $1/lb
Peanut butter—about $1.6/lb
Food items that cost a bit more than $1.5/lb
Apples—about $1.60/lb. Apples vary a lot in price but a thrifty shopper should be able to get apples for less than $2/lb.
Food items that cost much more than $1.5/lb but are consumed in small amounts (alphabetically)
Peanuts, shelled (unsalted or lightly salted)—about $3/lb but are consumed in small amounts
Adkison EC, Biasi WB, Bikoba V, Holstege DM, Mitcham EJ. Effect of Canning and Freezing on the Nutritional Content of Apricots. J Food Sci. 2018 Jun;83(6):1757-1761. doi: 10.1111/1750-3841.14157. Epub 2018 May 22. PMID: 29786843.
Centers for Disease Control (CDC, 2022). 6 Tips for Eating Healthy on a Budget. Available at https://www.cdc.gov/diabetes/healthy-eating-budget.html. Last accessed on June 30, 2023.
Cleveland Clinic (2022). 12 Inexpensive Healthy Food Choices. Available at https://health.clevelandclinic.org/cheap-healthy-food. Last accessed on June 30, 2023.
Cao XL, Popovic S, Dabeka RW. Trends of bisphenol A occurrence in canned food products from 2008-2020. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2023 Jun;40(6):781-786. doi: 10.1080/19440049.2023.2209898. Epub 2023 May 8. PMID: 37154823.
Della Rocca Y, Traini EM, Diomede F, Fonticoli L, Trubiani O, Paganelli A, Pizzicannella J, Marconi GD. Current Evidence on Bisphenol A Exposure and the Molecular Mechanism Involved in Related Pathological Conditions. Pharmaceutics. 2023 Mar 10;15(3):908. doi: 10.3390/pharmaceutics15030908. PMID: 36986769; PMCID: PMC10053246.
Elliott B (2023). 28 Healthy Foods That Are Incredibly Cheap. Available at https://www.healthline.com/nutrition/29-cheap-healthy-foods. Last accessed on June 30, 2023.
González-Hidalgo I, Moreno DA, García-Viguera C, Ros-García JM. Effect of industrial freezing on the physical and nutritional quality traits in broccoli. Food Sci Technol Int. 2019 Jan;25(1):56-65. doi: 10.1177/1082013218795807. Epub 2018 Aug 28. PMID: 30153746.
Lipton B (2017). 7 Healthy Foods That All Cost Less Than $1. Available at https://time.com/4855542/cheap-healthy-foods. Last accessed on June 30, 2023.
Mayo Clinic. 8 ways to shop for healthy food on a budget. 2022. Available at https://diet.mayoclinic.org/us/blog/2022/8-ways-to-shop-for-healthy-food-on-a-budget. Last accessed on June 30, 2023.
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