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Abstract
Background/Objective: Past studies have shown that healthier diets tend to cost more. This study identified groups of positive deviants (PD) who are able to achieve healthier diets at lower cost, and characterize them by socio-demographics, dietary components, and food attitudes.
Subjects/Methods: The Seattle Obesity Study (SOS) was a cross-sectional study based on a representative sample of 1266 adults of King County, WA, conducted in 2008–09. Socio-demographic and attitudinal variables were obtained through telephone survey. Dietary intake data were obtained using a food frequency questionnaire (FFQ). Diet cost was calculated based on retail prices for FFQ component foods. Healthy Eating Index-2005 (HEI), mean adequacy ratio (MAR), and energy density (ED) were used as three measures of diet quality.
Results: Higher diet cost is associated with being female, aged 50–64, a college graduate or higher, and having annual household income $100,000 or more. 66 HEI positive deviants, 73 MAR positive deviants, and 33 ED positive deviants were identified who had higher diet quality at lower cost. Compared to other individuals, PD varied by gender, age, race, education, income, marital status and perceived importance of eating foods that are healthy, inexpensive and convenient. Regardless of cost, individuals with high diet quality had similar HEI component scores. However, PD were able to achieve the same high HEI at lower cost. Their diet was constituted by more fruits, vegetables, whole grains, and milk, and less saturated fats, solid fats, alcohol, and added sugars (SoFAAS).
Conclusions: One way to achieve high diet quality at low cost is by choosing less expensive forms of fruits and vegetables—such as apples and carrots instead of strawberries and kale. Increasing intake of healthful food components that are less expensive, such as whole grains, meats and beans is another way to achieve a healthier diet at lower cost. Strategies to improve diet quality at low cost should also include techniques to increase the perception that it is important that food be healthy, and to improve the accuracy of self-assessments of diet quality.
