The Evolution of the U.S. Food Environment and Its Impact on Chronic Illness: A 30-40 Year Perspective
Over the past three to four decades, the United States has experienced a significant transformation in its food environment, coinciding with a dramatic increase in chronic illnesses. This article explores the changes in the American food landscape and their relationship to the rising prevalence of diet-related health issues.
The Changing Food Landscape
Increased Availability of Hyper-Palatable Foods
One of the most notable changes in the U.S. food system has been the proliferation of hyper-palatable foods (HPF). These are foods designed with specific combinations of fat, sugar, sodium, and carbohydrates that enhance palatability and create an artificially rewarding eating experience1. A study examining the period from 1988 to 2018 found that the prevalence of HPF in the U.S. food system increased significantly, with over 60% of foods falling into this category by 20161.
Shift in Dietary Patterns
Americans' eating habits have undergone substantial changes2:
- Protein Sources: There has been a shift from beef to chicken consumption
- Dairy Products: Whole milk consumption has decreased, while cheese consumption has increased dramatically
- Sweeteners: While sugar consumption has decreased, the use of corn-derived sweeteners has risen significantly
- Fats: The consumption of cooking oils has more than tripled since the early 1970s
Changes in Food Establishment Access
The food environment has also evolved in terms of access to various food establishments:
- Supermarkets: By 2005-2008, the average residential distance to the closest supermarket had decreased by 1,406 meters compared to 1971-19753
- Fast-Food Restaurants: Access to fast-food establishments increased across all neighborhoods, with a more significant increase in wealthier areas, reducing the disparity that existed in earlier decades3
- Convenience Stores: The number of convenience stores along commute routes steadily increased over time3
Impact on Chronic Illnesses
Obesity Epidemic
The prevalence of obesity in the U.S. has risen sharply. In 1988, about 23% of the adult population had obesity. By 2018, this figure had nearly doubled to 42%1.
Diabetes and Cardiovascular Disease
As of 2022, nearly half of U.S. adults have pre-diabetes (38%) or diabetes(11.3%), with most cases being type 2 diabetes4. Cardiovascular disease (CVD) affects approximately 37% of the U.S. population, and it remains the leading cause of death for both men and women4.
Factors Contributing to the Changing Food Environment
Food Industry Innovation
The number of new food products introduced to the U.S. food system nearly doubled from 1985 to 1998, with a focus on snack items and frozen foods1. This proliferation of processed and convenience foods has significantly altered the American diet.
Economic and Social Factors
Poverty and lack of access to healthy foods in certain communities have exacerbated health disparities. Areas with higher poverty rates often have limited access to affordable, nutritious foods, contributing to poor dietary habits and increased risk of chronic diseases4.
Agricultural and Food Policies
U.S. agricultural policies have influenced food production and availability. Subsidies for certain crops have made ingredients like corn syrup more prevalent in processed foods, contributing to the increase in hyper-palatable food consumption14.
Environmental Concerns
The relationship between diet and environmental sustainability has become increasingly important. Climate-smart and resilient food systems that focus on whole grains, legumes, fruits, and vegetables sourced from environmentally sustainable practices are gaining attention as a way to address both health and environmental concerns4.
Conclusion
The U.S. food environment has undergone significant changes over the past 30-40 years, characterized by increased availability of hyper-palatable foods, shifts in dietary patterns, and changes in food establishment access. These changes have coincided with a dramatic rise in chronic illnesses such as obesity, diabetes, and cardiovascular disease. Addressing this complex issue requires a multifaceted approach that considers not only individual dietary choices but also broader economic, social, and environmental factors that shape the food environment.
As the U.S. continues to grapple with the health consequences of these changes, policymakers, health professionals, and the food industry must work together to create a more healthful and sustainable food environment. Initiatives such as "food as medicine" programs and policies aimed at improving access to nutritious foods in underserved communities are promising steps toward reversing these troubling trends and improving the overall health of the nation4.