Archive | December, 2014

Denver Healthy Corner Store Initiative Expands Access to Healthy, Fresh Food

4 Dec

Food “deserts” or areas of high food insecurity exist in all of Colorado’s communities and cause residents to be at higher risks for poor health outcomes and chronic diseases. Starting in October 2014, the Denver Department of Environmental Health (DEH) partnered with a nationally-known food access nonprofit organization, The Food Trust, to launch the Denver Healthy Corner Store Initiative (DHCSI) in an effort to expand access to healthy, fresh food to improve health outcomes and quality of life for all residents.

Based on the success of the Philadelphia Healthy Corner Store Initiative, the DHSCI helps store owners to expand the selection of healthy food in corner stores, convenience stores, bodegas, and neighborhood grocery stores to encourage youth and adults to purchase and eat healthier foods. The development model is designed to partner with store operators, community groups, distributors, the school health teams and other stakeholders to build demand and ensure responsiveness to the needs and desires of the surrounding neighborhoods. An advisory committee of stakeholders also serves to guide program and policy decisions. In year one, five pilot corner stores will help staff to discern barriers to implementation, distribution issues, affordability, community response and best practices. During years two and three, the program will expand to 50 stores and will include a school/corner store pilot in which the nutrition program in the school is connected to a nearby store that is implementing healthy food changes.

The DHSCI aims to serve as a replicable model for communities, both urban and rural, across the state and is funded by the Colorado Health Foundation. The long-term sustainability of the program lies in its alignment with the national vision for transforming the food system – from producers to distributors to retailers – to become more sustainable and to change the current course of poor health outcomes for Americans. The DEH seeks to be at the forefront of this movement as it becomes a national best practice through continued proven effectiveness of this model, policy change, and greater local and federal funding. It is hoped that model policies established to promote expanded healthy food access during this program will continue to shape the Colorado food environment for years to come.

The DHSCI was featured in a recent Denver Post article.

For more information, please contact DHSCI staff at or

Re: Built

3 Dec

HE_Cover_Summer2014_Thumb_150pxBy Michael Booth

Modern society has designed human movement out of daily life.

We’re overweight because we eat too much, no doubt about it. And we eat too much of the wrong things.

But we’re also bigger as a result of long-term, pervasive, systemic pressures that make daily living a largely sedentary experience for the average Coloradan.

We take elevators for one-story rides to work cubicles that tie us to a video screen for eight hours straight. The kids ride in our cars to school. Exercise means moving our smartphone thumbs more rapidly on Candy Crush. We can’t even be bothered to walk through the drugstore to pick up diabetes medication or Lipitor – prescription drive-thru windows are everywhere.

Reversing the momentum toward collective stasis is going to take a lot of hard work. One startling measure is simply the steps we walk in a given day. The Swiss walk 9,650 steps daily. Japanese citizens, even in the narrow confines of urban spaces like Tokyo, fit in 7,168 steps.

Americans? Just over 5,000 steps a day. The difference amounts to 30 to 40 fewer minutes of plain walking, every single day. The results – 35 percent obesity in American adults – are as well-known and shame-inducing as the Broncos’ Super Bowl score. Coloradans can’t duck the dangerous trend, even in stretchy yoga pants. Our adult obesity rate of 22 percent is the best in the nation, but it has doubled in 20 years.

We are Mississippi in the 1990s.

Doug Linkhart, Denver’s executive director of Environmental Health, finds numbers that trouble him even more about the near future: 31 percent of Denver Public Schools children are overweight or obese.

“We’re trending in a bad direction,” said Christopher Smith, an architect and senior program officer, Healthy Living, with the Colorado Health Foundation, and a former housing and economic development official with the City of Denver. “Seventy percent of health is dependent on behavior and environment. We’re at the beginning of recognizing this need for bringing choice back into people’s lives, in how they move about the environment.”

There is a movement of thought that promises to lead to more physical movement for us all: the “healthy places” efforts by nonprofits, health leaders and government – also referred to as “built-environment” policies – are off and running in the right direction.

In this edition of Health Elevations, we’ll explain the principles of the healthy places and built-environment movement – even some of the architects and city planners rolling up their sleeves to work on these ideas aren’t aware there is a common language and a detailed battle plan.

And because detail is always more illuminating than an abstract discussion among policy wonks, we will highlight projects that employ the principles. We will also highlight efforts that tried to employ some of the high concepts, but ran into real-world problems – problems that healthy places advocates need to consider.

In late 2013 the Urban Land Institute convened thought leaders and codified the healthy places principles. We’ll go through all 10 principles and see how they play out on the ground in Colorado and other states eager to get people moving again.

1. Put people first

In other words, stop thinking of a car’s needs first when designing a street, a sidewalk, a building front, a neighborhood plan or a new housing development.

Bill Swalling is a Colorado developer trying to put people first in two residential projects he is proposing for empty nesters: one in Fort Collins, another in the red rock formations of the Jefferson County exurbs. He has seen that his buyers don’t want big backyards or three-car garages – they would rather see smaller dwellings pushed to one side of a landscape, with trails linking their front door to the open space, a walking-distance community center for yoga classes and continuing education, and a homeowners association or municipal district to clear snow from their sidewalks and mow lawns.

What developers will need from policymakers, Swalling said, is increased density in some reluctant suburban areas. Many neighbors resist density for fear of increased vehicle traffic and parking problems, he noted.

“But empty nesters travel about half as much as those living in traditional single-family homes, so the idea of density bringing too much traffic doesn’t really happen,” he said.

2. Recognize the economic value

Designing a healthier building or streetscape shouldn’t always be seen as creating a wishful landscape with expensive doodads. Millennials are gravitating to cities where they can give up cars and walk to their favorite restaurant district,pushing up apartment rents and making development attractive. Light rail stations integrated into a healthy transit network are some of the biggest economic development draws in the nation.

Governments that spend taxpayer money on healthy, attractive open spaces are also likely to see the investment pay off economically as well as medically. Sale prices of homes within 1,500 feet of a park in Portland, Ore., were $845 to $2,262 higher than other homes (in 2000 dollars). The larger the nearby park, the greater the increase in property values, according to a report by the Robert Wood Johnson Foundation.

In Colorado, the same report noted that a greenbelt in Boulder raised the value of neighboring homes by $5.4 million, which in turn generated as much as $500,000 in new city property taxes.

Public amenities are so attractive to some Colorado developers, said Linkhart, that the city should consider asking them to contribute to improving or expanding those amenities. Apartment builders are flocking to the South Platte River and Cherry Creek confluence, he noted, in large part because of a well-designed Commons Park. “Can we capture some of those benefits?” Linkhart asked.

3. Empower champions for health

Engage the community in all phases of a project or redesign. What are the chances of creating something the community wants if residents aren’t asked what they want? How much will the new streetscape get used if it never accounted for local character and desires?

Planners in communities like Arvada have learned some of these lessons the hard way. ( See What’s Working) Not surprisingly, announcing at a community meeting that “You’re fat, and we’re here to help” is not a promising opening line.

Even residents who welcome the idea of healthier amenities can worry about the long-term results, including gentrification that will push out the very modest-income residents who could benefit most from a healthier built environment. Arvada real estate agent Mimi Tugaoen said some residents fear Olde Town improvements will further divide the suburb along its northwest/southeast contrasts.

“The southeastern part of Arvada that was previously inexpensive will now become more desirable, and cost of living might skyrocket,” Tugaoen said. “Where affordable housing will be, I don’t know.

4. Energize shared spaces

A city’s residents may seem tightly packed into commonly used spaces, but bad planning can lead to neighborhoods cut off from transit, parks and other services or amenities. Towering public housing projects of the 1960s and ‘70swere great examples of how not to build a healthy space.

Chicago researcher Frances Kuo and colleagues found that residents who lived without views of or access to green space, in notorious projects like the since-demolished Robert Taylor Homes, had higher incidents of aggressive or violent conflicts with neighbors. A “barren” landscape was linked to children outdoors without supervision, higher rates of illegal activity, property crime, graffiti and other problems, noted Kuo, a professor of natural resources, environmental science and psychology at the University of Illinois.

Denver planners promoting healthy living design ideals point to a before-and-after study of City of Axum Park in northeast Park Hill. After extensive renovations, including new play equipment and flowing walking paths, a 2011 assessment found a fivefold increase in park use compared to the 2009 baseline.

5. Make healthy choices easy

If you want more people to bike to work, you need many miles of safe bike lanes on popular streets or dedicated paths through parks. If you want children to walk to school, you need to finish sidewalks through the neighborhood, keep them clear of snow and provide safe crossings at scary intersections.

Denver architect Yong Cho and many other local designers have employed many of these principles at the redevelopment of the former Lincoln public housing project in central Denver, just southwest of downtown. Designs include appealing public corridors that seniors can use for exercise-walking in winter and a “beautiful, inviting stairway” with wide treads for sitting and talking. The stairway also acts as an observation point for a courtyard where children can gather and play, bringing the generations out at the same time, and has art integrated into the climb to draw people up and down.

“Basic, dull utility areas of a building are becoming destinations,” Cho said.

6. Ensure equitable access

Obviously it’s a matter of fairness – extend the benefits of a healthier lifestyle to as many people as possible, regardless of their race, creed, religion or “birth ZIP code” status. But it’s also a practical matter: Many unhealthy developments in American life, including obesity rates, affect minorities and low-income communities disproportionately. That includes high rates of obesity among Colorado Hispanic communities as well as intense rates of poverty and obesity in whites and blacks in the Bible Belt states.

Kaiser Permanente’s community benefit spending asks grant applicants to prioritize schools with high reduced- and free-lunch needs, and also to seek out underserved populations for “Walk & Wheel” alternative-transit funding.

The Urban Land Institute’s study of Denver’s Westwood neighborhood mapped stark inequities that block healthier communities, including the map on page 12, showing how much more green space the neighborhood would have if it rose even to the Denver average.

Addressing those gaps can mean very practical, basic steps, said Lois Brink, a professor of landscape architecture at University of Colorado Denver and a founder of the Learning Landscapes program of healthier designs at Denver Public Schools.

“Sometimes you actually have to teach kids and parents how to ride a bike. Seriously,” she said.

7. Mix it up

When a big space opens for development, design offices and retail near residences in livable ways. Make sure residents are within a half-mile of attractive open space. And “mix up” everything – housing and exercise for young and old alike,dads with strollers and grandparents with canes. Provide affordable housing near middle- and high-income housing, as Stapleton and Lowry and parts of LoDo have tried to do.

Susan Powers and other developers of the Aria project in northwest Denver put all these ideas in a blender and mixed it up at high speed. On 17 acres purchased from an order of nuns, Aria is building low-income housing near $450,000 homes, large community gardens, a production-size restaurant garden, an on-site medical and wellness clinic, walkways connecting Regis University to Zuni Park, and intergenerational cohousing.

Aria is also “mixing up” the development process itself: While Aria’s investors are a for-profit venture, they must work with nonprofits and foundations to build trails and other health amenities, and with city and state agencies on streetscape and other infrastructure.

Along the way, Powers said, Aria hopes to be a pioneer in a part of the city where the healthy places movement hasn’t yet taken hold in a big way.

“North of I-70 has been forgotten, and we’re a small part of what can happen there,” she said.

8. Embrace unique character

Don’t design away the interesting bumps and quirks of a neighborhood that give it character. Integrate existing natural systems in more useful ways, whether a city drainage ditch or a pocket park with old trees. If neighbors sun themselves on an impromptu creek side beach, connect the beach to walking and biking paths.

In an ethnically influenced neighborhood like Westwood where brightly colored buildings reflect an international tradition, encouraging more brightly colored buildings will promote walking and calm drive-by traffic.

Westwood has the kind of good news/bad news example that can be a challenge for city planners, said UCD’s Lois Brink. Weir Gulch winds through the neighborhood, beckoning redevelopment as a more attractive green space as has happened in other neighborhoods cut by the gulch. But according to Brink, some residents tell developers, “We don’t like gulches! They’re deep and scary.” Neighbors need to be involved in the redesign and see examples of how urban trails have worked elsewhere.

9. Promote access to healthy food

Attacking two problems at once can leverage the results: Create more outlets for healthier food to fight obesity, and speed up the battle by encouraging healthier paths to that store.

Colorado’s burgeoning Fresh Food Financing Fund is one of the first well-financed, cooperative programs to take on food deserts in a practical way. Launched with $7.1 million in seed money from the Colorado Health Foundation, CO4F has since gained more investors for its goal of removing “financial barriers from the construction, expansion and renovation of grocery stores in underserved areas.”

Since the launch, CO4F has added $1 million for loans from Kaiser Permanente, $1 million from The Piton Foundation and another $300,000 from The Colorado Trust.

10. Make it active

Put multiple activities in the same place to attract the most diverse participants possible. Plan housing, work and retail so that each trip can begin with a walk. Work on that “last mile” of a commute, making it easy to put a bike on alight rail train or rent transportation for the final mile to home.

The City Loop playground rebuild in City Park had grand ambitions to better activate one of the crown jewels of the open space system in Colorado. City Park looks crowded to families who only try to use it on the free zoo day, who run the Boo at the Zoo in October, or try to find parking for a peak-hour IMAX film at the Museum of Nature & Science. But in between the big events, City Park is largely empty, said Gordon Robertson, director of planning at Denver Parks and Recreation. The quiet green space is a respite to a few regulars, but not an effective or healthy use of precious land for 25,000 surrounding residents.

City Loop meant to bring innovative climbing and movement equipment for children right next to a knee-friendly walking path for seniors. A kiosk to check out sports equipment would sit near a plaza for demonstrations, including cooking hours employing goods from an on-site community garden. It was to be the city’s first “outdoor recreation center,” Robertson said.

And it was all too new, too fast, at least for that pocket of Colorado. (See Observations for an extensive Q&A deconstructing the fate of City Loop.)

Reversing 150 years of design trends in a sprawling built environment is not always smooth or swift, as you will see throughout this summer’s edition of Health Elevations. Advocates of healthy places ideas often have to take a deep breath and look at the long view, Powers said.

“These are generational projects,” the Aria developer said. “They seem like they can take forever.”

Michael Booth is the Editor in Chief of Health Elevations.

HEALTH ELEVATIONS seeks to further the goals of the Colorado Health Foundation by highlighting problems that can be solved, illuminating the people who are making progress in solving them and provoking a new way of looking at complex health issues. HEALTH ELEVATIONS reports on a variety of sources to provide information that can further the work of policymakers, grantees, providers and the engaged public in advancing better health care, health coverage and healthier living.

The Future of Food Help in America

3 Dec

HE_Fall2014_Cover_150width_SBy Michael Booth

“Of all the preposterous assumptions of humanity over humanity, nothing exceeds most of the criticisms made on the habits of the poor by the well-housed, well-warmed, and well-fed.”–Herman Melville

I’ve made plenty of those assumptions myself.

That’s why it was long past time to take the SNAP Challenge. Eat for a week using only the same small allotment granted to the average food stamp recipient in Colorado – for me, about $30, or $1.45 a meal. I assumed cheap food was plentiful and full of variety.

I assumed it would be easy to avoid processed, boxed calories and buy fresh produce instead. I assumed that if I bought groceries ahead and had a rigid menu, I’d stop thinking about food all the time. I assumed coffee was in the budget.


Few things ruin the hearty taste of oatmeal like the knowledge you can’t afford anything else for breakfast. Greens grow from dirt but they are not dirt cheap. And just because your menu is fixed doesn’t mean you stop thinking about trades and upgrades – “If they’d just let me use five more dollars, I swear I’d buy broccoli and a bag of oranges.”

My experiences on a SNAP (food stamp) budget were merely annoying, and I’d never claim otherwise, in the face of nearly 50 million Americans and 500,000 Coloradans who rely on the food support program for much of their daily sustenance.

Choosing to eat cheaply is a luxury of the idle. Having to eat cheaply – because of unemployment, or health problems, or lack of education or a fair job – that is the grueling chore of more than a tenth of our population. The reason the SNAP Challenge thrives is because it’s a one-week seminar, massively open to everyone, held at the spot where public policy meets the public.

SNAP Judgments

Robin Dickinson, MD, had her own set of assumptions before strokes and other setbacks put her family on food stamps two years ago. “You don’t go into medical school thinking, ‘I’m going to need food stamps someday,’” said Dickinson, a practicing physician in Englewood.

Before her own illness, she would constantly advise unfortunate patients to seek out Medicaid, or to use the Supplemental Nutrition Assistance Program (the modern moniker for food stamps) to help the family get by for a while. She encouraged her patients to use the MyPlate nutrition plan to get healthier, eating half their food in fruits and vegetables. She thought people had time and interest and knowledge to cook healthy from scratch, starting with the SNAP benefits as a base.

Then the strokes hit, with two young children at home. She couldn’t work a private practice job, having to sleep 20 hours a day to recover. Home and car repairs piled up. They canceled their family health insurance, even as the stroke bills piled up.

“We were down to eating rice and potatoes and oatmeal, and spicing it up with soy sauce until we ran out of soy sauce, Parmesan cheese until we ran out of Parmesan cheese, raisins until we ran out of raisins,” Dickinson said.

At one point she stepped back and re-examined all she had assumed about her poorest patients, even as she gave them good advice. “And I realized it had nothing to do with how hard we were trying, what kind of people we were. Our financial situation was terrible,” she said.

Feeling at the end of her rope, Dickinson called a human services agency, and after explaining her medical disability, was qualified for SNAP over the phone. She remembers vividly the joyful first day of using the unobtrusive Electronic Benefits Transfer card to get new groceries.

“The first time going in – after eating brown-bland food for so long – to get colorful, delicious, flavorful food was so exciting,” she said. “That was like a celebration day for us.”

Budget Crumbs

Passage of a five-year U.S. farm bill in 2014 would seem to let SNAP proponents breathe easier for a while. Negotiators did manage to protect some basic levels of food assistance, despite an $8 billion trim for some states (not Colorado) that had connected food assistance to home heating aid.

That does not mean advocates for the poor are sanguine. Food benefits are stuck at an average of about $130 a month per person. Even that level is subject to political whim: If the fall 2014 elections result in a partisan shift in Washington, D.C., as most commentators assume it will, then Rep. Paul Ryan’s summer poverty blueprint will receive more serious attention. The Wisconsin Republican, considered a conservative thought leader on social programs, has more strongly backed federal aid to the poor, but still wants much of it to be consolidated into the equivalent of block grants to the states.

The libertarian Cato Institute in late 2013 issued a paper calling SNAP “a deeply troubled program. … It has high administrative costs and significant levels of fraud and abuse. The program’s work requirements are weak and frequently evaded at the state level. The program increasingly breeds greater dependence on the government.”

Colorado, meanwhile, is still struggling to meet its own “SNAP Challenge.” The state had long suffered from poor participation rates, meaning hundreds of thousands of state residents were eligible for food aid but were not signed up because of notorious computer problems and a lack of coordinated outreach.

That has gotten better, but is far from a gold star. Statewide SNAP use rose to 508,000 people in fiscal year 2013, up from 252,933 in 2008, in part because of the faltering economy pushing more people into eligibility. But signups improved, too. Though state data lags the budget, 51.4 percent of eligible Coloradans got SNAP in 2011, up markedly from only 35.1 percent in 2008, according to the state Department of Human Services.

The participation gap fences off millions of dollars in economic activity from the Colorado economy – growers, producers and grocers would all be seeing revenue boosts if more eligible consumers received SNAP.

Anti-hunger advocates like Hunger Free Colorado will be carefully watching state and federal policies on SNAP, even as they gear up to protect school nutrition in the five-year reauthorization of that program up for debate in Congress in 2015.

Conservatives’ block-grant idea is a nonstarter, argued Hunger Free Colorado executive director Kathy Underhill.

“The whole point of SNAP is that it can expand and contract, counter-cyclically to the economy,” Underhill said. “So to hobble it that way” – through set amounts in block grants – “would be incredibly damaging.”

$1.40 a Meal

About the time I was talking macroeconomic policy, I also was spending time licking the peanut butter knives.

Underhill said there is no definitive way of knowing how many Coloradans rely on SNAP budgets for all of their food needs, but judging from the thousands of people her organization has interviewed over the years, the number is significant. So it’s not just a random exercise in budgeting to live on $1.40 a meal: it’s walking in other people’s shoes.

If you haven’t had to budget very tightly lately, the grocery store looks something like this: The relatively nutritious foods that get you enough calories on SNAP come packaged in pasta cellophane; egg cartons; rice bags; cans of black beans; and in the child-centered packaging of peanut butter and raw oatmeal. You can afford enough apples and bananas to get you through half the week’s challenge; greens are nearly impossible, but for a sale on zucchini.

Bargains come in unexpected places, at least for those lucky enough to have a car to try more than one grocery store. Trader Joe’s takes EBT cards, and has a jar of pasta sauce for $1.29 that becomes a flavor-saver deep in the challenge week. Get to know your egg recipes – at $5 for four dozen, they are hard to pass up.

Most of the working poor, or the poor looking to work, have little time to plan out the SNAP budget and cook from scratch for cheap nutrition. New York hunger activist Joel Berg has some choice words about that: “Michael Pollan has made a profound contribution to the food dialogue, but he has said poor people have more time than money and so they should spend more time preparing good food,” Berg said. “I don’t think that’s in touch with reality in America. Every hour they are preparing food is an hour they are not looking for a better job or taking care of their children. And they may spend two or three days in line waiting for benefits to which they are legally entitled.”

The business world likes to talk about “opportunity cost,” Berg said – the idea that productive people waste time in bureaucracy and thereby lose money. “The truth is low-income people are already the busiest people on the planet,” Berg said.

Anti-hunger and pro-nutrition advocates have come up with innovative tools. Colorado lawmakers this year passed a tax credit for farmers who donate healthy produce to food banks, which could supplement SNAP households with previously out-of-reach fruits and vegetables.

Leanne Brown wrote a cookbook for food budgets of $4 a day, and used a Kickstarter campaign to jazz it up with beautiful food-porn shots of the menus. Her “Good and Cheap” became an Internet hit. I used it to make a “crustless quiche” – perhaps more realistically known as a frittata – with a kitchen sink of cheap zucchini, onions, garlic and cheese. For dinner – delicious; rolled up in a burrito for lunch the next day – almost as good, though the March of the Cheap Eggs seemed relentless.

Challenged by SNAP

Cathy Kuo recalls those queasy moments from her own family’s SNAP Challenge. Chief marketing officer of cable and Internet provider Wide Open West, Kuo is also on the board of Hunger Free Colorado. Her family agreed to do the challenge with her, pooling what SNAP would have given them to add a few extras.

She used cooking techniques learned from her Chinese mother to stretch a Costco roast chicken by using picked bones for broth and adding rice for soup. “We bought the cheapest soy sauce we could find and it was awful,” she remembered. They found some frozen vegetables that fit the budget, but nothing fresh.“

One of the apples we bought was bad, and that was devastating!” Kuo said. The most surprising thing, she added, was the mental and emotional toll both she and her young daughter felt by the end of the week. She could see her daughter slumping and whining by Friday. For herself, Kuo said, “If you needed a critical decision from me, that was not the week for it. I was having difficulty thinking problems through.”

Cheap But Good

Sometimes the SNAP policy battles come down to a translucent raw chicken carcass sticking up out of a boiling pot.

Many of us seize up at the sight of a whole, raw chicken. Seems like a good idea, really, but where to start? So imagine the intimidation for a single working mom prepping dinner between shifts, with no clue where to start slicing.

Cooking Matters classes try to bring such useful knowledge to families struggling on tight food budgets around the state. Local chefs lead weekly courses in simple but delicious meals at extremely low cost. During downtime at a metro area meeting site, nutritionists from the Anschutz Medical Campus demonstrate the jaw-dropping high sugar levels in soda and other processed foods.

But getting busy families to turn out for the information is one of many frustrating moments for those reaching out to the working poor. On an early July night at Anschutz, four families had signed up, and 15 minutes in, only one family had shown up.

Chef Dennis Taylor ignored the small size of his audience, and focused on engaging three young children brought by Lori Tsosie of Green Valley Ranch. A whole fryer goes for 98 cents a pound, Taylor noted, while chicken breasts cut off the bone by someone else cost $3.99 and up. Taylor sliced off clammy chicken parts while the children alternated between shock and awe. He showed them how to blanch broccoli and carrots for 15 seconds before adding them to a chicken stir-fry to keep them fresher.“

So, you have to learn the value of unprepared food vs. prefabricated foods,” he said.

Tsosie is trying, both on the budget issues and the better-nutrition issues. “I’ve been learning a lot about prices, and how much fat there is in some foods,” she said. “We looked at how much lard is in a Whopper, and we were grossed out.”

Tsosie said she has banned sugar drinks from her house, and because her young kids have already suffered through oral surgery, “They know why.” She has been looking for alternatives – at Anschutz, the whole family sipped from ice water dotted with cucumber slices and mint leaves. “This is really good,” Tsosie said.

Ethics of Choice

Some families give up and head to the junk food aisles.

“If I’m a mom with three kids and you send me to the store with a buck, do I buy a plum, or three boxes of mac & cheese,” Underhill said. She wasn’t really asking a question.

Decrying the families buying soda and chips on SNAP’s EBT cards is a favorite tactic of government-aid opponents. It’s an easy target – in Los Angeles, neighborhood bodegas hang signs saying “All Rockstar Energy Drink Products are EBT Approved.” A 16-ounce can of Rockstar holds 15 teaspoons of sugar in its caffeinated suspension.

These easy charges lead to dubious connections between SNAP and rising obesity. Isn’t it ironic, critics like to say, that those receiving food aid are often the ones ingesting too many of the wrong calories?

A 2012 review called “SNAP to Health” by the Center for the Study of the Presidency and Congress said, “SNAP is a missed opportunity for improving children’s nutrition and preventing obesity.”

But the same center followed up with “The Facts and Fictions” of SNAP and obesity, pointing out with thorough research that the connection between public assistance and excess weight was blurry at best. Some respected studies show a bond with obesity; others show SNAP benefits increase dietary quality in a household.

What the center and other SNAP critiques have recommended is experimentation with dietary incentives or restrictions within SNAP benefits. Private money or public waivers could be used to increase incentives for fruits, vegetables and whole grains, for example. SNAP retailers might have to meet higher standards for what they stock, mixing more produce in with their processed foods. Some trials have shown willingness to spend SNAP on better foods when purchased in nutritionally designed food baskets. With Amazon and others diving into the grocery-delivery business, such private-public partnerships in nutrition have great potential.

Colorado has not seen strong state-level efforts to put nutrition incentives or restrictions into SNAP, said Hunger Free’s Underhill. “People’s purchasing habits are nearly identical, with or without SNAP,” Underhill argued. There is an ethical danger in “the paternalism of eliminating that choice,” she added.

New York’s Berg put it more bluntly, on the idea of blocking certain popular foods for certain people: How can the U.S. government, for example, subsidize corn and corn-sweetened calories, then turn around and ban those food items for certain taxpayers?“

So unless it’s worse than heroin, and banned for everyone, it’s pretty selective to ban it for poor people in a public food program,” Berg concluded. “If it’s a public health threat, then ban it for everyone. Let’s not equate obesity with something wrong with the moral fiber of one economic group.”

Some SNAP critics and advocates do seem to agree on lesser steps, including more record-keeping and transparency in how SNAP money is spent, and where. The “SNAP to Health” report called for it, and food system writer Michele Simon demanded it more pointedly in her 2012 investigation, “Food Stamps: Follow the Money. Are Corporations Profiting from Hungry Americans?”

Simon’s critique estimated how many billions of dollars major brand names like Walmart, Coca-Cola and Kraft Foods, and bank processors like JPMorgan Chase make through SNAP purchases, and said they have worked against nutrition standards and transparency in the program.

The goal, Simon wrote, should be to “develop policies that ensure SNAP resources are used to reduce food insecurity and promote healthier diets, and not to subsidize the profits of the food industry or banks.”

Sneaking Around SNAP

Of course you want to know if I cheated on the SNAP Challenge. And of course, I did. They ask you to keep the rules strict – don’t take free lunch offers from friends or family; don’t use your leftover $8 bottle of arugula-infused, locally-sourced balsamic to make the chicken palatable; don’t walk your plate of rice over to the nearest Thai joint to “borrow” a dash of Sriracha.

Let’s just say my capacity for self-pity is much greater than my affinity for self-denial. I was good in many places. I cooked salmon for a dinner party but had an egg and green chile burrito on my own plate. But I accepted a glass of wine and some fresh garden greens at a friend’s house, while bringing my own sad frittata. To make the undrinkable cheap tea go down better, I snuck some sugar packets from coffee shops. My wife and daughter lifted an extra dessert from a ladies-only 40th birthday party – it tasted like cream cheese and remorse.

Coffee was a tough loss – even the bad stuff was three times as much as cheap tea. Not sure if I’ve ever gone a week without java, since middle school.

Overall, I’d say I stuck to the spirit of the challenge. If If my cheating items were worth some small change, I also had leftovers that would allow me to buy some variety in the next week. Two pounds of uncooked pasta, a dozen eggs, a small jar of peanut butter, some tortillas and cheese. The tea will be donated, though that in itself might be cruel.

There’s a separate question, of course: How did I do for vitamins and essentials? Man should not live on peanut butter alone, though many a third-grader has tried. I sent Anschutz nutritionist Jimikaye Beck my weeklong SNAP menu – tantamount to asking Julia Child to critique a baloney sandwich.

She was kind, but tough. “There is a lack of vegetables in this diet.” Baby carrots could add a vegetable at lunch, she said; frozen broccoli could fit into the budget and nicely into the frittata. The broccoli would also replace some calcium she saw lacking.

Beck worried my cheap pasta was not whole-grain. (It wasn’t.) She wanted to know if I’d gotten the Jif knock-off peanut butter with all the sugar and salt, or something better. (Um … no. Something likely worse.)

I argued back, no doubt irritated by deprivation of dessert, coffee and lettuce. Whole-grain pasta is three times the price! Upscale peanut butter is a rip-off (not to mention I happen to like Jif and its chemical clones).

Beck laughed in my face while pouring me a nice cucumber water. “Yes! Price is a challenge, isn’t it?” Lesson learned.

Shaking Off Stigma

Robin Dickinson’s family became ineligible for further SNAP benefits in August, she said, as her physical recovery allowed her to work more hours as a physician. She was happy for the progress, but also nervous about the transition without a food safety net.“

We’re going to creep over that cutoff, but that doesn’t mean all of a sudden we’re comfortable,” she said. Home and car repairs were put off, as they still had credit card debt. One broken down car could wipe out part of their monthly food plan.

She is more than ready, she said, to grocery shop without the stigma of other people’s judgments. She assumed she could guess what was going through other customers’ heads if they saw her swipe the EBT card over chocolate ice cream for her kids. Or if her cart included a cheap plastic toy as a reward to her special-needs son.

“They may not be thinking that, but it’s hard not to wonder,” Dickinson said. “I’m looking forward to going through that checkout line without worrying about it.”

Michael Booth is the Editor in Chief of Health Elevations.

This article is a feature story of Health Elevations Food Issue: Can Public Policy Trim bad Choices? Download the issue here

HEALTH ELEVATIONS seeks to further the goals of the Colorado Health Foundation by highlighting problems that can be solved, illuminating the people who are making progress in solving them and provoking a new way of looking at complex health issues. HEALTH ELEVATIONS reports on a variety of sources to provide information that can further the work of policymakers, grantees, providers and the engaged public in advancing better health care, health coverage and healthier living.