The Sad 'Standard American Diet' Is Taking Over the World
To understand the reputation of the Standard American Diet—low in fiber and featuring a wealth of processed foods, sodium, and fats—one doesn’t have to go much further than its acronym: SAD. It has had real consequences: Between 1999 and 2010, one Harvard study found, not only did people with a higher socioeconomic status have a better diet than those from a lower status but the gap between them increased. Today, according to the Centers for Disease Control and Prevention, 90 percent of Americans consume too much sodium, and roughly one-third of the population is obese.
SAD no longer applies to the United States alone. It’s becoming the diet of industrialized countries throughout the world—and the differences between rich and poor have come along with it. A study published Thursday in the journal BMJ Open took urine samples from people throughout Italy and found that sodium intake was “significantly higher in less advantaged groups.” "The dietary inequality followed the country’s entrenched geography of wealth and poverty, with those living in wealthier and more educated Northern Italy having a lower sodium intake than their Southern counterparts. Though Italy may have a reputation for its healthful Mediterranean diet, low incomes make it hard to eat well regardless of cultural attitudes toward food.
The study’s author, Francesco Cappuccio, professor of cardiovascular medicine & epidemiology at the University of Warwick, found similar patterns in the United Kingdom in a study published last year.
In industrialized countries, cheap food is not only high in calories but takes little time to prepare. This translates into a lot of frozen meals, fast food, and other out-of-the-box meals that are often formulated for taste rather than health. In the U.S., 75 percent of all sodium comes from processed foods and restaurant meals, the CDC reports. This is now the standard narrative for the poorer people of wealthier nations, but what happens when a family has a low income in an undeveloped or developing country?
While there’s a high consumption of processed foods in Central and South America, according to Derek Headey, a research fellow in the Poverty, Health, and Nutrition Division at the International Food Policy Research Institute, this is a pattern that’s common to transitioning, middle-income countries.
“In poor countries in rural areas, that’s not really the case,” he continued. Rather than moving toward high-fat convenience foods, poor families in places such as rural Africa survive on a monotonous diet of starchy cereals, roots, and tubers. Like low-income Americans, “they’re trying to fill their bellies to get enough calories,” Headey said. But the result in underdeveloped countries where there aren’t processed foods to fall back on is a dearth of micronutrients. “They’d be short of things like vitamin A, zinc,” he said, adding that rates of anemia and deficiency-related diseases are more common than those of SAD’s heart disease, diabetes, and obesity.
Headey explained that “we know very little about diets or how national strategies can change diets.” That applies to countries of any economic standing, as nearly all have either too little or too much of certain foods—but that hasn’t stopped governments from trying to shift and supplement dietary trends.
In underdeveloped countries, attempts have been made at using supplements and bio-fortification to make up for the micronutrients people are missing. “These micronutrient health deficiencies are hard to fix,” Headey said. Some countries are taking a bigger-picture view in changing agricultural policies themselves. If more micronutrient-rich foods are grown, the thinking goes, maybe they will become cheaper and easier for people to access. Then there’s the safety-net approach favored by industrialized countries where vouchers, food stamps, or other forms of “income” are given to people directly.
But how can governments improve when it comes to addressing public health through diet? As transitioning countries have shown, it’s easy for obesity or heart disease to replace vitamin deficiencies in a population. According to Headey, “A lot of dietary diversification in rich countries is potentially harmful.” Yet some countries have managed to develop their economy without ruining their traditional diets. South Korea industrialized earlier than other Asian countries, adding more meats and processed wheat into its diet as well as introducing fast-food restaurants in the country. Yet even as the dietary profile of the country has shifted, the obesity rates have remained below those of other countries, even those of a lower income or development rate.
Authors of a study on this phenomenon published in 2000 conjectured that one possible reason is “that movements to retain the traditional diet have been strong in South Korea.” Mass media and the government concurrently emphasized local foods as the Western diet crept into the country. Since 1980, for example, extension workers have given monthly public training sessions on traditional foods and how to make them, suggesting that it may be difficult for countries like the U.K. or the U.S. to campaign against sodium or trans fats without offering an alternative diet that’s culturally resonant.
Still, South Korea’s low obesity rate—currently 4 percent—has been rising and is expected to climb another 5 percent in the next decade.