Academy Comments to FDA re Enhancing Retailer Standards in the Supplemental Nutrition Assistance Program

May 18, 2016

Vicky Robinson
Chief, Retailer Management and Issuance Branch
Retailer Policy and Management Division
Food and Nutrition Service, U.S. Department of Agriculture
3101 Park Center Drive, Room 418
Alexandria, VA 22302

Re: Enhancing Retailer Standards in the Supplemental Nutrition Assistance Program (SNAP); Request for Information and Comments (Docket No. FNS-2016-0018)

Dear Ms. Robinson,

The Academy of Nutrition and Dietetics (the "Academy") appreciates the opportunity to submit comments to the Food and Nutrition Service (FNS) of the United States Department of Agriculture (USDA) regarding its proposed rule for "Enhancing Retailer Standards in the Supplemental Nutrition Assistance Program (SNAP)." Representing over 90,000 registered dietitian nutritionists (RDNs),1 nutrition dietetic technicians, registered (NDTRs), and advanced-degree nutritionists, the Academy is the largest association of food and nutrition professionals in the United States and is committed to improving the nation's health through food and nutrition across the lifecycle and work to ensure that all Americans have access to a healthy, safe food supply by leading efforts to reduce food deserts and food swamps and by delivering effective nutrition education programs.

Subject to certain qualifications, the Academy supports 1) enhanced retail product stocking standards and 2) enhanced retailer standards, contingent on limiting adverse effects on access, which would exacerbate the transportation difficulties already faced by many SNAP participants. Such proposals would assist the administration and enforcement of the Food and Nutrition Act (the "Act"), particularly in effectuating its purpose "to provide for improved levels of nutrition among low-income households."2 Notably, although "SNAP is working to reduce food insecurity"3 dietary quality remains an ongoing and critical concern.

A. SNAP, Food Insecurity, and Dietary Quality

SNAP is the nation's largest federal domestic nutrition assistance program, and provides 45.4 million Americans of all ages, races, ethnicities, and geographic locations with critical support to purchase food for themselves and their families. In 2015, the average SNAP client received a monthly benefit of $126.39, and the average SNAP household received $256.11 monthly. SNAP benefits have proven to be one of the most important safety nets across the United States. Almost 90% of SNAP households live below the poverty line, and about 40% of SNAP households have incomes less than half of the poverty line. At the same time, SNAP reduces the likelihood of being food insecure by 30% and being very food insecure by 20%. Yet while SNAP helps to reduce hunger and food insecurity, research has found that SNAP participants still consume fewer fruits, vegetables and whole grains, and more added sugars than those with higher incomes and those with low incomes who do not participate in SNAP.4

SNAP is a critically important tool for addressing the crisis of food insecurity and its sequelae among one of the most vulnerable populations in America. Thus, an effective and efficient SNAP program is essential to fulfilling mandates to improve dietary quality, reduce the epidemic of overweight and obesity and enhance overall health in this underserved population. The Academy acknowledges the importance of improving food security, which is independently associated with both important nutrition and non-nutrition outcomes, including:

  • inadequate intake of key nutrients; poor physical and mental health in adults and depression in women;
  • overweight and weight gain (especially among women from marginal and low food security households);
  • adverse health outcomes for infants and toddlers;
  • behavior problems in preschool-aged children;
  • lower educational achievement in kindergarteners; and
  • depressive disorder and suicidal symptoms in adolescents.5

As average food security improves, improving dietary quality among SNAP participants becomes an increasing priority, given the correlation of poverty and lack of food access to higher incidence of obesity and chronic disease, including type 2 diabetes, cardiovascular disease, hypertension, chronic renal failure and other poor health outcomes.6 Risk factors for these conditions are exemplified by dietary shortfalls (e.g., fewer fruits, vegetables and whole grains) and excesses (e.g., more added sugars, especially in the form of sugar-sweetened beverages).7 Other research shows deficits in seafood and plant protein intake as well.8 The Academy is committed to improving the nutritional intake of all Americans, and supports efforts to align SNAP with the Dietary Guidelines for Americans (DGA) and SNAP's statutory purposes.

The recently issued DGA offer substantial guidance to improving SNAP standards to effectuate the DGA's purpose to "help all individuals ages 2 years and older and their families consume a healthy, nutritionally adequate diet."9 Most importantly, "[t]he information in the Dietary Guidelines is used in developing Federal food, nutrition, and health policies and programs. It also is the basis for Federal nutrition education materials designed for the public and for the nutrition education components of HHS and USDA food programs."10

Among the DGA key points is a distinct focus on "nutrient-dense" foods which "contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects"11 while also containing relatively few calories. This includes

  • a variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other;
  • fruits, especially whole fruits; and
  • grains, at least half of which are whole grains.12

This approach aligns closely to the dietary shortfalls and excesses documented in SNAP and low-income populations. Additionally, "large servings of foods or beverages high in solid fats, added sugars, sodium, or alcohol are not compatible with the [DGA]."13

B. Staple Foods and Accessory Foods

The Academy supports FNS's proposal to clarify the meaning of staple foods and accessory foods to promote healthier options and provide better access to foods consistent with the food patterns outlined in the 2015 Dietary Guidelines for Americans. Congress and regulators have long recognized the difficulty in defining specific foods to include or exclude from SNAP and its predecessors. One commentator recalls that "[a]s it drafted the 1977 bill, the House Committee on Agriculture considered and rejected an amendment to eliminate foods with negligible or little nutritional value, deciding that efforts to define and prohibit ‘junk food' were too complex."14 However, FNS's proposed rule here will help fulfill the purpose of SNAP to improve the nutrition of beneficiaries and do so in a relatively administratively simple manner.

We emphasize that it is only the (well-documented) administrative complexity of categorizing all the various, constantly changing food items as either eligible or ineligible that has precluded strong regulatory action in this area, not any specific statutory language. Indeed, in finding it acceptable to eliminate certain stores (i.e., those that did not primarily sell staple foods15) from the program altogether, the Third Circuit held that the purposes of the program were highly relevant:

"These criteria must be read, however, in light of the purposes of the program to raise levels of nutrition and to eliminate hunger and malnutrition. Thus, the quality and character of the food sold in exchange for food stamp coupons is pertinent to the determination whether a participant furthers these ends."
-Webb v. Berglund, 621 F.2d 594 (3d Cir. 1980), citing 7 U.S.C. § 2011 (Supp. II 1978).

Defining staple foods as "food items intended for home preparation and consumption in each of the following four categories: Meat, poultry or fish; bread or cereals; vegetables or fruits; and dairy products" is easily understandable and ensures retailers stock the essential items for home preparation of food. It is the Academy's position that "programs that target increased consumption of fruit, vegetables, whole grains, and low-fat dairy products are needed to reduce future risk of chronic diseases."16 Further, it is the position of the Academy that RDNs and NDTRs can contribute to the goal of reducing food insecurity in the United States by "[a]dvocating that stores accepting the Supplemental Nutrition Assistance Program have nutrient-dense offerings for clientele."17

The Academy recognizes that "[w]hen parents and food providers have demanding work schedules, such as long hours away from home or evening shifts, they often cope with time challenges by using more takeout meals and precooked entrees and missing family meals."18 Commercially processed and multiple ingredient meals can be important time-saving options for many families, but under the proposed definition these foods would still be eligible for purchase using SNAP funds.

However, the Academy encourages emphasis on home-prepared meals as the best and most practical way to increase nutrient density while limiting items higher in fat, sugars, and sodium. Such an approach is also consistent with the SNAP nutrition education component and enhances the self-reliance of SNAP participants while minimizing intake of carryout, restaurant and heavily-processed and instant foods which tend to dominate dietary patterns of low-income populations. Thus, we strongly support the proposed definition of "staple foods" that encourages home preparation and consumption of foods, which positively impacts dietary quality and is consistent with the DGA:

  • Widome and colleagues "found that, compared to food secure youth, food insecure youth consumed a greater percentage of energy from fat, ate fewer family meals and breakfasts, had less food availability at home, and perceived greater barriers to eating a healthful diet. Therefore, the authors suggested that interventions aimed at eliminating barriers to healthful eating would be prudent."19
  • "According to a study conducted at the University of North Carolina at Chapel Hill and published in the August 2011 issue of the Journal of the American Dietetic Association, eating location and food source significantly impact daily energy intake for children. Foods prepared away from home, including fast food eaten at home and store-prepared food eaten away from home, are fueling the increase in total calorie intake."20
  • "Additional strategies [to lower sodium intake] include eating at home more often; cooking foods from scratch to control the sodium content of dishes; limiting sauces, mixes, and ‘instant' products, including flavored rice, instant noodles, and ready-made pasta; and flavoring foods with herbs and spices instead of salt." 21
  • "Mixed dishes—including burgers, sandwiches, and tacos; rice, pasta, and grain dishes; pizza; meat, poultry, and seafood dishes; and soups—account for almost half of the sodium consumed in the United States. The foods in many of these categories are often commercially processed or prepared."22

C. Stocking Standards

The proposed rule changes in retailer standards will improve SNAP recipient access to a variety of healthy food options by allowing FNS to ensure that retailers authorized to participate in SNAP as retail food stores stock food items that are consistent with the purposes of SNAP. The proposed changes reinforce the purpose of SNAP, which supports participants in using their benefits to purchase more nutritious foods intended for home preparation and consumption. In light of the recently-published research referenced above contrasting improvements in food security with dietary quality, incentivizing retailers to increase their stock of nutrient-dense foods is an essential tool that can directly improve SNAP participants' dietary quality, and should not be dismissed.

Many communities do not have well-stocked traditional grocery stores or other stores with an extensive and affordable array of high-quality and culturally-appropriate foods. The problem of access to well-stocked stores is compounded by several factors: 1) the inadequate transportation resources and options many low-income people face; 2) the increased weight and bulk of many healthy foods (e.g., produce) compared to processed and packaged items substantially increases the difficulty of transport under any circumstance (except for perhaps, a private vehicle); 3) the time constraints they face (even while the program's benefit allotment assumes unreasonable amounts of time to purchase and prepare food); 4) the age, disabilities and other mobility limitations of many beneficiaries; and 5) the lack of cooking resources many face.

The Academy is concerned about access for low-income consumers, particularly in food desert areas, and for all shoppers with mobility issues, such as those who are elderly, have disabilities, and/or lack affordable transportation. We caution the Department against implementing regulations that would cause stores to drop out of SNAP and lessen food access, particularly for these particular SNAP consumers. To that end, we encourage FNS to consider a phased implementation approach, perhaps with the first phase to include WIC retailers, who are likely to meet many of the proposed requirements already.

We also urge the Department to carefully consider the potential undue impacts of the proposed rule on retailers operating in "shared space" environments, and to revise the language to avoid adverse impacts on food access for SNAP participants while ensuring retailers are complying with the intent of the rule.

D. Importance of SNAP Ed and Technical Assistance

The Academy recommends maximizing SNAP Ed as a valuable resource guiding principle of the SNAP Ed Program is to provide learning experiences "designed to facilitate voluntary adoption of food and physical activity choices and other nutrition related behaviors conducive to the health and well-being of SNAP participants...."23 According to a USDA Report to Congress, "the Nation's investment in nutrition education is important to further improve diets and promote health among low-income Americans."24 Shopping practices commonly taught in SNAP-Ed (e.g., reading nutrition labels, shopping with a list) are associated with more nutrient-dense purchases among SNAP participants.25

Significant, individualized and ongoing Technical Assistance for small retailers is necessary to effectively implement the proposed rule. Recent findings from implementation of the Healthy Neighborhood Store project suggest that healthy foods can be promoted by "facilitating successful relationships or partnerships between storeowners and key stakeholders," including registered dietitian nutritionists throughout implementation and on an ongoing basis.26 The Partnership for a Healthier America (PHA) has brokered a number of commitments with convenience stores and other similar outlets to increase access to healthier foods. To date, PHA has commitments with Kwik Trips, Vintners Inc., Walgreens, Sheetz, U-Gas, and Twice Daily to sell and promote healthier options. Specifically, stores have committed to increasing the variety of healthy foods including fruits and vegetables, low-fat dairy products and whole grain items, providing pricing that incentivizes the purchase of the healthier items, and marketing and promoting the healthier items.27 We encourage FNS to work closely with retailers, educators, and industry to identify ways to ease the burden of implementation and encourage the purchase and consumption of nutrient dense foods in SNAP.

E. Conclusion

The Academy appreciates the opportunity to comment on the proposed rule to enhance retailer standards in SNAP. We are happy to discuss these recommendations in greater detail in the near future. Please contact either Jeanne Blankenship at 312-899-1730 or by email at jblankenship@eatright.org or Pepin Tuma at 202-775-8277 ext. 6001 or by email at ptuma@eatright.org with any questions or requests for additional information.

Sincerely,

Jeanne Blankenship, MS, RDN
Vice President
Policy Initiatives and Advocacy
Academy of Nutrition and Dietetics

Pepin Andrew Tuma, Esq.
Senior Director
Government & Regulatory Affairs
Academy of Nutrition and Dietetics


1 The Academy approved the optional use of the credential "registered dietitian nutritionist (RDN)" by "registered dietitians (RDs)" to more accurately convey who they are and what they do as the nation's food and nutrition experts. The RD and RDN credentials have identical meanings and legal trademark definitions.

2 7 U.S.C. § 2011 (2015).

3 Godoy M. How America's Wealth Gap Shows Up On Our Dinner Plates. National Public Radio: The Salt citing Andreyeva, T, et al. Dietary Quality of Americans by Supplemental Nutrition Assistance Program Participation Status. Am J Prev Med. 2015 Oct;49(4):594-604.

4 Ibid.

5 Stang J, Bayerl CT. Position of the American Dietetic Association: child and adolescent nutrition assistance programs. J Am Diet Assoc. 2010;110(5):791-99.

6 Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010;140(2):304-10.

7 Godoy M. How America's Wealth Gap Shows Up On Our Dinner Plates. National Public Radio: The Salt citing Andreyeva, T, et al. Dietary Quality of Americans by Supplemental Nutrition Assistance Program Participation Status. Am J Prev Med. 2015 Oct;49(4):594-604.

8 Nguyen BT, et al. The Supplemental Nutrition Assistance Program and dietary quality among US adults: findings from a nationally representative survey. Mayo Clin Proc. 2014 Sep;89(9):1211-9.

9 U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015.

10 Ibid. (Emphasis added.)

11 Ibid.

12 Ibid.

13 Freeland-Graves JH, Nitzke S. Position of the academy of nutrition and dietetics: total diet approach to healthy eating. J Acad Nutr Diet. 2013;113(2):307-17..

14 Nicole Pepperl, "Putting the ‘Food' in Food Stamps: Food Eligibility in the Food Stamps Program from 1939 to 2012" (April 2, 2012).

15 See, Implementing the Food Stamp Act of 1977, 43 Fed. Reg. 43274 (1978) (codified at 7 C.F.R. § 271.2).

16 Stang J, Bayerl CT. Position of the American Dietetic Association: child and adolescent nutrition assistance programs. J Am Diet Assoc. 2010;110(5):791-99.

17 Holben DH. Position of the American Dietetic Association: food insecurity in the United States. J Am Diet Assoc. 2010;110(9):1368-77.

18 Freeland-Graves JH, Nitzke S. Position of the academy of nutrition and dietetics: total diet approach to healthy eating. J Acad Nutr Diet. 2013;113(2):307-17, citing Devine CM, Farrell TJ, Blake CE, et al. Work conditions and the food choice coping strategies of employed parents. J Nutr Educ Behav. 2009;41(5):365-370.

19 Holben DH. Position of the American Dietetic Association: food insecurity in the United States. J Am Diet Assoc. 2010;110(9):1368-77., citing Widome R, Neumark-Sztainer D, Hannan PJ, Haines J, Story M. Eating when there is not enough to eat: Eating behaviors and perceptions of food among food-insecure youths. Am J Public Health. 2009;99:822-828.

20 "Trends in energy intake among US children by eating location and food source, 1977-2006" by Jennifer M. Poti and Barry M. Popkin, PhD. It appears in the Journal of the American Dietetic Association, Volume 111, Issue 8 (August 2011).

21 U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015.

22 U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015.

23 SNAP-Ed Guiding Principles. March 29, 2014. Accessed May 12, 2016.