Families' diets have too much, and not enough

Eli Saslow / The Washington Post /


McALLEN, Texas — They were already running late for a doctor’s appointment, but first the Salas family hurried into the kitchen for another breakfast paid for by the federal government. The 4-year-old grabbed a bag of cheddar-flavored potato chips and a granola bar. The 9-year-old filled a bowl with sugary cereal and then gulped down chocolate milk. Their mother, Blanca, arrived at the refrigerator and reached into the drawer where she stored the insulin needed to treat her diabetes. She filled a needle with fluid and injected it into her stomach with a practiced jab.

“Let’s go,” she told the children, rushing them out of the kitchen and into the car. “We can stop for snacks on our way home.”

The family checkup had been scheduled at the insistence of a school nurse, who wanted the Salas family to address two concerns: They were suffering from both a shortage of nutritious food and a diet of excess — paradoxical problems that have become increasingly interconnected in the United States, and especially in South Texas.

For almost a decade, Blanca had supported her five children by stretching $430 in monthly food stamp benefits, adding lard to thicken her refried beans and buying instant soup by the case at a nearby dollar store. She shopped for “quantity over quality,” she said, aiming to fill a grocery cart for $100 or less.

But the cheap foods she could afford on the standard government allotment of about $1.50 per meal also tended to be among the least nutritious — heavy in preservatives, fats, salt and refined sugar. Now Clarissa, her 13-year-old daughter, had a darkening ring around her neck that suggested early-onset diabetes from too much sugar. Now Antonio, 9, was sharing dosages of his mother’s cholesterol medication. Now Blanca herself was too sick to work, receiving disability payments at age 40 and testing her blood-sugar level twice each day to guard against the stroke doctors warned was forthcoming as a result of her diet.

She drove toward the doctor’s office on the two-lane highways of South Texas, the flat horizon of brown dirt interrupted by palm trees and an occasional view of the steel fence that divides the United States from Mexico. Blanca’s parents emigrated from Mexico in the 1950s to pick strawberries and cherries, and they often repeated an aphorism about the border fence. “On one side you’re skinny. On the other you’re fat,” they said. Now millions more had crossed through the fence, both legally and illegally, making Hidalgo County one of the fastest-growing places in America.

“El Futuro” is what some residents had begun calling the area, and here the future was unfolding in a cycle of cascading extremes:

Hidalgo County has one of the highest poverty rates in the nation ... which has led almost 40 percent of residents to enroll in the food-stamp program ... which means a widespread reliance on cheap, processed foods ... which results in rates of diabetes and obesity that double the national average ... which fuels the country’s highest per-capita spending on health care.

This is what El Futuro looks like in the Rio Grande Valley: The country’s hungriest region is also its most overweight, with 38.5 percent of the people obese. For one of the first times anywhere in the United States, children in South Texas have a projected life span that is a few years shorter than that of their parents.

It is a crisis at the heart of the Washington debate over food stamps, which now help support nearly 1 in 7 Americans. Has the massive growth of a government feeding program solved a problem, or created one? Is it enough for the government to help people buy food, or should it go further by also telling them what to eat?

Blanca walked her children into the doctor’s office in the sprawling town of McAllen and they took turns stepping onto the scale: 110 pounds. Seventy-eight. Fifty-five. “Not perfect, but not so bad,” the doctor said. Then a nurse handed him the children’s blood work — a series of alarming numbers that lately read more like averages in this part of Texas. Clarissa needed to watch her sugar, he said. Antonio needed to increase the dosage of his cholesterol medication.

“Can I still eat hot Cheetos?” Antonio asked. “Just one bag a day?”

“Not anymore,” the doctor said.

“One a week?”

“No.”

The doctor set down his chart and turned to face Blanca. He had 17 more appointments on his schedule for the day — 17 more conversations like this one. The waiting room was filled with the children of Hidalgo County, 40 percent of them experiencing severe hunger at least once each month and 32 percent of them obese. His challenge was the same one that preoccupied so many in the Rio Grande Valley: How could families who had so little find ways to consume less?

“Either you address this now or it will be too late,” he told Blanca. “I can give you medicine, but that’s not the permanent solution.”

The legislative approach

There was a time when Terry Canales thought he knew the solution, and that solution could be accomplished through politics.

Canales, a 33-year-old Texas state representative, grew up outside McAllen, surrounded by the poverty and obesity he called “the double deaths” of Hidalgo County. He had waited in line at the area’s ubiquitous drive-thru convenience stores and watched people use their government Lone Star cards to purchase some of South Texas’s most popular snacks, paying $1 for hot Cheetos smothered with cheese or $2 for a Mexican snow cone covered with gummy bears and chili powder. He had seen children use food stamps to buy Red Bull energy drinks by the case, and he had seen some of those same children waiting in line at the medical clinic near his house where 28 people had diabetes diagnosed every day.

“We are slowly killing ourselves,” he concluded.

So, he took time off from his law practice in 2012 to run for office, spending $500,000 of his own money to win a job that pays $600 a month. He left his wife and three young children at home to spend each week at the Capitol in Austin, where he became one of several lawmakers across the country working to change what people can buy with food stamps.

Minnesota wanted to ban candy, New York City hoped to eliminate soft drinks and South Carolina wanted to rule out cookies and cakes. As a model, they heralded the U.S. Department of Agriculture’s own WIC program, which subsidizes the purchases of only a few hundred essential foods such as milk, cheese and baby formula for young mothers and children under 5. But no state had yet persuaded the USDA, which prohibits using food stamps only to buy tobacco and alcohol, so Canales decided to start smallest of all.

Instead of trying to regulate the estimated $2 billion in junk-food purchases enabled each year by food stamps, he wrote a bill to ban the food-stamp purchase of only one product. That was energy drinks — high in caffeine and higher in sugar, expensive and marketed to children despite offering little nutritional value.

“A no-brainer,” he explained as he introduced the bill in a committee meeting last summer.

Then he yielded the microphone and waited for rebuttals. The first critic was one he had anticipated, a lobbyist for the Texas Beverage Association, which desperately wanted all of its drinks available for sale to the fastest-growing market in America: the food-stamp market, which has quadrupled from $20 billion to $80 billion in the past 12 years. Companies such as Coca-Cola, Kraft and Mars have spent more than $10 million in the past several years lobbying Congress to keep their products available to those using food stamps.

But next came a litany of speakers Canales hadn’t expected. They were Democrats who shared his ideals and equaled his devotion in the fight against poverty. At previous committee meetings on his other bills, many of them had lined up to speak on his behalf.

“Better not to micromanage other people’s diets,” said the director of an interfaith organization.

“Opposed,” said the representative of a Texas food bank.

“Against,” said the head of an anti-hunger group.

For more than half an hour, Canales listened to their concerns about his bill and another proposed by a lawmaker who wanted to eliminate candy and chips: Should government really be in the position of telling adults what to eat? And if so, who would be trusted to sort through the 40,000 items sold in a typical grocery store and divide healthy from unhealthy? If energy drinks were banned, why not also ban canned iced coffee that has twice the caffeine and triple the sugar? Or Sunny D fruit drink? Or Gatorade? Or fruit punch? And once every product had been rated and sorted, what if some grocery stores decided it was easier not to accept food stamps at all? Or what if food-stamp recipients felt too stigmatized to shop?

Wouldn’t lawmakers be better off working to solve the problems of poverty rather than regulating them? How about funding programs for nutrition education, or encouraging more fresh produce in inner-city grocery stores, or building playgrounds and making streets safer so people would exercise? Why not focus on alleviating the stresses of poverty, which so many studies had linked to overeating?

The committee meeting ended without a vote on Canales’ proposal, and suddenly he, too, felt a little less sure. He did nothing to resurrect his bill over the next weeks, deciding instead to raise money for diabetes awareness and nutrition education.

“The more you learn in this job, the more complicated it gets to take a position,” he told his district director one evening a few months after the committee meeting.

“What do you want to do about it, boss?” the district director asked.

“I don’t ever want to pass a bill and end up regretting it,” he said. “Let’s teach people to make good choices and go from there.”

The education approach

Later that same afternoon, Luisa Colin and Jessica Rueda grabbed their nutrition brochures and their plastic vegetables and headed toward the Mexican border to do that kind of teaching. They had been working together for three years as nutrition educators, paid in part by the USDA to instill better eating habits in low-income families. Theirs was the government-sponsored solution.

“If only people had the basic knowledge,” Colin said.

“If they just understand their choices,” Rueda said.

The two women drove out of McAllen and into the desert until the paved roads gave way to gravel, and the gravel gave way to a roller coaster of irrigation ditches and rocks. Two miles from the border, they stopped at a collection of a few hundred ramshackle houses called Little Mexico where residents had built their own homes using drywall and scrap metal. The community had no running water and only intermittent electricity. Chickens wandered through the streets and a donkey stood in an intersection eating trash. Two children ran outside to greet them, and Rueda asked them in Spanish, “Is your mom home? I’d like to talk to her about something.”

Her job was to walk through the neighborhood and enroll women in nutrition classes that would improve their diets: better portion sizes, more dark green vegetables and whole grains, fresh fish instead of ground beef, at least 30 minutes of exercise each day. These were the tenets of their work. Research showed that every $1 spent on nutrition education saved the government $10 in future health care costs. But lately, the USDA had cut funding for nutrition programs by 25 percent and Congress was threatening cuts again. A dozen nutrition workers in Hidalgo County had been steadily reduced to six devoted women who worked 60-hour weeks to keep pace with the rising need. Now, in some of her conversations, Rueda’s goals had become more basic: to keep people nourished and living, she said.

“How is your nutrition?” she asked one woman in Spanish as they stood together at a front doorway missing its door.

“We eat what we can get,” the woman said.

“Do you ever eat vegetables?”

“Not much. Maybe beans, some salsa.”

“Do you exercise?”

“No.”

“Do you have a fridge?”

“Not anymore.”

The woman explained that she stored what little food she had in an icebox, and that the closest grocery store offering fresh produce was seven miles away. Nobody in Little Mexico exercised outside after 4 p.m., she said, for fear of the dogs and drug cartels that roamed the streets.

Rueda started to move on to the next house, but the woman called after her with a question of her own — one not covered in the six nutrition lessons, and the one Rueda heard most often in Little Mexico and the hundreds of places like it.

“Do you have any extra food?” the woman asked. “Anything?”

“Yes,” Rueda said. “We can bring you some.”

One meal at a time

If education had failed to break the cycle of poverty and obesity, and politics had failed to break the cycle, then the only solution left for one family at the center of the crisis was the most basic solution of all: to eat better, one meal at a time.

“It ends today,” Blanca Salas told her son, Antonio, after they came back from the doctor.

“I’m on a diet!” he said.

“Me, too,” she said.

She had attended a nutrition class earlier in the week, and now she held a sheet listing federally recommended foods in one hand while sorting through her fridge to take inventory with the other. She had already exhausted her food-stamp account for the month, and she had nothing else to spend until the next deposit arrived in a few days. This time she would receive about $30 less, like everyone on food stamps, because of stimulus funding that expired in November. She looked again at the list of recommended foods: fat-free cottage cheese, quinoa, bok choy, chickpeas and dozens of other items. Some she had never heard of; most she had never encountered in the dollar stores of South Texas.

She had been born in the United States in the last years when being poor also usually meant being thin. Her parents had lied about her age when she was 11 so she could get a job picking with them in the fields. They ate what they picked, raised their own chickens and boiled rice by the pound. But the sprawl of McAllen edged into the farmland, and Blanca dropped out of school in 10th grade and took a job at a Kentucky Fried Chicken. She had her first baby at 19 and her second a few years later, with a man who soon disappeared to Mexico. She applied for public housing in a community that offered little space to grow her own food, near a commercial road lined with 17 fast-food restaurants. Now, each morning on the way to school, her children rode past signs that advertised “Dollar Menu,” “Ultimate Dollar Menu,” “Dollar Tacos,” and “Hot Cheetos, two for a dollar.” These were the treats they loved and the treats they could afford.

For years, Blanca had tried to provide an antidote by forcing the children to sit nearby as she gave herself insulin shots. “You need to look at your future,” she told them. “Is this what you want?” She had tried planning a menu and cooking family dinners, but tailoring meals on a budget to the varied tastes of five children exhausted her. They would eat broccoli only if she slathered it with butter and cheese. They would eat Mexican mole sauce only if it came with a hulking side of tortilla chips. The prepackaged diet lunches she splurged on at $3.50 each sometimes came back from school with uneaten turkey and whole-wheat crackers.

As her health worsened, she had started shopping mostly for foods she knew they would eat and prepare themselves.

Now Antonio came into the kitchen looking for something to eat. “Make a smart choice,” she told him. She watched him grab a bag of Super Mario Brothers Fruit Flavored Snacks and a Coke Zero.

“Fruit and diet,” he said.

“Good,” she said.

They sat together in the living room, shoulder to shoulder on the couch while Antonio did math homework and ate his snack. Three o’clock came, and together they swallowed their cholesterol medication. Four o’clock came, and Salas pricked her thumb and tested her blood sugar. Five o’clock came, and she injected her next dosage of insulin.

“I’m hungry,” Antonio told her.

“Wait for dinner,” she said.

He sat next to her for a few more minutes on the couch, attempting to be patient, caught in the cycle that has confounded politicians and nutritionists and families in the Rio Grande Valley. Was it more hazardous to go hungry or to eat junk? The choice was left to a 9-year-old boy stuck in a culture that provided him both too much and far too little.

“I need to eat,” he said, and he walked back to the kitchen and opened the fridge.