This is a four-part series by National Health Journalism Fellow Caitlin Yoshiko Kandil. Find more articles in the series.
The 66 bus runs from Harvard Square to Dudley Square, connecting one neighborhood of culinary plenty to another of culinary dearth.
In Harvard Square, consumers can find nearly every kind of food: pizza, ice cream, coffee, tea, vegetarian, curry, burritos, falafel, pad thai, sandwiches, pasta, tapas, hamburgers, cupcakes, chocolate, fast food, healthy food and fancy food. Variety is the prevailing feature of Harvard Square's culinary landscape.
While diversity greets passengers on one end of the 66 bus line, monotony welcomes them on the other. In Dudley Square, food options are severely limited — fried food in the form of pizza, subs, chicken, doughnuts and Chinese dominate the area. With the notable exceptions of Haley House Bakery Café and Tropical Foods grocery store, fried fast food and convenience stores are the only choice for consumers.
Although the culinary differences between Harvard Square and Dudley Square — that is, between a high-income and a low-income neighborhood — are pronounced, "food desert," the commonly used phrase to describe food inequality, is not the best description of Dudley's shortcomings. After all, Tropical Foods offers fresh produce and other staples for a nutritious diet.
Instead, these neighborhoods are more aptly described as "food swamps," a term recently coined in the Archives of Internal Medicine to indicate an overabundance of bad food in contrast to the shortage of good food that the term "food desert" describes.
"In many disadvantaged communities," Drs. Jonathan E. Fielding and Paul A. Simon write, "the food environment is more swamp than desert, with a plethora of fast food; convenience stores selling calorie-dense packaged foods, super-sized sodas, and other sugar-loaded beverages; and other nonfood retail venues selling junk food as a side activity."
Dwight Morrison, a Dorchester resident who works in Dudley as a barber, described the swamp around his workplace. "The only place that's healthy around here is Haley House," he said. Everything else is "all greasy ... Here I feel like I'm doing something bad to myself by filling up with grease." Morrison explained that he used to buy his lunch every day, but has started to pack food as a way to be healthier.
The food swamp in Dudley Square mirrors patterns found throughout the country. For instance, researchers found that in New Orleans, predominantly black neighborhoods had nearly one more fast food restaurant per square mile than white neighborhoods.
Another national study of urban zip areas examined the availability of fast food restaurants in black zip codes versus white zip codes, and found that black areas had a higher proportion of fast food restaurants than white areas.
Although recent studies have pegged Boston and Massachusetts as relatively healthy places — Boston spends the least amount of money on fast food amongst major cities in the United States, and Massachusetts is the fourth slimmest state and has one of the highest rates of fruit and vegetable consumption in the nation — fast food consumption remains a critical obstacle to healthy eating.
In recent decades, patterns of American food consumption have changed dramatically. More meals are eaten outside the home and a larger portion of what people eat is unhealthy. While in 1970, money spent eating out accounted for just a quarter of all food dollars spent in the U.S., by 1999, eating out jumped to 47 percent of Americans' food budget. Fast food has increasingly become a staple in the American diet — one third of youth between the ages of 2 and 17, and one quarter of adults eat fast food every day. Nationwide, there are five fast food restaurants for every grocery store.
In addition to fast food, junk food, soda and other sugar-sweetened beverages, consumption is on the rise. Today, American children consume at least 30 percent of their daily calories from junk food, with soft drinks alone comprising 10 percent. Teens drink an average of 21 ounces of soda each day, compared to the average five ounces they consumed three decades ago.
But this overabundance in low-income communities of color does more than just make bad foods easily accessible. Writing in The New York Times, food guru Mark Bittman cites a study that finds eating too much fast food "triggers addiction-like neuroaddictive responses" in the brain. "In other words," he writes, "the more fast food we eat, the more we need to give us pleasure; thus the report suggests that the same mechanisms underlie drug addiction and obesity."
In his new book, "Eating Behavior and Obesity," Shahram Heshmat, a professor at the University of Illinois in Springfield, cites research claiming that the chronic temptation of palatable foods creates feelings of hunger. Food swamps, therefore, make bad foods easily accessible and highly desirable.
The allure of fast food has been demonstrated in a new study released a few months ago in the Journal of the American Medical Association. It concludes, "Fast food consumption was related to fast food availability among low-income respondents, particularly within 1.00 to 2.99 km of the home among men." The same study found no correlation between grocery store availability and fruit and vegetable consumption — meaning the pull of a fast food restaurant is stronger than that of a grocery store.
The harmful and disparate effects of food swamps are not just outside — they are creeping inside the home as well.
According to a report released by the Rudd Center for Food Policy and Obesity, black children see 56 percent more fast food advertisements than white children, and black teens see 46 percent more than white teens. A greater number of hours spent in front of a television accounts for some of the discrepancy in ad viewing between blacks and whites — but not all of it, since many ads are targeted specifically to African Americans, the study showed.
Black youth are not just seeing a greater number of fast food advertisements — they are also viewing more unhealthy foods. The report also calculated the number of calories depicted in each ad, and African American children ages 2-11 see 617 calories in each fast food ad, totaling 2,099 calories of fast food every day. White children in the same age group see significantly fewer calories in fast food advertising — 575 per ad and 1,160 each day.
"We're up against million dollar ad campaigns from fast food chains that are everywhere," City Councilor At-Large Felix Arroyo said when assessing the City of Boston's challenges in creating healthier communities. "You can turn on a TV, you look out your window, there are these billion dollar ad campaigns that are pushing these foods," he continued. "So that's what we're up against. We have to find a way to tackle that — to tackle that billion dollar industry."
And these marketing tactics work. In 2009, the top 20 fast food restaurants brought in $117 billion in sales. McDonald's topped the group with $30 billion in revenues.
The success of fast food is no accident. Dr. David Kessler, former commissioner of the U.S. Food and Drug Administration and current professor at the University of California San Francisco, explains in his book "The End of Overeating" that combinations of fat, sugar and salt are the most pleasurable to humans' brain chemistry and promote overeating — the more fat, sugar and salt people eat, the more they want to keep eating fat, sugar and salt. The food industry has perfected these combinations to make its products as seductive and profitable as possible.
Recounting a presentation on obesity he delivered to a room of food industry executives, Kessler recalls one of them admitting, "Everything that has made us successful as a company is the problem."
According to its own nutrition facts, a Big Mac, large French fries and a large Coca-Cola drink from McDonald's totals 1,350 calories — well over half the recommended daily calorie count. This meal also has 34 grams of fat and minimal nutritional value.
But the problem of junk food consumption is not easily solved through nutrition lessons alone — in underserved neighborhoods, fast food restaurants offer more than just food. For a group of older men in Roxbury, for example, the McDonald's on Warren Street near Dudley Square is a hangout spot.
Bernard Coulter, pastor of Macedonia Baptist Church, said that he stops by this McDonald's once or twice a week. He eats a fish sandwich, and on occasion, a cheeseburger. "I come here periodically to socialize with the older guys, my friends. The older guys come in and talk a lot of politics," he said. "It's a larger place and it's more comfortable because it's directly in Roxbury. All their friends come and they sit and talk and joke."
For Coulter and his friends, McDonald's is not just about the fat, sugar and salt, but about what is missing in their neighborhood — a comfortable place to sit and talk.
Jewel Vanderhoof, an elderly woman, echoed similar sentiments. Vanderhoof goes to McDonald's every day and typically buys coffee, a biscuit or yogurt. "I think it's pretty well run," she explained. "I've been coming a long time — since I retired — and they don't have too much in the way of problems here ... They keep it clean."
The culinary differences between Harvard Square and Dudley Square extend beyond the food available to customers. In Harvard Square, most restaurants offer spacious seating for guests, and many even have outdoor seating. The neighborhood also has several coffee shops and outdoor public areas where residents can hang out and talk comfortably.
In Dudley, however, these options are nowhere to be found. Seating — if any — is extremely limited in each restaurant and space in general is tight. None have outdoor seating and there are no coffee cafes.
Of course, not all McDonald's customers are like Coulter or Vanderhoof. At the McDonald's off Dorchester Avenue near the Fields Corner T stop, dozens of customers rushed in at lunch time, and most did not sit down to eat. But again, the built environment seemed to be at play — the restaurant is bright, clean and inviting, compared to the America's Food Basket grocery store just a few steps away that is dirty and dingy.
The food swamp therefore, is a problem far more complex than just nutrition — fat, sugar and salt pull consumers in, while the built environment pushes them in the same direction.
Until both forces are remedied, customers like Coulter will continue going to McDonald's. Coulter, who teaches in addition to his pastoral duties, also uses the restaurant as an office. "I have a lot of my school work material, I sit down and go over my notes," he said. "It's comfortable and I can see a lot of people I know."
Next week's installment will address solutions to the challenges in Boston's food landscape. This series was funded by the University of Southern California National Health Journalism Fellowship.