A recent Government Accountability Office (GAO) report concluded that the United States Department of Agriculture’s (USDA) nutrition education efforts lack clear evidence of effectiveness. The findings were strikingly similar to a 2004 GAO report, and they underscore the challenges of improving dietary choices and reducing obesity among low-income populations through the federal government. Costing almost $1 billion per year, the USDA’s education programs are poorly coordinated and possibly ineffective, as questions remain about whether these programs have lasting effects on the health of children and their families. The latest GAO report should therefore prompt federal policymakers to reexamine nutrition education programs in the USDA, perhaps consolidating them into one federal agency, such as the Centers for Disease Control and Prevention (CDC).
The USDA administers a number of food assistance programs for low-income families, such as the Supplemental Nutrition Assistance Program (SNAP), the National School Lunch Program, and the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC). Less known are the several nutrition education programs aimed at improving dietary choices among food assistance recipients, with one of the largest being SNAP-Ed at $404 million per year.
SNAP-Ed mostly funds direct education to low-income children and adults, such as lessons in the classroom about eating more fruits and vegetables. SNAP-Ed also funds marketing and policy, system, and environment interventions aimed at changing how the food system works to support healthier eating, but these efforts are small and not well studied in the context of SNAP-Ed. Although direct education gets the bulk of funding, the GAO’s review noted the particularly weak evidence for it in SNAP-Ed:
Without information that can be compared across states or easily aggregated or reviewed nationwide, USDA is unable to assess the effectiveness of interventions used across the country to determine whether SNAP-Ed is achieving program goals.
In the absence of evidence across programs, one would hope that strong evidence of effectiveness exists for individual programs. But results from a 2012 USDA-sponsored impact evaluation of five SNAP-Ed programs found little:
While none of the three child-focused demonstration programs resulted in a statistically significant impact on the key outcome of interest, average daily at-home fruit and vegetable consumption combined, the evidence suggests that all three interventions influenced mediating factors such as in-home availability of fruits and vegetables and parental offerings of fruits and vegetables for snacks or at dinner.
And similar results were found in a second wave of the SNAP-Ed study released in late 2013. Individuals in some programs made positive gains in dietary knowledge and behaviors immediately after participating in nutrition education classes. But as often is the case, researchers found no evidence that the efforts influenced long-term behaviors or affected nutrition and obesity in any meaningful way.
Childhood obesity remains a major public health problem in the United States and has lasting effects on health and productivity in adulthood. Almost 1 in 5 children were obese as recently as 2016; a trend that has steadily increased since at least 1999. And the prevalence of obesity is highest among low- and middle-income children.
Congress had an opportunity in the 2018 Farm Bill to makes some needed changes to the USDA’s nutrition education programs, but political compromise watered down these efforts. The House-passed version of the 2018 Farm Bill proposed combining the nutrition education programs within the USDA, but this measure was abandoned in the Senate-passed version. In the end, SNAP-Ed was reauthorized at consistent funding levels through 2023 with the conference committee report toning down expectations. From the conference report, members “expect both States and partner organizations to make improvements to the evaluation process of their SNAP-Ed programs and to leverage evaluation results to deliver nutrition education in the most effective manner.”
Although too late for the 2018 Farm Bill, the GAO report made three recommendations for future consideration:
[I]mprove how [the USDA] gathers information on SNAP-Ed effectiveness, develop a formal mechanism for coordinating nutrition education across the department, and take steps to fully leverage the department’s nutrition expertise for its nutrition education efforts.
These steps could help marginally improve nutrition education offered by the USDA. But Congress should also reexamine whether the USDA is the best agency to house nutrition education at all. The CDC funds similar programming and has demonstrated the capacity to rigorously evaluate their nutrition and obesity prevention efforts, offering Congress a viable alternative. Undeniably, Congress rarely consolidates duplicative programs, especially when they are administered by separate agencies under the jurisdiction of different Congressional committees. But nutrition and obesity prevention efforts are not working well under the existing structure. Low-income children and their families deserve better.