Budget cuts knock down a ‘pillar of public health,’ ending nutrition education

Sixteen children tumbled into nutritionist Kelsey Davis’s cooking class on a hot July morning, some hugging their counselors, some high-fiving the other 9- and 10-year-olds. Full of energy and opinions, they took their seats in the YMCA classroom in Boston’s Roxbury neighborhood, ready for another lesson.

Davis asked them to name their favorite fast food restaurants and what they like about that food. McDonalds. Burger King. Popeyes. 7-11. Why? The fried and crunchy choices. And “the smell is something else.”

On this day’s menu were zucchini fritters and ranch dressing that they would make and eat, taking turns grating the vegetables, mixing the eggs and flour, combining the lemon and yogurt, and measuring the spices. Leavened into Davis’s directions were reminders of what fast foods and the sodas served with them may contain: unhealthy amounts of sugar, fats, and salt.

“Cooking can help you control those things,” she said.

The YMCA class is one example of SNAP-Education, an extension of the federal government’s Supplemental Nutrition Assistance Program. About 400 children participate in this particular program in Boston neighborhoods, while a total of roughly 1,100 individuals are also touched by the program’s Mobile Markets, where fresh food and education are available for families to choose.

Across the country, there is a common theme among educators: Telling people to eat healthier foods is one thing. Teaching them how to do it is another. 

It’s not enough to remove soda and over-processed foods from the products eligible for the federal government’s SNAP, experts told STAT. People also need to learn where they can find healthy foods and how to prepare them on the budget allowed by what used to be called food stamps. 

“That’s the role that education plays,” said Beverly Durgan, dean of the University of Minnesota Extension. Like other land-grant universities across the country, hers oversees SNAP-Education efforts throughout her state, from staffing teaching kitchens to improving food offered in child care settings to organizing ways to be physically active. “If you want people to make good choices, they need to know what those good choices are.” 

Children in YMCA Roxbury’s SNAP-Ed program grate zucchini for zucchini fritters. The students learned how cooking at home can be better than fast food.Billy Hickey for STAT

That has been the mission of SNAP-Ed, the companion program to SNAP benefits for people whose low income makes food security a challenge. But despite its documented success, the long-running educational effort whose goals align with the Make America Healthy Again movement has lost its battle to survive. 

The federal budget bill signed into law on July 4 balances lower taxes for the well-off with pared-back government programs for the poor, restricting access to health coverage through Medicaid and food assistance. For SNAP, that means more stringent work requirements for recipients and expanded cost-sharing with the federal government for states, including stricter penalties for local administrative errors. For SNAP-Ed, that means it will end with the fiscal year. 

SNAP-Ed, whose formal name since 2010 has been the Nutrition Education and Obesity Prevention Grant Program, brought nutrition education and obesity prevention programs to nearly 90 million Americans with limited income. Children and adults learn how to apply their limited dollars to more nutritious food and find ways to be more physically active, in line with the federal Dietary Guidelines for Americans.

The University of Minnesota Extension educated 180,000 people across the state last year, staffed by people who lived in the communities they served, partnering with farmers’ markets, food pantries called SuperShelf designed to allow more choice than traditional food banks, and tribal initiatives that made use of the university’s curriculum.

Physical activity was also part of the educational initiative, Durgan said.

Some SNAP-Ed educators have worked in their communities to find safe places to walk and create groups for people to walk together. Helping people make these changes in their lifestyles can ultimately improve lives, increase life expectancy, and reduce health care costs.

“That’s what education is,” Durgan said. “Doing by showing.” 

Across the country, similar programs offered instruction for cooking fresh foods from farmers’ markets to people whose only experience might have been preparing highly processed food.

Ingredients for zucchini fritters before a cooking class for children at a YMCA in Boston.Billy Hickey for STAT

“SNAP-Ed was the only part of the federal SNAP program that really tried to promote nutrition education and nutrition knowledge around SNAP participants so that they could better adhere to a healthier diet,” Cindy Leung, a nutritional epidemiologist and an associate professor of public health nutrition at Harvard T.H. Chan School of Public Health, said earlier this month during a media call after passage of the budget bill. “Even though the impact on SNAP-Ed may not be as large as reducing SNAP or, for example, imposing stricter work requirements, I do think there’s going to be some spillover effects.” She predicts that cutting education will make it harder to eat nutritionally on a limited SNAP budget.

Two congressional committees recently called SNAP wasteful, and one deemed SNAP-Ed’s activities “ineffective and duplicative.” The new budget, effective Oct. 1, “eliminates an Ineffective and Duplicative SNAP Nutrition Education Program,” the House Committee on Agriculture said, ending “a program that has yielded no meaningful change in the nutrition or obesity of SNAP participants, eliminating $536 million in annual spending wasted at the expense of the taxpayer.”

Public health experts disagree. 

Leung took issue with SNAP-Ed being described as duplicative, unaware of another program within SNAP that helps participants access a healthy diet. Erica Kenney, an associate professor of public health nutrition at Harvard’s Chan School, disagreed with blaming SNAP-Ed for failing to reduce obesity.

“It’s really not fair to expect SNAP-Ed, this relatively tiny little program, to be fixing this huge, huge problem of food insecurity,” Kenney said on the call. “It’s really unfair to say, ‘Oh, well, we haven’t seen a reduction in obesity. So we should get rid of SNAP-Ed.’”

In Minnesota, getting rid of SNAP-Ed means ending the jobs of 60 people who implemented the program in rural and urban counties.

Researchers reviewing national evidence dating to the 1990s concluded that “SNAP-Ed has earned its position as a pillar of the public health infrastructure in the U.S.,” they wrote in the Journal of Nutrition Education and Behavior. “The expansion of SNAP-Ed would enable the program to reach more Americans so that our nation can end hunger and reduce diet-related health disparities.”

The authors praised day-to-day education, citing a 2019 review of research that found program participants lived with increased food security after participating in the program. Then there’s an example of SNAP-Ed’s impact in emergencies. 

When water supplies in Flint, Mich., were contaminated by lead and disproportionately affected people served by SNAP-Ed, the program provided information on which foods might mitigate lead absorption and improve overall nutrition. Working with other federal programs, SNAP-Ed helped develop a “Nutrition and Lead” recipe booklet that was distributed to 10,000 families.

The money saved by SNAP-Ed’s elimination amounts to $5 billion through 2034, a Congressional Budget Office estimate predicts. The review article put it another way: The annual expense comes to $5.15 per person, or about the cost of one bag of oranges or potatoes.

Almost 20 years ago, Leung coordinated SNAP-Ed programs at the Alameda County Community Food Bank in Oakland, Calif., working with a registered dietitian to create recipes aligned with food available at 200 food pantries, churches, and other charitable resources.

“When we were doing SNAP-Ed in the community, it was holding workshops, it was holding classes, it was preparing educational materials on how to shop on a budget, how to read nutrition facts on labels, how to cook recipes,” Leung said. “There was also some community outreach that we did through SNAP-Ed, like campaigns around trying to eat more fruits and vegetables.”

Beyond nutrition education, the research-based efforts taught children how to cook, too, and helped day care programs deliver healthier options.

“It reaches beyond just SNAP participants, too, because it’s a mechanism for a lot of public health departments around the country to be able to actually offer these programs to the community,” Kenney said. 

Before passage of the budget bill, the U.S. Department of Agriculture had already cut the Local Food for Schools and the Local Food Purchase Assistance programs. While not part of the new budget, the USDA decision rankled Marion Nestle, a nutrition expert and professor emeritus at New York University. 

“These cuts were especially stupid because the programs did not cost much but were demonstrably a win-win,” Nestle wrote on her blog, Food Politics, in May. “Schools got fresh produce, and small farmers got paid.”

Harvard’s Leung pointed out that people don’t stay on SNAP forever, but when it’s available, the need is undeniable, based on the program’s success in the Covid-19 pandemic’s earliest days. When more people became eligible for expanded benefits in March 2020, the response exceeded predictions among public health experts, she said. Food insecurity fell by 9%, the Institute for Policy Research at Northwestern University reported, but rebounded in 2023 when the benefits ended, a study in Health Affairs concluded.

Students in the cooking class try their homemade zucchini fritters.Billy Hickey for STAT

“SNAP has been the main line of defense against poverty and hunger for decades,” she said.

Leung worries about what will happen once fewer people benefit from SNAP and SNAP-Ed. Food insecurity and low diet quality are associated with increased risk for multiple cardiometabolic diseases and, for older adults, a higher risk of cognitive impairment and dementia. “I think we’re going to see a lot of these conditions become exacerbated in populations with low incomes.”

What now?

States and charities can’t pick up the slack, although Durgan is holding out hope for some help in Minnesota. 

“We have over 700 partners that we work with throughout the state, and many of them have relied on our SNAP-Ed educators to help conduct classes, to help them with curriculum,” she said. “Hopefully we can continue to get volunteers or others that will continue these community gardens, but you know, I think what happens sometimes is when a program looks like this, you don’t realize the fabric and the network that has been built until that ends.”

Kenney was not optimistic.

“I’m sure we’re going to see a lot of very good-hearted, kind-hearted people stepping up and trying to volunteer and help their communities through the charitable food system, but I don’t think it’s going to be enough to counteract the cuts that we’re seeing,” Kenney said.

Leung struggles to see how cutting SNAP aligns with the MAHA agenda.

“It does seem very counterintuitive when you eliminate nutrition education funding, especially when that was such a very small percentage of the overall SNAP budget,” she said. “Because people need to have the knowledge and the awareness, as well as the accessibility to healthy foods, in order to be healthy and live a healthy lifestyle. So to me, it actually doesn’t fit in with the ‘Make America Healthy Again’ motto.”

In Massachusetts, the YMCA of Greater Boston “remains deeply committed to our neighbors’ access to healthy food and nutrition education,” the organization said in a statement. “This federal divestment certainly presents a challenge, but with unwavering commitment, new and existing local partners, and innovative solutions, we are actively exploring sustainable solutions to ensure we can continue our commitment to stability, health, and wellness for all.” 

Meanwhile, in Roxbury, some of the YMCA campers who are also cheerleaders clapped and stomped their feet to basketball cheers (“shoot that ball!”) while the fritters were sizzling. By the end, they had created a cheer for their teacher.

“Ay, ay, eat, eat, eat that food.”

And they did.

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.