Earlier this week, Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services, went on Fox Business to talk about U.S. government programs that provide low-cost or no-cost health insurance for elderly people, low-income people, pregnant people, and people with disabilities. The former physician and television host, with a long history of purveying false or unproven medical claims, brought a carrot cake on air to celebrate the 60th anniversary of Medicare. But he effectively told Medicaid and Medicare recipients that even if they had their own cake, they shouldn’t eat it, too.
“We’ll be there for you, the American people, when you need help with Medicaid and Medicare, but you gotta stay healthy as well,” Oz insisted. “Do the most you can do to really live up to your God-given potential to live a full and healthy life. Don’t eat carrot cake. Eat real food.”
Of all the treats to shame people for eating, then, carrot cake is a particularly ridiculous one for Oz to choose.
Now, I bake a lot of cakes. And carrot is my husband’s favorite. So, I can tell you that carrot cake is actually chock-full of so-called “real” food. The recipe I use includes two cups of grated carrots, 3/4 cup of applesauce, and two cups of chopped pecans, and I like to add a cup of raisins and sometimes pineapple, too. Between the vegetables, the fruits, the nuts, the flour and the cream cheese in the frosting, it basically covers the whole food pyramid — something I’ve joked about before.
Of all the treats to shame people for eating, then, carrot cake is a particularly ridiculous one for Oz to choose. Yet, when I take off my chef’s hat and put on my sociologist’s hat, I can’t say that I’m surprised at his comments. The U.S. has a long history of food shaming, and particularly of shaming the food choices of people who are poor.
For example, Dr. Elaine Hernandez and I have found in interviews with first-time pregnant individuals and their health care providers that Medicaid-serving prenatal clinics are required to screen patients for alcohol consumption. That leads those patients to be more wary about consuming alcohol during pregnancy than more privileged patients whose doctors never question them about alcohol. And sociologists Dr. Sinikka Elliott and Dr. Sarah Bowen have found that WIC and Medicaid providers use children’s diets as a proxy for whether they have “good” or “bad” moms, forcing parents to defend the food choices they make for their kids.
That shame and scrutiny might seem warranted. We know that lower incomes are linked to diets that are lower in fruits, vegetables, whole grains and vitamins, and higher in processed meat and fast food. Studies link such diets to a heightened risk of obesity, cancer and heart disease, including for children, who make up about 40% of Medicaid recipients.
Yet, shame and scrutiny are not always effective for changing people’s diets, and even nutrition education only goes so far. In our survey research, Dr. Brea Perry and I find that socioeconomically disadvantaged parents are more likely to give in to their kids’ food requests — like a request for a snack after school, or a request for a candy bar in line at the grocery store — than socioeconomically advantaged parents. Yet, we find that these differences are not explained by differences in parents’ nutritional knowledge, differences in how closely parents monitor their kids’ diets, or variations in the value parents place on good health. Instead, and consistent with what Dr. Allison Pugh finds in observations and interviews with families, we find that socioeconomically disadvantaged parents likely give in to their kids’ food requests out of the simple desire to give their kids a little joy.
We all deserve to have our cake and eat it, too.
These low-income families typically can’t afford to shower their children with real luxuries, like fancy vacations. They can’t even afford savings for college: programs like Supplemental Nutrition Assistance Program (formerly known as food stamps) come with asset limits, meaning that households generally can’t qualify for benefits if they have more than $2,750 in savings. And a recent survey shows that more than 40% of U.S. families with young children are struggling to afford basic expenses such as utilities, food, housing, health care and childcare.
Despite these challenges, low-income parents don’t want their children to feel different or less than. As Pugh finds, these parents often turn to food treats — like a slice of cake after dinner — as an affordable way to help their children feel like “normal” kids. And in the same way I’ve recently found myself stress-eating homemade cookie dough to get through particularly hard news days, there’s a good chance that if these low-income parents have a cake on hand, they’re cutting themselves a slice as a respite from the stress they’re facing in difficult moments.
So, shame on Dr. Oz for suggesting that Medicaid and Medicare recipients should avoid even the most meager of indulgences. Because we all deserve to have our cake and eat it, too. Especially when President Trump and his allies are putting the county on a metaphorical diet that falls so far short of meeting our basic needs.