In Reply: We agree with Drs Egger and Tapia Granados that economic downturns can produce specific health benefits, an effect partially attributable to transient reductions in risk behaviors such as smoking and alcohol consumption, as well as other changes such as reduced overtime work hours. The writers draw attention to the work of Ruhm, which provides further information.1
We do not believe that extreme experiences of German-occupied Europe or post–Soviet-era Cuba reliably inform our understanding of how US obesity prevalence may change in the coming decade. Barring profound disruption of food production and distribution, recession will not severely reduce the availability of calories in the domestic food supply, presently estimated to be about twice that required on a per-capita basis.2 Rather, we believe that the primary effect of financial stress will be on dietary quality, encouraging consumption of highly processed, commodity-based products over more nutritious but costly vegetables, fruits, and other whole foods. Previously, the cheapest foods tended to be calorie-poor whereas today they are calorie-dense, explaining in part the negative correlation between income and obesity in the United States (an historically unprecedented development). Economic pressure may also cause inexpensive sedentary pursuits such as television viewing to displace recreational physical activities, which, especially for urban populations, often involve transportation and other costs.