The Price of Nutrition: Can Household Food Budgets Support a Healthy Diet?

Abstract

Background: Access to nutritious food remains a major public health challenge in urban low- and middle-income settings, where economic barriers limit dietary adequacy. Despite growing awareness about nutrition, many households continue to consume energy-dense but nutrient-poor diets due to price constraints and limited affordability. Aims: To assess whether household food budgets are sufficient to support a balanced diet in low- and middle-income households in Kolkata using the Cost of the Diet (CotD) analysis. Methodology: A convergent mixed-method approach was employed, combining a cross-sectional household survey with embedded qualitative interviews. The study was conducted in Khidirpur, Kolkata over a two-month period from February to March 2025. Seventy households were purposively selected, and data were collected using a structured questionnaire that captured income, food expenditure, household size, and frequency of food group consumption. Qualitative questions assessed perceptions of diet quality, affordability, and openness to nutrition interventions. A market survey was conducted to record local food prices for 98 commonly consumed items. These prices were analyzed using the Cost of the Diet (CotD) software developed by Save the Children to model the minimum cost of four diet types based on nutritional adequacy. Food expenditure was then compared with modeled costs to determine affordability. The affordability ratio and affordability gap were derived for each household using descriptive analysis. Variables assessed included total income (independent), household size, and affordability gap (dependent). Descriptive analysis was conducted in Microsoft Excel. No formal inferential tests were performed. Results: The average household spent ₹5,535 (USD 66.61)/month on food. CotD analysis revealed the minimum cost of a nutritious diet for a 5-member household was ₹6,866 (USD 82.64)—representing 33.28% of monthly income, which exceeds average food budgets. Most households consumed cereals daily but had inadequate intake of fruits, vegetables, and proteins. Major barriers included high cost of nutritious foods (64.3%) and limited availability. A majority (82.9%) expressed interest in low-cost nutritious meal plans. Conclusion: The cost of a balanced diet often exceeds household food budgets, leading families to rely on cheaper, nutrient-poor diets. These findings emphasize the need for targeted food subsidies, nutrition education, and policy-level interventions to improve affordability and ensure dietary adequacy.