The Nutrition Society Paper of the Month for December is from Public Health Nutrition and is entitled: ‘The economic burden of inadequate consumption of vegetables and fruit in Canada’. Authors: John Paul Ekwaru, Arto Ohinmaa, Sarah Loehr, Solmaz Setayeshgar, Nguyen Xuan Thanh, Paul J Veugelers.

Despite the issuing of public health recommendations to reduce the burden of chronic diseases, Canadians are still not meeting recommendations for vegetables and fruit consumption, physical activity, body weight, and tobacco use. When issuing such recommendations, public health decision makers consider health benefits along with associated financial implications.

While estimates exist for the economic burden of other lifestyle risk factors, estimates of the economic burden associated with our diet are rare. In response to this gap, and in light of recent studies revealing that nearly 75% of Canadians are not meeting daily recommended vegetables and fruit servings, our study estimated the economic burden attributable to the inadequate consumption of vegetables and fruit in Canada.

We took an approach called the population-attributable fraction with a societal perspective. Using this approach, we considered the consumption of vegetables and fruit by Canadians, the risk that inadequate consumption poses for chronic diseases, and the direct costs for the treatment and management of these diseases (e.g., hospital care, physician services, medication) and indirect costs due to productivity losses. We accessed the Canadian Community Health Survey (CCHS) to complete this analysis. CCHS is a large cross-sectional survey that collects information about health status, health care, and health determinants, including diet, from the Canadian population. It has been collected annually since 2007.

We found that about 80% of women and 89% of men consume inadequate amounts of vegetables and fruit, resulting in an economic burden of $CAN 3.3 billion per year. Direct health care costs accounted for 30.5% of this total; indirect costs accounted for 69.5%. These avoidable costs translate to $CAN 92 per capita per year. This is equivalent to 36 dollars for each daily serving short of the recommended amount. For example, an adult woman is recommended to consume 7 servings of vegetables and fruit per day. If her actual consumption is 4 servings per day, she adds, on average $CAD 108 per year to avoidable health care costs.

An annual reduction of a single percentage point in the prevalence of inadequate consumption of vegetables and fruit over the next 20 years would avoid almost $CAN10.8 billion. An increase of one serving of vegetables and fruit per day would avoid approximately $CAN 9.2 billion.

Our results highlight the importance of further investments in the promotion of vegetables and fruit intake to prevent chronic disease and substantially reduce the associated costs to society.


The full paper ‘The economic burden of inadequate consumption of vegetables and fruit in Canada’ is freely available until the 14th January 2017.

Nutrition Society Paper of the Month
Each month a paper is selected by one of the Editors of the five Nutrition Society Publications (British Journal of Nutrition, Public Health Nutrition, Nutrition Research Reviews, Proceedings of the Nutrition Society and Journal of Nutritional Science).

Take a look at at the entire Nutrition Society Paper of the Month collection



  1. One has to take into consideration also that the sugars in the fruits, and even vegetables, are so high nowadays that if one would eat 7 servings of fruits or sweet vegetables, then it would add on other health costs such as costs for diabetes… It is dangerous not to not look at the whole picture.

    1. Anna, wake up!!! it is ridiculous. Diabetes because of seven portions fruit and veg a day? So better fast food and sugar packed cereals and drinks? Most of the people who fail to eat fruit and veg are going exactly that direction. In the UK 1 portion is – 80g. seriously? Who cannot eat few portions of that a day?

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