When I saw that the lettuce that is sold here is expensive AND the size of the lettuce we put on hamburgers at home, it immediately made me want to know more about the Filipinos perception and consumption of vegetables.
I had wishful thinking when I was making my grocery list on the plane. My list looked like what I would have bought at home: Salad with chicken, avocados with pepperonis, fresh fruits, BLT lettuce wrap, etc. I still have seen an avocado regardless of how many grocery stores I’ve been to, there are not fun salad toppings like the ones I would have chosen at home, and then the lettuce made me shove my shopping list in my pocket and take another route to my grocery shopping plan.
The picture of lettuce above would have cost almost ~1$ (45 pesos) in the US and would not have been hardly enough to make one salad. Notice the corn in the picture above to give you a frame of reference to how small the lettuce is. So trying to encourage a family of 6 to eat salads for dinner, it wouldn’t have been affordable! My bottle of water from this fancy coffee shop I am sitting in was 45 pesos. If you wanted Romaine lettuce, that’s even more expensive and not much more in quantity. Now take a look at what we can get at HEB at home.
About the same cost for probably 4 times the amount!
Why does this matter? Because we will need to find a way to counsel about healthy nutrition, but what is we told our patients “eat salad and cook with olive oil”. We would probably get nods, but inside they’d laugh at us because of how expensive those items are here! Olive oil was 200-500 pesos. That is more than a days wage for some of our patients.
Now I understand why my research said the Filipino consumption per capita of vegetables only averages 22kg/yr when compared to the Food and Agriculture Organization (FAO) recommendation of 146-182 kg/yr.
It's not affordable!
Then the next question I asked was to know what all the options were for our patients to buy groceries? Were they more likely to travel to the grocery store like we were in or were there more accessible options, what was available to them and the associated cost?
The most accessible option would be the Sari Sari store. These are storefronts built into the front of people's homes in the middle of neighborhoods or regular shops in the market. This was mostly chips, cookies and canned food. All items high is sodium, sugar and fat. There was rice and hygiene products as well.
Another diet suggestion that came to mind from seeing how my mother modified her diet was to recommend Brown Rice, but in none of these accessible options provided that option. And the cost difference was quite drastic (80 pesos per KG for brown rice VS 49-55 pesos per KG for white rice).
Next my cousin told me about the mobile stores that are the equivalent of the produce that is sold on the side of the roads occasionally at home or often in foreign countries. The selection of produce looked to be a good variety and the price were typically about 10 pesos cheaper than the grocery store. There was even meat options!
Then there are the “wet markets”. It is like a flea market, but for food. As you navigate the maze, you’ll pass vendors that specialize in just fruit or a type of meat/fish, or vegetables. Here is a great example of up-charing foreigners: When I asked how much their lettuce was, guess how much? 240 pesos vs the 160 in a grocery store!
Then I stumbled across some beautiful and lush batchoy (which was my favorite!) and asked how much for it? She said 50 pesos and I thought compared to the last ladies quote that this lady was being honest and I appreciated that! But turns out Batchoy must be really affordable there because she did triple the cost from what it was at the grocery store (16 pesos) hahaha
So where do studies show that our Filipino patients shop at? 58% access through a nearby small retail shop; 52% obtain food from their own gardens or backyards, 47% purchase from wet markets; 17% consume from own harvest; and only 16% buy from a grocery shop
When I my cousins about the perception of eating salad, they said that it is what the socialites and rich people eat. Then my internet research said “Some Filipinos consider vegetables as a poor man’s diet and thus usually opt to purchase meat and meat-based products as a status symbol. Even if convinced of health benefits, some households still opt to consume fewer vegetables as these require more preparation and have short shelf life.”
Regardless, it shows me that teaching nutrition to our patients is going to be a challenge, but a challenge accepted.
Now that I know what is affordable and attainable from near shopping sources, next will be to develop out culturally relevant recipe suggestions that do not rely heavily on salt like most of the current veggie recipes here do.