Cindy Thompson, a single mom in Glen Burnie, Md., knows that struggle all too well.
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Last year, she was spending about $160 a week on groceries for herself and her two teenage boys. Now, that weekly register receipt is running more than $200. Thompson has made several changes to keep her family eating right -- that means not living off macaroni and cheese.
Her boys love to drink fruit juice, but instead of buying Capri Sun, she buys a concentrate and keeps it in a pitcher in the fridge -- with a little extra water mixed in.
"They still get fruit juices, but not in the cute little packages," Thompson said.
The family is also buying a larger percentage of its food at the local Wal-Mart, instead of grocery stores.
"It's annoying, because it's packed," Thompson said, "but the food prices tend to be a little bit better."
She also tries to consolidate trips to the store, buy items in bulk and do things like buy extra bread and freeze it.
But the biggest change is in the backyard.
"Since fresh produce was always the first thing to fall off my grocery list," Thompson said she decided to plant a garden.
She now grows lettuce, spinach, cucumbers, carrots, radishes, tomatoes, green beans, lima beans, zucchini and squash. She also invested in an apple tree, a pear tree and some blueberry bushes.
"I'm planting only those items I know my family will eat," Thompson said, "and will be freezing and canning to help ease the burden throughout the winter."
Schools, Hospitals Skimp on Meals
School cafeterias struggle to continue offering nutritious meals without overwhelming school budgets.
The federal government's 2005 dietary guidelines for Americans, which schools use to plan their meals, encourages the consumption of fruits, vegetables, low-fat dairy and whole grains.
"Unfortunately, those are a lot of the same food items that we're seeing tremendous price increases on," said Eric Peterson, a spokesman for the School Nutrition Association. "It's definitely creating a strain."
Peterson said many cafeterias are finding creative solutions to cope with the rising costs.
Some are eschewing expensive grape tomatoes in favor of slicing larger tomatoes. Baby carrots, too, are out, because long carrots that cafeteria workers cut themselves are the better buy.
But a handful of schools are making tougher choices.
In Florida, for instance, schools in Broward County recently started using white buns instead of wheat. School officials there told ABC News that the move would save the district $200,000 a year.
"Nutritionally, of course, we would prefer whole wheat," said Barbara Leslie, the director of food and nutrition services for Broward schools. "But we evaluated it and decided that we would only be sacrificing about a gram of fiber, and we really needed to do that for financial reasons for now."
Other school districts are swapping out fresh produce with frozen or canned fare. The latter, Peterson said, are "nutritionally equivalent" to fresh fruits and vegetables, but students might be less likely to eat them.
"A canned or a frozen green been is going to be the same nutrition as a fresh green bean -- the difference is students tend to prefer fresh because they taste better," he said. "You obviously want students to consume the product."
School districts are also raising lunch prices. On average, Peterson said, schools seem to be raising prices between 15 to 20 cents per student meal.
The suburban New York school district of North Rockland is considering a price increase, but school superintendent Brian Monahan says he worries that more expensive school lunches might prompt parents and students to turn to less healthful alternatives.
"For many families, it takes time as well as money to prepare a lunch. In this day and age, both are in short supply," Monahan said. "We know the school lunches are healthy. We don't know that what students would bring would be healthy."
Like schools, hospitals must also balance rising food costs with nutrition guidelines.
William Notte, the director of food and nutrition services at the University of Florida Shands Hospital, said the hospital cut the size of patients' side salads in half after a food waste study revealed that patients generally don't finish the salads.
Patients wanting more salad can request it, Notte said.
"With the cost being higher, you certainly don't want to be wasting any [food]," he said.
Meanwhile, the price of food sold at the hospital's cafeterias is going up.
Notte said he'll soon implement a 10 percent price increase for cafeteria fare.
Lack of Options for the Poor
For those living in poor neighborhoods, it is just that much harder to get healthy food.
Leslie Mikkelsen, a managing director at Prevention Institute, a non-profit group based in Oakland, Calif., said that some neighborhoods simply don't have a full-service grocery store, and residents lack the financial means to drive the few miles to the nearest store. The smaller stores offer fewer food choices, often at higher prices than supermarkets. Their produce often looks a little wilted and their dairy and meat products might be outdated, she said.
"They might have some fruits and vegetables, but not nearly the variety you would see in a suburban area," Mikkelsen said.
Mikkelsen fears the higher prices could lead to a fatter America, both in urban areas and elsewhere. She said about 40 percent of meals consumed in the United States are from fast food and take-out restaurants. Given the higher prices of groceries, she said it's harder to shift Americans away from those high fat, high sodium foods, toward healthier habits.
Shoppers Change Their Ways
Kenneth J. Dalto, a retail analyst who studies supermarkets, said that people who choose to eat at home aren't necessarily eating healthier food.
Dalto said shoppers are buying less meat and vegetables and more breads, potatoes, pasta, rice, frozen fish, frozen pizzas and TV dinners.
"It's lower quality food," Dalto said. "Foods that are prepared, frozen or reheated are of lower quality."
But Jon Hauptman, a partner with Willard Bishop, a retail consulting firm that focuses on groceries, said the biggest change he has seen is a shift to more store brand or generic brand items.
Several big grocery chains have developed their own store brands of natural lines of organic products that "allow consumers to trade down" without changing their diet or food quality.
"People do want to get healthy, but they also want to be smart shoppers," Hauptman said. "So, traditional supermarkets have jumped on this opportunity by providing less expensive lines of products these consumers need."
David L. Katz, associate director of nutrition science at Yale University's Rudd Center for Food Policy and Obesity, said it's too early to tell how the downturn will affect people's health.
"I think there's real cause for worry, because the data we do have, in general, indicates that more nutritious foods tend to be higher priced. It's only going to compound that problem [when] the food prices rise," Katz said.
In general, he added, "poverty is associated with poor quality diets and increased rates of obesity, diabetes -- all the bad stuff."
There are some healthy food options Katz recommends for budget-conscious shoppers:
Lentils and beans are a good protein substitute for meat.
Cooking grains, such as brown rice, bulgur wheat and barley are cheaper and healthier alternatives to cereal grains that don't need preparation.
Store brands can rival name brands in nutritional value, but check their labels to be sure.
