Are dollar stores hurting Americans’ diets? A Tufts economist’s answer is complicated

There are 37,000 dollar store locations across the United States. Dollar General alone is approaching 20,000 stores. By percentage of the American food dollar spent, dollar stores have been the fastest-growing food retailer for over a decade.

So are they making us less healthy?

Dr. Sean Cash, an economist who chairs the Division of Agriculture, Food, and Environment at the Friedman School of Nutrition Science and Policy at Tufts University, has spent years studying that question using scanner data from 50,000 households – tracking everything they buy, everywhere they buy it. His answer: it’s more complicated than the headlines suggest.

He joined the Food Bullying Podcast to share what the research actually shows about dollar stores, food deserts, online grocery shopping, and what nutrition professionals should know before advising patients on where to buy food.

What dollar stores actually sell – and who’s buying it

Walk into a dollar store and you see shelf-stable items, sugary beverages, salty snacks, canned goods, and cereals. The variety doesn’t match a traditional grocery store or a large-format retailer. On average, the mix of food available at dollar stores scores lower on the USDA’s Healthy Eating Index – a measure of how well a diet aligns with the Dietary Guidelines for Americans – than what’s available at other retail formats.

That’s real. But it doesn’t lead directly to the conclusion that everyone would be better off with fewer dollar stores nearby.

Dr. Cash’s research identifies three reasons why dollar stores matter to the people who rely on them most. First, prices: dollar stores are often genuinely cheaper on specific items. Dr. Cash found shelf-stable milk at his local dollar store for 50 to 60 cents less per liter than the next cheapest option nearby. Second, convenience: for many households, particularly in rural areas, the dollar store is simply the closest place to buy food. Third, satisfaction: when SNAP participants were surveyed about their satisfaction with different types of food retailers, dollar stores ranked highest of all formats studied. The people relying on dollar stores most aren’t reluctant customers – they prefer them.

The compensatory purchasing finding that changes the conversation

The most important finding from Dr. Cash’s Tufts research isn’t about what people buy at dollar stores. It’s about what they buy everywhere else.

Using home scanner data tracking purchases across all retail formats, Dr. Cash found that households relying more heavily on dollar stores do buy less healthy food on average – but the difference is small. More significantly, those same households buy healthier food at other retailers than comparable households who use dollar stores less.

The explanation is compensatory behavior. Dollar store shoppers appear to be making deliberate decisions: stretch the food budget on shelf-stable and packaged items at the dollar store, then free up funds to buy fresher and more nutritious items when they reach a grocery store. It’s not that dollar store shoppers are eating worse overall – it’s that they’re using different stores for different purposes as part of a calculated household food strategy.

For rural households in particular, this pattern is pronounced. The data shows dollar store use growing twice as fast in rural areas as in urban ones between 2008 and 2020. Rural shoppers often make less frequent trips to larger stores because of travel distance, using dollar stores for fill-in purchases and buying in bulk at larger retailers when they do make the trip.

What this means for dietitians and healthcare professionals

Dr. Cash’s direct advice to nutrition professionals: ask patients where they shop before making recommendations about what to buy. Assuming that someone who shops at a dollar store is simply making poor choices misses the strategic context in which those purchases are happening.

He also cautions against what he calls “nutritionism” – an excessive focus on the nutritional content of individual foods that can tip into unhealthy hypervigilance. When healthcare professionals lead with judgment about food choices rather than curiosity about food circumstances, they risk losing the patient’s trust and the opportunity to be genuinely helpful.

The better approach is meeting people where they are: understanding their actual food environment, what’s working in their current system, and how to build on that rather than replace it entirely.

Dollar stores, race, and rural food equity

The equity dimensions of dollar store growth are significant and Dr. Cash addresses them directly. Non-Hispanic Black households have the highest average percentage of food dollars spent at dollar stores in the dataset – averaging 10 to 12 percent, and higher in rural areas. Low-income households spend a much higher proportion of their food budget at dollar stores than higher-income households.

The research raises legitimate questions about whether dollar store growth is crowding out traditional grocery stores in some markets and limiting the competitive landscape for healthier food retail. These are valid concerns. But simply banning or limiting dollar stores doesn’t automatically improve food access for households that currently depend on them – particularly if no alternative retailer would serve those same communities.