The Role of Medical Nutrition Therapy in Addressing Food Insecurity and Disease Prevention
By Sheri Vettel MPH, RD, LDN
“Let food be thy medicine………” The more I learn about nutrition, the more I believe Hippocrates’ words to be true. Unfortunately, the best dietary “medicine” is out of reach for many. There are myriad reasons why this is so, several of which, are beyond the control of those who do wish to make nutritious food choices for themselves and their families. Emerging models of healthcare must not only make recommendations that promote eating quality, nutrient-dense foods, they should also strive to make such recommendations attainable. This may include dissolving barriers to limited nutritious food access, empowering patients to make healthier choices (and feeling confident about what these food choices are), and recommending Medical Nutrition Therapy for those with health conditions directly related to food decisions they may or may not be making. In this article, I plan to review each of these strategies in further detail.Food insecurity is defined as “limited or intermittent access to nutritionally adequate, safe, and acceptable foods in socially acceptable ways (Holben, 2010). The food insecurity rate in the United States is currently 13.4%. The rate in North Carolina is higher as 16.5% of households are considered food insecure, with Guilford County sitting at an even higher food insecurity rate of 18.5% (Feeding America, 2015). This is important data to know, but what do these numbers mean for the patients we serve? I have seen firsthand the struggles of many of my patients to find and procure quality, nutritious foods for their households. Many of the barriers they confront are simply a result of affordability and availability in the communities they live. Grocery stores with an abundance of fresh, budget-friendly foods are unavailable, leaving convenience stores as the only option within walking distance. These convenience stores likely accept EBT (“Food Stamp”) benefits, yet primarily offer packaged, processed, and disease-promoting “junk” foods.
Nearby food pantries offer nourishment, yet the foods clients receive are often nutrient-poor and high in sodium and/or other potentially harmful additives. The literature informs us that food pantry users are often deficient in many disease-fighting nutrients (Companion, 2010). Delving even deeper into the issue, one can find a clear link between food insecurity and the risk of and progression of chronic disease (Holben, 2010). For example, food insecurity promotes stress and elevated cortisol levels, which are linked to the progression of disease and adiposity. In addition, food insecurity may cause poor glycemic control for those already diagnosed with diabetes due to variable amounts and types of food available (Seligman, 2010).
Unless we collectively wish to continue our healthcare efforts in the realm of secondary and tertiary prevention, a solution to the lack of acceptable, nutritious food access in our communities must be addressed. The design and implementation of the Partnership Pantry Healthy Food Bank Program has allowed our organization to increase fresh fruit and vegetable access within the vulnerable populations we serve. We are connecting farmers to families and offering a model for other food pantries to follow in terms of which foods are health promoting. We have seen momentum toward establishing similar efforts in our community with fresh produce prescriptions from health care providers, interest in community gardens, and partnering nutrition education with donations from food pantries. My hope is that the momentum does not stop here. I envision a community where local hospitals and healthcare providers join us and seek innovative ways to address the issue of food insecurity.
Once communities increasingly have access to nutritious food choices, as healthcare providers, certain assumptions must be avoided. First, we cannot assume that the nutritious foods will be prepared and eaten, even when an individual can afford them. Second, we cannot assume that this access will lead to lasting, impactable change unless individuals are empowered to continue any lifestyle changes they have begun.
Only 10% of our nation’s population like to cook, and I would argue an even smaller percentage know how to prepare fresh vegetables, legumes, and whole grains in a palate-pleasing way. We are not empowering our patients by instructing them to “eat more vegetables,” or to “eat less salt.” We empower them by teaching the nutritional benefits of a vegetable, cooking it with them (or at least finding and discussing an appealing, easy recipe or two), and then using motivational interviewing to explore the likelihood of this vegetable making a repeat appearance on the dinner table. For food insecure families this will require even more discussion about food budgeting, making cost-effective choices, and planning. Ideally, society would support these behavior changes, but until that day, as healthcare providers, we can let our patients know that they have the power to take control of their health with positive reinforcements. This is where Medical Nutrition Therapy may provide additional support.
With the overload of information available to healthcare providers and patients, nutrition science is confusing. We all eat, yet there are conflicting messages about what to eat to promote health and manage chronic disease. Medical Nutrition Therapy is an added support to addressing food insecurity and empowering patients to achieve ideal health outcomes with food choice. Medical nutrition therapy is patient-centered, individualized, nutrition education and counseling provided by a Registered Dietitian, often in conjunction with the healthcare team. Evidence demonstrates the effectiveness of medical nutrition therapy as part of a patient’s medical treatment (Food is Medicine Coalition, 2013).
In our programs, we provide hands on applications for our patients via cooking activities, grocery store tours, and one-on-one consultations to break down the basics of food label reading and health management with nutrient and targeted food intake. Our approach is holistic, knowing that nutrition and healthy food access alone is not the answer. This support, in conjunction with increased access to nutritious foods, is one essential key to improving health outcomes, and promoting primary prevention of disease, within the communities we serve.