Practical Pearls: Navigating A Food Desert

Imagine you have five dollars to spend on dinner for yourself and your two children. The nearest grocery store is 10 miles away and you have no car. The only food options within walking distance are a gas station/convenience store, a dollar store, and a barbecue food truck. So, what’s for dinner?

Many of us probably cannot imagine not having the means to eat what we want when we want. Every day we decide between something healthy and nutritious versus something solely for enjoyment. But – we have that choice. Many of our patients are much less fortunate, especially those who live in food deserts, areas with limited access to healthy and fresh foods. For census reporting, the USDA defines a food desert as an area meeting poverty guidelines plus specific criteria for limited food access. In urban areas, at least 500 people or 33% of the population live more than one mile from the nearest large grocery store. In rural areas, at least 500 people or 33% of the population live more than 10 miles from the nearest large grocery store.(1) Therefore, lack of transportation is often another burden that further hinders access to nutritious foods. These patients depend on food sources that are the most convenient and least costly to access.

Most patients will not readily reveal that they struggle with food insecurity or live in a food desert. We need to inquire about home environments and general food habits to help identify them. Asking some simple questions can also give valuable insight into a patient’s food accessibility or hardship. For example:

• Where do you shop for groceries?
• What do you use for transportation?

Another option is to use the condensed version of the complex 18-item US Household Food Security Scale (HFSS) for identifying families at risk for food insecurity.(7) The modified, simplified 2-question screening tool can easily be used in clinical settings to quickly identify these families.(6) Patients are presented with two statements (below) and asked to respond, “often true,” “sometimes true,” or “never true.” If the response to either statement is “often true” or “sometimes true,” the individual is identified as food insecure:

1.    “Within the past 12 months, we worried whether our food would run out before we had money to buy more.”
2.    “Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more.”

Nutritional Considerations  
Ellyn Satter, MS, RD, LCSW, developed a food management model based on the principles of Maslow’s Hierarchy of Needs. In her “Hierarchy of Food Needs,” motivators of food behaviors are ranked according to level of need.(2) Food adequacy and accessibility are two of the most basic needs. Having enough food and having reliable, consistent access to this food, takes priority over nutrition value or the impact of nutrition on health. However, as basic food needs are met, food selections can expand. Motivators of food choices can then be driven by desires to achieve a specific purpose, such as choosing foods for health improvement, disease resistance, or weight control. However, until then, people living in food deserts remain primarily concerned with simply obtaining reliable, affordable food and are less concerned about the impact of their food choices on cardiovascular health. Therefore, our nutrition guidance must consider not only nutrition value but affordability and practicality as well.

Making a Change
Overcoming the socioeconomic barriers that contribute to food deserts will require major interventions, including resources, education, and time. What, if anything, can be done now to help these patients make healthier food choices or to expand their access to nutritious foods? Some unique nationwide programs are now available. A few of them are highlighted here: 

The Million Gardens Movement (3) is a charitable food initiative created to empower families living with food insecurity to grow their own food. The concept, targeting low-income families, was started during the COVID-19 pandemic lock-down. As schools were forced to shut down, many children of low-income families lost access to free daily breakfast and lunch. To provide more than a one-time distribution of fresh food, Kimbal Musk, brother of Elon Musk, organized a campaign to distribute garden kits to these families. The kits included a planter box, soil, and a variety of vegetable seedlings. Due to the huge success, Musk and philanthropist, Frank Guistra, combined their resources to launch a national campaign aimed at educating and supporting a million people to grow their own food and reap the benefits of gardening. The Million Gardens Movement provides necessary resources for families to grow their own healthy foods in any location, whether it’s a community garden, on a fire escape, or along a window box. Families in need are given beginner-friendly garden kits along with education and supportive resources to sustain it.

Mom’s Meals® (4) is a meal delivery service that provides ready-made fresh meals directly to patients’ homes. They service most Medicare and Medicaid members and have a self-pay option for other individuals. Many Medicare Advantage Plans include a 14-day supply of Mom’s Meals as part of their hospital discharge program and chronic care support program for patients with chronic diseases. They offer several special diets, including “lower sodium” and “renal friendly”.

The Summer Food Service Program (5), also known as the Summer Meals Program, is a federally funded, state-administered program established to ensure that children continue to receive nutritious meals during summer break. Free meals are provided for children and teens in low-income areas.

Area food banks are another source of supplemental foods. Many local food banks have partnered with Feeding America to offer mobile food pantries that travel to rural communities. Catholic Charities is another well-known charitable organization that has mobile food pantries aimed at serving underserved populations in rural communities. The food bank in my area, the Central Texas Food Bank, has a Fresh Food program in which boxes of fresh foods are made available to families on a monthly basis at various sites, including many rural areas. They often partner with local churches to be distribution sites. Contact your area food bank to find out if it has a similar program.

Immediate Options
While these programs can supplement food for a family or household, they are usually insufficient to fulfill 100% of daily food needs. Therefore, many of these patients rely heavily on local food sources, which are convenience stores, discount or dollar stores, and fast-food restaurants. Thus, the diets of individuals living in food deserts often consist of highly processed foods laden with sodium, saturated fats, and refined carbohydrates which increase risk of developing cardiovascular disease, insulin resistance, and obesity. 

The nutrition quality of most of these foods does not align well with a heart-healthy diet, but, surprisingly, some note-worthy foods can be found. Several high fiber foods are available at most discount/dollar stores, such as whole oats, dried beans and lentils, brown rice, applesauce and raisins, and quinoa. Yes, quinoa!

A hallmark of my practice is meeting patients where they are in terms of readiness to change and food availability. We must educate them to make the healthiest food choices from their available options. Emphasize the beneficial effects of fiber and healthy fats. In most circumstances there will be an option that is nutritionally “better” than another. It may be marginally “better,” but as healthcare providers it is our responsibility to educate and empower our patients to change what is within their control. 

Education and Resources
Below is a simple handout with information to help your rural patients make healthier food choices, especially at discount and dollar stores. Also, consider creating a resource sheet of local programs that can help patients access nutritious foods. A template for this is also below.

Through the combination of nutrition education and local food programs, we can impact this group of patients and empower them to take an active role in their personal health management. With persistence over time, small changes can create big results.

Disclosure statement: Ms. Rychlik has no financial disclosures to report.
References are listed in the 2021-2022 Winter LipidSpin .pdf on www.lipid.org