Tackling the Widespread Problem of Food Insecurity – Indianapolis Business Journal

Many Hoosiers — one in nine, according to national food bank network Feeding America — don’t know where their next meal will come from. Or they settle for poor quality foods that are detrimental to their health.

A new initiative from Indiana University’s Eskenazi School of Medicine and Health, called Food Resources and Kitchen Skills (FoRKS), hopes to tackle food insecurity and help Hoosiers make choices healthier foods. The initiative, which includes a study and recently received a $2.9 million grant from the National Institute on Minority Health and Health Disparities, will provide participants with healthy foods, cooking classes and even kitchen utensils to try to advance the needle.

Daniel Clark

“In Indianapolis, food insecurity is as severe as the national average (just over 10% of the U.S. population, according to the U.S. Department of Agriculture),” said Daniel Clark, associate professor of medicine at the IU School of Medicine and a principal investigator of ForKS. “As many as one in three people in some areas report food insecurity.”

The problem is as deep as it is pervasive. According to recent statistics from Chicago-based Feeding America and its Indiana subsidiary, Feeding Indiana’s Hungry, one in six Hoosiers (1.1 million people, about 33% of whom are children) use pantries and restoration programs. About 85% of food-insecure households in Indiana report buying cheap and unhealthy foods because they simply cannot afford better options.

Perhaps unsurprisingly, 34% of those same households include a member with diabetes and 64% include someone with high blood pressure. National studies have long linked lack of regular access to affordable nutritious food to health problems such as type 2 diabetes and hypertension.

Clark and his co-principal investigator, Richard Holden, chair of IU’s Health and Wellness Design Department, designed the program after years of observing the types of intervention efforts related to the power supply that worked and did not work.

“I think we’ve been thinking for decades about ways to get people to eat healthy foods,” Holden said. “But we realized that not everyone can eat healthy foods because they don’t have access to them.”

Richard Holden

For example, investigators observed classes in which dietitians and physical activity coaches told people to exercise and eat superfoods like kale. But when they followed up to see if patients were putting the advice into practice, they heard again and again that patients didn’t know where to find such items and had no idea how to prepare them.

“It occurred to us that we could give out all the information we wanted, but if we don’t help people understand how to use that information, it’s going nowhere,” Holden said.

The program itself is somewhat of a community effort between IU and the team of dietitians at Eskenazi Health.

“We worked with them, thinking about what a program would look like if it addressed not only the lack of calories faced by food-insecure people, but also long-term nutrition and disease issues. “Clark said. “We wanted to address the underlying challenge of nutrition in the context of food insecurity and, often, health illiteracy.”

With the new grant, researchers will soon launch a randomized trial in Indianapolis with 200 patients following a 2021 pilot program that has shown some success.

The small group of pilot participants selected from food-insecure patients in the Eskenazi Health System had low-sodium and low-carb meals delivered to their homes. They also received a set of kitchen tools and a tablet loaned to them to participate in virtual cooking classes to teach them how to prepare food in a healthy way. They also joined Eskenazi Health’s Hypertension Management Course.

“What’s new and groundbreaking about this is that we’re combining healthy eating with health education, cooking skills and food delivery with scientific study to see if it’s actually moving the needle on key outcomes like blood pressure and diabetes,” Holden said.

Mariah Adams, a registered dietitian at Eskenazi Health, leads a virtual class as part of a program called Food Resources and Kitchen Skills that caters to people who are food insecure. The program delivered healthy foods to participants and then taught them how to prepare them. (Photo courtesy of Eskenazi Health)

This pilot included a 67-year-old retiree, Jerome Williams, whose lack of good food options, coupled with his lack of cooking skills, contributed to a myriad of health issues, including hypertension. By the end of the program, he could competently prepare a number of healthy dishes, including Asian-style chicken and rice, he said.

“I can’t speak for anyone else, but for me it made a difference,” Williams said. “And they taught us so much more than just cooking.”

Classes will be overseen by Eskenazi Health dietitians, including outpatient clinical dietitian Mariah Adams, who also helped teach the pilot FoRKS course.

“I think there’s a range of cooking abilities with the participants that we see,” Adams said. “Most had basic cooking skills, but perhaps weren’t as familiar with cooking from a recipe or using fresh ingredients.”

She hopes to see programs similar to FoRKS spread across the country, programs that take a holistic approach to healthy eating and spend more time on the “how” of food preparation at home, rather than just explain why it’s important.

“We talk about many food-related topics throughout the program, including budget-friendly shopping,” Adams said. “I hope that when the band members graduate, they can use these skills for life.”

The expansion of the FoRKS concept will depend on the type of concrete data coming from the current program. The results of the pilot project were promising; class attendance averaged 87.1%, participants’ blood pressure and weight decreased, and their food security improved. Ideally, the program could provide a relatively inexpensive way to reduce risk factors for cardiovascular disease in adults with food insecurity and hypertension.

In other words, avoiding a problem that can be quite costly to treat, simply by helping people access healthier foods and teaching them how to cook healthier meals.

FoRKS is currently lining up students for its first official session, which will begin in a few weeks. Clark and Holden will carefully monitor participants to see if, above all, they develop lower average systolic blood pressure. Also, to determine if they stick to new approaches to food selection and preparation.

“We are focused on the first scientific study of this type of project to assess blood pressure outcomes,” Holden said. “This is our number one concern. And to go further, it would be wonderful if none of the participants in the program gave up. It will be great if the dietitians running the program like it, the healthcare system likes it, and most importantly, the patients like it.

The grant will fund the program for five years, but Holden hopes it will last longer.

“While I want to see this work and improve blood pressure control, my overarching goal is to make sure it gets implemented and stays in the system forever and ever.”•
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