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November 12, 2015

Diabetes in the food-pantry line: how food banks can help reach the hard-to-reach

November 12, 2015

On a sunny spring day in 2013, the Redwood Empire Food Bank of Sonoma County, California, set up a mobile food pantry in the parking lot of a boarded-up Albertson’s supermarket. Nearly 85 people—mostly mothers with very young children—came to pick up fruits and vegetables, which can be expensive items for low-income families. But that day, the food bank was also providing another service: screenings for diabetes, a disease that can be impossible to control if you can’t afford enough to eat.

About 80 people signed up to be screened, and several had elevated A1C levels, a marker for blood sugar control used to diagnose diabetes. In some cases, these young moms were not aware they were sick. Others told food bank staff that they previously had been diagnosed with gestational diabetes, a risk factor for developing Type 2 diabetes, but could not afford medical care or had lost their health coverage after the birth of their child. 

For these clients, the mobile food pantry’s public health intervention came at a critical moment. Prior research suggests that food insecurity may act as a risk factor for diet-sensitive diseases and that people struggling with both diabetes and food insecurity have poorer health outcomes. People facing hard choices between buying food and medicine or medical care may all but give up on managing their disease.

Piloting diabetes interventions at food pantry sites

Because many people with food insecurity have health problems that can be managed or improved with a better diet, food pantries are ideal sites for health interventions. We tested this concept through a pilot project that included Redwood Empire, The Food Bank of Corpus Christi in Texas, the Mid-Ohio Foodbank in Grove City, Ohio, and their food pantry partners.

Between February 2012 and March 2014, we enrolled 687 food pantry clients with diabetes in a six-month intervention program. Participants received diabetes screenings, blood sugar monitoring, diabetes-appropriate food, medical-care referrals, and self-management support. The hope was that the program would empower clients to manage their diabetes by providing them with food and with educational resources that would support them in following through on their doctor’s orders.
My coauthors from the University of California, San Francisco and from Feeding America and I recently published our evaluation of the pilot project. We found that, by the end of the intervention, participants had improved their blood sugar control, added more fruits and vegetables to their diets, and were better able to follow their doctors’ instructions for taking medicine and managing their disease.

While the results need to be confirmed in a controlled trial, already underway this fall, the study suggests that food pantries are a promising model for promoting better health among vulnerable populations—and not just for diabetes, but also for other diseases affected by poor nutrition, such as hypertension.

Food banks can partner with and educate health care providers

This vision places a heavy burden on food banks, which would need to continue improving the quality and nutritional content of the food they distribute, including adding more perishable food, which adds costs and complexity to their operations. Through the pilot, we gained crucial experience in working through challenges such as purchasing food when donated supplies didn’t meet quality standards, increasing the availability of fresh fruits and vegetables, and educating staff and volunteers about the needs of clients with diet-sensitive diseases.

But this vision also offers new hope for leveraging the nonprofit sector to reach those disconnected from or underserved by the health care sector. The Feeding America food banking network serves 46.5 million people annually, and about one-third of these households reported in 2014 that at least one member of their household had diabetes; more than half reported someone had hypertension.

Moreover, partnerships with food banks can give health care providers an important resource for food- insecure patients who are struggling to manage their health. Effective diabetes management requires a regular supply of healthy food, a need not typically addressed through the health care system. During the pilot study, food banks also reached out to health care providers about screening patients for food insecurity and referring them to the diabetes food program. At Redwood Empire Food Bank alone, providers referred more than 200 of their patients to the food bank during the study, as they began viewing the project as a real benefit for their patients.

While charitable solutions alone won’t be enough to improve the health of the nearly one in six Americans who are food insecure, policymakers should engage food banks in public health interventions, leveraging their ability to reach vulnerable populations with diet-sensitive diseases. 

Volunteer Caroline Osterman, center, of Boston, distributes oranges in the Franciscan Food Center food pantry at St. Anthony Shrine in Boston, Thursday, March 29, 2012. Photo by Michael Dwyer/AP

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