By Catherine Saint Louis [The New York Times]
HOUSTON — Lola Lathon couldn’t afford to buy the leafy greens or lean meat displayed so alluringly at the grocery store. Instead, she ate cheap staples like white rice and potatoes, and occasionally went hungry for days before her next paycheck because she needed gas money to get to work.
It was not an ideal diet for a woman who is 5 feet 2 inches tall and 224 pounds, with Type 2 diabetes. And there was no reason to think it would improve when she and her daughter turned to an emergency pantry at the Houston Food Bank.
Not long ago, the mission of food banks was to relieve hunger with whatever was at hand, including salty canned goods or even potato chips.
But what she found at the food bank was a surprise: yellow tomatoes, butter lettuce, diced cactus. An employee checked her blood sugar and found it was sky-high.
Many who depend on food pantries are not underfed, but are, like Ms. Lathon, obese and diabetic, experts have found. In 2014, one-third of the 15.5 million households served by Feeding America, the nation’s largest hunger-relief organization, reported that a household member haddiabetes.
Inconsistent access to food worsens the disease, and so can the offerings at the pantries many low-income people must rely on. Now researchers have begun pursuing innovative new methods to address Type 2 diabetes among people who rely on food banks.
More than $1 out of every $10 spent on health care nationwide goes directly to treating diabetes and its consequences, according to the American Diabetes Association. Blindness, amputations and other complications are all too frequent.
After that, “I changed everything,” Ms. Lathon said.
On a cold afternoon earlier this year, Ms. Lathon waited in line at the Houston Food Bank for the bags of asparagus, tilapia and bibb lettuce that have become her lifeline.
“I am putting a lot into it,” she said.
In 2014, 17.4 million households were “food insecure,” or lacking enough to feed the whole family, according to the Department of Agriculture. Many of them rely on food banks at least part time to feed their families.
Food insecurity usually means access to food is sporadic: Waiting for a paycheck, for example, parents may coast on a meal a day so their children can eat two. Hunger isn’t necessarily a constant in these households.
A growing body of research links food insecurity to uncontrolled diabetes. Diet is partly to blame: The inexpensive food favored by people stretching their dollars is often low in fiber and rich in carbohydrates, which contribute to obesity and Type 2 diabetes.
Even when food bank patrons are aware they have diabetes — and many do know — they are not in a position to turn down free fare.
Low-income people are admitted to the hospital with low blood sugar more often than people with higher incomes near the end of the month, when food budgets are commonly exhausted, researchers in California have found.
For the first time, new treatment guidelines by the American Diabetes Association urge clinicians to ask patients about food insecurity and to propose solutions.
Among diabetics, “stress is constant, and it can wear on you,” said Margaret Powers, president of health care and education at the association. “If we want to save health care money, we need to get more education to people who are food insecure.”
Set Up Like Grocery Stores
Some food pantries are set up like grocery stores; clients choose what they’ll eat. The offerings at the pantry attached to the cavernous Houston Food Bank are typical: gallons of milk and sweet tea, almost-expired breads, canned goods, frozen meats.
Researchers sitting at rickety tables outside the pantry asked patrons if they wanted their blood sugar checked and, if it was high, whether they wanted to enroll in a six-month program to lower it. (A control group was told to wait six months to begin.)
For those who enrolled, a staff member handpicked appropriate food from the bank’s shelves, saying no to prepackaged junk, yes to asparagus and peanut butter. Participants pick up bags of selected food twice a month. They also receive referrals to a primary care physician, classes about diabetes management, and regular blood sugar checks.
The initial results have been promising. In a pilot study of nearly 700 food pantry visitors in Texas, California and Ohio, published in Health Affairs last November, participants with the worst blood sugar readings managed modest improvements in a relatively short time.
Adela Padron, 64, a retired bus driver, picked up free food once a month at the Food Bank of Corpus Christi in Texas and sat down to troubleshoot with Georgiana Bradshaw, a registered nurse there. With her guidance, Ms. Padron learned “to keep my sugar at a steady level” and to take her medications faithfully, she said. Her A1c readings — a measure of long-term blood sugar control — dropped from 13.5 percent to 7.5 percent. (A reading below 5.7 percent is normal for someone without diabetes.)
But not everyone puts their newfound knowledge to use. Bruce Cook, a 61-year-old veteran, also took part in the program in Corpus Christi. Recently, after he picked up power greens and carrots from the diabetes pantry, he returned the next day, grabbing a dozen chocolate-chip-and-M&M cookies at the regular pantry.
“I know what I’m supposed to eat and not supposed to eat,” he said. “But I still eat what I want.”
Sadly, food banks are ideal places to reach patients with uncontrolled diabetes. What used to be temporary assistance has become a lasting fixture in many lives, especially among older adults and the unemployed. Some have access to medical care, but few doctors ask if patients can afford food.
“The choices you make depend on the choices you have, and often in health care we forget to ask about the choices people have,” said Dr. Robert L. Ferrer, the vice chairman of research in the department of family and community medicine at the University of Texas Health Science Center in San Antonio.
After two-thirds of Dr. Ferrer’s patients told him they ran out of money for food every month, he began a study with the San Antonio Food Bank for patients with Type 2 diabetes to see if handing out provisions and healthy recipes in his office parking lot might help.
But for many with low incomes, the challenges never end.
Three months into the Houston program, Ms. Lathon had lost 20 pounds, and her blood sugar was dropping. But she needed emergency surgery to remove her appendix, and then suffered severe burns on her arm when a pot of boiling water overturned at a crawfish festival.
Her blood sugar has risen significantly, as is often the case when people with diabetes experience stress or illness. And she has finished the experimental diabetes program at the Houston Food Bank.
She isn’t sure what’s next.
“I loved that nutritious program; that’s what kept me going,” she said.
She now eats salads loaded with vegetables twice a day instead of once a month. She walks for 15 minutes a day and takes medication regularly to control her blood sugar. She’s losing weight.In addition, some medications to control diabetes must be taken with food. But how can someone do that without being certain where the next meal will come from?But Dr. Seligman and colleagues at the University of California, San Francisco, and Feeding America have begun a randomized trial here and at two other sites to help patrons gain control of both their diets and Type 2 diabetes.