Study allows families to try food as medicine
on November 2, 2017
Sherrie Lowe pours brown rice into a saucepan in the narrow kitchen of her one-bedroom apartment in East Oakland while her daughter watches. Less than ten feet away, Lowe’s son, grandson, and nephew wrestle on the living room floor—working up an appetite—while the PBS Kids show “Cyberchase” plays in the background.
Rice is a key ingredient for jambalaya, a dish Lowe is making from scratch for the first time in her life. She lets out a nervous laugh as she covers the pan. “We don’t know how it’s going to turn out, but we’ll see,” she says.
It’s not the first time Lowe has made jambalaya. She just usually makes Zatarain’s brand out of the box. Until recently, most of Lowe’s family’s meals came premade, either from boxes or takeout. The foods were fried or contained refined carbohydrates, like enriched flour and white rice. Fast food was the easiest. McDonald’s. Taco Bell. Burger King. Denny’s.
“Wherever they wanted to go for that day,” Lowe says, referring to her kids. Because of her demanding work schedule bagging small boxes and envelopes, fixing labels on packages and cleaning out trailers at the United Postal Service (UPS), she says, it was easy to rely on quick fixes or old staples of her diet growing up with parents from Georgia and Alabama, like fried chicken, white rice with lots of sugar and butter, hamburgers and french fries.
Lowe drives two hours total to and from work at a UPS warehouse in Lathrop, where she was transferred to after the warehouse in East Oakland shut down for renovations. She either leaves home as early as 5:30 a.m. or gets home as late as 8 p.m., depending on how she’s scheduled, and always comes home to the four children who are now waiting for her to finish the jambalaya.
“That’s why it’s hard for me to cook,” she says while mixing the rice into the vegetables, tomato sauce, sausage, and shrimp. “I be tired after I get off with all these kids at my house every day.”
Still, the diet took its toll on her daughter Armajah Elliott, age 11. In 2016, Lowe took her daughter in for what she thought was a regular check up. Armajah’s doctor noticed that the back of her neck was getting dark. She had developed acanthosis nigricans, a skin discoloration that appears in people who have, or are at risk for, diabetes.
Lowe said she was in disbelief that someone as young as Armajah could be at risk for diabetes, even though she later realized that it was part of her family history. Her sister and her father both had the condition. Her father, she said, “was a healthy guy, but then he lost so much weight that he had to be hospitalized.” Then one of Lowe’s aunts died of complications resulting from diabetes.
When the doctor told her Armajah was “borderline diabetic,” Lowe recalls, “I said ‘Oh my god! So what do we do?’”
Shortly after Armajah was diagnosed with prediabetes, she and her family were invited to participate in the Food as Medicine study by UCSF Benioff Children’s Hospital Oakland and All In Alameda County, an anti-poverty program launched by Wilma Chan, the Alameda County supervisor that represents Oakland. Dr. June Tester, an Oakland-based pediatrician and researcher who studies childhood obesity, was researching the effect of providing “food prescriptions” to low-income children ages 8 to 16 who are at risk for developing diabetes and live in Oakland and Hayward.
Food prescriptions are similar to prescriptions for pills, but instead of recommending that patients take doses of metformin and acarbose (medicines prescribed to treat prediabetes), doctors recommend that patients eat servings of leafy greens and whole grains.
“Insurance covers medicine for diabetes, but could food be something that’s part of taking care of the whole patient?” Tester asked. And instead of simply telling the kids what to eat, Tester and her colleagues imagined a food “delivery service that actually comes to patients” and becomes part of their care.
Children who participated in the four-month study, and their families, received weekly deliveries of fresh produce and grains from Dig Deep Farms, a service that operates in Oakland and Hayward, and the Alameda County Community Food Bank. The deliveries contain leafy vegetables like cabbage, other vegetables like asparagus, legumes like lentils and whole grains such as brown rice. Deliveries also contained snacks, like original flavor Triscuits, that are specifically suggested for diabetes patients.
Tester encouraged the families to try out new dishes with the food they received. Anticipating that some of the participants would not be familiar with some of the items in the boxes, families received a binder with healthy recipes and access to cooking classes provided by the Alameda County Public Health Department.
The study, done in partnership with the health department, is one of a few experiments across the country in which doctors and researchers are prescribing specific food to obese, diabetic or pre-diabetic patients and then either increasing access to those foods or just giving the food directly to the patient. Typically, doctors only suggest dietary changes, rather than prescribing specific foods to eat. Or, they just prescribe medicines.
“It’s one thing for a doctor to say ‘You should eat this,’” Tester said. “And it’s another to be very concrete and hands-on and say ‘No, you really should eat this, and this is how much of it. And these are other food products you might pass up while you’re at the supermarket, but these are actually good for you.’”
Tester said that although “there’s a movement catching on with this general concept,” she’s not aware of any other program that delivers food to the homes of people with a diabetes risk.
But there are a few other programs that have tried similar strategies to increase prediabetic or diabetic patients’ access to healthy foods. A program called FoodRx in Chicago, in which doctors give their patients a checklist of healthy food to buy and a coupon to Walgreens to help them afford it, launched in 2012. And the Fresh Food Pharmacy in central Pennsylvania, a food market that provides free food to low-income, diabetic patients, started in 2016.
The trend of getting food delivered to homes—for convenience, and often for those, like seniors, who are not ambulatory—isn’t new. Entrepreneurs have turned urban farms into fresh produce delivery services, called community supported agriculture (CSAs), since the 1980s. More recently, meal services like Blue Apron and HelloFresh have allowed consumers to receive pre-cut ingredients for a meal with recipes to make the meal delivered to their doorstep.
But local CSAs cost anywhere from $16-$160 depending on the size of the order, delivery fees and season, and meal services typically cost over $100 per week for a family plan. According to a 2016 study in Preventing Chronic Disease, this is not affordable for low-income families in Oakland, some of whom qualify for food assistance from the government. The household income required to participate is anywhere from $1,980 per month to $6,816 per month depending on household size in Alameda County.
Lowe said the food deliveries provided to her family through the study, free of charge, were a relief. Prior to participating in the study, she said, she would make three or four runs to the grocery store a week, but now she only goes once or twice and has switched to lower-cost stores. She uses the 99 Cents Only Store to get her produce, much of it priced for a dollar or less. This includes asparagus, which she used to buy for $3 or $4 a bundle.
“Now that I found this store and we can afford it, this is what we’re doing,” Lowe said. “I find myself buying all healthy foods now when I go to the store.”
But her family was resistant to their new diet at first. Her daughter “kind of turned [her] nose up a little bit” upon receiving the first weekly delivery, Lowe said. Lowe recalls a box filled with food like lentils and wheel-shaped rotelle pasta, that she had never seen before. “What am I going to do with all of this?” she asked herself.
Chan, whose All In Alameda program has Food as Medicine as part of its anti-poverty action plan, said that a cultural change has to take place for a lot of the families to change their diets. “I mean, I know for myself if I’m used to eating something and I don’t know how to cook something else, it’s going to be very hard to change my habits,” Chan said. “And I think that’s true for anyone, whether they’re low income or high income or whatever.”
So far, the results of the study have been mixed. According to preliminary results announced in late September, Tester found that health improvements have been found among the parents, rather than the kids. While the early results did not show an improvement in the children’s diabetes risk, the parents did show a decrease in their blood sugar levels, which is a common measurement of diabetes risk. “Kind of a side benefit of this study was how much health benefit we saw in the parents, who I think improved more in terms of their eating behaviors,” Tester said.
And while the average result for all 60 children did not show improvement, some individuals did improve. “Much of that went along with who adopted the dietary changes and who didn’t,” Tester said.
Tester said that one of the most interesting results so far is that some families changed their shopping habits, discovering whole grain cereals or snacks like Triscuits, that parents previously would have passed up, figuring the kids would not eat them. “When you’re really poor and you’re doing the food shopping, if you think that it’s going to go uneaten or that it’s going to spoil because no one is going to want to eat it, you’re not going to want to invest in something that’s such a risk,” she said.
Lowe’s family was one of the few in which both parent and child showed improvements. After Armanjah’s diagnoses, Lowe had gotten a test for herself, and found that she was pre-diabetic, too. But over the four months that they participated in the study, they both reversed their diagnoses. Lowe said that the dark rash on Armajah’s neck is going away and she has more energy in school. “It was a big relief off of me. I’m so glad that’s not there anymore,” she said. “Our numbers are good, which I’m really proud about because that lets me know that I’m doing something right.”
Chan recalled hearing Lowe share her experience at a press conference announcing the preliminary results. “She loves it and she’s lost weight,” Chan said. “And June said that most of the moms in the program have lost an inch-and-a-half off of their waist, which is really great. So I was really happy with the results.”
Chan said that she wants to try to use this study to create more access to fresh foods, whether through food delivery services or “food pharmacies,” one of which is open twice a month at Children’s Hospital Oakland, for low-income families in Alameda County. A food pharmacy is sort of like a farmers market, except that it happens outside of a hospital or clinic, which allows patients with diabetes or obesity to shop for foods that are prescribed to them by their doctors. Chan, who has mentioned to the East Bay Times wanting to do another, year-long Food as Medicine study, said she also intends to use the results to get other healthcare providers on board and get more funding for future studies.
“Our goal was to use this study to show people positive results, so we can continue to get both financial as well as clinical support to expand the program,” Chan said.
For Lowe, the change in diet and reversal of diabetes symptoms were positive effects, but the program wasn’t flawless. She says the cooking classes were offered at times that she couldn’t make because of work. So there has been a lot of trial and error, like with the jambalaya she is trying out for the first time tonight.
“Maybe I should have cooked the rice before I put it in with the rest of the stuff,” Lowe wonders to herself quietly.
“How is it?” she asks Armajah, who has just taken a taste test of the experimental dinner.
“It tastes good, but the rice is still hard,” Armajah replies. She washes off her testing spoon and goes back into the living room to watch cartoons, plopping down on the loveseat, disappointed that she will have to wait longer for dinner.
Her brother Davonne, 9, runs into the kitchen and asks, “Is it ready yet?” The answer is no.
While waiting for dinner to be ready, Davonne and Armajah start munching on Triscuits, their new favorite snack. Davonne said that they acquired a taste for them through participating in the study.
Finally, Lowe clinks a fork against a cup, signaling that it is time for everyone to try her jambalaya. She dishes it into styrofoam bowls and hands them out with a piece of toast to her daughter, son, grandson and nephew. She saves some for herself, too.
“I might have cooked the rice a little too long, but that’s alright. Eat it,” she urges the kids. “It’s good. I think you guys are going to like it. I think. I’m not sure.”
“There is no think,” Davonne assures his mother after tasting a bit. “It is good.”
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