My last patient, Joyce, a 45-year-old single mother of four with high blood pressure and diabetes, is late. She was in the emergency department last week with dizziness and blurred vision, a blood sugar of 345 and a blood pressure of 190/110.
Her last office visit was a month ago, when weighing in at 222, she joked that she wished she could pull those numbers at the casino’s slot machines. She often left work early to catch the early-bird buffet there one day near the end of the month, as her money ran out, to eat two meals for the price of one, and to stow what she could in her oversized purse for later.
Sometimes she couldn’t control herself, however, and ate some on the way home to her sister’s house. That’s where she usually dropped her kids off so they would have dinner, before going to school for breakfast the next morning.
Joyce, like one in seven Americans and more than one in three poor people in the U.S., is food insecure. According to the USDA, she does not have “access, at all times, to enough food for an active, healthy life for all household members.”
These numbers are up dramatically over the past 20 years: In 1995, just one in ten Americans was food insecure.
Buried in the new Dietary Guidelines Advisory Committee 2015 report is a short research review of food insecurity. It suggests that “a positive association may exist between persistent and progressing household food insecurity and higher body weight in older adults, pregnant women, and young children.’
In other words, food insecurity looks like an average American. The food insecure are more likely to be overweight or obese than normal or underweight.
No kidding. Americans have been overfed and undernourished since the start of our obesity epidemic, awash in inexpensive candy bars, cookies, and cereals, half gallon “cups” of soda and juice, and meals served on platters instead of plates.
Abundant, cheap poor quality food — loaded with sugars and starches, lacking in good quality fats and proteins –causes much of our chronic disease. Food insecure adults and children drink more sodas and eat fewer vegetables, in part because most cannot readily afford the money or time for anything but inexpensive, highly processed toxins masquerading as meals. It is, literally, low hanging fruit in medicine.
Yet what physicians see is disease, not diet. Physicians receive fewer than 20 hours of training in nutrition in medical school, on average. Physicians are not trained at all to define, detect or measure food security, or see food insecurity as a medical problem. But it is.
Food insecure adults require about five more physician encounters per year than those who are food secure. Food insecure adults visit the emergency department 20 percent more, monitor their blood sugars less, and are half again more likely to be diabetic than those who are not. They’re also more likely to have heart disease, high blood pressure, and clinical depression. One-third of lower-income chronically ill adults cannot afford both food and medicine.
It’s time the medical system took some responsibility for examining the food-disease link, and began to treat the cause, not just the symptoms. As a medical problem, food insecurity deserves recognition, research, diagnosis, and treatment.
If another problem this big afflicted 14 percent of Americans and caused the disease and misery food insecurity does, we would call it a plague.
Physicians don’t yet have the tools to treat this plague. So medicine must look outside the box, beyond pharmaceuticals, to community programs and innovations designed to provide skills, training and shared resources to Americans most in need.
Culturally-appropriate prescription meals and foods, unfortunately, are not on a hospital formulary or fillable at a pharmacy. Not yet, anyway. But they should be and could be.
Doctors should be able to write prescriptions for healthy food on prescription slips. Those prescriptions should be fillable at not just farmer’s markets but grocery stores and food banks. Health insurance companies, including those in Obamacare subsidized plans, should pay for such meals, and provide for a variety of culturally appropriate higher quality foods — especially fruits and vegetables — for their insured members.
Federally subsidized nutrition programs such as SNAP, WIC, and school lunches should offer community cooking classes, gardens and meal assembly “parties” to improve time efficiency, increase variety, and create community.
If clinicians asked lower-income patients, each visit: “In the past month, was there any day when you or anyone in your family went hungry because you did not have enough money for food?” we would be able to detect high blood sugar and high blood pressure before it went out of control in those patients, and quite possibly prevent it.
And we might keep more patients like Joyce out of the emergency department and in a lot better health.