“ We need to be honest about what causes diabetes--It’s not your DNA, it’s your dinner! We need a cultural shift in how we eat.”
--Brooklyn Borough President, Eric Adams, advocating for better access to healthy foods in NYC’s poorest neighborhoods at the Crain’s Healthcare Summit on Diabetes (11/16/17)
Most people “know” that good nutrition is linked to better health. Yet, folks are often very confused as to what exactly eating “healthy” means, let alone how to begin making positive changes in their own lives. Even those who understand basic nutrition and want to make better choices, may find it incredibly difficult to actually do so.
Challenges to Making Changes
No matter how much we learn about the health benefits of a good diet, there are still socioeconomic, psychological, social, and cultural obstacles that work against some households:
Literacy—Those living in poverty are more likely to have limited literacy, so it’s likely that members of low-income households have difficulty reading or comprehending written materials such as scientific health information, recipes, and cooking instruction;
Access—A lack of conveniently located markets often impedes people’s ability to buy fresh foods; Physical disabilities may further limit options, as carrying grocery bags up flights of stairs might prove difficult;
Affordability—Several programs, such as WIC, help make fresh food more affordable, but many lack the skills to plan meals and use food efficiently. This makes perishable “feel” more expensive because much is wasted;
Storage and Preparation—Many people with low socioeconomic status live in places that don’t include a kitchen or even a refrigerator, such as a shelter or hotel room; This usually means a diet based on take-out and heavily-processed packaged foods;
Culture and Preference—Healthy foods tend to be less palatable than highly processed, hyper-flavored, high-salt/sugar/fat foods. And people often have an attachment to eating certain foods that are part of a traditional culture or are popular in their social circles. Healthier foods might even be viewed as “weird” or “gross.”
Unsurprisingly, lower socioeconomic populations suffer from a disproportionate share of chronic disease—especially diabetes, heart disease, cancer, and asthma—and poor diet is one clear cause. In fact, research suggests that household food insecurity, that is, the economic and social condition of limited or uncertain access to adequate food, is significantly linked to type 2 diabetes, which, if untreated, can lead to high risk of stroke, heart disease, infection, vision impairment, kidney damage, nerve damage, and more.
The Cost of Chronic Disease
Chronic disease accounts for more than 80% of healthcare spending, with diabetes being the most expensive disease to diagnose and treat, costing more than $100 billion in 2013. Ischemic heart disease is the second most expensive condition, costing a total of $88 billion that same year. And the diabetes-related costs are growing at an alarming rate.
If healthcare providers can help patients change their lifestyles, we would significantly lower our costs and improve the quality of patients' lives. Healthcare providers hoping to reverse or prevent these conditions know that their patients must eat better, but compliance rates with nutritional recommendations are fairly low. A visit to the doctor to address some symptoms isn’t a lot of time to go over these recommendations and for people to really learn what they need to know regarding proper nutrition. It is clear that there is a strong need for more substantive support to help patients make meaningful changes to their diets.
What Can We Do?
Changing eating habits and moving the needle on preventing chronic disease will require an interdisciplinary effort involving public and private sector collaboration. Not only do we need to enact legislation to address social determinants of health, we need educational programs tailored around the literacy level and resources available to low-income/high-risk populations.
Here are some lessons we’ve learned in the course of our work that address the previously mentioned areas of concern:
Literacy—Avoiding “academic” language, and instead, use visuals, like pictures, graphics, and videos can help explain information in simpler terms. Our minds tend to want to know "the rules,” as they help us organize our thoughts and to more quickly make decisions… for this reason, it’s important to avoid making blanket statements (“fat is unhealthy”), moralizing (“this food is good; this food is bad”), or speaking in absolutes (“vegan diets are best”). Explain how to decode food labels or to “eyeball” portion sizes; Teach people how to think rather than what to think!
Access—Creating local maps of fresh-food sources and discussing and brainstorming strategies for getting to the market (is transportation or ability to carry things an issue?) can aid in accessibility.
Affordability—People are sometimes unaware of available resources and they don't take advantage of programs that support healthy eating. Learning about and then sharing local resources and programs may include helping them enroll in programs or some degree of case management.
Storage and Preparation—It’s important for classes to offer suggestions for eating choices that are actually feasible, such how to order a healthier meal at McDonald's. Making "better" food choices, rather than "best" may be adequate. Offering cooking classes that teach students how to prepare food they actually want to eat, that they can realistically afford, and that don't take a huge amount of time or lots of equipment, can be a great solution to the challenge of preparation. Start small, such as boiling eggs, making a salad, or preparing oatmeal.
Consider the family and social environment—Do patients feel pressure to eat meals prepared by relatives, to buy junk food for kids, or to eat out with friends?
Motivation—Connect changes in eating to improvements in quality of life. It’s imperative to frame the benefits of healthy eating within the context of the patient's values, not yours. What matters to them? Change is not only difficult, but time consuming! People need to be convinced that the rewards will be worth the work.
Combine exercise with nutrition education—Movement helps people connect with their bodies and enables them to more accurately tune in to sensations of hunger and fullness. Increasing muscle mass boosts metabolism and helps stabilize blood sugar, and it also provides an outlet for stress, reducing the tendency to eat junk food to cope.
If you would like support with designing nutrition education programs for your patients and members, please call for a free phone consultation to learn more about our resources and service offerings!