Less food access but more weight gain: How hospitals tackle the paradox of food insecurity

On the surface, it seems counterintuitive that the term “food insecurity” would have a link to obesity. However, in the United States, that is exactly the case. Those with lower incomes tend to have more limited access to affordable, healthy food options, such as fresh produce, but have far more access to less expensive food options that tend to be processed and calorie-dense with limited nutritional value.

Low-income individuals are also more prone to overindulgence, which can occur when they are forced to restrict or skip meals, sometimes due to a lack of funds. They then overeat when food is more available. This yo-yo eating behavior can increase the risk for obesity. Research shows that in the U.S. individuals who live in poverty are the most prone to obesity. According to the Obesity Society, almost 90 percent of people living with type 2 diabetes are overweight or have obesity.

In Philadelphia, lack of supermarket access corresponds with higher rates of death from diet-related disease, including heart disease, cancer, and diabetes. Hunger Free America’s 2018 Report found that roughly one in five Philadelphians suffers from food insecurity. The report also included alarming data showing that, despite a national trend of decreasing food insecurity, it has increased in Philadelphia by 22 percent over the last six years.

Two hospitals in Pennsylvania have launched programs to try to reduce food insecurity by treating food as a medicine. Children’s Hospital of Philadelphia recently opened the first pediatric, hospital-based food pharmacy in the country. Healthy Weight Food Pharmacy, a food bank and education center in West Philadelphia, will not only provide eligible families with healthy food but will aim to provide them with the resources to develop healthy habits. It will also connect them to community resources that can help address their food needs and educate them on how to maintain healthy eating habits on a budget.

The Healthy Weight Food Pharmacy comes as part of CHOP’s Healthy Weight Program, launched in 2005. It is a multidisciplinary patient-management program, distinct from the pharmacy, that attempts to improve the health and quality of life of overweight and obese children between ages 2 and 18. It uses a combination of medical management, nutrition advice, and encouragement of physical activity with plans that are specifically tailored to families’ needs.

In Shamoken, Pa., Geisinger Health System launched a Fresh Food Pharmacy for adults on the grounds of its main hospital in 2016. It provides low-income patients suffering with or at-risk for diabetes with free healthy groceries each week. Like CHOP’s food pharmacy, Geisinger requires patients receiving free groceries to meet with a dietician who provides healthy recipes and hands-on instructions to accompany their food “prescriptions.” Geisinger found that diabetes patients lost weight and reduced their hemoglobin A1C levels (the way that providers track how well patients are controlling their diabetes).

According to Geisinger, the cost of providing free groceries to one patient is $1,000 a year, while the average medical expenditure for people with diabetes is about $16,750 per year overall, of which about $9,600 is for the cost of treating diabetes alone. A decrease in hemoglobin A1C levels of one point can save about $8,000 a year. With more than 100 million adults in the United States living with diabetes, healthier patients with lower A1C levels could mean significant savings.

These figures are for adults. The savings for children could be even greater. Children with obesity are four times as likely to develop Type 2 diabetes compared with children with a BMI within the normal range. With 13.7 million children and adolescents in the United States suffering with obesity, this could mean improved health for children and major cost savings for their families.

Food pharmacies like those at CHOP and Geisinger could significantly reduce healthcare costs that result from diet-related diseases, ranging all the way from malnutrition to obesity. They could be the medicine that many patients really need.

Mara Smith is an associate at Montgomery McCracken specializing in health law.