Wednesday, May 6, 2015

Food for Thought

Rebecca Morgenstern ministers with Dominican Sisters Family Health Services as a traveling nurse throughout the Bronx and Manhattan. She shares community in the Bronx Lay Community.

Rebecca (second from left) shares community 
with Shani Toor, Jimmy Hannigan, and Kelly Litt.

Almost every time I make a home visit to one of my patients, something that I discuss with them, or educate them on, is a healthy diet. The vast majority of my patients are on a special diet, such as a “low sodium diet” or a “Diabetic diet.” Sometimes the specific prescribed diet is a result of a health condition that already exists, and sometimes it is to prevent the individual from developing a health condition once warning signs are present. Even if a patient is on a regular diet, discussing a healthy and balanced diet is part of my plan of care for each individual.

Recently, I was discussing diet with a particular patient of mine in the Bronx whom I will call Beth. Beth is diagnosed with many diseases such as morbid obesity, Type 2 Diabetes Mellitus, and hypercholesterolemia, or high cholesterol.  Ideally, Beth should be very conscious of the amount of sugar, fat, cholesterol, and salt that she eats.

Knowing that Beth’s diet largely consists of snacks or junk food, I asked Beth what her favorite snacks are.

“I like cookies. I eat them a lot. Also…I eat a lot of potato chips and popcorn,” she said.

“What kind of popcorn do you eat, Beth?” I asked.       

Beth replied, “I like the Movie Theater Butter popcorn that I make in the microwave.”

I said, “Okay. Remember, we’re going to start by making small changes in the food you eat, Beth. Would you be willing to eat the ‘Light’ or ‘97% Fat Free’ popcorn?”

“Yes, but they don’t sell that in the store here,” Beth said with a disappointed look on her face.

“How about rice cakes, Beth, can you buy some of those next time you go grocery shopping? Those are a tasty snack and they’re a lot healthier than potato chips.”

“Nope,” Beth said, “They don’t have those either.”

This conversation is just a glimpse into a situation that I frequently encounter in my ministry. 

Rebecca prepares to care for clients in their homes.

Think about food. Food is universal. Food is a reflection of our cultural and familial traditions. Recipes are passed down from generation to generation and bring comfort to us. Food is used in celebrations and is offered as a gift to those we love and care about. Eating certain foods can change our mood and can resurface memories that were formed long ago.

Food is powerful. Think about how the economy, politics, and many wars have revolved around food or crops. Food not only drives the world in many ways, but it drives our bodies. Food nourishes us and provides the fuel we need to live our day to day lives. Many say that food also nourishes our minds and spirits. I am constantly amazed by the effect that food has on one’s health. A few examples of some of the diseases that are directly related to a poor diet include obesity, hypertension, and Type 2 Diabetes Mellitus.

My heart hurt when Beth told me that she was unable to buy certain foods that are usually common, at least in other parts of the country. Generally speaking, it is very difficult to get my patients to be willing to change their diet at all. Beth was now at a point in her life in which she was starting to understand the impact that her poor diet was having on her health and told me that she wanted to start making some small changes in her diet. My heart hurt not only because Beth is unable to purchase these healthier snacks, but because I know that if she lived elsewhere she would easily be able to.

Granted, Beth does have access to some sort of grocery store and a variety of foods, which makes her more fortunate than many individuals in the world. The Bronx has an abundance of convenience stores that mostly sell unhealthy snacks and sugary drinks. There are very small grocery stores around the Bronx that have small sections of out of season and often overly ripened produce. In the warmest months, one can also often find produce carts and stands on some street corners.

But compare this to another New York City borough, Manhattan. There are four Trader Joe’s grocery stores and at least five Whole Foods stores in Manhattan. There are zero in the Bronx.

Let me offer a personal example. The closest grocery store from the Bronx Community of Dominican Volunteers in which I live is half a mile away. My community members and I are able to walk to the store with a cart or carry bags home as we need to. Imagine an individual with impaired mobility or severe respiratory issues attempting to make a one mile round trip, which is filled with steep hills, to a grocery store. For many individuals who live in the Bronx, such a journey is an unrealistic concept. However, they are able to walk down to the corner convenience store to pick up some packaged snacks that satisfy their hunger.

Rebecca collects items for her visits with clients.

The United States Department of Agriculture states, “Food deserts are defined as parts of the country vapid of fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas. This is largely due to a lack of grocery stores, farmers’ markets, and healthy food providers. This has become a big problem because while food deserts are often short on whole food providers, especially fresh fruits and vegetables, instead, they are heavy on local quickie marts that provide a wealth of processed, sugar, and fat laden foods that are known contributors to our nation’s obesity epidemic.” As you can imagine, living in a food desert presents a variety of complex challenges and effects on one’s health.

After personally facing the challenge of living in a food desert of some sort for the past nine months, as well as the challenges my clients face in healthy eating, I found myself asking the question, “Why is the Bronx a food desert?” Some theories suggest that land-use policies and lack of demand lead to the existence of food desserts. For example, individuals on a low-income budget would be unable to complete their weekly grocery shopping trip at a store such as Whole Foods. So, those stores do not exist in poor areas. Then I wondered, “Why can’t existing grocery stores have a larger selection of fresh produce?” There are many possible answers to this question. Again, it seems demand drives supply. If people are not purchasing produce but are purchasing packaged junk food, grocery stores will stock those items and reduce the amount of produce available. If we do not provide education regarding nutrition and healthy, balanced diets, many individuals will not be aware of the importance of what they eat.

So what can we do about the availability of healthy and nutritious food options, or lack thereof? First, I believe that it’s extremely important to educate yourself on this issue. It’s also important to support the education of others, such as providing nutritional education in high school health classes. We can encourage programs such as WIC (Women, Infants, Children) and SNAP (The Supplemental Nutrition Assistance Program) to provide education on nutrition and increase the amount of vouchers provided for produce and other healthy foods. We can ask farmers markets to accept food stamps as a form of payment and we can volunteer in community gardens. I encourage you to write letters, attend town hall meetings, and vote on legislation regarding the availability of healthy foods.

Food is a complex issue, and surely the answer to this issue will be as well. I am encouraged every time I see a father helping his daughter to eat a banana on the way to school in the morning and every time I see a mother include her son in grocery shopping for healthy foods. I gain hope from the people who are devoting their time and energy to this issue, ranging from the elderly man volunteering in his community garden to First Lady Michelle Obama’s dedication to health and fitness programs. I challenge each of you to take some time to learn about the food you eat and the availability of healthy food in your community. I encourage you to plant an extra row of vegetables in your garden this Spring that you can donate to your local food bank. I invite you to become an active participant in this journey. I think you’ll find it rewarding, and you’ll certainly discover the opportunity to be of service to others.

Here are some links for more information:

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