Patients can chose healthy items inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. Following a referral from their physician, patients are offered a week's worth of healthy food. The initiative is to combat the food desert in the Fairfax neighborhood, a preventive model to address chronic health conditions with free access to healthy food choices. (Lisa DeJong/The Plain Dealer)
By Ginger Christ, The Plain Dealer
CLEVELAND, Ohio – Local health systems are hoping an apple a day really will keep the doctor away.
Cleveland’s three largest systems are turning to on-site food clinics to curtail the rate of chronic illnesses such as diabetes and hypertension by providing healthy food to patients who otherwise might not be able to afford a healthy meal or aren’t sure from where that next meal will come.
The effort is part of a local and national movement to use food as medicine to enable healthier lifestyles and reduce levels of food insecurity.
Joyce Kavaras, a registered dietitian for University Hospitals Population Health Management, left, helps Yvonne Zellner, 80, right, pick out green leafy lettuce inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. (Lisa DeJong/The Plain Dealer)
“We know that clients want and need fresh fruits and vegetables but the fact is that fresh fruit and vegetables are hard to afford,” said Kristin Warzocha, president and CEO of the Greater Cleveland Food Bank. “If you’re on a tight budget, boxed carbohydrates stretch farther and may fill you up but they’re certainly not as good for your health.”
Joyce Kavaras, a registered dietitian for University Hospitals Population Health Management, left, helps Yvonne Zellner, 80, shop for healthy items for her husband inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. (Lisa DeJong/The Plain Dealer)
Of the roughly 250,000 people the Food Bank annually serves in Northeast Ohio, two-thirds of the households included someone with hypertension while one-third had someone with diabetes. In Cuyahoga County, about 19 percent of the population, or 234,000 people, are food insecure.
Anne Leach, community program director and wellness dietitian for Sodexo Healthcare, reaches for healthy items inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. (Lisa DeJong/The Plain Dealer)
During a recent checkup at University Hospitals' Otis Moss Jr. Health Center in Fairfax, 67-year-old Rosemary Cash found out she had high a blood sugar level, which is an indicator for diabetes. Her doctor offered to put her on medication or give her a referral to UH’s new Food for Life Market, she said.
“I’m not taking any medications if I don’t have to,” Cash said. “I’d rather eat to get more healthy than take a pill.”
Joyce Kavaras, a registered dietitian for University Hospitals Population Health Management, right, helps patient Robin Goins, 50, left, shop for healthy items inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. (Lisa DeJong/The Plain Dealer)
At the UH market, which opened at Otis Moss in October, a dietician helps patients select healthy foods, ranging from turkey to Brussels sprouts to blueberries.
“At the end of the day, we’re empowering and educating people,” said Lora Silver, the community outreach dietician for the Food for Life Market.
Patients can chose healthy items inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. They can visit the food market once a month, choosing items such as healthy greens, yams, beans, bananas, apples and canned vegetables. (Lisa DeJong/The Plain Dealer)
Cash lives in Cleveland Heights and takes care of her older brother, who has an intellectual disability, and her teenage granddaughter.
“Food (cost) is so high. We manage but I think it’s a challenge for most folks,” Cash said. “You go to these other food pantries, and they have food but it’s not necessarily healthy food.”
The "Food as Medicine" food clinic is located in the outpatient plaza at the MetroHealth System. (Lisa DeJong/The Plain Dealer)
Prescribing food, not medicine
The Greater Cleveland Food Bank launched new “food as medicine” initiatives in 2015, inspired by the opening of Toledo-based ProMedica’s food pharmacy that same year. Local efforts include nutrition education, fresh produce distributions, food pharmacies and food prescriptions, among other things. The goal is to find ways to get healthier food to the community and to educate those receiving it on how to create nutritious meals.
Anne Leach, community program director and wellness dietitian for Sodexo Healthcare, left, helps patient Robin Goins, 50, right, shop for healthy items inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. (Lisa DeJong/The Plain Dealer)
Anne Leach, community program director and wellness dietitian for Sodexo Healthcare, right, helps patient Robin Goins, 50, left, shop for healthy items inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. "Food insecurity has been found to be associated with a range of chronic illnesses, including hypertension and diabetes," said Leach. (Lisa DeJong/The Plain Dealer)
Last year, 21 million of the 45 million pounds of food the local food bank supplied to the community was fresh produce, driven by grants and partnerships with food producers. And, with new agreements with hospital systems who help pay for healthy food, the organization hopes to increase those numbers.
Anne Leach, community program director and wellness dietitian for Sodexo Healthcare, left, helps patient Robin Goins, 50, right, shop for healthy items inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. (Lisa DeJong/The Plain Dealer)
Joyce Kavaras, a registered dietitian for University Hospitals Population Health Management, left, helps put groceries into the car of patient Robin Goins, after she shopped for healthy items inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. Goins' grandkids Terra Stubbs, 10, right, and Terrance Moore, 4, are in the back of the car. (Lisa DeJong/The Plain Dealer)
“Our mission is to ensure that everyone in our community has access to nutritious food every day. Working with healthcare partners allows us to reach more clients,” said Warzocha. “If we can reduce food insecurity, ultimately we can improve community health.”
Cooking tips are available inside the MetroHealth food clinic. (Lisa DeJong/The Plain Dealer)
The local food bank first reached out to MedWorks, a local nonprofit healthcare organization that hosts free health clinics, and to area Federally Qualified Health Centers (FQHCs) like Northeast Ohio Neighborhood Health Services to help distribute healthy food. Now that effort has extended to area healthcare systems, who can help foot the bill.
Diced tomatoes are available inside the MetroHealth food clinic. (Lisa DeJong/The Plain Dealer)
This past fall, UH’s Food for Life Market and a food clinic at MetroHealth both opened. And, once fundraising is complete, the Cleveland Clinic is planning to launch a Functional Food Farmacy through its Center for Functional Medicine, building upon food as medicine efforts at its Stephanie Tubbs Jones Family Health Center in East Cleveland.
Grain rotini pasta is available inside the MetroHealth food clinic. A primary care provider writes a prescription for patients for two visits a month to the food clinic. (Lisa DeJong/The Plain Dealer)
However, not everyone thinks food-as-medicine efforts are the cure-all. While diet does contribute to disease management and prevention, there is some danger in referring to food as medicine, according to Dr. Dylan MacKay, a nutritional biochemist at the University of Manitoba.
Peanut butter is lined up inside the MetroHealth food clinic. (Lisa DeJong/The Plain Dealer)
“I think there is a risk of blaming individuals for their illness when the food as medicine narrative is used too much. There is the risk of people forgoing real medicine; there are so many cases of people doing detox or cleanses or retreats with special diets, gershon therapy, etc., instead of cancer treatments and then starting too late or dying,” MacKay said. “Moving the blame for poor health to individuals when the food environment can be so bad is passing the buck.”
Onions are available inside the MetroHealth food clinic. The food clinic is part of a pilot program that offers healthy foods to those who don't have access to affordable and nutritious foods. (Lisa DeJong/The Plain Dealer)
Making it work
While each food as medicine clinic operates differently, the basic premise is the same: Those wanting to access the food clinic must first visit a doctor to get a referral. Doctors identify patients who are food insecure by asking two standard questions:
- We worried whether our food would run out before we got money to buy more. Was that often, sometimes or never true in the last 12 months?
- The food that we bought just didn't last and we didn't have money to buy more. Was that often, sometimes or never true in the last 12 months?
Shopping bags and grocery carts are available inside the MetroHealth food clinic. (Lisa DeJong/The Plain Dealer)
A dietician then helps patients choose healthy options and offers tips for preparing foods using the ingredients available that day. At the MetroHealth food clinic, patients are given a small shopping cart to push around the room and can take home reusable shopping bags.
A board shows what is in the cooler today at the MetroHealth food clinic. (Lisa DeJong/The Plain Dealer)
“More and more, health systems are seeing that we need to go more upstream. It’s not enough to just give them medicine when they’re sick,” said Jennifer Bier, manager of ambulatory nutrition for MetroHealth.
A food chart from the U.S. Department of Agriculture, Center for Nutrition Policy and Promotion hangs on the wall inside the MetroHealth food clinic. (Lisa DeJong/The Plain Dealer)
At the Clinic, Dr. Mark Hyman, director of the Center for Functional Medicine, even wants to see the federal government’s reimbursement models changed so that Medicare and Medicaid can help pay for prescriptions for healthy food instead of medicine.
“We are trying to focus on the most pressing problem of the day, which is how social determinants and food insecurity drive disease,” Hyman said. “Doctors could be writing prescriptions for food rather than drugs.”
Robin Goins, 50, left, puts groceries in the back of her car with the help of Anne Leach, community program director and wellness dietitian for Sodexo Healthcare, right, after shopping for healthy items inside the new Food for Life Market located at the University Hospitals Otis Moss Jr. Health Center. (Lisa DeJong/The Plain Dealer)
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