Background Food insecurity is a complex public health problem affecting many individuals in the United States. Digital health interventions that promote behavior change and provide access to affordable and healthy food may help to alleviate food insecurity. Objective The aim of this study was to characterize food-insecure users of Foodsmart, a telehealth and nutrition platform with meal planning, food ordering, nutrition education, budgeting, and grocery discount features, and to evaluate changes in diet and food insecurity. Methods We retrospectively analyzed data collected from 4595 adults who used the Foodsmart platform between February and October 2021. Participants self-reported their diet, demographics, biometrics, and food insecurity status in a 56-item questionnaire. Participants were reported to be food insecure if they answered “sometimes” or “often” to the question “How often does the food you buy not last and you don't have money to get more?” from the United States Department of Agriculture’s Household Food Security survey. We examined baseline characteristics of participants by food insecurity status, associations between characteristics and baseline food insecurity, and changes in diet quality and food insecurity status. To evaluate potential causes of reversing food insecurity, the use of 6 Foodsmart features was compared between food-insecure participants who achieved food security versus food-insecure participants who remained food insecure, based on their last response to the food insecurity question. Results We found that 16% (742/4595) of participants were food insecure at baseline. Participants who were food insecure at baseline were more likely to be obese, to have at least one chronic condition, to have a lower diet quality, to cook less frequently at home, to think healthy food is too expensive, and less likely to order takeout or eat at a restaurant. Among participants who were food insecure at baseline, 61% (451/742) improved their nutrition and 29% (217/742) responded that they were food secure at follow-up, with an increasing percentage achieving food security with longer enrollment time. Using a multivariable logistic regression model, we found that age, diabetes, prediabetes, BMI categories, and diet quality at baseline were statistically significantly associated with the likelihood of being food insecure at baseline. Among those who were food insecure at baseline, there was a higher relative proportion of participants who achieved food security and used the “deals” (28.6% higher), “CookItNow” (36.4% higher), and “telenutrition” (27.5% higher) features compared to those who remained food insecure. Conclusions This study assesses the characteristics of individuals enrolled on the Foodsmart platform who answered the food insecurity question. We found that a significant number of participants who were food insecure at enrollment achieved food security. This finding shows that telehealth and nutrition platforms may potentially help users improve household food security.
Background Diabetes-related costs are the highest across all chronic conditions in the United States, with type 2 diabetes accounting for up to 95% of all cases of diabetes. A healthy diet is strongly associated with lowering glycated hemoglobin A1c (HbA1c) levels among individuals with diabetes, which can help curtail other health complications. Digital health platforms can offer critical support for improving diet and glycemic control among individuals with diabetes. Less is known about the characteristics of people with diabetes who use digital health platforms (specifically, a platform that integrates personalized healthy meal plans and food ordering) and changes in their HbA1c levels. Objective The aim of this study is to characterize Foodsmart users with diabetes and evaluate the longitudinal impact of Foodsmart—a personalized digital nutrition platform with meal planning, food ordering, and nutrition education features—on changes in HbA1c levels. Methods We retrospectively analyzed data collected from 643 adults with at least two self-reported HbA1c entries in the Foodsmart platform between January 2016 and June 2021. Participants self-reported their HbA1c levels, height, weight, health conditions, and diet in a 53-item food frequency questionnaire. Diabetes was defined as HbA1c ≥6.5%. We analyzed distributions of characteristics by baseline diabetes status and examined the association of characteristics with the likelihood of having diabetes at baseline. To evaluate the change in HbA1c levels among Foodsmart users, we calculated mean changes (absolute and percent) in HbA1c among participants with diabetes and by length of follow-up. We also compared changes in HbA1c and weight between participants with diabetes at baseline who achieved a normal HbA1c level and those who did not. Results We found that 43.5% (280/643) of the participants with at least two HbA1c level entries had diabetes at baseline. Participants with diabetes at baseline were more likely to be male, have a higher weight and BMI, report high blood pressure, and have a poorer diet in comparison to participants without diabetes. Using a multivariable logistic regression model, we found that being male and obese were statistically significantly associated with baseline diabetes. Among participants with diabetes at baseline, HbA1c was reduced, on average, by 0.46%. In addition, 21.4% (60/280) of participants with diabetes achieved a normal HbA1c level (<6.5%) in their last HbA1c level entry; this percentage increased with longer follow-up time (39% [7/18] at >24 months). In a sensitivity analysis, users with an HbA1c ≥7.0% at baseline had an average absolute change of –0.62% and 31.2% (62/199) of these participants achieved HbA1c levels of less than 7.0%. Conclusions This study assessed characteristics of individuals enrolled on the Foodsmart platform with HbA1c levels and found that users with diabetes had lower HbA1c levels over time and a sizable percentage of participants were successful in achieving normal levels.
Background While there is a strong association between adhering to a healthy dietary pattern and reductions in blood pressure, adherence remains low. New technologies aimed to help facilitate behavior change may have an effect on reducing blood pressure among individuals with hypertension. Objective This study aims to evaluate characteristics of participants with stage 2 hypertension who used Foodsmart and to assess changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods We analyzed demographic, dietary, and clinical characteristics collected from 11,934 adults with at least two blood pressure readings who used the Foodsmart platform. Stage 2 hypertension was defined as SBP ≥140 mmHg or DBP ≥90 mmHg. We calculated mean changes in blood pressure among participants with stage 2 hypertension and stratified by length of follow-up and the covariates associated with achieving blood pressure levels below stage 2 hypertension. We compared changes in diet quality and weight between participants with stage 2 hypertension at baseline who achieved stage 1 hypertension or below and those who did not. Results We found that 10.63% (1269/11,934) of participants had stage 2 hypertension at baseline. Among Foodsmart participants with stage 2 hypertension at baseline, SBP and DBP decreased, on average, by 5.7 and 4.0 mmHg, respectively; 33.02% (419/1269) of participants with stage 2 hypertension at baseline achieved blood pressure levels below stage 2 hypertension (SBP <140 mmHg and DBP <90 mmHg). Using a multivariable ordinal logistic regression model, changes in Nutriscore (P=.001) and weight (P=.04) were statistically significantly associated with changes in blood pressure categories for users with stage 2 hypertension at baseline. Using a multivariable logistic regression model, we found that baseline Nutriscore, change in Nutriscore, and change in weight were associated with greater likelihood of users with stage 2 hypertension at baseline achieving a lower blood pressure category. Conclusions This study evaluated changes in SBP and DBP among users (with hypertension) of the Foodsmart platform and found that those with stage 2 hypertension, on average, improved their blood pressure levels over time.
BACKGROUND While there is a strong association between adhering to a healthy dietary pattern and reductions in blood pressure, adherence still remains low. New technologies aimed to help facilitate behavior change may have an effect on reducing blood pressure among individuals with hypertension. OBJECTIVE To evaluate characteristics of participants with stage 2 hypertension who used Foodsmart and to assess changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). METHODS We analyzed demographic, dietary, and clinical characteristics collected from 11,934 adults with at least two blood pressure readings who used the Foodsmart platform. Stage 2 hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. We calculated mean changes in blood pressure among participants with stage 2 hypertension and stratified by length of follow-up and the covariates associated with achieving blood pressure levels below stage 2 hypertension. We compared changes in diet quality and weight between participants with stage 2 hypertension at baseline who achieved stage 1 hypertension or below and those who did not. RESULTS We found that 47.2% (5,627/11,934) and 10.6% (1,269/11,934) of the participants with at least two SBP and DBP readings had stage 1 and stage 2 hypertension, respectively, at baseline. Among Foodsmart participants with stage 2 hypertension at baseline, SBP and DBP had an absolute reduction, on average, of 5.6 mmHg and 4.0 mmHg, respectively. 33.0% (419/1,269) of participants with stage 2 hypertension at baseline achieved blood pressure levels below stage 2 hypertension (SBP < 140 mmHg and DBP < 90 mmHg). Using a multivariable ordinal logistic regression model, changes in Nutriscore and weight were statistically significantly associated with changes in blood pressure levels for users with stage 2 hypertension at baseline. Using a multivariable logistic regression model, we found that baseline Nutriscore, change in Nutriscore, and change in weight were all associated with the likelihood of users with stage 2 hypertension at baseline to achieve a lower blood pressure category. Among Foodsmart participants with stage 2 hypertension at baseline, systolic blood pressure and diastolic blood pressure had an absolute reduction, on average, of 5.6 mm Hg and 4.0 mm Hg, respectively. 33.0% (419/1,269) of participants with stage 2 hypertension at baseline achieved blood pressure levels of stage 1 hypertension (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) in their last blood pressure entry. CONCLUSIONS This study evaluated changes in SBP and DBP among users of the Foodsmart platform with hypertension and found that users with stage 2 hypertension, on average, improved their blood pressure levels over time.
BACKGROUND Diabetes has the highest cost across all chronic conditions in the United States, with type 2 diabetes accounting for up to 95% of all cases. Diabetes affects most of the body’s organ systems and can lead to the development of comorbidities such as cardiovascular and kidney disease. A healthy diet is strongly associated with lowering HbA1c levels among individuals with diabetes, which can help curtail other health complications. Digital health platforms can offer critical support in improving diet and glycemic control among individuals with diabetes. OBJECTIVE To characterize Foodsmart users with diabetes and evaluate the longitudinal impact of Foodsmart, a digital, personalized nutrition platform with meal planning, food ordering, and nutrition education features, on changes in HbA1c levels. METHODS We included 643 adults with at least two self-reported HbA1c entries in the Foodsmart platform between January 2016 and June 2021. Participants self-reported their HbA1c levels, height, weight, health conditions, and dietary habits in a 53-item food frequency questionnaire on the platform. Diabetes was defined as HbA1c ≥ 6.5%. We analyzed distributions of characteristics by baseline diabetes status, and examined the association of characteristics with the likelihood of having diabetes at baseline. We calculated mean changes (absolute and percent) in HbA1c among participants with diabetes and by length of follow-up. We also compared changes in HbA1c and weight between participants with diabetes at baseline who achieved a normal HbA1c level and those who did not. RESULTS We found that 43.5% (280/643) of the participants with at least two HbA1c level entries had diabetes at baseline. Participants with diabetes at baseline were more likely to be male, have a higher weight, higher BMI, report high blood pressure, and have a lower baseline Nutriscore in comparison to participants without diabetes. Using a multivariable logistic regression model, we found that being male and obese were statistically significantly associated with baseline diabetes. Among participants with diabetes at baseline, HbA1c had an absolute reduction, on average, of -0.47%. 21.6% (60/280) of participants with diabetes achieved a normal HbA1c level (<6.5%) in their last HbA1c level entry; this percentage increased with longer follow-up time (38.9% at >24 months). In a sensitivity analysis, users with an HbA1c ≥ 7.0% at baseline had an absolute change of -0.62%, on average, and 31.2% (62/199) of these participants also achieved HbA1c levels of less than 7.0%. CONCLUSIONS This study assessed characteristics of individuals enrolled on the Foodsmart platform with HbA1c levels and found that users with diabetes improved HbA1c levels over time and a sizable percentage of participants were successful in achieving normal levels. Thus, the Foodsmart platform may be a cost-effective option in managing diabetes.
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