Clinic-to-Community Models to Address Food Insecurity

Medically Tailored Meals as a Prescription for Treatment of Food-Insecure Type 2 Diabetics

“…27 In light of these costs and the immense rise and projected continued growth in diabetes prevalence ─ the number of patients with diabetes globally has more than doubled over the past 3 decades, and prevalence is expected to rise to almost 440 million by 2030 17 ─ it becomes clear that novel, more effective, and cost-reducing treatment options of diabetes are needed. 9,17 Current Programs to Address FI Are Not Adequate Currently the health care system does not directly address FI, 16,18 and existing resources aimed at addressing the issue of FI are either not nutritionally appropriate, not robust enough in size, or not reliably reproducible. 14,18,21,22,24 The largest governmental safety net for the food insecure is the Supplemental Nutrition Assistance Program (SNAP), which was created in the 1960s and has failed to adjust its dietary offerings as the dietary practices of Americans have become increasingly unhealthy.…”

“…Evidence now suggests that nutritional deprivation or malnutrition of pregnant mothers can actually predispose the developing fetus in utero to epigenetic changes that result in an increased risk for impaired glucose metabolism and diabetes as an adult. 17,18 Beyond these risk factors, food-insecure diabetic patients are more likely to have poorer glycemic control, 2,4-6 and FI has been shown in multiple studies to be independently associated with elevated hemoglobin A1c levels. 2,7 The mechanisms by which FI increases the risk of diabetes and the propensity for it to be uncontrolled are multifaceted.…”

Why Marginalization, Not Vulnerability, Can Best Identify People in Need of Special Medical and Nutrition Care

“…12 It is linked to adverse outcomes, such as inadequate diet, poor physical and mental health, challenges to cognitive development, and noncommunicable diseases in adulthood. 13,14 Programs addressing food insecurity often appropriately prioritize children due to their unique nutritional needs. However, issues related to food insecurity are, at root, issues of marginalization (based on social identities and positioning).…”

“…14 Direct relationships between clinics and organizations such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and local food banks also contribute to communities of care. 14 Such systems of social support that are connected to or integrated into facility-based settings can increase families’ receipt of resources to address their unmet needs. 22 …”

Design and Implementation of a Clinic-Based Food Pharmacy for Food Insecure, Uninsured Patients to Support Chronic Disease Self-Management

“…Food insecurity, a household condition of unreliable access to an adequate, nutritious food supply, 1 is increasingly recognized by the medical community for its negative implications regarding disease management outcomes. 2,3 Clinic-to-community models to address food insecurity offer a direct approach for health care systems to link patients who are at risk to community food resources 4 and can involve physician food prescriptions that can be filled on-site through medically tailored food pharmacies. Few published studies have described the design and implementation of food pharmacies, which may provide opportunities to address immediate food needs of patients while teaching nutrition-related disease self-management skills.…”