Reprinted from the spring 2023 issue of The Ohio Family Physician
By: Allison Macerollo, MD, The Ohio State University Department of Family and Community Medicine; Siera Holley, MS, RDN, LD, The Ohio State University Wexner Medical Center; and Ryan Poland, MD, PGY-2, The Ohio State University Department of Family and Community Medicine Residency
The World Health Organization (WHO) reports that an unhealthy diet is a leading global health risk. They also note that a healthy diet can protect against non-communicable diseases like diabetes, heart disease, stroke, and cancer.1 The Centers for Disease Control and Prevention recognizes a healthy diet as one of the largest impacts on a healthy body weight and that obesity is directly linked with severe illness.2 Together, these demonstrate the importance of access to and consumption of nutritious food.
Across Ohio, there are many people without this seemingly simple requirement for a healthy life. According to the United States Department of Agriculture Electronic Status Reporting data on the 2010 census, at least 1.5 million Ohioans were living in areas without adequate access to healthy food,3 or rather, they were living in food deserts—an area with limited or no access to affordable and nutritious food.
Most often these areas, in both rural and urban settings, lack resources, have a low socio-economic income, and are even impoverished.4,5 They are typically bound by geographic limitations, have transportation disparities, and are saturated by unhealthy food options provided by convenience stores, dollar stores, and gas stations.6
Interestingly, there are additional related concepts of food mirages and food swamps. A food mirage is the appearance of good access to healthy food, but the residents in the area are unable to afford the resource.7 A food swamp is the oversaturation of an area with unhealthy food options despite the access to healthy foods.5
- Reliance on general retailers close to home, such as dollar stores, corner stores, and gas stations, for the bulk of their groceries. Access to fresh produce, meat, dairy, whole grains, and other minimally processed options is greatly limited. Patients may consume a larger amount of packaged, shelf stable foods since they visit a grocery store less frequently.
- Consumption of meals from local fast food and/ or restaurant establishments multiple times per week, if not daily. It can be easier and more convenient for patients to purchase a meal outside of their home than to navigate the logistics of getting to a grocery store on a consistent basis.
- Small-portioned or skipped meals. Patients tend to go long durations between grocery store visits due to the difficulty and/or inconvenience of getting there. They may try to stretch the amount of food they have to extend the duration of time between grocery store visits.
- Barriers to accessing culturally preferred foods. Patients living within food deserts may be uncertain on how to incorporate the foods that are available to them and express concerns with being able to follow their cultural food practices.
- Overall lack of nutrient density and variety within the diet. Diet recalls and food frequency questionnaires indicate typical intakes that do not align with the recommendations in the Dietary Guidelines for Americans, 2020-25.8 Calories, sodium, added sugar, and saturated fat are consumed in excess, whereas fiber and many vitamins and minerals are lacking.
There are potential solutions in place around Ohio, though many are tied to interventions through physicians/healthcare systems. The OSU Department of Family and Community Medicine has a program titled “Farmacy.” Through this program, patients are screened for food insecurity. When patients are identified as having a need, they are offered the option to increase their weekly fresh produce allowance at their local food bank. Once started, patients have weekly access for one year.
The University Hospitals Cleveland Medical Center has started a similar initiative called the “Food for Life Program.” Patients who screen positive for food insecurity can be referred to one of four locations of the “Food for Life” market, which is staffed by registered dieticians. The referral allows one visit per month for up to six months.9
In Columbus, OH, an organization called Local Matters10 has been working to provide education and access to healthy nutrition. They offer virtual classes to help families shop for and cook healthy meals on a budget, provide safe access to healthy food through the Veggie Van, grow food for neighbors in 14 community gardens, and advocate for policies that support food education and access in the Columbus community.
Another way that Ohio is working to improve access to nutrition is through federally provided benefits. The digital age has arrived for those in Ohio who receive Supplemental Nutrition Assistance Program (SNAP) benefits. The SNAP card can be used like a debit card to purchase eligible food. In the past, SNAP was only available at brick and mortar stores, but as of January 2023 can be used online for the following Ohio retailers: Amazon, Giant Eagle, Meijer, and Aldi.11 Future directions include better access to community supported agriculture for those with SNAP benefits.
Food deserts have resulted from a myriad of issues and there will not be one simple solution. Awareness of the problem and prioritizing identification of specific food deserts are incredibly valuable when working to mitigate the root cause for each region. A solution in one city or neighborhood will not be the perfect solution to all locales. Government involvement is a necessary part of the solution. Resolving this issue is imperative given the strong link that poor diet has with chronic disease progression and longevity.1,2 Ohio has some programs in place, but there is much work that needs done. You can help patients by utilizing some brief interventions, such as screening for food insecurity and referring patients to 211 or freshtrak.com12 to provide local resources based on zip code. Lastly, there must be some incentive for food retailers to seek out areas lacking good access to nutritious food options. Please use your voices and your votes to advocate for Ohioans facing food insecurity.
References available on the Ohio Academy of Family Physicians website.