Addressing Food Insecurity and Obesity in the Same Household

In this podcast, Jacquelyn Nyenhuis, PhD, RDN, LDN, discusses the compounded burdens of obesity and food insecurity in rural United States, designing a culinary nutrition session for families affected by these burdens, and the resources available to nutritionists and dietitians in rural areas.

Additional Resource:

• Myers J, Boe-Feltman R, Nyenhuis J. Unwinding the COVID-19 paradox of food insecurity and obesity in the same household in rural populations. Paper presented at: Food & Nutrition Conference & Expo 2020; October 17-20, 2020; Virtual. https://2020.eatrightfnce.org/sessions/1287906/ 

Jacquelyn Nyenhuis, PhD, RDN, LDN, is an assistant professor at the University of Central Florida College of Medicine. You can contact her via email at Jacque@ucf.edu.

TRANSCRIPTION:

Amanda Balbi: Hello everyone, and welcome to another installment of Podcasts360—your go-to resource for medical news and clinical updates. I’m your moderator, Amanda Balbi with Consultant360 Specialty Network.

The compounded burdens of obesity and food insecurity are recognized global health issues. However, the distinct factors protecting against and contributing to this nutritional health paradox in rural America are less understood.

With us today to talk more about this paradox is Dr Jackie Nyenhuis, who is an assistant professor at the University of Central Florida College of Medicine.

Thank you so much for joining me today, Dr Nyenhuis. To start, can you talk about the COVID-19 paradox of food insecurity and obesity? What are the roles of the nutritionist and dietitian?

Jackie Nyenhuis: The registered dietician has a key role in preventing and treating COVID‑19 and in the recovery. The paradox of needing to up our immune system can be paired to what grocery stores report consumers are buying the most of. There's a big mismatch.

Our needs during COVID‑19 don't match what we're eating. Registered dieticians can help our community focus on foods that increase immunity and decrease inflammation. Walking through the grocery store aisle, we could see the things that were there on the shelf, the things that weren't there. We're talking flour. We're talking a lot of baking items, frozen pizzas. The kinds of foods that consumers are buying were more comfort foods, which is also important during the pandemic.

If we want to strengthen our immune system, all those fruits and vegetables are really important for their antioxidants and their anti-inflammatory properties. When I walked through the grocery stores in several different states, there were lots of fruits and vegetables available. Some of the healthiest fruits and vegetables that we often don't know how to prepare were the ones that were still sitting there on the shelf, when other areas of the grocery store were completely void of product.

Amanda Balbi: As you were talking, I was also thinking of all these advertisements for fast food places and “order on the app.” The fast food places are making it super easy to be accessible. Going back to what you said, that's not exactly the food that we should be consuming. My question, building from that is, as a dietitian, what are your tips for encouraging people to buy the fruits and vegetables, and the healthier food?

Jackie Nyenhuis: One of the really big problems is the double burden of food insecurity and obesity. Just imagine if that is in the same household, at the same dinner table. How do you address when a family has that kind of situation?

The solution is really the same for both food insecurity and for obesity. It's the produce section. It's learning how to use those vegetables.

Some of the tips that I have are very common sense. They're very down to earth, and you say, "Wow, I can do that." It's really not all that difficult. Let me just give you an example.

I had a patient who was court ordered to see a dietitian. I talked with the mom. She was obese. Her 2 young boys that were 4 and 6 years old, were morbidly obese.

As we talked and as she started to trust me, she tearfully told me that what happened in their house is that she would receive her check at the beginning of the month. She would get groceries. She would set them in the middle of the kitchen table. They sat there. The kids and herself, they just ate from the bags until the food was gone. It often didn't last until the end of the month.

She said I just don't even know how to begin to...For one thing, when you bring the groceries home, you take them, and you put them in the cupboard. The foods that can cause obesity, those are the ones that you would put up high and that only a caretaker or a parent can reach, so the children can't freeload off of it. Then foods that the children can have any time might be on the lower shelf of the refrigerator. That might be the fruits and vegetables.

I had another patient who came in, and the child was obese. We're talking about what kind of meals they have, what kind of foods, and everything seemed really good. Then she said he grabs the raw hot dog package out of the refrigerator and, as a 3-year-old, would proceed to eat the entire package of raw hot dogs.

The simple solution was to put those hot dogs on a higher shelf so that he can't reach them. When we have young children who are obese, every single piece of food that they take, someone has to give it to them. That lasts for quite a while.

I talk about a division of responsibility. The responsibility of the parent or the caretaker is to have nutritious, healthy foods available. It's the responsibility of the child of what goes into their mouth. Any food that the child can reach, any food that's at their eye level, should be healthy nutritious foods. Then those occasional foods can be put up higher and can be given to them.

That advice works well for children who are food insecure and children who are obese. It doesn't matter whether a child is thin or heavy, we recommend that you treat the children exactly the same, both with a healthy diet. Not shaming, not causing guilt, but encouraging them to eat until they're comfortable and stop at that point.

Amanda Balbi: Can you walk us through how you would design a culinary nutrition session for your patients?

Jackie Nyenhuis: Yes. If household finances don't allow for adequate food, then food insecurity is very real. I've seen young children hoard food or candy under their bed. They worry that they're not going to get enough to eat.

Now, where they get this idea from can come from many different areas. It can also happen in families where the child is considered just a little bit overweight and food is constantly being withheld, or the child is told that they can't have a specific food because it's "not healthy."

Both scenarios, when there's not enough money for food and when a child is not allowed to have foods for whatever reason, they can both cause food insecurity. The interesting thing here is it can actually lead to weight problems, both as children and then later on as adults.

When we're designing a food program, it goes back to no food guilt, no food shaming. The child needs to learn how much food they can eat in what proportions, what quantities. As parents and caregivers, we have healthy foods there available. If they're really hungry just before the evening meal, have some carrots and celery and apple slices on a plate. While they're helping you fix dinner, they can have some of those instead of maybe a higher-calorie food.

If they reach for a higher-calorie food, it's not like we're going to slap their hands or take it away from them. We have to trust that they're going to be able to deal with the food in a good way. We need to trust that even if we ourselves can't.

Sometimes, as parents or caregivers, we might have a problem with chocolate, we might have a problem with fried foods. We might have a problem with overeating chips and snacks, or mindless eating while we're watching TV. We shouldn't let that overshadow parenting our children. We need to trust that, even if we don't have a good control on food, that they will. That trust starts to build a really good relationship of the child with food.

You asked how to design a culinary nutrition session. We work in teaching kitchens. The parent comes with the children to the teaching kitchen. We start cooking all kinds of interesting, fascinating, amazing foods.

We did one culinary medicine session with middle schoolers. I had middle schoolers pronounce, "This is the first healthy food I've ever liked." It was a great session. We had about 12 students, and we had 6 medical students. We paired the medical students up with middle school students to learn how to cook healthy foods.

Amanda Balbi: That's really interesting. Definitely hands‑on experience. I guess my next question, to alter it a little bit, is for nutritionists and other dietitians who don't have access to a test kitchen where they can actually bring in their patients, what tools and resources are available to them in more rural settings, too?

Jackie Nyenhuis: In rural settings, I have found just even a hot plate, an air fryer, or maybe an instapot is enough, or a microwave. Any one of those items, I can set up an entire culinary medicine session just using one of them.

If I have a table...I've done it before where I have lots of fruits and vegetables available. The group can come up, and they can make salads for themselves out of all these different greens, and grains, and beans, and legumes that I have already cooked. There's actually no cooking involved. It's just putting different ingredients together. That's a possibility where there are no cooking facilities, too.

Amanda Balbi: What would you say is the overall key take‑home message here for nutritionists and dietitians?

Jackie Nyenhuis: I think that we as dietitians, we need to really listen, to understand, and determine what the real issue is. In this age of information on the internet, anybody can go to the internet. They can find out a solution, find out how to deal with something else, but it's not as easy to know what the real problem is.

When you have a child, maybe, that is a little bit underweight or possibly a little bit overweight, you think that the problem is food. Well, taking them to a dietitian, a dietitian can help you see maybe the food really isn't the problem. Maybe it's how they're thinking about the food. Maybe they're feeling food insecure, so they're hoarding it. Maybe they don't have enough time to eat, so that's why they're a little bit underweight. The first thing would be to really listen to your patients and consumers to determine what the real issue is.

Then secondly would be to help others to peel back the layers that are keeping them from moving forward with better health. The obvious is, "Oh, it's a food problem." Actually, as we peel back the layers we see, well, maybe it's because they're feeling a lot of guilt, and they're hiding that in food.

The third would be to strengthen our immune system and good nutrition with more than just food. It's also how we think about health. Obsessing, stressing, and guilting over food is not going to help our immune system. We need to let loose, and say, "I need to increase the variety of foods I'm eating instead of restricting, and leaving out this group of foods, and this group of foods, and this group of foods." Be more inclusive of a lot of different foods.

I do travel across the country doing culinary medicine presentations. If a group of dietitians wanted to learn how to do culinary medicine presentations, I would love to come and show their group or help them devise a culinary medicine program for others.

Amanda Balbi: Absolutely. Great, thank you again for speaking with me today and answering all my questions.

Jackie Nyenhuis: I enjoyed being here. I especially appreciate that we're talking about food and how important it is to address both food insecurity and obesity at the same dinner table.

So often we forget that in rural areas, these issues are compounded by the isolation and the distance from places to get food. We end up with food deserts and food mirages where there is food available at convenience stores, but it might not be the healthiest kinds of food.