Why are You Eating Hot Dogs Every day?

Transcription

1 Why are You Eating Hot Dogs Every day? Navigating Food Deserts, Swamps, and Health Disparities Edwin McDonald, MD Associate Director Adult Nutrition Image: wikepedia commons

2 Disclosures: I have no relationships to disclose I will not discuss off label interventions or medications Image by bells design retrieved from

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4 Why?

5 3 Reasons

6 1.

7 2.

8 3.

9 Lecture Goals 1. Impact of processed foods 2. Food Swamps and Deserts 3. Health Disparities 4. Interventions Image: Goals by Florian Christoph Retrieved from Flickr creative

10 59 yearold Veteran

11 Divorced Underemployed Couldn t Cook

12 Diabetes Hypertension Fatty Liver Obesity Mild CVA

13 What do you eat?

14 Image: wikepedia commons

15 Photo by Mpumelelo Macu on Unsplash

16 Hot dogs every day?

17 A glimpse into his world Can t cook Likes hot dogs No money No grocery stores

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19 Processed Foods Can t cook Likes Hot Dogs Cheap Easy

20 Not alone Reasons for eating processed foods Affordable Easy Taste Convenient Good Statista. (n.d.). Which of the following do you consider to be reasons why you might consume processed or packaged foods?. In Statista - The Statistics Portal. Retrieved August 22, 2018, from

21 USDA: Daily Caloric Intake 523 calories Image- brown cupcake on white plate, retrieved from Wells, H. F., & Buzby, J. C. (2014). USDA Economic Research Service-US Food Consumption Up 16 Percent Since 1970.

22 ~60% of calories come ultraprocessed foods NHANES (n=23,847) Percent of Caloric Intake Ultraprocessed Foods Processed Foods Processed Culinary Ingredients Unprocessed Baraldi, L. G., Steele, E. M., Canella, D. S., & Monteiro, C. A. (2018). Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study. BMJ Open, 8(3), e

23 What s are the types of processing? NOVA Classification unprocessed or minimally processed foods fresh, dry or frozen fruits or vegetables packaged grains and pulses; grits, flakes or flours pasta, fresh or dry, made from flours and water eggs fresh or frozen meat and fish and fresh or pasteurised milk) processed culinary ingredients sugar, oils, fats, salt and other substances extracted from foods and used in kitchens processed foods canned foods dry fruits salted meat product cheeses freshly made unpackaged breads other ready-toconsume products Ultra-processed foods soft drinks packaged snacks Industrialized desserts/packaged breads Poultry/fish nuggets and other meat products instant noodles/ soups additives Monteiro, C. A., Cannon, G., Nutrition, J. M. H., (n.d.). The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing.

24 Ultra-processed foods Photo by Fernanda Rodríguez on Unsplash

25 650,000 deaths per year are due to diet related diseases Photo by Hugues de BUYER- MIMEURE on Unsplash Murray, C. J. L. (2013). The State of US Health, Jama, 310(6),

26 Due to non-communicable diseases Photo by rawpixel on Unsplash

27 Diabetes Hypertension Fatty Liver Obesity Mild CVA

28 Disparities in non-communicable diseases

29 Higher rates in African- Americans Obesity Hypertension Diabetes CVA

30 Are disparities in diets a cause?

31 % of Energy Intake from Ultra-processed Foods Non-Hispanic Black 60.6% Non-Hispanic White 60.2% Other Hispanic 52.0% Other 49.6% Photo by Patrick Fore on Unsplash Baraldi, L. G., Steele, E. M., Canella, D. S., & Monteiro, C. A. (2018). Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study. BMJ Open, 8(3), e

32 What about veggies? Photo by chuttersnap on Unsplash

33 Only 9.3% of Americans meet guidelines vegetable intake NHANES 2015, n= 441,456 Lee-Kwan SH, Moore LV, Blanck HM, Harris DM, Galuska D. Disparities in State-Specific Adult Fruit and Vegetable Consumption United States, MMWR Morb Mortal Wkly Rep 2017;66: DOI:

34 No significant difference by race/ethnicity Photo by Jonathan Pielmayer on Unsplash Lee-Kwan SH, Moore LV, Blanck HM, Harris DM, Galuska D. Disparities in State-Specific Adult Fruit and Vegetable Consumption United States, MMWR Morb Mortal Wkly Rep 2017;66: DOI:

35 What accounted for the largest disparity in vegetable consumption? Income Meeting Recommendations: Highest vs. Poverty 11.4% vs. 7.0% Image: Money by Andrew Magil Lee-Kwan SH, Moore LV, Blanck HM, Harris DM, Galuska D. Disparities in State-Specific Adult Fruit and Vegetable Consumption United States, MMWR Morb Mortal Wkly Rep 2017;66: DOI:

36 No Money No Stores

37 Image: wikepedia commons

38 Food Insecurity Food Deserts

39 I don t have any money

40 1 in 7 Americans are Food Insecure Half are white Rates are 2x higher in Black and Hispanic Households 4.Alicia Coleman-Jensen, Mark Nord, and Anita Singh. (2013). Household Food Security in the United States in 2012, ERR-155 (Washington, DC: U.S. Department of Agriculture, Economic Research Service), Earlier years are available at Photo by Jonathan Kho on Unsplash

41 Poor pay more due to higher prices at convenience stores 25-50% more Photo by Christian Dubovan on Unsplash Do the Poor Pay More for Food? An Analysis of Grocery Store Availability and Food Price Disparities. (1999). Do the Poor Pay More for Food? An Analysis of Grocery Store Availability and Food Price Disparities, 33(2),

42 No Grocery Stores

43 Lived in Englewood

44 Englewood Southside $19, 854 African-American 35.1%-57.1% Food Insecurity Image Wikimedia Gundersen, C., Engelhard, E., & Waxman, E. (2014). Map the Meal Gap: Exploring Food Insecurity at the Local Level. Applied Economic Perspectives and Policy, 36(3), content/uploads/2016/10/food-insecurity-rates jpg /126764/Englewood.pdf

45 A tale of two cities Englewood Lakeview Rates of diabetes related deaths per 100,000 persons City of Chicago. Public Health Statistics--Selected public health indicators by Chicago community area [Data file]. Retrieved from Services/Public-Health-Statistics-Selected-publichealth-in/iqnk-2tcu.

46 Blocks from the University of Chicago Image Wikmedia çommons

47 Englewood is a food desert Photo by Eduardo Gutiérrez on Unsplash Gallagher, M. (2006, July 24). Examing The Impact of Food Deserts on Public Health in Chicago. Retrieved August 8, 2018, from

48 Chicago s food deserts are almost exclusively African-American hoto by Lance Anderson on Unsplash Gallagher, M. (2006, July 24). Examing The Impact of Food Deserts on Public Health in Chicago. Retrieved August 8, 2018, from

49 Food desert 1 st used in Scotland in the 1990s Photo by Steffen Kastner on Unsplash Food deserts-- evidence and assumption in health policy making. (2002). Food deserts-- evidence and assumption in health policy making., 325(7361),

50 Food Desert- Farm Bill Definition (2008) limited access to affordable/ nutritious food predominantly lower-income Photo by Jordi Ganduxe on Unsplash The Public Health Effects of Food Deserts: Workshop Summary. (2009). The Public Health Effects of Food Deserts: Workshop Summary.

51 USDA expanded definition to low access at least 100 households more than ½ mile from the nearest supermarket with no access to a vehicle at least 500 people or 33 percent of the population live more than 20 miles from the nearest supermarket Photo by Osman Rana on Unsplash

52 Predominantly Black Neighborhoods have 52% as many supermarkets compared to white neighborhoods Photo by Nicola Fioravanti on Unsplash Food store availability and neighborhood characteristics in the United States. (2007). Food store availability and neighborhood characteristics in the United States, 44(3),

53 Types of neighborhood stores have health implications

54 Atherosclerosis Risk in Communities Study N= 10,763 Associated supermarkets with a lower prevalence of obesity and overweight (obesity prevalence ratio [PR] = 0.83, 95% confidence interval [CI] = ; overweight PR = 0.94, 95% CI = ) Morland, K., Diez Roux, A. V., & Wing, S. (2006). Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. American Journal of Preventive Medicine, 30(4), Photo by Clark Young on Unsplas

55 Should we solely focus on the presence of grocery stores?

56 Food balance score (relative distances of grocery stores and fast food) Gallagher, M. (2006, July 24). Examing The Impact of Food Deserts on Public Health in Chicago. Retrieved August 8, 2018, from

57 Average Years of Potential Life Lost By Food Balance High Score (worst) Middle Score (average) Low Score (Best) Cancer CVD Gallagher, M. (2006, July 24). Examing The Impact of Food Deserts on Public Health in Chicago. Retrieved August 8, 2018, from

58 Englewood is also a food swamp area in which large relative amounts of energy-dense foods, inundate healthy food options Photo by Edward Franklin on Unsplash Rose, D., Bodor, J. N., Swalm, C. M., Arbor, J. R. A., MI: University, (n.d.). Deserts in New Orleans? Illustrations of urban food access and implications for policy. Citeseer

59 Food swamps frequently occur in predominantly Black neighborhoods Predominantly Black neighborhoods 2.4 restaurants /sq. mile Predominantly White neighborhoods 1.5 restaurants / sq. mile Photo by Tyler Domingue on Unsplash Rose, D., Bodor, J. N., Swalm, C. M., Arbor, J. R. A. MI: University, (n.d.). Deserts in New Orleans? Illustrations of urban food access and implications for policy. Citeseer.

60 I can t cook

61 Men Who Cook to % to 42% 37 min/day to 45 min/day Photo by Travis Grossen on Unsplash Smith, L. P., Ng, S. W., & Popkin, B. M. (2013). Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies from to Nutrition Journal, 12(1), 45.

62 Women who cook decreased ( ) 92% to 65% Smith, L. P., Ng, S. W., & Popkin, B. M. (2013). Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies from to Nutrition Journal, 12(1), 45.

63 Low income groups had the largest decline in cooking Smith, L. P., Ng, S. W., & Popkin, B. M. (2013). Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies from to Nutrition Journal, 12(1), 45.

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65 Recipes Greater Food Depository 61 st Farmer s Market

66 His story highlights 3 major themes Availability Access Knowledge/ Behavior

67 Should we just make food cheaper?

68 LinkUp Illinois 85 Farmer s Markets Matched SNAP spending

69 Goddu, A. P., Roberson, T. S., Raffel, K. E., Chin, M. H., & Peek, M. E. (2015). Food Rx: A Community-University Partnership to Prescribe Healthy Eating on the South Side of Chicago. Journal of Prevention & Intervention in the Community, 43(2), FOOD Rx Prescription Walgreens Discount Farmers Market Discount Educational Information Map for participating stores

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71 Should we just add more grocery stores?

72 It depends

73 Increased supermarkets by 20% (2007 to 2014) 0.5 million people had persistently low access Kolak, M., Bradley, M., Block, D. R., Pool, L., G Toman, C. K., et al. (2018). Urban foodscape tr Disparities in healthy food access in Chicago, Health & Place, 52, Photo by Jeff Brown on Unsplash

74 80% were African - American Kolak, M., Bradley, M., Block, D. R., Pool, L., Garg, G., Toman, C. K., et al. (2018). Urban foodscape trends: Disparities in healthy food access in Chicago, Health & Place, 52,

75 The new stores weren t in low access areas

76 Philadelphia- Pennsylvania Fresh Food Financing Initiative Store in a food desert Improved perceptions No improvement in behavior or obesity Photo by Fredy Martinez on Unsplash New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity. (2014). New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity., 33(2),

77 Should we just teach cooking classes?

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80 You have to use all of the pieces

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82 Image: wikepedia commons

83 QUESTIONS All photos were taken personally or used via common license agreements. Thank you