Challenges in Nutritional Counseling for Patients Living in Food Deserts

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Nearly 12% of Americans live in households considered food insecure.
Nearly 12% of Americans live in households considered food insecure.

Nearly 40 million people in the United States go hungry during the year, meaning that 12% of households are considered food insecure.1 Many patients have difficulty accessing food, let alone nutritious meals, leaving physicians with a challenge.

"[I]mproving diets of people who live in food deserts is a complex problem," wrote Annalynn Skipper, PhD, RDN, author of a study published in the AMA Journal of Ethics on the topic. "[It's] at the intersection of culture, education, and economics that will require community partnerships and clinician self-education to solve."2

Physicians tend to have little training when it comes to this kind of counseling on behavior change, and that particular expertise also is not typically covered by insurance. However, there are steps that physicians can take to help patients who live in food deserts.

Dr Skipper addressed ways physicians can have an effect in the clinic and their surrounding communities to promote access to nutritious food, using a case study of "Dr D" to help illustrate the examples.

In the clinic, physicians should approach the topic of nutrition with humility and respect toward the patient. Although a physician's first instinct toward encouraging behavior change may be to counsel patients directly on what to eat, that is not always practical. Counseling usually relies on consistent check-ins with patients for months for behavior change to occur. In addition, telling a patient that certain foods must be off-limits can come across as disrespectful.

"[F]oods patients viewed as traditional — regardless of nutrient density — can be important simply because they can serve as cultural and community touchstones," Dr Skipper noted. "As a result, Dr D has become more humble about attempting to steer patients away from some foods in case doing so might be interpreted as disrespectful of food preferences driven by cultural practices."

For physicians who are not properly trained in food and nutrition, a registered dietitian nutritionist can help provide the latest information on food assistance programs and accessibility options around the community. Registered dietitian nutritionists can also provide ideas for how to communicate with patients about obtaining healthy meals in the area.

To help affect change in the community, physicians can dedicate time to research and brainstorm ways to promote access to nutritious foods in their neighborhoods. In the case study, Dr D found data showing that community members purchase the same types of foods at any store they visit. Because corner stores are closer in distance than grocery stores in Dr D's community, he could think about the possibility of engaging with those storeowners.

"[B]ecause corner stores can be viewed as a community resource and because they can be more successful in promoting nutritious foods than full-service grocery stores," Dr Skipper wrote. "Dr D might decide to help strengthen the existing business community by engaging corner store operators in an intervention to stock nutritious foods."

Solving the issue of food deserts can seem insurmountable. However, making small changes in everyday practice can lead to a meaningful effect on patients and the community.

References

1. US Department of Agriculture. Food security status of US households in 2017. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx. Updated September 5, 2018. Accessed November 5, 2018.

2. Skipper A. How should physicians counsel patients who live in food deserts? AMA J Ethics. 2018;20(10):E918-E923.

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