Healthy food access, education play key role in reducing diabetes

Food insecurity, or a lack of consistent access to nutritious and affordable food, is a pervasive issue that affects communities across the country. In St. Louis, this problem is prevalent, with a significant portion of the population facing challenges in getting the right kinds of food. Often, this is because grocery stores or other fresh food options are limited or simply because many can’t afford to buy nutritious food.

According to Feeding America’s 2021 data, 8.9% of the overall population of St. Louis County and 14% of the population of the city of St. Louis is food insecure. Food insecurity often occurs in under-resourced communities. In many cases, those communities are predominately Black. In the county, 23% of Black residents are food insecure compared with 7% of white residents. In the city, that number jumps to 30% of Black residents compared with 11% of white residents.

The numbers are sobering, but organizations throughout the region are working together to try to change them.

“We’re working with community-based organizations to make more food available in non-traditional outlets like farmers markets,” said Kara Hughes, a partnership specialist with BJC HealthCare. BJC is focused on holistically improving community health in the region through various initiatives. One of its focuses is food insecurity.

The consequences of food insecurity extend far beyond hunger and malnutrition. Studies like The SEARCH for Diabetes in Youth Study: Rationale, Findings, and Future Directions and the TODAY study have shown a direct correlation between limited access to healthy food and the development of chronic diseases such as diabetes. In the St. Louis area, the impact of food insecurity on diabetes rates is concerning. It’s estimated that 12% of adults in St. Louis County have diabetes. That’s three points higher than the state’s percentage.

But perhaps even more disturbing is the rise of type 2 diabetes in children.

“Before the mid-1990s, type 2 diabetes would almost never be diagnosed in adolescents,” said Dr. Jennifer Sprague, a Washington University pediatric endocrinology specialist at St. Louis Children’s Hospital. “Now we’re diagnosing about one adolescent weekly.”

Adolescent type 2 diabetes is more aggressive than adult type 2 diabetes, Sprague said. The disease is associated with multiple other problems including high blood pressure, high cholesterol and sleep apnea, among others. And complications like eye disease and kidney disease develop faster in adolescents than in adults.

Sprague says there are many factors involved in the uptick of the disease in younger people, but food is a key factor — both from an access and an education perspective. And while overhauls in lifestyle can help stop the disease, the goal is always prevention. And that starts with education about food choices and exercise.

Sprague said mixed messages about certain food groups also can be harmful, like when people mistake processed meats like sausage, bacon and hot dogs for suitable protein, or believing that high-sugar juice drinks are better than soda.

“We need more holistic food education throughout our communities, at every level,” said Marilyn Tanner, a dietitian in the department of pediatric endocrinology at Washington University School of Medicine. “This doesn’t just impact children — it impacts their families. There is a lifestyle aspect to this as well, along with cultural and multigenerational factors. We need everyone in the house to eat healthily.” Another factor is simply the fast-paced lifestyles of many people today. “People gravitate toward quick and easy food because meal prep takes time,” said Melissa Sicard, a pediatric nurse practitioner at Washington University School of Medicine. “This type of eating is more prevalent in all populations.”

Still, the lack of access to affordable and nutritious food disproportionately affects low-income and Black communities that have endured generations of intentional disinvestment, which created areas with limited grocery stores commonly referred to as "food deserts.”

Addressing this issue requires collaboration — which is where BJC HealthCare comes in. The team brings together resources and organizations that can work together to make more sweeping improvements.

BJC is focused on a variety of efforts to help improve access to healthy foods and address diabetes disparities. This includes collaboration with community organizations to provide diabetes education and nutritional counseling, as well as delivering medically-tailored and culturally-appropriate foods to select patients and their families who have expressed food insecurity. BJC also provides nutrition education in schools, libraries and community recreation centers and supports the creation of new healthy food access points through local, state, and national advocacy in communities experiencing low food access.

“We work with community-based organizations to connect and identify resources that can enhance the overall food ecosystem,” said Hughes.

An example of this is BJC’s collaboration with Fatimah Muhammad to make healthy food accessible through the Be Well Farmers’ Market. The market brings together urban farmers and growers, artisans, health providers and food trucks in the Hyde Park neighborhood of North St. Louis. It began as a farmers market in 2020, and last year BJC worked with Muhammad to include access to free exercise demonstrations and health screenings, which will continue in 2023.

“It’s more than just a market. It’s a holistic meet-up place,” said Muhammad, who is chair of the Hyde Park Neighborhood Association and the founder of Be Well Café, Apiary at the Park and the Be Well Farmers’ Market.

In the three years since the market opened, its popularity has steadily increased. “People like that it offers an alternative-style menu, and they like finding different types of food to try,” she said. The market offers gluten-free, low-sugar, vegan and vegetarian options.

And in the spirit of education, Be Well Farmers’ Market offers food demos onsite to showcase produce and products some market-goers might deem unusual, like Swiss chard.

“We’re changing mindsets and opening up new opportunities and new tastebuds,” Muhammad said. The market also accepts SNAP and EBT payments, which makes a huge difference in accessibility, she said.

Both Muhammad and Hughes hope that by showing up and meeting people where they are, it will continue to make a difference in the health and lives of the community.

“Everything we’re doing with BJC and with other organizations locally is creating the needed synergies so we can start to work on healthful food, healthful living and healthful minds to build an entire healthy community,” said Muhammad.