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inventive incentive

To make bread or give love, to dig in the earth, to feed an animal or cook for a stranger—these activities require no extensive commentary, no lucid theology. All they require is someone willing to bend, reach, chop, stir. Most of these tasks are so full of pleasure that there is no need to complicate things by calling them holy. And yet these are the same activities that change lives, sometimes all at once and sometimes more slowly, the way dripping water changes stone. In a world where faith is often construed as a way of thinking, bodily practices remind the willing that faith is a way of life. Barbara Brown Taylor ~ (An Altar in the World: A Geography of Faith)

On a cloudy and dreary Saturday morning in October, I headed into Albany to catch up with the ever-busy Veggie Mobile in order to get a glimpse of the Veggie Rx Program in action. It had been almost two years since I began administering this program that I had helped establish at the Health Center, and as a concerned mom, it was time for a periodic check-up to see how it was doing.

Capital Roots Veggie Mobile

Veggie Rx is a “produce prescription incentive” wherein fruits and vegetables are “prescribed” to medically high-risk patients by their health care providers as a means to encourage healthier diets and to improve health outcomes. Similar programs have begun to emerge in the past few years, and are being considered as a model of a viable public health intervention for disenfranchised communities. This medically-housed approach provides powerful messaging, unique for an institution that traditionally proffers mainly pharmaceutical solutions and well-meaning but often weak recommendations for health behavior change. It affirms, “Let food be thy medicine.”

Veggie Rx was initiated as a collaboration between Capital District Community Gardens (CDCG) (now known as Capital Roots) and the Whitney Young Health Center and is funded by the NYS Department of Health’s Hunger Prevention and Nutrition Assistance Program. It was designed as a pilot to serve fifty persons with diabetes and/or hypertension. Once recruited and enrolled, the participants receive “prescription coupons” valued at $7 each, which can be redeemed once per week on CDCG’s Veggie Mobile. They also receive an additional food bag valued at $4 provided as part of the Veggie Mobile’s Taste and Take tasting program each time they shop.

The bio-diesel fueled, hip-hop pulsing, “produce aisle on wheels” Veggie Mobile which I chatted about in No Passing, toodles around many Capital District neighborhoods most days of the week, year-round. It irrigates identified food deserts by arriving at a variety of community locations where anyone can shop, right on the truck. It is somewhat akin to an ice cream truck except that it hawks an impressive array of fresh fruits and vegetables, much of it from local farms.

I met up with the Veggie Mobile that day in the city’s Arbor Hill neighborhood. Parked at the corner of a side street, it was a burst of color in a rather gray landscape. That brightly painted truck always shows up representing the rainbow, but it is the activity that it fosters that is the pot of gold. Among the customers were two Veggie Rx participants. One was a woman whom I had just enrolled in the program. She was there with her two young granddaughters. ‘Patient with diabetes’ instantly transformed into ‘loving grandma’ as I watched her solicit the girls’ advice for what to choose.

The other was a gentleman who had been enrolled for a while but who had not really participated. I had recently called him to discuss removing him from the program—but he asked for another chance. He explained that he had experienced a host of health problems but was feeling better and really wanted to have this opportunity to improve his diet. Sure enough, there he was like a kid in a candy shop–but instead of candy, he was purchasing a sophisticated assortment of produce.

After an hour at that location, the dedicated Veggie Mobile staff women closed up shop. I hopped in my car and followed them as they got back on and off the highway and made their way over to the next scheduled stop at a low-income housing complex—not too far from the Governor’s Mansion. Arriving there, about fifteen people were already waiting–men, women, and children–including two more Veggie Rx participants. They were surprised to see me and greeted me with smiles and hugs.

This was a busy site, so I assisted with bagging while anchoring myself at a good vantage point. Shopping on the Veggie Mobile begs some patience—but perhaps not any more than waiting in a fast-food drive-thru line. Here though, was connection, community and lots of conversation about good food. There was squeezing back and forth as people reached to add another sweet potato, banana or onion to their order. All forms of “monetary green” (cash, SNAP EBT cards, New York State Fresh Connect, and Farmer’s Market Coupons–along with the cute Veggie Rx coupons) were exchanged for “nutritional green” (collards, kale, green beans, green peppers, and broccoli). It was a beautiful sight to behold.

Despite my sheer love of this program, I am still not sure yet if these incentive initiatives are token, feel-good, short-term experiments–or the templates for a new health and food revolution. Are they worth the effort for the few that they serve? Can they put even the tiniest dent in the massive problem they are trying to solve and might a few fruits and vegetables a week really affect change?

What I do know is that I have seen Veggie Rx change the behaviors and well-being of many of those in the program. Let me strengthen that. I have witnessed some profound changes. There has definitely been some powerful “medicine” going down. Participants have started juicing, making smoothies, and taken to more plant-based diets. Many have attested to feeling better and have noticeably become more enlivened. While I have also noted improvements in individuals’ health markers (weight, blood pressure, hemoglobin A1c)–to see these markers shift in a significant way for this highly challenged population will take time. I caution not to base the success of these types of programs solely on those indicators–it is too myopic a lens.

Veggie Rx offers more than just food access and is about something greater than fruit and vegetable intake. Relationship building is the true foundation of this program. This power of relationship–between participants and the Health Center and Veggie Mobile staff–is not to be underestimated. Having undertaken an evaluation of this program and through my direct contact with the participants, I know that they feel better valued as both patients and consumers which increases their engagement in both roles. I also know that they consider this program to be a blessing in their lives–those are their words, not mine.

Participation comes with some requirements which asks something deeper of its recipients–like standing out on street corners in the cold, shopping in cramped quarters, finding a specific time and place to shop, and committing to follow-up medical appointments. Not everyone enrolled has taken advantage of the program, but the majority have–and some quite extensively.

As a metaphor for, or a substitute expression of the universal yearning to return to the land, the capacity to access the bounty of the earth perhaps subconsciously reminds us of the connection to our source and our birthright of health. The mere act of showing up and filling one’s bag with beautiful produce yielded from the soil reflects a powerful commitment to one’s self. Standing witness on that morning shed light on what a new paradigm of healthcare could look like–particularly in response to the problems associated with health disparities–but in the larger context as well. I returned home with a reassurance that my little toddler-aged program was doing well. I can’t wait to see it grow.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

Double Value Coupon Program–Diet and Shopping Behavior Study

Building Healthy Communities Through Equitable Food Access

J’s My Plate

My Plate Haiku

Food is medicine

Farmers are doctors, Cooks priests

Eat, pray, eat, pray, love.

By Gordon

out of the fire and into the frying pantry

Feb19

I am not new to this rodeo. For about 40 years, in many ways, I have provided opportunities for people stripped of the usual means, to get some good food. Addressing the nutritional mishaps associated with prevailing health issues–in which I have been long engaged–generally requires food to achieve improved outcomes. Procuring such food, especially with a dearth of necessary currency, begs some creativity and much activity.

Some of my activities involved people coming to me for a few healthy and tasty nibbles, but mainly they required me to send them scurrying off to another program or service; or sometimes more directly to grocery stores, farmers’ markets, veggie mobiles, and food pantries with some voucher, coupon or referral form in hand. While glad to have some options to feed the malnourished cells of chronic disease and to stave off the hungry wolf knocking at the door, I always did so with a sigh. Scurrying is not an easy form of ambulation, especially for those whose bodies are worn down by the toll of strained lives and the lack of quality food. This would not be easy one-stop shopping.

For many years I listened to the sensitive stories of many hundreds of individuals striving toward some recapture of wellness. In exchange, I offered education and support, and guided people as best I could to obtain the remedy of good food. While I would hear of the relief that receiving SNAP benefits (or having them restored) instilled; or the thrill of being able to get fresh fruits and vegetables, only occasionally was I witness to the experience of having a grocery bag in hand and heading to the comfort of one’s home.

This however changed for me a year ago when I took the position of running a Food Farmacy. It is a small food pantry nestled within a medical facility. Its mission (and thus its name) fits into the growing Food As Medicine model of programs by providing health-supporting and enhancing foods–and the services of a Registered Dietitian. As we may look similar to other pantries, distinguishing ourselves and reinforcing messaging about food as a pathway to healing is important. Clients in the pantry community are referred to as guests. At my pantry, guests are those with nutritional risk factors for chronic disease or compromised well-being, and without enough–or enough good–food to eat. They are referred by a medical or behavioral health provider.

Our main model is to provide an order of client-chosen food, generally on a monthly basis. We strive to serve everyone regularly for some number of consecutive months–with a focus on healthy offerings. (But, with other funding streams we operate a little differently.) When I started in December 2021, Covid still dictated our practices. We took all food orders by phone and gave the packed bags out at curbside or by delivery. While this allowed for some interpersonal contact, it was somewhat limited. This changed in September 2022, when we became able to fully open our doors and welcome guests back into the pantry, by appointment. We now serve many in person, enabled some by a limited grant-funded ride service, though a fair number still require delivery–and support by phone. Limited access to transportation is a profound contributor to not having food.

Being able to develop relationships with our guests is certainly facilitated by being able to do so in person, as is deepening the conversation about food while standing amidst it. Discussing the intimate topic of our eating behaviors and revealing how full or empty the larder is, is harder to do on the telephone with a stranger than in the presence of someone greeting you at the door with a warm welcome. Still, we need to do both.

In my role, I carry food out to cars and sometimes, when my volunteer drivers are not available, I do the deliveries. This means schlepping bags into trunks and back seats; or, in my urban locale, involves driving down alleys, circling through subsidized-housing neighborhoods, climbing steep stairs, and occasionally riding elevators to knock on a door. I gain entry to the threshold of someone’s personal space and transfer the goods. And, while it is usually a quick transaction, that is a powerful exchange. The expressions of gratitude are deep, as the most basic human need–food–is made available.

Then there are connections that take place in the Farmacy. Here things go from soup to nuts, so to speak. The welcome, the conversation, entering the pantry space, being up close and personal with each item, the decision-making, and the often mutual act of the ‘filling of the bags’. I am out constantly hunting and gathering for as much fresh produce and meaty morsels as I can–largely aided and abetted by my regional Food Bank–currently overly strained, as are most–and Nourish New York dollars. To procure some particular healthy items, and enough food, I also have to purchase retail food and rely on some other food donations as well. It is a weekly dance of food in and food out, dictated by availability and price and how many we are serving. Though fresh is always celebrated, I have seen even a can of asparagus, beets, collard greens, olives, pineapple –or salmon make a heart happily flutter. Many a floppy tote bag turns upright, stuffed with victuals, fulfilling its duty to help folk carry out and carry on. Right then and there, some magic happens. Food has appeared. While not as surprising as pulling a rabbit out of a hat, or a quarter from behind the ear, there is often some degree of awe. Here, I witness most directly, more than with any of my other experiences, how much this matters. Here is whispered, ‘This is a lifesaver’ or, ‘I can’t believe this’.

For many of our guests, making way to this little, simple food sanctuary–if I may call it that–is like a pilgrimage. Some arrive limping, others in wheelchairs, on crutches–this week, a man with a cane, due to a bullet lodged somewhere in his body. A chair stands waiting in the pantry for those who need to sit. Pain accompanies many, hiding in backs, hips, knees, and feet. Rarely, but not never, in a missing toe or limb. It hobbles in and hobbles out. Sadly though, we can’t perform miracles. We can only provide food, some education, lists of other resources, and an ounce of love.

As big as my work seems to me, this Food Farmacy operates at the tiniest of scale–a staff of three and the few lovelies who lend their helping hands. Out in the big wide world, big programs, projects and pantries with similar intentions are hard at work, day and night. They employ many, yet largely rely on scores of volunteers with the gathering capacity of mice and squirrels; and a skillset that surpasses those of Santa’s elves. A huge invisible army gathers, transports, warehouses, organizes, packs, cooks, distributes, educates, and delivers sustenance to millions. All are starved for dollars and crave legislation that will subsidize their efforts. Wow. Time for a group pulse check.

Ostensibly, there are two intentions of these programs–to decrease nutrition insecurity (and hunger), and to ameliorate–if not heal–illness of such magnitude that should have been prevented in the first place– predominantly diabetes, heart disease, and obesity. Unfortunately, these diagnosis-limited programs exclude so many other conditions that are exacerbated by poor nutrition. There are many different types of program design, though they generally fall into the categories of Medically Tailored Meals, Healthy Groceries, and Produce Prescriptions. While some great initiatives are underway, and some good food medicine is going down, they often lack sustainability, sufficient dose, reach, and duration; and additionally, adequate targeted nutritional sophistication to address the profound problems largely related to the long-term metabolic dysfunction at hand.

At the end of my day, I can find myself collapsed on the couch–sometimes with my head hanging over the edge, below my heart. In its usual dog-like apparition, my dilemma wanders over and licks my face. It takes a seat, quietly nearby. It knows what I will ask, but I ask it anyway. Does this really have to be so hard? Is it too little too late, and, are we really making even a dent in the problem at large? Not only do the little mice, squirrels and elves have to do the hard lifting, they are also expected to measure the impact–to prove to the big guys that they should care and maybe invest. Maybe they will after many more short-term pilot programs are implemented; and while they limit dollars, access, and impose restrictions on and to programs that are known to provide benefits. How’s that for passing the buck? Lots of little mammals have now been left to shoulder the burden of the collective failure of many entities to prioritize the proper nourishment of the populace.

I’ve had my eyes on this work for a long time, since the early years of these efforts, and have shared my thoughts about my own Veggie Rx program in Inventive Incentive. When you peek at the research literature, what you mainly find is mention of increased fruit and vegetable consumption of about a quarter to a half-cup or so per day–which is considered significant. Or, sometimes a small decrease in diabetes markers or pounds. Less easy to measure, but occasionally found, is a documented decrease in hospital admissions–which is what the big insurance companies care about for cost containment. So much wonderful effort for a relatively small return in quantitative terms–though there are other benefits. Our guests report eating better, feeling improved physically and emotionally, being less worried, and trying new foods. Many appreciate being cared for by our program. And while I can see it is very helpful, it is often too little too late.

When I look both broadly at the societal issues, and intimately at the guests served by my little pantry–I am deeply saddened. How could such injury have been imposed on so many? (Not to mention the insult to dignity that need for such charity can provoke.) Chewed up and discarded by many forces–I wince sometimes at what is required to come find me in some corner of a building, just to get a modicum of food and nutrition education and support–no matter how nice, easy and good we try to make the process.

My dilemma looks at me with those adoring eyes. It knows I have a tendency to be rather grim on these matters. It knows I have bigger thoughts, but it begs for one. So, I tell it something my mother once told me. In the olden days, when my mother was a little girl, the children were given a spoonful of cod liver oil to start their day. Now, maybe that’s where things should start. And, then there are my other ideas about……My dilemma paws at my arm. Oh, what’s that? You were just asking for a dog treat?

Thankfully, there are so many ordinary folks with big hearts that are pumping with generosity. Much gratitude is due to the multitudes who are out there day in and day out, in various capacities (including growing our food and fostering transformation) feeding their neighbors main dish entrees served with a side of love. Or, maybe love is the entree and food the side dish that truly matters. Please check out the organizations, resources, and articles below, consider donations where accepted, and look at the love spread by Alphabet Rockers–a hip-hop children’s music collective based in Oakland, California. Their work is focused on education, diversity, and a healthy lifestyle.

Thank you for listening, sharing, following, and supporting my writing. Comments and greetings are always welcome.

In health, Elyn

My Plate Rap

Average out what’s heavy

Multiply your veggies

Eliminate the junk food

Simply makes you feel good. By the Alphabet Rockers

Healing Meals Community Project, HEAL Food Alliance (10-point Platform)

Tri-County Services-Ellis Food Farmacy (Agency: Tri-County Services, Option: Ellis Food Farmacy)–my program

Green Bronx Machine; About Fresh/Fresh Connect; Tangelo; Future Farmers of America

Food Bank News: Food Insecurity Isn’t About Food; Here’s What To Do About It

Foodtank: 13 Global Food Banks Reshaping Food Distribution to Address the Root Causes of Hunger

food insecurity, food pantries, food as medicine, foodtank, HEAL Food Alliance, Alphabet Rockers, Healing Meals Community Project, Food Bank News

isle of you

Feb14

I describe a large part of my career as sitting in small rooms speaking with individuals about the intimate art of eating and self-nourishment. My geography was usually contained within a 10′ x 10′ space. However, the last few years have found me wandering about (albeit mainly, though not entirely, figuratively) in a larger and more vast landscape observing the radical movements taking place concerned also with matters related to eating and nourishment.

These movements are taking what was quiet and personal and are making them loud and public. They are serving to challenge the status quo that served to foster the nutrition and health quandaries and crises that have defined the past few decades. These are movements made up of people passionately determined to decry the depriving of access to real food, the poisoning of plants and people, the hunger of our children and seniors, and the seducing of the vulnerable with manipulative marketing. They assert through their efforts and missions that denying folk of their birthright of health is no longer ok.

This week I’ve been trying to decide how I might, in a timely manner, in the spirit of Valentine’s Day appropriately honor those whose work I have stumbled upon in my wanderings whose efforts have astounded me. I did so once, many years ago, in Who Do I Love. While flailing about in my decision-making process, one new food hero came to my attention. With that, my dilemma gently placed its hand on my heart. It said, “Just do it. Don’t delay. Just put this out there. Now.”

So here are a few of those Who I Love ‘Two’. There are many more organizations and individuals also doing what I call Random Acts of Crazy Love. This short list includes initiatives addressing food/nutritional insecurity, food injustice or apartheid, hunger, and health either started by just one person taking one huge step, that I have a personal connection to, are perhaps not well-known and/or have struck me with Cupid’s arrow. My brief descriptions do not them justice, therefore, please check them out to really see the deep work being done and where donations would be appreciated.

Keep Slauson Fresh — Olympia Auset shows up and commits. Frustrated by the lack of healthy food in South LA, and concerned about its inherent consequences, she sets up pop-up produce stands and delivery service for (organic) produce at different locations on different dates throughout the community. This is no small feat. Now in its third year, with more than 25,000 pounds of fresh produce sold, Olympia is working toward establishing a healthy market in the neighborhood.

Chilis on Wheels–In 2014, Michelle Carrera wanted to just do something to help her community. When on Thanksgiving Day she discovered that soup kitchens did not serve vegan meals, she made her own vegan chili and carted it through Union Square in NYC on a wagon. Seeing the response, she committed herself to prepare vegan food to serve those in need. Now, the organization’s chapters continue to do that, and, so much more.

I Love You Restaurant–Jaden Smith started a Vegan Food Truck serving the homeless free meals in Los Angeles.

The Market@25th–This is a full-service grocery store with a mission in a historically-rich but economically-ignored neighborhood in Richmond, Virginia. The community-focused store provides an opportunity for local food entrepreneurs, cultural connection, and nutrition, health, and other empowering educational programming.

First Fruits Farm — Jason Brown was the highest-paid Center in NFL history, but he walked away from a 35 million dollar contract with the St. Louis Rams to become a farmer. Spiritually inspired, he taught himself to farm and now grows and harvests over 100,000 pounds of vegetables in North Carolina to serve communities in need.

Champale Anderson— This St. Louis, Missouri woman prepares and distributes free sandwiches and snacks to hungry children in her neighborhood.

Civil Eats –Founded by Naomi Starkman, Civil Eats serves up daily online news and commentary about the American Food System. The content is quite comprehensive and the stories are compelling. It is where I often learn about these amazing folks and initiatives.

Mazon–A Jewish response to hunger through advocacy, education and strategic partnerships.

Comfort Food Community–Here are good folk doing big things in the small rural communities in Washington County, New York (not far from my home) to eliminate hunger and food insecurity, and building community through the power of food.

LEAP for Local Food, Produce Perks Midwest, Farm Fresh Rhode Island, Community Food and Agriculture Coalition–These are my friends at four state and region-wide organizations committed to improving the health of their communities and the strength of their local agricultural and food systems through policy and advocacy work and the growth of nutrition incentive programs facilitating healthy food access for low-income citizens.

And last but not least,

Feed The Mass–Jacobsen Valentine (yes!), founded this nonprofit cooking school in his hometown of Portland, Oregon providing affordable culinary education to address the culinary and health gap in his community. The low-cost and scholarship-supported classes for adults and children focus on meals based on whole foods and made from scratch.

Well, that is it for now, though there are many more to mention. Whose work do you love? Please let me know.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

Happy Valentine’s Day.

Isle of you, Elyn

Isle of You was the name of a little store in Ithaca, New York–where once upon a time I found my heart–high on a hill.

Isle of You Necklace My Plate

My Plate Quote

I alone cannot change the world,

but I can cast a stone across the waters

to create many ripples.

by Mother Teresa

weight, weight, please tell me

Aug28

This is a post about weight–weighty matters, the weight of the world, mainly the ongoing conundrum of there being too much of it. It is a topic I think about sometimes–trying to wrap my arms around it to contain it properly.

Actually, you will see that I don’t have much to say about it, but instead am sharing the brilliant voices of others who do. It seems these stories have recently, coincidentally collected in my little basket of big dilemmas.

Before I proceed and attempt to offer something up on this largely considered nutritional–but so much greater– matter, let me digress for a moment to share something about me and my nutrition work and my nutritionist status. I have a little explaining to do.

I have experienced a lot of changes in the past few years. Some of these are profoundly personal while others are professional. I will stick to the latter and how they have influenced what I write about–perhaps some of you who follow me have noticed–but they are both intertwined.

When I began writing this blog in the fall of 2010-wow-I was perched in a clinical setting that continued to make me privy to the upfront and personal stories of individuals’ eating lives. I had been doing nutritional counseling for many years at that point in time. My clients’ issues strongly reflected, what I refer to in My Story, the massive changes in our food culture and highlighted the intimate art of eating in response to the personal and cultural milieu. The nutritional crises of our time, including the obesity crisis and its shadowed sister–eating disorders–were about twenty plus years deep in the making.

Professionally, I had been riding this unforeseen wave since its onset in the early 1990s and felt I had something to say to personalize and humanize what was projected as a faceless statistical trend. Having worked with so many people, I was able to synthesize the common experiences that were impacting us all. I could also relate some true experiences of my clients in my writings. I would juxtapose these experiences alongside the larger impacts of poverty, trauma, environmental changes, food adulteration, community access, societal messaging, etc.

What I never stopped to share, was that two and a half years ago, I stepped out of direct care. I began doing nutritional program development and administration for a statewide program serving childcare centers–the preschoolers, families, and educators. It is a good program. Though its implied mission is to prevent childhood obesity, I strongly prefer a redirection of intention to support the full health potential of all our children and mitigate the effects of what I am wont to refer to as nutritional violence and size stigmatization. Anyway, at that time, the nature of my posts changed and their frequency decreased. I had less material and more other things to tend to.

And now, I have just begun a new position. I am working for a breastfeeding support organization. This is a nutritional and health issue I am passionate about, but for the first time in my career, I am not carrying the title of Nutritionist. I seem to be welcoming this change–it is a natural extension of my life work and public health orientation that fits well with my current circumstances. But it also stirs some emotion. Due to a combination of my personal experiences and the fact that I have not done direct care for a few years now, I no longer feel I can assist others with the acute health challenges of our time and the precise nutritional approaches they demand. So, along with other big changes I am now facing, I think it may be that I am no longer a Nutritionist.

So, my dilemma asks me, “Then what’s with the name of your blog?” For now, I will answer that until I have time to reconsider it, it will stay the same. I am still deeply interested in nutrition and how it relates to our individual and collective health. I am still paying deep attention and I still want to be part of the larger conversation. And, I still want to help people. I may present more concise offerings on my Lifeseedlings Instagram page which are budding perspectives and occasional haikus on food politics, nourishment, body respect, eating, and cooking. Join me there.

And so, back to the issue of weight which I raised as the focus of this post. I wish it wasn’t all that it was and is. I wish it didn’t dominate the headlines and pervade our thoughts. I am bothered by my own sometimes prejudiced assumptions and that despite my somewhat larger awareness of its complicated nature, I still conflate weight with health and want to help ease and prevent the physical and emotional burdens it encumbers. But it is about time for all of us, those with or without the business to do so, to stop believing that banishing this weight, this unruly fat, is similar to scrubbing dirt and grit off of a coal miner’s body–some effort no doubt, some soaps better than others, but once undertaken, the job would be done.

From my observations, I think MAYBE things are changing. We may finally be realizing that plain out calorically restrictive diets of any ilk and fat-shaming just don’t seem to be working to solve the problem in the long run nor are they doing anyone much good.

And, while not entirely new, more voices–powerful, angry and/or tender voices, are emerging that challenge the once firmly held ideas and attitudes held by our scientific and medical communities, our society and even our personal selves about the ‘weight problem’. Their words and advocacy may be shifting our perspectives, sharpening our sensitivities, and providing new approaches to care.

Here is a short little syllabus of what I consider to be very interesting insights on the topic. It includes:

Where the story often begins. A post by Your Fat Friend, a personal story about the implications and consequences of early childhood weight interventions; and a discussion on What Harping on A Child’s Weight Looks Like 20 Years Later about the importance of fostering body appreciation for everyone, by Maryann Tomovich Jacobsen on her website, Raise Healthy Eaters.
What No One Ever Tells You About Weight Loss. A powerful and personal look at how expectations about ways to lose weight imply a process that is both isolating and not sustainable, by Nick Eckhart in What I Wish Someone Had Told Me About Losing a Lot of Weight.
How Even Well-Meaning Assumptions about Fat Athletes Can Be Misguided. Here, Ragen Chastain (whose blog Dances With Fat I have written about before) deconstructs such assumptions in her post, What Fat Olympians Prove (and What They Don’t).
Really? Just five amazing stories from an episode of This American Life, entitled, Tell Me I’m Fat. (Transcript or Audio).

This is not required reading, but I hope you find something thought-provoking, attitude- adjusting or maybe even life-changing within. And, though I don’t have Carl Kasell to answer my phone, you can leave me a message here.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

(Update 2019: After a year and a half working for the breastfeeding organization, I moved forward to work for Wholesome Wave, a national organization dedicated to food access and affordability and a leader in programmatic and policy changes related to addressing food insecurity. My work here reunites me with my previous efforts of developing Produce Prescription programs as I described in Inventive Incentive. This work certainly has brought me back into the food and nutrition space, and gives me new types of stories to think about.)

Wholesome Wave’s My Plate

My Plate Haiku

Pick your own today

Happy kids in wide-brimmed hats

Sweet summertime fruit.

by Nan (Blessings on her new little grandson, Orion!)

some big feet to fit

Oct5

Yesterday, my first patient, Harry, was late and my second patient, Dan, was early. As I went out to the waiting room to call Dan, I saw Harry checking in with the receptionist. I had worked with him a few years back and remembered him well. He greeted me warmly and said he understood that he would have to wait. He assured me that this was not a problem.

This is a story about these two men. It probably should be two different stories. But, since the lines of their lives intersected on that morning, and since they share many commonalities–though Harry is black and Dan is white–merged, for now, they will be.

Harry and Dan are both 52-years-old. They are both over six feet tall and over three hundred pounds, though Dan dwarfs Harry in height and weight. They both are caring fathers. Harry has some older boys while Dan has an adorable non-biological three-year-old son he is raising. They are unemployed and poor, have had difficult lives and confront stress on a daily basis. They have diabetes and the usual laundry list of related issues. Impressively, and not commonly seen, they have both successfully and proudly quit 35 year-long cigarette addictions–Harry in the past two years, Dan about three months ago. You can see they were both once very handsome. Harry’s good looks are better preserved. Dan’s are more difficult to perceive due to his lack of teeth, long dirty stringy hair and enormous belly, but his pretty blue eyes and sculpted face tell me he once broke a few hearts. Oh, and they both like ginger ale.

I started working with Dan a few months ago. The loud-talking, heavy-walking, gentle giant stomped into my office in June feeling lousy. He had just been diagnosed with diabetes. He described to me a life marked by serious fatigue and inertia. He spent most of his day splayed on the couch watching television while keeping an eye on his preschool son. He started his day with coffee containing a mountain of sugar, drank iced tea throughout the afternoon and despite his lack of teeth, mainly ate an enormous dinner of starchy, fatty food which he said could probably feed five. At 380 pounds and smoking at least a pack a day, he could barely climb a flight of stairs. His ability to do the odd jobs he got paid for like mowing lawns and shoveling snow was becoming too difficult.

He presented with the common combination of desperation and despair but with a twinkle in his eye. I am always looking for some sign of the life force because making change necessitates pulling something out from the inside. Being illiterate and impoverished as Dan is, can profoundly dampen if not obliterate that inner will, but an eye twinkle is a good indicator that there is still fire within. Illiteracy and diabetes education are not a great combination but he has persevered and has made some amazing changes for someone who has only known mainly one path for half a century. He has literally and figuratively awakened recently and expresses his gratitude for the wake-up call. Though some of his work has been championed from my wonderful little office support team, he actually greatly surprised me by undertaking to quit smoking essentially from his own initiative.

At this week’s visit, he told me that his son just started a daycare program at a local YMCA. He and I had discussed his getting a Y membership which would now be great since he has to take his son there every day. He told me that he had tried to apply for a scholarship as I suggested, but that required bringing in some documentation and filling out some forms. Even as I handed him some free trial membership coupons I have for my clients, I knew that even this simple step requires filling out some paperwork at the other end.

At the end of our meeting, I brought him to the scale. I asked him to remove his old, worn-out heavy steel-toed boots that barely had a lace left between them. I weighed him and I weighed his boots at 4.2 pounds. Cumulatively, that is a lot of weight to drag around. Knowing the answer, I asked if he had sneakers.

With my steps already weary, I then walked back out to the waiting room to call Harry who I knew was waiting. I was still thinking about Dan–wondering how much a pair of good, supportive sneakers for his very large feet would cost. Being able to read and write and having some good sneakers sure would help this man to get moving.

I was abruptly brought back to the moment upon encountering Harry. There he was sitting at an empty table usually reserved for insurance representatives–about to dive into a take-out container of eggs, bacon, home fries, and toast. Though just last week I had to confiscate the bag of Swedish Fish a patient had brought into my office, in all my years I had never experienced catching anyone with a full-blown meal. “Where did you get that?” I asked in shock. “From the diner,” he replied. “How did you get it since I last saw you just a few minutes ago?” “I called them and they delivered it,” he explained somewhat surprised by my reaction and naiveté. “Am I busted?” he asked. No wonder he hadn’t minded earlier if I took my time. I dragged him and the breakfast into my office.

Harry actually has a lot more personal and community resources than Dan, but right now his blood sugar and health markers are much worse–and his situation had deteriorated since I had last worked with him a few years ago. I expressed my concern. He said that he had a lot of personal and family problems recently–though he was not making excuses. He lives alone and barely cooks at home. He is a personable guy and when I asked if there are a lot of local restaurants that know him by name–he confirmed my suspicion. Though he still has his teeth, he could soon not have working kidneys.

We looked at pictures from an old Parade Magazine about the comic Drew Carey’s diet and weight transformation. I told him the story of the film “May I Be Frank” that I discussed in Meditation v Medication. He put down the bacon and he told me he wanted his health.

I suppose I tell these tales to give a face and a fake name to the real people behind the current health crisis. Sometimes, I am hoping to inspire with stories of how people do overcome serious health and dietary challenges. Today though, I am wondering how to really help Harry and Dan a little more. I can assist Dan with the Y application and can call Literacy Volunteers of America; I will loan Harry my DVD copy of the film. But what would those who dream, think and act big do? Who should I call? Oprah, Shaquille O’Neal, Michelle Obama, Drew Carey, the Tom Shoes guy? What do NBA players do with their Nike’s and and1’s after they have worn them on the courts a few times? Is there a healthy food delivery service for patients left languishing while waiting in doctors’ and hospital waiting rooms?

If you have any ideas let me know. Besides, these guys deserve something. They have taken the biggest step to health by quitting smoking. I am thinking of lauding them by posting their photos in the Health Center. Maybe we could write them a Haiku? What do you think?

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

Related Posts: Meditation v. Medication; Inventive Incentive

Update 2020: The 2018 Farm Bill allotted $25 million dollars in funding to Produce Prescription Programs. These dollars have ferried in an increase in the number and types of programs designed to provide food as medicine. They are an extension of the pilot program I developed and managed beginning in 2012 at the Health Center where I worked and described in Inventive Incentive. These programs have evolved over time, becoming increasingly sophisticated, supported by additional dollars, research confirming savings in health care spending, and new technologies. Programs increasingly do include the provision of medically tailored meals for specific health conditions and home delivery. Harry certainly had the right idea, just the wrong food.

The Yellow Deli My Plate

My Plate Haiku

We serve the fruit of the Spirit

At the deli. Why not ask?

The Yellow Deli

the new food revolution, food stamp cuts and health disparities

Oct9

My Dilemma cuddled up next to me in bed and rested its head on my shoulder. “What is coconut palm sugar?”, it asked. I explained tenderly while rubbing its dear little head, that it is a natural product made from the nectar of the coconut palm tree. There are several different varieties of palm, and “coconut palm” specifically refers to the coco nucifera plant. It possesses a low glycemic index making it a healthier choice than sugar refined from sugar cane or beet sugar and is an option for diabetics. My Dilemma looked at me with the pure innocent eyes of a child.

English: Coconut Palm tree on the beach in Nusa Dua Bali Indonesia (Photo credit: Wikipedia)

“And what about goat’s milk kefir?”, it then asked. I answered, “Oh, you know. Kefir is a fermented milk product that originated centuries ago in the Caucasus mountains, made from the milk of any ruminant animal–in this case, goat. The various types of beneficial microbiota contained in kefir make it one of the most potent probiotic foods available.”

I thought it might be drifting off to sleep, but then it muttered, “Can you tell me the story about chia and hemp seeds, lukuma, stevia and mesquite sweeteners, oh and kombucha and cacao nibs?”. Try saying kombucha and cacao nibs five times fast. Wait a minute. Looking its way, I noticed a little smirk on its face.

I realized then it must have been looking through some of my papers that I have lying around among all of my resources. It was getting late and I was not in the mood to be playing games–even the one apparently called, describe the recently sourced foods deemed essential to a really healthy diet and that are alternatives to the substances compromising our health. Really, it is getting hard to keep up with these emerging products. I could have been annoyed but instead just planted a kiss on its little cheek. Besides, my Dilemma is always incredibly patient with me as I stagger about waving my sword attempting to slay the conundrums of our modern world’s feeding debacle. It is essentially the Sancho Panza to my Don Quixote–forever loyal.

I plumped the pillow, pulled up the covers and made sure it was quite comfy. It puffed a little sigh, the kind that signals the final controlled exhale of the day, but then it managed one last exertion. “Do you tell your patients at the Health Center to eat these foods?” I remained still and didn’t say anything. I knew if I ignored it, sleep would blanket its cares and it would choose sweet dreams over reality-drenched answers.

I was glad to lay the matter to rest and tucked myself in for the night. But still, I knew my innocent-seeming Dilemma was playing me. It knows that every day as I walk into my office, I pray that I may not alienate my clients by making totally unrealistic suggestions and that I am grateful as I leave that there is still air in my car’s tires. It is quite aware that I oft apologize when I utter things like extra virgin olive oil, stevia, quinoa, almonds, and organic milk. It knows I choke and can’t say grass-fed, locally raised beef and heirloom tomatoes, and that I break out in hives when considering presenting the advantages of a gluten-free diet for certain individuals.

My economic assessments must be made fast and furiously and I cannot instantaneously calculate what a person’s monthly social security income, low wage earnings and varying food stamp dollar allotment translates into in terms of a daily food budget for themselves and their family. I have no lab values measuring the degree of food insecurity. Many of my clients depend on the graces of food pantries–especially at the end of the month; some live in shelters or at rehabilitation centers with absolutely no control of their food choices.

If quizzed, I would say the majority of my patients know the price, more or less, of white rice, corn or vegetable oil, hamburger meat, chicken and twelve-packs of soda–and messing with their math by offering well-meaning alternatives does not make for good calculus. Though food budgeting education is valuable, most of whom I work with are already experts in that regard. I can’t surmise how much wiggle room someone has in order to make their diet more of a priority, but I must venture in and gather and glean some sense in order to gauge what is possible. At the end of the day, I can only hope that I was close if there is to be any hope of meaningfully promoting diet for health.

A shelf in my office contains food boxes and wrappers, non-perishable examples of “consider this” and “please, whatever you do, try to avoid this” foods. The shelf is not big enough. My patients are kind as they pick up from the floor the items that have fallen as I search for something from my display to show them. For those with grass-fed dreams but ground beef budgets, I have a few things to suggest, though I lament that it is nary enough. These include beans, oats, sardines, milk substitutes, flax seeds, teas, lemon juice, spices, dried apples, low-sodium chicken broth, canned salmon, whole grain pasta, boxed tomato sauce, sunflower seeds, and apple cider vinegar. When I can, I offer little samples. On some days I have coupons for the farmer’s markets, the local food coop, and manufacturer’s products to share-and I do have a small group of patients tucked under my wing participating in Veggie Rx, a Produce Prescription Program that provides free fruits and vegetables on a weekly basis.

Almost everyone is thoughtful, attentive and appreciative and willing to try to do something. Hardly anyone looks at me and yells, “Are you kidding me?” as I proffer a baggie of cinnamon. Still, I need a lot more to ameliorate the consequences of the nutritional junkyard that litters the land and to which those living in poverty are most vulnerable. With sugar at 62 cents a pound and coconut palm sugar going for about $5 for that same amount, what I could really use is a more level playing field if I am going to accomplish my goal of minimizing health disparities.

In the morning, I found my Dilemma curled up on the couch with a cup of coconut palm sugar-sweetened teeccino caffeine-free herbal coffee alternative and the newspaper. “Good morning”, it greeted me. “Just reading about the cuts to the food stamp program.” “Have a good day!”, it shouted after me, as I ran out the door to work.

If you have any suggestions or would like to hear what I think my patients could really benefit from, drop me a line.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

P.S. Please take a moment to watch this beautiful video, Place Matters, by Clint Smith

the nutritionist's dilemma

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