Medically Tailored Meals | the nutritionist's dilemma

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?

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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.