In her white lab coat and slacks, Maureen Villaseñor looked better suited to be handing out prescriptions at a clinic than talking salad dressing in a grocery store aisle.
But on a May afternoon, the Orange County pediatrician was at a Ralph’s supermarket in Tustin, Calif., dispensing shopping tips instead of pills. Inquiring shoppers got advice on everything from how to coax toddlers to eat more vegetables (she suggested mixing them with favorite foods) to how to make a tasty, low-calorie salad dressing at home.
The endeavor, called “Shop with Your Doc,” is meant to help people make educated, healthy choices one grocery cart at a time. The program is about more than just nutrition.
Shop with Your Doc is part of a broader – and still growing – movement in US medicine to shift the focus away from simply treating disease toward caring for the whole person. Across the country, hospitals are setting up food banks and medical schools are putting cooking classes on the curriculum. Nonprofits are connecting medical centers with community resources to ensure that low-income Americans have access to fresh fruits and vegetables.
The common thread is an effort to incorporate into treatment the lifestyle choices, socioeconomic circumstances, environmental factors, and history that contribute to a person’s overall health.
“It’s about working to take care of the community where they’re at and about understanding the conditions affecting the community,” says Nisha Morris, executive director of public relations at St. Joseph Hoag Health, which started the program in 2015.
“In general, medicine has not recognized the role that lifestyle choices have played in the chronic disease epidemics we have now. [It’s] really sick care, it’s not health care,” adds Brenda Rea, assistant professor of family and preventive medicine at Loma Linda University, a private health-sciences institution just south of San Bernardino, Calif. “We want to shift that paradigm.”
Rethinking health care
For centuries, Western medicine’s mission was to cure disease. When patients felt sick they went to their doctor, who evaluated the problem and offered a solution. The patient typically only came back when something else was wrong.
“That’s the type of care we’ve been doing for two millennia, and we’ve gotten really good at it,” says Tim Harlan, executive director of the Goldring Center for Culinary Medicine at Tulane University in New Orleans.
But over the past generation, he says, two significant trends took place that are of concern to the medical community: Health-care costs began to soar, and relatively inexpensive, poor-quality food became more ubiquitous. The result was a rise in chronic diseases that are preventable, Dr. Harlan says.
“There’s a very straightforward … link between people improving their diets and improving the condition that they have,” he says.
The connection drove the medical and nonprofit communities to rethink their approach to health and disease. What emerged was the concept of the “social determinants of health” – the notion of taking into account the biological, physical, and socioeconomic circumstances surrounding a patient. A healthy person isn’t just someone who is free from disease, the theory goes; he or she also enjoys “a state of complete mental, physical, and social well-being.”
“Doctors are starting to recognize that we can hand out shots and antibiotics day in and day out, but people will not stay better or not necessarily get better – unless you pay attention to the social determinants,” says Deborah Frank, a professor of pediatrics at Boston University.
The question the medical community now faces is how to get patients – especially low-income families – to recognize those determinants and make it possible for them to eat and live healthier.
“If you are a mom, and you don’t have enough to eat, your first concern is that nobody cries from hunger. So you go for stuff that is very cheap and very filling,” Dr. Frank says. Soda and french fries “are very filling and very cheap per calorie. Whereas broccoli is not.”
From hospital to kitchen
In response to the problem, Frank in 2002 helped found an on-site food pantry at Boston Medical Center (BMC), which has since evolved into a kind of nutrition center where primary care providers at BMC send patients for food. Today the pantry hosts free cooking classes and serves about 7,000 people a month.
Among them is Marie, a mother in her late 20s who relies on the fruits and vegetables the pantry supplies to make healthier meals for her young children.
“Food is very expensive, it’s helping us a lot,” she says in broken English. “I have two kids and it’s helped.”
“We’re creating clinic-community bridges,” says Kathryn Brodowski, a physician of preventive medicine and director of public health and research for the Greater Boston Food Bank, which supplies the BMC pantry with 95 percent of its stock. (The rest comes from donations.) “Why reinvent the wheel? We can smartly leverage our resources and take better care of our patients.”
The Greater Boston Food Bank has also launched its own initiatives, striking partnerships with four community health centers across the state to offer free mobile produce markets that have served more than 800 households. The organization also helped develop tool kits that map local pantries, markets that accept government food vouchers, and other resources.
“We need to get to the root problem, and social needs are a big part of that,” Dr. Brodowski says. “If we can link together and bridge this community space with the health space, we can take better care of our patients.”
At Tulane in New Orleans, Harlan is leading the development of a curriculum that blends the science of medicine with the art of food preparation. His philosophy: Doctors who know their way around a kitchen are better at helping their patients. And empowering patients to take charge of their own diets is one way to help them deal with the staggering costs of health care, Harlan says.
“Although we know what works in ‘diet and nutrition,’ no one has done a very good job of translating that for a practical approach,” he says. “We take all of that information that we learn in the first two years of med school .... and we translate that into peanut butter and jelly sandwiches.”
The modules have since been adopted at 35 medical schools nationwide. They equip students with the language and skills to help patients tailor their diets to fit their lifestyles, says Ben Leong, who helped design the program and now applies its principles in his residency in Long Beach, Calif. His patients have told him they really appreciate the approach.
“They’ll say, ‘I’ve never had a doctor share with me their recipe for grilled chicken.’ ”
'No more pain'
For some people, the results have been transformative. Clarival Cruz, a registered nurse, says she has gone from being on crutches after being diagnosed with gout to moving freely, after working with Dr. Rea to reshape her approach to meals. “I feel more awake and energized. There’s no more pain,” she says.
Chipping away at bad habits is a good place to start getting patients to think about the choices they make for themselves and their families.
“You don’t try to change anyone’s lifestyle completely,” says Ms. Villaseñor, the pediatrician. “When you have two working parents, and they’re coming home late, and one kid is picking up dinner, how can we make healthy choices within the lifestyle they have?”
“It’s lost on people sometimes how much it means to us as physicians that our patients get better,” Harlan adds. “I want them to be healthier, take less medication, feel better. At the end of the day, that’s what we do for a living – and this is a fabulous strategy for doing that.”