It may seem odd, but obese children are malnourished, and their lifelong well-being is at risk every bit as much as children who aren’t getting enough calories, says registered dietitian Fred Stichel of MAHEC Family Health.
“Mal” means bad, he continues. And malnourishment affects both the underweight and the obese.
Too often, the cause of malnourishment is that families live in what’s known as a food desert, where getting nutritious food is difficult. The only store within striking distance for someone who doesn’t have access to a car might be the corner gas station convenience store.
The U.S. Department of Agriculture defines a food desert as “a low-income census tract where either a substantial number or share of residents has low access to a supermarket or large grocery store.”
Although food deserts are most common in cities, they’re also found in rural areas, where there is little or no public transportation and low-income people often have cars that are unreliable at best.
In an urban setting, a food desert is defined as an area in which one-third of the population lives more than a mile from a supermarket or large grocery store. In a rural setting, the definition is a distance of more than 10 miles. Western North Carolina has both, and the long-term ramifications are troubling, Stichel says.
A map of Western North Carolina shows food desert areas in Asheville and Hendersonville, as well as in Cherokee, and portions of Transylvania and Jackson counties and near Rutherfordton. The map can be zoomed in for more accurate boundaries of the food deserts.
Risks to developing brains
Research in recent years has shown that brain development is impaired by malnutrition. Children who don’t have ready access to healthy foods fall behind intellectually, and that lag is lifelong. The brain development that happens in utero and in the early years of childhood can’t be made up for later.
In an issues brief published last year, Dr. Hilary Seligman, lead scientist and senior medical adviser for Feeding America and associate professor of medicine and epidemiology and biostatistics at the University of California, San Francisco, wrote about the developmental effects of poor nutrition. In addition to lagging behind intellectually, Seligman writes, “Children living in food-insecure households are at higher risk of poor physical and mental health. They are substantially more likely to be diagnosed with iron-deficiency anemia, asthma, mental health problems such as anxiety and depression, cognitive impairment and behavioral disorders.”
Stichel says he doesn’t often see vitamin deficiencies because most processed foods today are fortified with vitamins and minerals. But he does see numerous problems occurring in younger and younger people associated with processed foods, especially chronic illnesses such as Type 2 diabetes, metabolic syndrome (a group of risk factors that raises risk for heart disease and other health problems, such as diabetes and stroke) obesity, and high cholesterol and blood pressure.
Seligman also writes in the issues brief about the effects of food deserts and other forms of food insecurity on pregnant women and their babies: “[It] is associated with iron-deficiency anemia, depression, anxiety and excess weight gain. Infants born to food-insecure mothers are smaller, sicker and have an increased risk of some birth defects.”
For adults, the food insecurity that results from living in a food desert is compounded by the stresses of living in poverty and the ailments that accompany stress — high blood pressure, depression, anxiety and more.
One program that helps low-income mothers and their young children get adequate nutrition is WIC, the federal Women, Infants and Children nutrition program. But Stichel says women have to travel to a WIC office once a month during business hours to have their cards replenished. That can be a big obstacle for someone with a low-wage job, who may have to take time off without pay or may not have reliable transportation to the office, which may be on the other end of the county.
Increasingly, schools, government departments of social services and nonprofits are partnering with agencies that help people gain access to healthier foods.
Many children get free or reduced-price breakfast and lunch at school. But Stichel says school meal programs still offer some foods that aren’t nutritionally sound.
“Look at the school menus on the websites,” he says. “For breakfast, kids can choose a doughnut or a sausage biscuit. There are healthy choices, but there are bad choices, too.”
The meals are high in calories, and vegetables and fruits are offered, but children still may choose less healthy options, he adds.
Emily Jackson, director of ASAP’s Growing Minds Farm to School Program, says part of the problem is that we as a culture place more value on how cheaply we can feed people rather than getting wholesome foods to them.
“Our schools are doing a pretty good job, but there’s not enough money budgeted for food, and that food budget has to pay for salaries and equipment,” she says. “It’s very undervalued.”
The other problem with relying on schools is that they are in session only about 180 days of the year, which means children don’t have access to these meals for half the year.
ASAP has worked with farmers in the region to make fresh foods more available to low-income people. At several tailgate markets, people can pay for food with their EBT cards (what once was known as food stamps). ASAP also has published a brochure with a map of tailgate markets and bus lines to help people get to the markets.
At MANNA FoodBank, which serves the 17 westernmost counties in the state, the focus is on nutritionally dense foods — fresh vegetables, whole grains, lean meats and nuts — instead of nonperishable canned foods. MANNA recently added a large walk-in cooler to store perishables.
Hannah Randall, CEO of MANNA, explains that the number of food deserts in the region is caused by a unique socioeconomic storm.
“It’s a combination of low-wage jobs (when there are jobs), very, very, very high housing costs and little to no public transportation in the region,” she says. “We have childhood food insecurity averages of one in four in the region overall, but there are communities where that number is eight in 10.”
One solution might be a mobile food pantry that can take needed food into neighborhoods without the cost of a brick-and-mortar pantry, Randall says.
Stichel says he believes people can choose healthy foods for the same money they spend on fast foods. He points to bags of frozen vegetables that cost about $2 — the price of two “dollar menu” items at a fast-food restaurant.
But, Randall says, many of the people who buy fast food or junk food for their families work full time or more at low-wage jobs and have little or no time to cook for their families.
Another problem, Stichel says, is the shame associated with poverty.
“When I ask people whether they have enough food at home, they always say they do,” he says. “I can’t challenge their answer. I have to believe them, but I’m not sure they really do.”
The solution, Randall says, is multipronged: getting nutritious food to people who need it, creating easier access to food vendors accepting EBT cards, making more mobile food pantries available, offering better foods to children at schools and promoting education about what people need to be healthier.
MAHEC added nutrition education to its family practice clinic this year. Stichel arrived in July and consults with patients who come in for appointments with physicians there.
He speaks with the enthusiasm of an evangelist as he talks about how to choose healthier, more plant-based foods that are lower in fats and higher in fiber.
“We can all eat healthier,” he says. “I take issue with people who say it’s cheaper to eat bad food. It really isn’t if you know what to look for. Lentils have more iron than meat. You can have rice and beans with vegetables, and that’s far, far healthier than two Burger King burgers.”