Group cooking and exercise classes help treat chronic illnesses for low-income Californians.
By George B. Sanchez Tello
This story was produced by the award-winning journalism nonprofit Capital & Main and is co-published here with permission.
For low-income Californians looking to adopt healthier eating habits, smoothies could be a good first step. That’s what doctors, researchers, and patients are finding in Alameda County, where, as I wrote in a column earlier this month, doctors prescribe health foods to patients with chronic illnesses. One of the lessons taught to patients through a pilot program called Recipe4Health was that mixing leafy greens into their drinks can help manage blood sugar levels.
Blending smoothies allowed people to experience the taste of vegetables in an easy-to-make format, and those who didn’t make salads or cook vegetables became more interested in a plant-based diet, and the program also offered online cooking lessons and recipes.
Most of the attention on programs like Recipe4Health has focused on providing fresh produce to low-income residents with chronic conditions. But just as important as providing fresh food is teaching patients how to prepare it. Exercise instruction is key, too. As lawmakers in Sacramento consider the future of the state’s food-as-medicine pilot program, it’s crucial to recognize that losing classes means missing an opportunity to give people life-changing knowledge and skills.
“The behavior change aspect hasn’t been discussed much,” says Wei-Ting Chen, a Stanford University researcher who studied the impact of Recipe4Health over a year and whose colleagues presented their findings at the American Heart Association’s spring meeting.
Doctors typically prescribe behavioral changes to patients with these conditions, including diet and exercise. Sound familiar? Doctors can prescribe behavioral changes. But there is no “behavioral pharmacy” to fill that prescription. Patients are left to figure it out for themselves.
To help patients figure out how to adopt healthy behaviors, doctors and health officials need to ask them what they want and what they’re willing to do, said Zarak Trivedi, a dietitian with Recipe4Health in Alameda County. Patients often know what they want and need to do, but they need help learning how to do it, Trivedi said. That might mean learning how to start exercising or learning how to make healthy foods they’ve never made before.
“It’s not just food. It’s group support,” Chen said of the Alameda program. “It’s action.”
To teach these behaviors, the Oakland-based organization Open Source Wellness hosted weekly Zoom meetings for Recipes4Health, offering exercise and cooking instruction. These meetings were doctor-ordered behavioral therapy. Dr. Elizabeth Markle, co-founder of Open Source Wellness, said patients received support and encouragement from supportive doctors, nutritionists and classmates.
In their study, Chen and her colleagues found that patients who participated in the program were more active, ate more fresh vegetables, and experienced less food insecurity, which in turn led to lower cholesterol levels and better control of their blood sugar levels.
“When people feel accepted, supported and belong, they are more likely to change their behaviour,” says Markle, the chartered psychologist.
More than 3 million California adults experienced hunger in 2021. Food insecurity affects nearly half of California’s Black adults and half of the state’s undocumented residents. Three million Californians have been diagnosed with diabetes, while 10 million Californians, one-third of the adult population, have prediabetes. People of color are twice as likely to have diabetes and 1.5 times more likely to have prediabetes.
Nearly every county in California has some kind of state-sponsored food and drug program for Medicare recipients, and lawmakers in Sacramento are working to pass a bill to keep the program running after federal funding ends in 2027.
In addition to MediCal, Open Source Wellness works with YMCA associations across the country, including in San Diego, with the Los Angeles and San Francisco YMCAs set to join the network next year.
Healthy food and social support are what get some people back on track, whether through public programs like MediCal or private organizations like the YMCA. For their Alameda County patients, it starts with smoothies and support, Chen and Trivedi say.
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