How Boston Children’s physicians have teamed up to tackle obesity and food insecurity

When nutritious, high-quality food is not easily accessible, families are often left to purchase what is available — usually, highly processed, nutrient-poor food. Children in these households — who also have food insecurity and various socio-economic stressors — face additional barriers and are at risk for developing chronic diseases, such as obesity. 

To address such concerns, Alison Wu, MD, and Jason (Yanjia) Zhang, MD, PhD, in Boston Children’s Division of Gastroenterology, Hepatology, and Nutrition are tackling childhood obesity and food insecurity where their patients are — directly in the community, rather than expecting patients to travel far to a different location for care.

“Taking a subspecialty focus on obesity and nutrition into a community-based pediatrics practice is a unique model,” explains Zhang. “To understand and trace the root cause of obesity within a community, we’ve learned that we must show up for our patients and be where they are. That’s why we’ve had an established GI clinic at Martha Eliot Health Center for four years now.” 

Located in Jamaica Plain, Massachusetts, Boston Children’s at Martha Eliot provides care to families in that community and in surrounding neighborhoods. “What makes Martha Eliot unique is that primary, and some specialty care, are provided side-by-side,” explains Wu. “This is way, we can meet our patients’ specific needs and provide informed care.”

Community-centered care 

For Wu and Zhang, a driving force behind much of their work is building stronger community connections as clinicians and providing true health equity to patients. 

“Equity does not necessarily mean providing the same thing to everyone,” explains Zhang. “We’ve had to ask ourselves how we can change our practice to better serve our community.”

For example, clinicians have made it a point to know the patient population as personally as possible. Many of the Martha Eliot clinicians and staff live within the same community as their patients, giving them a more intimate look into the day-to-day lives of their patients. “Our team knows the school system well because our own kids are in the same system,” explains Zhang. “We’re familiar with the same grocery stores, parks, and after-school programs as our patients, both through our own experiences and by actively trying to better know our community.”

Through this community-focused care model, they’ve seen more consistent visits to Martha Eliot, along with more success seeing patients lose weight in the Center’s obesity program — something that was hard to achieve before opening the GI clinic.

A meal kit program reimagined

Wu believes that to address obesity, clinicians must view food as medicine. “Nutrition-based interventions in health care settings can help patients prevent, manage, and treat certain disease,” she explains. “Food and nutrition security are critical for our patients and families to achieve their full health.”

One approach?  Healthy meal kit delivery programs. Previous research has evaluated the effectiveness of meal kit programs for adults with chronic illness and food insecurity, but little work has been done to determine their effects on children. That’s why Wu and her colleagues are currently studying whether such a program could benefit families who identify as food insecure and who have children with obesity.

Phase 1 of the Intervening in Food insecurity to Reduce and Mitigate (InFoRM) childhood obesity study involved 30 families from Boston Children’s at Martha Eliot who had a child meeting criteria for obesity and reported food insecurity.

Each family was delivered EatWell Meal Kits — locally-made meal kits developed by a trained chef and health coach — to their home every week. Each meal kit included fresh ingredients and picture-based recipes (two recipes per week for six weeks) in both English and Spanish.

“Caregivers appreciated the hands-on, experiential learning that came with the meal kit program. They found it easy and convenient to prepare the meals, they were culturally appropriate, and their kids were more interested to try and taste new food after they helped prepare it,” says Wu.

Fueling the future of research

While phase 1 of the study focused on defining the basic elements of the meal kit delivery intervention, Wu shares that phase 2 will take a detailed look at how this program affects behavioral risk factors that are associated with childhood obesity.

“The first phase of this trial was to see if this program would be both feasible and acceptable as a nutrition-based intervention by both clinicians and patients” explains Wu. “Now that we have demonstrated this, phase 2 will test if the meal kit program could meaningfully impact household food insecurity, dietary quality, and other risk factors linked to child nutrition-related diseases.”

For more, visit the Division of Gastroenterology, Hepatology, and Nutrition