Kids Health Annual

Produce Rx: A Hospital and a Family's Fight Against Food Insecurity

How two questions are jump-starting healthier lifestyles for thousands of Houston kids and families.

By Laura Furr Mericas August 3, 2018

Image: Todd Spoth

EVELYN ESPARZA IS A SINGLE MOTHER of two boys. Brian, her oldest, is a junior at Lamar Consolidated High School in Rosenberg and an active member of the basketball team. Joseph, her youngest, is a sixth grader at Wessendorff Middle and is at risk of developing diabetes.

At 12 years old, Joseph weighs 230 pounds, and at 5 feet, two inches is classified by the CDC as obese. A few months ago, Esparza decided it was time to get help, and took her family to the Lamar Health Center—one of Memorial Hermann’s 10 school-based clinics for uninsured and Medicaid students and their families. Here, Esparza was handed a form that included two questions that asked to consider if, in the last year, she’d worried she’d run out of food before she had money to buy more, or if she actually had run out. She had to answer “yes.”

Like many Houstonians, Esparza and her family are food insecure. Though they aren’t what the government classifies as going “hungry,” their financial situation limits them from getting adequate nutrition. Instead of buying typically more expensive fruits and vegetables at the grocery, a food-insecure family’s cart would likely include calorie-dense items with little to no nutritional value. For Esparza, it was pizzas, starches, and cereal.

“I wanted to eat healthy, but then again, I couldn’t afford to buy all the fruits and vegetables,” Esparza explains.

In the area around Joseph’s school, about 12 to 20 percent of households suffer from food insecurity; in other parts of Houston, the distribution is as high as 57 percent. It’s an issue with wide-reaching effects—like obesity, anxiety, depression, and neglect of chronic health problems—and one that Memorial Hermann is hoping to change. But to do that, they had to start asking questions.

Image: Todd Spoth

“If a patient is food insecure, they are not going to follow a diet; they are not going to get their prescriptions filled if they are having to make those kinds of choices,” says Carol Paret, senior vice president and chief community health officer for Memorial Hermann, who led the effort in getting the two new questions aimed at food insecurity into waiting rooms. “But not knowing that means we can’t deliver the best kind of health care to our patients.”

In 2015, Memorial Hermann rolled out the two questions to the electronic medical records system at their 10 school-based clinics and at the Physicians at Sugar Creek center to start gathering data on the issue. They have since screened more than 336,000 patients, and were surprised to find that about one in six—about 30 percent of families at the school-based clinics and 10 percent of the patients at Sugar Creek—classified as food insecure. The results were so impactful, Memorial Hermann decided to start asking the same questions across the entire health system in March.

“It has really infiltrated every finger of Memorial Hermann,” Paret says. “We know we are starting to make a difference. It’s that first patient that a physician has that makes them say ‘Oh?’ that makes them begin to see.”

With this new knowledge came treatment. The health care system has begun placing food-insecure patients with navigators and nutritionists who provide them with a food-centric education and programming they likely have not received before. Many children are placed in school lunch programs, families are connected with the proper resources at food banks and pantries, and patients at the Physicians at Sugar Creek can even pluck fresh produce from the clinic’s community garden.

Image: Todd Spoth

In Evelyn and Joseph’s case, they were sent home with a cookbook of easy-to-make, nutritional recipes and a new understanding of how to shop smarter. “What they told me in the health and nutrition program was for [Joseph] to eat more colorful foods because that had more vitamins,” Evelyn recalls. “They told me about how iceberg lettuce has more water than vitamins, so I’ve been buying packages that have different colors with reds and purple.” Esparza and her boys were also selected to participate in Wholesome Wave, a pilot program for Memorial Hermann underwritten by Target that provided families with vouchers to shop for healthy foods. Evelyn estimates that she spends about $150 or more on fruits and veggies with these vouchers, something she never would have been able to afford before.

Today, Evelyn says she notices a more positive and energetic version of Joseph. Meals of sugary cereal and pizza have become ones of oatmeal with fruit and salads. He’s even started to show an interest in working out for the first time. But despite the change in diet, Evelyn fears Joseph has many more pounds to shed before reaching a healthy weight for his age. “Once Joseph goes to junior high, I think it will be better because he will be more active,” she says. “He wants to play basketball like his brother, which is good. Right now, I know [his weight] has to do with physical activity.” Fittingly, physical fitness, and treating exercise as medicine, is one of the health needs Memorial Hermann plans to focus on next.

Still, Esparza counts her son’s progress to date as a step in the right direction—in her words, “a blessing.”

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