Farmers Markets

Farmers markets are an effective way to promote healthy eating while benefitting the environment. Because locally grown food does not have to be packaged and shipped to its destination, the food is at its peak ripeness. The fresher the produce is, the more nutrients and antioxidants it contains. Because locally grown food does not have to be transported long distances, it is better for the environment because it reduces fuel consumption and the waste from packing supplies. Farmers markets have recently increased efforts to encourage Supplemental Nutrition Assistance Program (SNAP), or Food Stamps, and WIC (Women, Infants, and Children program) customers. Many farmers markets offer incentives that make fresh produce more affordable and easier to access.

Food Security

A family is considered food secure if they have sufficient access to nutritionally adequate and safe food. Conversely, a family is considered food insecure if they do not have sufficient access to nutritious food. Factors that limit access and thus increase food insecurity include: inability to afford nutritious food, insufficient transportation to obtain nutritious food, and lack of knowledge about basic nutrition.  In Maryland, 12.5% of all households (Coleman-Jensen, Nord, Andrews, &  Carlson, 2011), and 20.8% of households with children are considered food insecure (FRAC, 2010). Children living in food insecure homes are more likely to experience behavior problems, have more school absences, be overweight, and suffer from chronic diseases like diabetes and high cholesterol (Maryland Hunger Solutions, n.d.).

Fruit and Vegetable Consumption

Although fruit and vegetable consumption provides essential nutrients such as folate, potassium, vitamins A and C, and plays a part in weight management and reducing risk for obesity, most Americans do not eat enough fruits and vegetables. Currently, the USDA recommends 2-4 servings of fruits and 3-5 servings of vegetables a day. Research has found that higher income and higher education are associated with increased fruit and vegetable consumption. Refuting the excuse to not eat fruits and vegetables because of their expense, research also shows that it is possible to meet dietary recommendations for less than one dollar a day. Despite the increased efforts to encourage more fruit and vegetable consumption, consumers have not responded and fruit and vegetable consumption remains low (Guthrie, 2004).

Health Literacy

Health Literacy is defined as an individual’s ability to obtain, process, and understand the health information and services they need to make good health decisions. The skills needed to be considered health literate may include calculating dosages, interpreting test results, locating health information, and analyzing health information for credibility and quality. Health literacy can be limited due to lack of educational opportunities, learning disabilities, and cognitive decline in older adults. Populations such as the elderly, low-income, immigrant, minority, or those with chronic mental or physical limitations are particularly vulnerable to being health illiterate. Limited health literacy decreases the quality of health outcomes and also places a financial burden on our health care system (National Network of Libraries of Medicine, 2012).

Home Nutrition Environment

Diet quality is directly impacted by the home nutrition environment. Research shows that eating meals as a family is correlated with healthier eating. When meals are prepared at home and eaten as a family, the family receives more essential nutrients than those families who do not frequently eat meals together. Also, because children model parents eating choices, if parents do not eat healthy, children will not view healthy eating as important (Meals Matter, 2012). The home nutrition environment also determines what is available to eat. When kitchens are stocked with ample fruits and vegetables, whole grains, and limited fats and sweets, it is easier to make healthy choices. With the percentage of overweight and obese Americans on the rise, the home is a wise place to start to encourage healthier lifestyles.

MHealth

MHealth is short for Mobile Health. MHealth describes programs that promote healthier lifestyles by communicating through text messaging, social networking, and mobile device applications. Through MHealth, health educators and health care providers can reach people outside of a doctor’s office or education setting. The goal of MHealth is to bring health education into a person’s day-to-day routine as a means of increasing the efficacy of health interventions. MHealth also makes it possible to increase health education access to low-income populations because, through these modalities, health education can be delivered right to your phone.

Nutrition and Diet Intake and Quality

The USDA recommends a diet rich in fruit and vegetable consumption, using whole grains over processed grains, low-fat dairy products, lean meats, and limited consumption of fats and sweets. Research shows that most Americans do not meet the USDA recommendations. In general, Americans eat too many servings of food with added fats and sugars and too little servings of fruits, vegetables, whole grains, and lean meats. Research has recently demonstrated that Americans are increasingly eating foods prepared away from home, which results in a decrease in diet quality. Socioeconomic factors also play a role in diet quality. Higher income and higher education are correlated with better diet quality. Married parents tend to have better diets than single parents. There are also differences shown in immigrant populations. Hispanics that do not speak English tend to have better diets than Hispanics that are more acclimated to American lifestyles. An obstacle that inhibits efforts to improving diet quality is that many Americans perceive their diets to be better than they actually are (Economic Research Service, 2012).

Numeracy

Health numeracy is defined as an individual’s ability to understand quantitative health information through methods such as computation skills, interpreting data from graphs, and the ability for both the individual and the health care provider to communicate. Health numeracy is similar to health literacy but the focus here is on an individual’s ability to interpret quantitative information. The use of quantitative health information is growing rapidly. For those who are health literate, readily understanding health information can empower patients, but for those who are not, the use of quantitative health information may increase the divide in health literacy.

Obesity - Adulthood

Obesity means having excess body fat and is defined by an individual's body mass index or BMI. BMIs over 30 are considered obese. Maryland has an adult obesity rate of 27.1% and is the 26th most obese state in the United States. Obesity disproportionally affects minority, low-income, and less educated populations (Trust for America’s Health, 2011). Obesity can lead to numerous health problems such as: diabetes, high blood pressure, high cholesterol, cancer, sleep apnea, stroke, and respiratory problems. Obesity is caused by eating too much and not getting enough physical activity. A number of environmental factors contribute to this problem, including limited access to parks and recreation centers or safe routes to walk or bike to work on. Obesity can be prevented by monitoring your food intake, being physically active, replacing sugary drinks with water, and promoting public policies that encourage healthy lifestyles (CDC, nd).

Obesity - Childhood

12.5 million children and adolescents in the United States are considered to be obese and this number has tripled since the 1980s. Childhood obesity disproportionally affects ethnic minority and low-income children (CDC, 2012). This epidemic is most often caused by lifestyle issues such as too much caloric intake coupled with too little physical activity. There are also rare circumstances in which childhood obesity is caused by genetics and hormone imbalances. Within the family setting, childhood obesity can be treated by incorporating more fruits and vegetables into the family diet, limiting sugary beverages, eating meals as a family, avoiding processed foods, and limiting the number of times a family eats out (Mayo Clinic Staff, 2012). As a community, we can incentivize farmers markets and grocery stores to do business in low- income areas, create and maintain safe neighborhoods and parks to encourage physical activity, and encourage programs that bring fruits and vegetables into schools (CDC, 2012).

Parental Feeding Practices

15% of children in the United States are overweight and even more are at risk of becoming overweight (Stang, Rehorst, & Golicic, 2004). A child’s weight is determined by a combination of genetics and environment. Parental feeding practices are a salient aspect of a child’s food environment. Parental feeding practices include everything from which foods a parent makes available to their child, to how they implement eating practices, to the foods parents eat and model for their children. Feeding practices such as eating meals as a family, not using food as a reward, modeling healthy food for your children, and limiting television viewing time have been shown to increase healthier eating behaviors in children (Golan & Crow, 2004).

School Cafeteria Environment

Can pizza be considered a vegetable? Although common sense says no, in the past school cafeteria nutrition guidelines have counted the tomato sauce on pizza as a serving of vegetables. Around 32 million children participate in a school lunch program and thus are affected by inadequate nutrition provided by school meals. As of January 2012 new rules were implemented that seek to improve the school cafeteria environment. Now school lunch programs will double the amount of fruits and vegetables children are served, require that all grains served are whole grains, limit the amount of salt and trans fats, and serve only low fat milk (Nixon, 2012). Maryland also implemented a farm-to-school program in which locally grown products supplement school meals. This encourages children to eat healthy and teaches them the importance of supporting locally grown products (Fedor, n.d.).

References

Ancker, J.S. & Kaufman, D. (2007). Rethinking Health Numeracy: A Multidisciplinary Literature Review. Journal of the American Medical Informatics Association, 14(6): 713–721.

Centers for Disease Control and Prevention. (nd). Adult Obesity: Latest Findings. Retrieved from:

http://www.cdc.gov/vitalsigns/AdultObesity/LatestFindings.html

Centers for Disease Control and Prevention. (June, 2012). Childhood Overweight and Obesity. Retrieved from: http://www.cdc.gov/obesity/childhood/index.html

Coleman-Jensen, A., Nord, M., Andrews, M. & Carlson, S. (September, 2011). Household Food Security in the United States in 2010. Retrieved from: http://www.ers.usda.gov/Publications/ERR125/ERR125.pdf

Economic Research Service. (2012). Diet Quality and Nutrition. United States Department of Agriculture. Retrieved from: http://www.ers.usda.gov/topics/food-choices-health/diet-quality-nutritio...

Fedor, K. (nd). Maryland Profile. National Farm to School Network. Retrieved from: http://www.farmtoschool.org/MD/

Food Research and Action Center. (August 2011). Food Hardship in America 2010. Retrieved from:

http://frac.org/pdf/aug2011_food_hardship_report_children.pdf

Golan, M. & Crow, S. (2004). Parents Are Key Players in the Prevention and Treatment of Weight-related Problems. Nutrition Reviews, 62 (1), 39-50.

Guthrie, J. (2004). Understanding Fruit and Vegetable Choices Economic and Behavioral Influences. United States Department of Agriculture. Retreived from: http://webarchives.cdlib.org/sw1tx36512/http://www.ers.usda.gov/publicat...

Maryland Hunger Solutions. (n.d.). Childhood Hunger in Maryland. Retrieved from: http://www.mdhungersolutions.org/childhood_hunger_in_maryland.shtm

Mayo Clinic Staff. (2012). Childhood Obesity. Retreived from: http://www.mayoclinic.com/health/childhood-obesity/DS00698

Meals Matter. (2012). Family Meals: More than just eating at home. Retrieved from:                   http://www.mealsmatter.org/Articles-And-Resources/Healthy-Living-Article...

National Network of Libraries of Medicine. (2012). Health Literacy. Retrieved from: http://nnlm.gov/outreach/consumer/hlthlit.html/

Nixon, R. (2012). New Rules for School Meals Aim at Reducing Obesity. The New York Times. Retrieved from: http://www.nytimes.com/2012/01/26/us/politics/new-school-lunch-rules-aim...

Stang, J., Rehorst, J., & Golicic, J. (2004). Parental feeding practices and risk of childhood overweight in girls: implications for dietetics practice. Journal of the American Dietetic Association, 104 (7), 1076-1079.

Trust for America’s Health. (July 2011). New Report: Maryland is 26th Most Obese State in Nation. Retrieved from: http://healthyamericans.org/reports/obesity2011/release.php?stateid=MD