1. The Elephant in the Room Question for Consideration
Food Access and Health Outcomes • What types and kinds of foods come to
mind when you think about community
Raul Lozano, Sacred Heart Community Services food security?
Marjorie Freedman, San Jose State University – Why did you choose those foods?
Michele Bunker-Alberts, Alameda Cty Med Center
For more information please contact
marjorie.freedman@sjsu.edu
People won’t eat healthful
Consider for a moment. . .
food if they don’t . . .
• If you were to choose one thing to focus
• have access to it, or can’t afford it
on to ensure that people eat healthfully,
what would it be? • like how it tastes, or want to eat it
• value being healthy
• know how to prepare it
• have the time or resources needed to
prepare it
Why This Matters Addressing Barriers
• People can’t eat healthful food if they don’t
• We can’t solve the current crises of food
have access to it, or can’t afford it
insecurity coupled with obesity, type 2 – Raul Lozano: La Mesa Verde
diabetes, cardiovascular disease and
• Just because you provide healthful food does
hypertension if people don’t/won’t eat not mean they will eat it.
healthful foods. – Marjorie Freedman: Community Soup Kitchen
• So, we need to figure out how to Evaluation
overcome barriers (access, taste, • People won’t eat healthful food if they don’t
values, skills and resources.) value being healthy
– Michele Bunker-Alberts: Bite to Balance

2. La Mesa Verde
Mission
La Mesa Verde
• To foster the widespread cultivation
of organic home vegetable gardens
in order to encourage healthier
Raul Lozano eating, build community, promote
Project Founder self-sufficiency and address food
Sacred Heart Community Services insecurity in San Jose/Silicon
Valley
La Mesa Verde La Mesa Verde
Program Overview Program History
• Participants receive: • In 2009-10, 100 families were enrolled
– 1 or 2 raised beds – Average household density: 5.3 individuals
• Number depends on sunlight, space availability at – 5% (n=5) dropped before the first planting due to
home and fsmily size home loss and economic hardship
– Organic soil – 95% (n=95) began the program and
– A custom-built drip irrigation system received all garden materials and plants
– Heirloom vegetable seeds and seedlings for a
minimum of 3 consecutive planting seasons
• All participants receive same plants
– Staff support and garden visits for duration of
enrollment and thereafter
Ethnic distribution
Gardening Experience
of 95 people who started program of 95 people who started program

3. Program Participation
Program Completers
• 70 families (74%) completed
the entire year-long program in
the first year
• This represents almost 400
individuals.
Factors Inhibiting Program
Completion
Provision of Raised Beds
• 166 raised beds were provided and
installed in participants’ homes
La Mesa Verde: Time Spent in Garden per
Evaluation Week
• 70 of the first 100 families
completed the year-long
program
–81% (n=57) of these families
completed the survey for this
evaluation

4. Participant Garden Knowledge Health of Home Gardens at End
Indicators of Program
Average Gross Annual Savings Vegetable Consumption at
per Household End of Program
91% of respondents reported increased
consumption
Ranked Benefits of La Mesa Verde:
Participating in La Mesa Verde Conclusion
• If you provide raised beds, people will
garden.
• When people grow food, they save
money, and they eat more vegetables
• When they eat more vegetables, they
are . . . ???
– Health outcomes were not measured

5. Soup Kitchen Evaluation
Community Soup Kitchen Objective
Evaluation • To examine food consumption patterns
among community meal center guests
– Protein, starch, fruit, vegetables and bread
Marjorie R. Freedman, PhD
Associate Professor
Dept of Nutrition, Food Science and Packaging
San Jose State University
Soup Kitchen Evaluation Soup Kitchen Evaluation
Study Rationale Methods
• There is little information about the food • Two community meal centers serving
adult men & women
intake patterns of soup-kitchen clients.
• Convenience sample of meal recipients
– Are nutritional needs being met?
• 4 study days at each site with one day
• Centers work on limited budgets and eliminated (7 days of data)
must maximize their resources. • Tray collection post meal service
Decreasing food waste will save limited – 797 total tray observations
resources and stretch dollars. – Food waste by component was collected
and weighed
Results Results
Average Total Waste Per Day (oz) Average Per Person Waste (oz)
Protein Starch Fruit Vegetable Bread Total Protein Starch Fruit Vegetable Bread Total
Site 1 Site 1
26.88 67.5 193.97 248.83 92.75 629.93 0.17 0.43 1.23 1.57 0.59 3.99
Men Only Men Only
Site 2 : Site 2 :
8.71 31.47 32.50 41.38 10.21 124.27 0.13 0.44 0.55 0.51 0.14 1.77
Men Men
Site 2: Site 2:
8.54 21.17 24.25 26.42 18.42 98.80 0.26 0.70 0.69 0.70 0.64 3.00
Women Women

6. Soup Kitchen Evaluation
Discussion
Conclusions
• More food distributed to clients resulted
in more overall waste. • It’s not nutrition until it’s eaten
– Providing healthful foods does not ensure
– Average per day food waste was 3.5 times
consumption
higher in site 1 vs site 2
– Choice and quantity of food served impacts
• Fruits, vegetables and bread were the consumption/waste patterns
main items discarded; protein was rarely – Gender differences need further examination
discarded • Further research concentrating on food
– Waste may be a function of palatability and preparation and menu patterns in
types/kinds of foods offered and overall relation to consumption patterns is
taste preferences needed
Bite to Balance
Program Objective
• To provide socioeconomically
Bite to Balance challenged families with obese
pediatric patients access to
Michele Bunker-Alberts, RN healthy produce on a regular
Alameda County Medical Center
basis in their medical home.
Funded by the American Association of
Nurse Practitioners
Bite to Balance Bite to Balance
Program Setting Program Components
• An urban pediatric clinic • The Alameda County Medical Center Veggie
Box Program enables employees of the
(Highland Hospital Pediatric medical center to sign up and receive a fresh
Clinic) in Oakland CA serving bag of locally grown fruits and vegetables
either weekly or bimonthly through a local
primarily underinsured families urban farm, The People’s Grocery.
• Expansion provides weekly bags to families
struggling with pediatric obesity.

7. Bite to Balance Bite to Balance
Program Components Participant Selection
• Train Model Neighborhood Program students in • A selected group of 15 families with a
customer service skills and interview techniques
• Offer low-income uninsured families skills that can
child between the ages of 10 and 18
support a strategy of creating environments years old (all with a BMI > 95%) were
conducive to active living and better eating. selected based on a screening tool
– 3 culturally appropriate food preparation targeting low-income, motivated families
demonstrations during course of project
with inadequate daily fruit and vegetable
– People’s Grocery food access component
– Celebrate differences between pre-and-post test
intake.
eating habits/trends/experiences
– Prepare families post-grant period to budget weekly
bags, use SNAP benefits
Bite to Balance Bite to Balance
Program Participants and Providers Outcomes: Attitudes and Knowledge
– “Carmen esta comiendo mas verduras, • Pre- and post-study educational
frutas – diario,” mama de Carmen questionnaires regarding general
– It’s fun! nutrition, patient dining habits and
– “It’s been great as a pediatric provider to attitudes for participants receiving
have a program to refer families to when boxes
they are struggling with these issues. So
often, we talk about them but this group
was really different.”
Bite to Balance Bite to Balance
Health Outcomes Program Deliverable
• At monthly visits, feedback was given to • Video documentary of project to be
the patient’s family via a “BMI Teaching submitted post-study filmed and
Tool” which tracked the patient’s BMI produced by People’s Grocery
over time
• Program goal: stabilized BMI in 60% of
participants
– Obesity labs followed at 6-month intervals
– Data comparison to be complete December 2011

8. Bite to Balance Bite to Balance
May-October 2011 May-October 2011
• Families shared increased intake of fruits • Questionnaires
and vegetables (anecdotal information) • Improved access
• Monthly group meetings with a nutrition • Use of SNAP benefits to continue weekly
educator and a clinic dietician included bags
lessons, movement, recipes, food • Basic budgeting for weekly bag
preparation, and fun purchase
• Labs
Bite to Balance The Elephant in the Room
Looking to the Future
• Connecting the dots . . .
• Data gathering happening now
Access
• Results by early 2012
• Pilot program with goal to expand in
2012 Consumption
• Work towards even more access
through community/food/healthcare Health Outcomes
partnerships and leadership
Can we talk about
food security
without talking
about nutrition and
health outcomes?