What's for Lunch?

Part of helping diabetes patients manage their condition involves helping them to eat better. What if patients are living in a 'food desert?'

• By Holly J. Wagner
• Dec 01, 2019

If you’ve noticed your diabetes patient population getting younger and fatter, you’re far from alone. Hardly a week goes by without a headline about childhood obesity or “e-sports” replacing actual physical sports.

Doctors consistently urge better diets and more exercise, even for non-diabetic patients. But they are up against a fast-food industry that spent $11 billion on advertising in 2017, $8.8 billion of that on the least healthy choices, according to the Rudd Center for Food Policy & Obesity at the University of Connecticut. And that was just on TV: most fast-food chains offer loyalty programs that send alerts directly to cell phones offering discounts and rewards based on purchase history. The study found that, on average, children are exposed to 10 fast-food ads a day.

As a result, poor food choices are always in your face. It’s not just ubiquitous advertising and store shelves stocked by chip and soda producers. A surprising number of schools even contract cafeteria space to fast-food chains — a practice that’s been going on since the 1990s and is only now starting to fall out of vogue. It’s still common to find McDonald’s, Chik-Fil-A, Panda Express, Pizza Hut, Quizno’s and Taco Bell in cafeterias from kindergarten to college.

In a study published in 2014 in JAMA Pediatrics, researchers from the Institute for Social Research at the University of Michigan found 10 percent of elementary school and 30 percent of high school cafeterias served branded fast-food weekly, and 19 percent of high schools served it daily.

In addition, many major cities have “food deserts,” where there are no stores selling fresh produce and fast-food outlets are highly concentrated — often around schools. Youngsters not only don’t learn to cook fresh food, they may not even know what it looks like. Those palates have been trained practically since birth to eat junk.

Like home economics classes, P.E. programs at many schools have fallen victim to budget cuts. Parents may not be able to spare the time or money for their children to play organized sports. Children may be less active because they’re playing Fortnite instead of soccer, or live in neighborhoods where it’s not safe to play outside.

All that unhealthy living is showing up in diabetes rates. According to the CDC National Diabetes Statistics Report for 2017, about 193,000 Americans under age 20 are estimated to have diagnosed diabetes, approximately 0.24% of that population. In 2011-2012, the annual incidence of diagnosed diabetes in youth was estimated at 17,900 with type 1 diabetes and 5,300 with type 2 diabetes. Many of those patients are minorities living in low-income areas. That means many of those patients are on Medicaid.

So now here you are, trying to help a generation that grew up thinking Gummi Bears are fruit and may only have eaten homemade food at grandma’s around the holidays. It’s a challenge for their health, but also an opportunity to show them a better way.

The increase in diabetes across populations is behind the CMS’ efforts at prevention and management, including the Diabetes Self Management Training (DSMT) program. The opportunity for pharmacies and DMEs comes in the form of reimbursement for offering DSMT. Getting set up and accredited to offer DSMT can help your bottom line and your community at the same time.

If you’re used to thinking strictly in terms of pills, potions, salves and splints, it’s time to start thinking about behavior modification and breaking bad habits. Nutrition and exercise programs are an important component of diabetes self-management, so it’s more important than ever to cultivate relationships with community partners who can help your patients meet goals, including grocery stores, food co-ops, exercise programs and community centers. The market is there, and it’s clamoring for your help.

This article originally appeared in the DME Pharmacy December 2019 issue of HME Business.