Senbagam Virudachalam, MD, MSHP
Case: A 5-year-old girl comes in for her annual checkup with her mother and 3 younger sisters. The girl’s weight is in the 90th percentile. The family has screened positive as experiencing food insecurity. When asked if the child was “eating a well-balanced diet,” her mother says she tries but identifies 3 obstacles she faces consistently:
- “Healthy” food is expensive, and the family has a low income.
- It’s difficult to spend much time cooking “from scratch” with 4 young children needing her attention.
- The girls’ father brings home a lot of junk food and fast-food meals, sabotaging her efforts to limit keeping those types of foods in the house.
Discussion: In Philadelphia, which has the distinction of being the United States’ poorest big city, food insecurity has long been a problem that pediatricians see every day. Food insecurity goes beyond the problem of not having enough food in the home; it is also the challenge of having nutritious food that will fuel children’s healthy growth and development. The problem is not restricted to Philadelphia.
It is well established that poor dietary patterns in childhood can lead to health problems, including obesity, diabetes, and cardiovascular disease— now and in the future. Poor diets can also have negative impacts on mental health, cognitive development, academic performance, and emotional well-being.
Children’s Hospital of Philadelphia (CHOP) is committed to addressing food insecurity, along with other social determinants of health, by harnessing the creativity and expertise of our staff and partnering with community groups and nonprofits.
The first step is identifying families in need. Families seen in CHOP primary care are screened for food insecurity. Parents or caregivers may be more comfortable responding via a standardized questionnaire. However, if the questionnaire isn’t completed, pediatricians can ask, with compassion, if the family has the resources to consistently obtain nutritious foods.
The second important step is to provide supports for families experiencing food and nutrition insecurity. Ideally all healthcare facilities would have benefits enrollment specialists to guide eligible families through the complicated process of applying for the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). However, many families who receive SNAP and WIC remain food insecure.
A Fresh Approach: Peer-led Cooking Classes
In 2012, CHOP began developing and evaluating a grant-supported program called Home Plate to address this gap. Home Plate is a food literacy and cooking skills program that empowers patients and families to eat healthier by maximizing the food resources they have. We developed Home Plate in partnership with staff and families from CHOP Early Head Start and have since offered the program to families from CHOP primary care, early care and education centers, and other community partners. Families cook together weekly for 6 weeks and support each other with incorporating food shopping, planning, cooking, and healthy eating into their daily lives.
We have also partnered with The Food Trust for the past several years to provide families with produce prescriptions: $100 worth of monthly vouchers for fruits and vegetables that can be redeemed at more than 25 farmers markets and stores in the Philadelphia area. By starting with healthy food habits when children are young, the hope is these habits will continue throughout a child’s life.
Initially, the peer-led Home Plate sessions were held at the Karabots Primary Care Center, West Philadelphia, and in the teaching kitchen at The Enterprise Center, a community business support nonprofit in West Philadelphia. The COVID-19 pandemic upended the in-person model, and Home Plate has been offered virtually ever since.
While initial results from a recent evaluation of Home Plate are forthcoming, families have expressed a high degree of satisfaction with the program. Another benefit is that caregivers see other caregivers dealing with the same struggles, and learning from each other helps reduce feelings of isolation.
Everyday Advice for Families
When a family facing food insecurity is in your exam room, what can you do to support their long-term food security?
- First, ask if they would like your support with this problem.
- If they do, ask whether they are eligible for and enrolled in food-related benefits such as SNAP and WIC. If not, refer them to benefits enrollment specialists to assist with this process.
- If they are facing barriers to food security other than having adequate monetary resources, brainstorm together ways to address these barriers.
References and Further Reading
Rabbitt MP, Hales LJ, Burke MP, Coleman- Jensen A. (2023). Household food security in the United States in 2022 (Report No. ERR-325). U.S. Department of Agriculture, Economic Research Service.
www.ers.usda.gov/publications/pub-details/?pubid=107702. Accessed June 17, 2023.
Virudachalam S, Kim LS, Seligman H. Produce prescriptions and a path toward food equity for children. JAMA Pediatr. 2023;177(3):225-226.
Heerman WJ, Kenney E, Block JP, Fiechtner L, McMahon E, Kruse L, Sharifi M, Edmondson EK, Virudachalam S. A narrative review of public health interventions for childhood obesity. Curr Obes Rep. 2024;13(1):87-97.
Other CHOP Food-related Programs
Food Pharmacy:
Families struggling to provide healthy food are given a “prescription” for food. It began as an extension of CHOP’s Healthy Weight Program and has expanded into two primary care practices.
Food as Medicine:
Brings entire families to the primary care practice one evening a month for a comprehensive program that includes food-related book reading, exercise, gardening and food preparation for the kids plus a free collection of food prep tools and weekly produce deliveries and twice monthly pantry staples delivery for families.
Complete Eats:
Provides free lunch to children in select CHOP primary and specialty care centers during the summer as part of the USDA free lunch program.
Community partnerships:
As part of the hospital’s Healthier Together initiative, CHOP partners with the Sankofa Community Farm at Bartram’s Garden, the Philadelphia Orchard Project, and the Southwest and West Philadelphia Agriculture Group to encourage growing fruits and vegetables in the Karabots Garden and in families’ own yards to promote food sovereignty.
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Specialties & Programs
Senbagam Virudachalam, MD, MSHP
Case: A 5-year-old girl comes in for her annual checkup with her mother and 3 younger sisters. The girl’s weight is in the 90th percentile. The family has screened positive as experiencing food insecurity. When asked if the child was “eating a well-balanced diet,” her mother says she tries but identifies 3 obstacles she faces consistently:
- “Healthy” food is expensive, and the family has a low income.
- It’s difficult to spend much time cooking “from scratch” with 4 young children needing her attention.
- The girls’ father brings home a lot of junk food and fast-food meals, sabotaging her efforts to limit keeping those types of foods in the house.
Discussion: In Philadelphia, which has the distinction of being the United States’ poorest big city, food insecurity has long been a problem that pediatricians see every day. Food insecurity goes beyond the problem of not having enough food in the home; it is also the challenge of having nutritious food that will fuel children’s healthy growth and development. The problem is not restricted to Philadelphia.
It is well established that poor dietary patterns in childhood can lead to health problems, including obesity, diabetes, and cardiovascular disease— now and in the future. Poor diets can also have negative impacts on mental health, cognitive development, academic performance, and emotional well-being.
Children’s Hospital of Philadelphia (CHOP) is committed to addressing food insecurity, along with other social determinants of health, by harnessing the creativity and expertise of our staff and partnering with community groups and nonprofits.
The first step is identifying families in need. Families seen in CHOP primary care are screened for food insecurity. Parents or caregivers may be more comfortable responding via a standardized questionnaire. However, if the questionnaire isn’t completed, pediatricians can ask, with compassion, if the family has the resources to consistently obtain nutritious foods.
The second important step is to provide supports for families experiencing food and nutrition insecurity. Ideally all healthcare facilities would have benefits enrollment specialists to guide eligible families through the complicated process of applying for the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). However, many families who receive SNAP and WIC remain food insecure.
A Fresh Approach: Peer-led Cooking Classes
In 2012, CHOP began developing and evaluating a grant-supported program called Home Plate to address this gap. Home Plate is a food literacy and cooking skills program that empowers patients and families to eat healthier by maximizing the food resources they have. We developed Home Plate in partnership with staff and families from CHOP Early Head Start and have since offered the program to families from CHOP primary care, early care and education centers, and other community partners. Families cook together weekly for 6 weeks and support each other with incorporating food shopping, planning, cooking, and healthy eating into their daily lives.
We have also partnered with The Food Trust for the past several years to provide families with produce prescriptions: $100 worth of monthly vouchers for fruits and vegetables that can be redeemed at more than 25 farmers markets and stores in the Philadelphia area. By starting with healthy food habits when children are young, the hope is these habits will continue throughout a child’s life.
Initially, the peer-led Home Plate sessions were held at the Karabots Primary Care Center, West Philadelphia, and in the teaching kitchen at The Enterprise Center, a community business support nonprofit in West Philadelphia. The COVID-19 pandemic upended the in-person model, and Home Plate has been offered virtually ever since.
While initial results from a recent evaluation of Home Plate are forthcoming, families have expressed a high degree of satisfaction with the program. Another benefit is that caregivers see other caregivers dealing with the same struggles, and learning from each other helps reduce feelings of isolation.
Everyday Advice for Families
When a family facing food insecurity is in your exam room, what can you do to support their long-term food security?
- First, ask if they would like your support with this problem.
- If they do, ask whether they are eligible for and enrolled in food-related benefits such as SNAP and WIC. If not, refer them to benefits enrollment specialists to assist with this process.
- If they are facing barriers to food security other than having adequate monetary resources, brainstorm together ways to address these barriers.
References and Further Reading
Rabbitt MP, Hales LJ, Burke MP, Coleman- Jensen A. (2023). Household food security in the United States in 2022 (Report No. ERR-325). U.S. Department of Agriculture, Economic Research Service.
www.ers.usda.gov/publications/pub-details/?pubid=107702. Accessed June 17, 2023.
Virudachalam S, Kim LS, Seligman H. Produce prescriptions and a path toward food equity for children. JAMA Pediatr. 2023;177(3):225-226.
Heerman WJ, Kenney E, Block JP, Fiechtner L, McMahon E, Kruse L, Sharifi M, Edmondson EK, Virudachalam S. A narrative review of public health interventions for childhood obesity. Curr Obes Rep. 2024;13(1):87-97.
Other CHOP Food-related Programs
Food Pharmacy:
Families struggling to provide healthy food are given a “prescription” for food. It began as an extension of CHOP’s Healthy Weight Program and has expanded into two primary care practices.
Food as Medicine:
Brings entire families to the primary care practice one evening a month for a comprehensive program that includes food-related book reading, exercise, gardening and food preparation for the kids plus a free collection of food prep tools and weekly produce deliveries and twice monthly pantry staples delivery for families.
Complete Eats:
Provides free lunch to children in select CHOP primary and specialty care centers during the summer as part of the USDA free lunch program.
Community partnerships:
As part of the hospital’s Healthier Together initiative, CHOP partners with the Sankofa Community Farm at Bartram’s Garden, the Philadelphia Orchard Project, and the Southwest and West Philadelphia Agriculture Group to encourage growing fruits and vegetables in the Karabots Garden and in families’ own yards to promote food sovereignty.
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Food Allergy Center