Social determinants of health (SDOH) can affect the way patients interact and manage their health. Particularly for patients with diabetes, who are also facing SDOH, meal planning with this chronic condition can prove difficult. With diabetes being the seventh leading cause of death in America and 1 in 3 adults having prediabetes¹, intervention from care teams can prove life-saving.
Social determinants of health (SDOH), such as geographic location, level of education and income can all directly affect the management of this chronic disease. Here are a few considerations when helping a patient adapt their diet to strengthen your care team’s intervention efforts.
Think Food Insecurity, Not Food Deserts
If patients with diabetes do happen to face SDOH, these determinants may still be nuanced in nature. A big concern a patient’s provider may have is access to healthy foods. Areas of “food deserts,” with low physical access to food are often the pinpoint of conversation². Low physical access is defined as 1 mile in urban areas and 10 miles in rural areas². However, one study conducted determined that higher HbA1C levels are more likely attributed to other, more impactful factors.²
One of these is namely food insecurity. The study defines food insecurity as “uncertain or limited availability of food owing to cost,” which affects 20 percent of Americans living with diabetes. This was more likely to be attributed to higher A1c levels, the study found. It even cited another study which found that adding a supermarket to a neighborhood in San Francisco did not drastically reduce A1c. Low physical food access is often associated with low incomes, but that in fact is more closely linked to food insecurity².
“Given their potential broad impact on overall health and many other conditions besides diabetes per se, we should not eschew interventions to improve physical food access,” the author of the study says. “Rather, combining food access interventions with interventions that directly address food insecurity may be more likely to improve diabetes outcomes specifically.²”
Health system interventions for addressing food insecurity could include²:
- Helping patients enroll in SNAP
- Connecting patients with community resources
- Writing prescriptions for healthy foods
- Working with local food banks to help patients secure food
Help Patients Build Healthy Meal Plans
There are also a variety of resources available to health centers so staff can assist patients with diabetes in building healthy meal plans, even on a budget. ChooseMyPlate.Gov has more than 800 SNAP-friendly food recipes that are also nutritious in nature³. This article also lists 30 ways to stretch a budget for a healthy meal plan. For example, a health center could print out or refer patients to this list, which gives tips on things like going to farmer’s markets that accept WIC, and buying dried and canned fruit that’s cheaper and longer-lasting.
However, it is important to not pass assumptions about what a patient may already have in their home. Mapping out a healthy meal plan is not always simplistic, especially for those who may not have the time and resources to commit to some more traditional budgeting methods.
In one article, sociologist Sarah Bowen harped on why blanket advice praising home cooking as a solution to food insecurity won’t work for everyone⁴.
“A lot of cooking advice, even budget cooking advice, makes assumptions about what a person’s life and home looks like,” Bowen told the Huffington Post. “Even ‘chop a bunch of vegetables’ assumes that you have a sharp knife, a cutting board, a working oven. And a lot of the recipes assume bigger things, like having a Crock-Pot or other specialized equipment.⁴”
Leading into the next point, cultural competence and considerations are also a major contributing factor to how a patient with diabetes might go about managing their condition.
Building Culturally Competent Meal Plans
When suggesting meal plans and groceries for a patient, building meals around traditional American ingredients could prove ineffective. Patients stemming from other cultures may want to keep eating their traditional flavors, as they have the right to, and this could also help ease the transition into diabetes self-management.
For example, Hispanic cultures consist of different palates. Knowing what a patient may traditionally eat at home could help a clinician tell a patient how they might eat it. Here are a few tips and insights from this CDC webinar on building culturally competent diabetes meal plans⁵:
- Hispanics consume more beef than non-white Americans; encourage the intake of leaner cuts of the meat
- Rice and beans are a staple in Hispanic cuisine; encourage the patient to introduce a greater proportion of beans and a lesser proportion of rice in their meals
- Some vegetables are already used to season dishes; encourage at least some carbohydrates, such as rice in Arroz Con Pollo, to be partly replaced with veggies.
- Fruit is added to a lot of shakes or preserved in juice in Hispanic culture; encourage patients to discern between fruit drinks and real fruit juice
- Remind patients that portions matter even if food is healthy; some cultures regularly consume oat beverages, olive oil and avocado, but if it’s being consumed in excess, it can still have a detrimental effect
- Many foods may be deep fried; encourage diversified cooking methods, such as baking plantains instead
- Hispanics may not always consume the same traditional American starches. When making grocery lists, consider building around:
- Different types of yam
- Hispanics may not always consume the same fats. Consider building around
- Olive Oil
- Pork Rinds
Visual learning tools are also extremely helpful⁵. For example, give a patient a picture of a meal they might typically eat. Then list the amount of carbohydrates next to each food item. When giving them a daily limit, ask what they might change or take out of the meal to make it suitable for diabetes management.
Also, give reference sizes for better portion control. For example, how many spoonfuls of a certain food item is allowable for a meal? Does your patient really know what an ounce of cheese looks like? For reference, it’s about the size of a domino⁵.
By doing these steps, patients can plan with real foods that are integrated into their lifestyle, rather than having to change it.
How Can We Help
Improving diabetes self-management within your patient population is a challenging task, but your clinic doesn’t have to go at it alone. Our health coaches are here to guide patients through every step of their journey, no matter where they’re starting off at. We can help with Principal Care Management and weight management through Remote Patient Monitoring, when your clinicians might not have the time to. Patients with diabetes sometimes need extra help, and that’s okay. With us as a partner, give them the extra support they need.
¹ “What Is Diabetes?” Centers for Disease Control and Prevention, 11 Mar. 2020, www.cdc.gov/diabetes/basics/diabetes.html.
² Berkowitz, Seth. “Food Insecurity, Food ‘Deserts,’ and Glycemic Control in Patients With Diabetes: A Longitudinal Analysis.” Diabetes Care, 1 June 2018, care.diabetesjournals.org/content/41/6/1188.
³ “Recipes | ChooseMyPlate.” ChooseMyPlate.Gov, www.choosemyplate.gov/myplatekitchen/recipes. Accessed 19 Nov. 2020.
⁴ Byrne, Christine. “Why Budgeting Cooking Tips Are Useless for Low-Income Families.” Huffington Post, 9 Oct. 2019, www.huffpost.com/entry/budget-cooking-tips-low-income-families_l_5d8a7a9ae4b08f48f4abfa46?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAJDIPG0b7mqra6soHrIQmPGFz_Ar-YR1INowhw1ML1SMyhGEbMQfSujGenrwu1whheak6_K9LNBS48MCKxu2JvN75GbNJsO8AHZ1_W2BOeA7Xj1iyRpPjivEJNe2_hKHBAcihkwXn8z8VGEJSlTxurw5HD9afHwV8aBab0Ip4VwK.
⁵ Drago, Lorena. “Diabetes and Nutrition in the Latino Community: The Role That Nutrition Plays in Managing and Preventing Diabetes.” CDC.Gov, 21 Mar. 2012, www.cdc.gov/diabetes/ndep/pdfs/62-mas-que-comida-diabetes-and-nutrition-in-the-latino-community-webinar.pdf.