Study shows nutrition education for low-income people in eight Southeast states resulted in healthier diets and better budgeting

By Melissa Patrick

Kentucky Health News

A little education goes a long way when it comes to helping people with limited budgets eat healthier and not run out of food before the end of the month. 

For a larger version of the chart, click on it.

So says a study by the Public Health Institute's Center for Wellness and Nutrition, published in the Journal of Nutritional Science.

It found that residents with low incomes in eight Southeastern states, including Kentucky, "consumed significantly greater amounts of fruits and vegetables, and improved several other shopping and nutrition-related behaviors" after they participated in the U.S. Department of Agriculture's SNAP-Ed program. SNAP is the Supplemental Nutrition Assistance Program, formerly known as food stamps.

“Healthy foods can be expensive, and a SNAP budget is modest. But SNAP-Ed is helping low-income Americans in the Southeast make strategic choices that stretch their food dollars and empower them to choose more fruits and vegetables and other healthy foods,” Amy DeLisio, the center's director and co-author of the study, said in a news release.

“In the long run,” DeLisio said, “these changes can play an important role in reducing their likelihood of diabetes, hypertension and other nutrition-related diseases, and in reducing health-care costs across the region.” 

SNAP-Ed provides comprehensive nutrition education and obesity-prevention interventions for individuals and families whose incomes are below 185% of the federal poverty line. Participants are not required to get SNAP benefits. 

Using 2017 data from 25 participating agencies in the Southeast, including surveys from more than 43,000 low-income children and adults before and after SNAP-Ed interventions, the study found people were more likely to meet USDA nutrition recommendations and manage their food resources better after participating in the program.   

On average, the study found low-income participants increased their daily consumption of fruit by 1/3 cup; increased their daily consumption of vegetables by 1/4 cup; drank more water and less sugar-sweetened drinks, and were more likely to drink low-fat or nonfat milk.

They were also likelier to choose healthier foods on a budget; read nutrition labels or ingredient lists; compare prices before purchasing foods; identify foods on sale or use coupons; use a list while shopping; and not run out of food before the month's end.

The report notes that in a region that experiences some of the highest rates of obesity and unhealthy dietary behaviors in the nation, "our study shows that SNAP-Ed programs can be part of the solution."

The study also documented 701 policy, systems and environment supports that complement the SNAP-Ed programs in the region, including things like creating edible gardens and improving food displays in school cafeterias. 

What about Kentucky?

In Kentucky, the Nutrition Education Program encompasses two separate USDA programs, SNAP-Ed and the Expanded Food and Nutrition Education Program. The programs are offered in each of the state's 120 counties and are run by extension agents or one of the 96 NEP assistants. 

NEP director Marisa Aull said the program is designed to provide its clients with life skills to promote a healthier lifestyle and to make the healthiest choice the easiest choice. 

"A lot of times it is simply lack of knowledge," Aull said. "Our program really does focus on bringing education to the individual so that they, along with their family, can make those choices and be healthier."

Omolola Adedokun, senior Extension specialist for evaluation, explained, "With education on how to spend the money, by using coupons, by being able to follow what's on sale, what's not on sale, and by budgeting for food, that by looking at cheaper options, like frozen vegetables, or canned vegetables, people will be able to eat healthier and in alignment with USDA guidelines."

Aull said the program is especially important in Kentucky, a state known for its high obesity rates and poor health.

According to America's Health Rankings, Kentucky is one of the worst states for adult obesity, with 36.6% of its adults obese. Thirty-eight percent of the state's children are either obese or overweight, the second highest in the nation, according to the 2020 Kids Count report.

Kentucky also ranks among the 10 worst for heart disease and diabetes, and is No. 1 in cancer deaths -- all conditions that could improve with better nutrition and exercise practices.

The study did not provide any state-specific data, but the 2019 NEP report says 97% of Kentucky's adult participants showed improvement in one or more diet quality indicator, like eating more fruits or vegetables, drinking less sugared soda and cooking dinner at home; 84% increased their physical activity; 92% showed safer food storage and prep; and 91% showed better food resource management. 

Kentucky had more than 4,500 participants in the SNAP-Ed program, said Adedokun. 

As for youth, after participating in the "Super Star Chef" program, which was offered in 53 counties, 99.6% of the state's 789 youth participants reported they could identify healthy foods; 96% said they planned to drink more water every day; and 95% said they planned to try new foods. The report says the two programs had 368,584 children and youth contacts. 

Aull said young people are an important part of the program because they often share their excitement for what they've learned with their families, inspiring them to eat healthier. 

"We often hear anecdotally, that they convince their family to try a new food or they convince their family to go to the farmers market where the family previously was maybe hesitant to go. . . .  The key to the family is often through youth," she said. 

Aull stressed that each of these small changes are important because they could have a lifelong impact, and not just for the individual but society at large.

"If we look at it from a kind of return-on-investment side, it has an effect on generational poverty, it has an effect on their health and well-being, and it also has an effect on those local health care systems," Aull said. "Those small changes lead to big impacts for not just our state as a whole but . . . their community, their city, their family. And we feel like those changes will also break a lot of cycles that need to be broken, that really are just due to lack of resources and lack of opportunity."

Aull encouraged qualifying Kentuckians to participate in the free nutrition-education programs, which are being held virtually during the coronavirus pandemic. 

Denise Rennekamp, assistant NEP director, spoke to the importance of community partnerships to promote the program. For example, she said Feeding Kentucky and other food banks help connect food-insecure Kentuckians with their program. 

The number of Kentuckians on SNAP varies from month to month, with participation increasing since the pandemic came to Kentucky in March. In August, 606,216 Kentuckians received SNAP benefits. 

Click on the Plan, Eat, Move website to learn more about the program. Below is a video that tells more about the program.

Kentucky's food insecurity declines slightly, but remains high in southeast; in 3 counties, rate among children is above 30 percent

Dots are food bank locations. For an interactive map with county data, click here.

The percentage of Kentuckians with an insecure food supply has declined slightly but remains ahead of the national average, with several counties well above the average, according to the latest measurement by Feeding America, which calls itself the nation's largest domestic hunger-relief organization.

Food insecurity by county in Kentucky and nearby states:
light green is up to the national average of 14 percent;
the darkest counties have rates of 30 percent or higher.

The latest calculations, for 2015, showed Kentucky's rate at 16 percent, down slightly from 17 percent in 2014, but still ahead of the national average of 14 percent. The rates ranged from 8 percent in Oldham County to 23 percent in Wolfe County.

The measurements use data from the census, the Bureau of Labor Statistics, food-price data and analysis from Nielsen, and information from the U.S. Department of Agriculture, which defines food insecurity as "lack of access, at times, to enough food for an active, healthy life for all household members and limited or uncertain availability of nutritionally adequate foods. Food-insecure households are not necessarily food insecure all the time. Food insecurity may reflect a household’s need to make trade-offs between important basic needs, such as housing or medical bills, and purchasing nutritionally adequate foods."

Southeastern Kentucky's Fifth District has the highest food insecurity rate among the state’s six congressional districts, at 19.2 percent, said a news release from the Kentucky Association of Food Banks. "Children are at a higher risk of food insecurity; 20 percent of Kentucky’s children are food-insecure," the release says. "Three Kentucky counties have childhood food-insecurity rates of 30 percent or higher: Wolfe (32.4 percent); Magoffin (30.7 percent); and Clay (30.2 percent). This represents a decrease from the previous year, when 11 Kentucky counties had childhood food-insecurity rates of 30 percent or higher."

More than a fourth of Kentuckians (27.3 percent) in food-insecure households have incomes above 185 percent of the poverty line, "making them likely ineligible for most federal nutrition assistance programs," the release says.

“Though far too many Kentuckians continue to struggle to put healthful food on the table, we are encouraged by the movement in the right direction on hunger in Kentucky,” said Tamara Sandberg, executive director of the food-bank association. “Kentucky is a leader in the nation for our strong public-private partnerships, such as the Kentucky Department of Agriculture Commissioner Ryan Quarles’s hunger initiative and the Kentucky Legal Food Frenzy sponsored by Attorney General Andy Beshear. We are committed to implementing creative solutions to the problem of hunger until the day when no Kentuckian has to go to bed hungry.”

Appalachians Together Restoring the Eating Environment to help Eastern Kentucky communities develop local, healthy foods

A new project searches for ways to increase access to healthy foods in Eastern Kentucky and looks to communities to find these solutions.

Appalachians Together Restoring the Eating Environment, or Appal-TREE, is a collaborative project between the Community Farm Alliance and the University of Kentucky. It is based in Whitesburg and funded by a grant from the National Institutes of Health. Other partners include Grow Appalachia, the Cowan Community Center and the Mountain Garden Initiative.

"This project is unique in that the community got to determine the pathway and the goal of the grant funding," Valerie Horn, director of the project, told the UKNow news service. "We wanted to talk to the people who have the most influence about food issues, as well as those people who are most affected by those decisions."

About one in six Kentuckians, or 16.4 percent, struggles with food insecurity in Kentucky, according to the U.S. Department of Agriculture. Food insecurity is defined as the lack of reliable access to a sufficient amount of affordable, nutritious food.

Horn has worked with several grass-roots efforts in Appalachia to combat food insecurity: Grow Appalachia, local farmer's markets, local food pantries, summer feeding programs for country children, weekend backpack programs and a free meal program at the weekend farmer's market for children. She told UKNow that these grassroots efforts represent a "growing awareness about local, healthy foods in Eastern Kentucky over the last several years."

The first year of the project was spent gathering community input about the topic. "The problems related to nutrition are ones that can be solved locally and they're not insurmountable, said Mark Swanson, associate professor in UK's College of Public Health and principal investigator on the grant. "We have solutions in the communities. It's neat when UK can help communities solve their own problems. We don’t know the solution — they do. It's the idea of pairing academic knowledge with local expertise."

The next two years of the grant will focus on several key projects, two of which focus on schools. The first is a "water first" campaign to encourage middle- and high-school students to choose water over sugary drinks, and the second will focus on increasing healthy options in school concession stands in Letcher County.

"We'd like to work with the schools to help them see that at a ball game, you can still make money selling snacks that are less harmful," Horn said.

Appal-TREE will organize free cooking classes throughout Letcher County. Each program will include six sessions that emphasize healthy food on a budget.

Nearby, the Clay County Cooperative Extension Service has also promoted food security through community cooking classes, teaching families how to can their own food and helping to start Clay County's first farmers market last summer, UKNow reports.

"Food is tied to so many things here -- when there's a funeral, dining room tables are covered with cakes and dumplings and just the best of food. We have wonderful cooks here," Horn said. "I say that it's like being a talented musician and learning another instrument — it's just learning another way to make food."

Website eases application process for SNAP, formerly food stamps, and promotes healthy food

With a federal grant, the state Department for Community Based Services has launched a customer service website to promote healthy foods by assisting the families receiving food benefits through the Supplemental Nutrition Assistance Program, formerly called food stamps.

The portal allows people to check their eligibility for SNAP and apply for benefits with a shorter application that will be followed by a DCBS interview. They can also check their benefit status, report changes and receive electronic notices.

The agency says an online application eliminates any transportation issues a family may have with visiting a DCBS office, and encourages applications. “Modern improvements like this make it easier for families to apply for benefits and ultimately increase access to healthy food,” said Audrey Haynes, secretary of the Cabinet for Health and Family Services, which houses DCBS.

“SNAP helps people of all ages afford healthy food,” said DCBS Commissioner Teresa James. “For some of our DCBS customers, it means the difference between having a family meal or nothing at all. This website makes applying for benefits, making updates or accessing information even easier since customers don’t have to make an office appointment or even pick up the phone to get help.”

Since the portal’s launch on March 11, DCBS has received more than 1,000 electronic applications. Click here to learn more about SNAP. 

W. Va. plans private-public model to provide school breakfast, improve child health, fight obesity; could this approach help Ky.?

By Molly Burchett
Kentucky Health News

Breakfast has been said to be the most important meal of the day, and it can be important in fighting obesity. Policymakers in West Virginia are pushing for breakfast food programs in schools through public-private partnerships, and a new report says similar programs could save $41 billion in federal dollars long-term by preventing obesity. Does this make sense, and does it make sense for Kentucky?

Like West Virginia, Kentucky has a high obesity rate among middle and high school students but has many children who don't always get the food they need to live a healthy life. Kentucky ranks fourth highest in food insecurity among children because 23 percent of Kentucky's children do not always know where they will find their next meal, according to Feeding America’s "Map the Meal Gap" study. (Here's a link to its interactive map, where you can see food insecurity rates by county in order to find out more about your county. One example appears below; orange dots are headquarters of regional food banks.)

A recent bill passed by West Virginia lawmakers addresses the problems of food insecurity, obesity and education simultaneously and serves as the first example for a statewide public-private funding partnership to improve school meals programs, reports David Gutman of The Associated Press. The bill would also require every county to set up a fund to collect private food donations.

The bill aims to require every school to have breakfast food programs so no student goes without it because of costs, says Gutman. Poor nutrition and diet are sometimes issues of cost and income level since healthy foods can be more expensive than unhealthy ones. For example, a bag of 10 apples may costs $4.99, but a package of Little Debbie oatmeal creme pies could be $1.79. A medium-sized apple has 93 calories and less than 1 gram of fat while an oatmeal creme pie has 318 calories and 13 grams of fat.

What does this have to do with obesity? The research-based logic is that a healthy, daily breakfast improves diet and can replace sugary alternatives such as donuts. Eating a healthy breakfast also improves education by combating hunger and aiding concentration and has been found to be associated with overall health and mental functioning. Overall, these factors may work together to improve education and diet, reports Gutman.

Such a program could help Kentucky address the state's problems related to food insecurity, obesity and education, while generating long-term savings. Similar food programs that provide meals to low-income children could generate as much as $41 billion in long-term federal saving by preventing obesity, says a new report from the Campaign to End Obesity.

The report says that the S-CHIP childhood obesity demonstration project, which combines changes in preventive care with community and school efforts to reduce childhood obesity in low-income communities, could prevent a child from becoming obese, saving an estimated $41,500 for an average female and $30,600 for an average male Medicaid beneficiary, says the report.

Three other programs were highlighted as huge cost-savers because they would prevent obesity and related chronic conditions in the long run, which would reduce health care costs and increase wages, says the report. These include increasing obesity screenings by physicians, bringing the Diabetes Prevention Program to scale and covering certain weight loss drugs under Medicare Part D. Preventive health policies aimed at obesity prevention could significantly reduce government expenditures, could save tax dollars and could improve the overall health of Kentuckians.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Following advice to eat healthy is too expensive for many

Though the Department of Agriculture has recommended that most of a dinner plate should be filled with foods rich in potassium, dietary fiber, vitamin D and calcium, a new study says adopting such a diet "would add hundreds more dollars to (Americans') grocery bill," reports Donna Gordon Blankinship of The Associated Press.

Adding more potassium to one's diet alone could add $380 per year to the average person's food costs, a paper published in professional journal Health Affairs found. Lead researcher Pablo Monsivais, an assistant professor at the School of Public Health at the University of Washington, objected to how healthy eating is marketed, with ads showing a plate of salmon with green, leafy veggies and rice pilaf. Many Americans cannot afford to eat that way, he said.

He added some government policies are helping to cut down on the cost of fruit and vegetables, but some policies create problems. A state policy in Washington makes it difficult to buy potatoes with food assistance coupons, despite the fact that eating potatoes is an inexpensive way to gain potassium.

The study was based on a random telephone survey of about 2,000 adults in a county in Washington. It was followed up by a printed questionnaire, to which 1,300 people responded. Hilary Seligman, an assistant professor of medicine at the University of California, found the results eye-opening. A lot of people assume the poor eat cheap food because it tastes good, but they would make better choices if they could afford to, she said. (Read more)