October 1, 2013

The Nutritional Environment: Notes from a Dietetic Intern (Part 4)

Caitlin Krekel

Caitlin Krekel

Dietetic Intern

Center for a Livable Future

KrekelFoodDepotAfter several weeks rotating through different clinical units, I found myself back at my old stomping grounds, the John Hopkins Bloomberg School of Public Health, to intern at the Center for a Livable Future (CLF). In the hospital setting, the nutritional focus is on managing the immediate health issues a patient is facing. Time is limited, the patients are ill, and often the broader nutritional barriers that are identified, such as access to appropriate foods, cannot be adequately addressed. At CLF I had the opportunity to step out of the hospital and interact with the Baltimore food system, which shapes the nutritional environment of our patients.

The first task of the week was to consider the upcoming revision of the Dietary Guidelines and decide whether current federal nutrition recommendations help support a sustainable food system. In addition to listening to the opening discussions of the 2015 Dietary Guidelines Advisory Committee, I watched several of the presentations from the Institute of Medicine’s Food Forum Workshop on Sustainable Diets: Food for Healthy People and a Healthy Planet. This was an eye opening assignment that made me more aware of the interconnectedness of human and environmental health.

Next, I assisted with the setup of the distribution of Community Supported Agriculture (CSA) shares at the School.  Buying a CSA share allows you to support local farmers by paying them upfront for a weekly batch of seasonal produce. This financial commitment at the beginning of the season helps cover farmers’ production costs and helps provide the security of a steady market. The prior year, I had a wonderful experience splitting the weekly bounty from One Straw Farms as a consumer. It was interesting to see the behind the scenes work that made my experience possible, including hearing about what it takes to get the sale of raw chicken approved on a public health campus.

Beyond the certainty that what you receive will be in season, the exact types of produce in a CSA share is fairly unpredictable from week to week. Even as a full-time nutrition student who regularly reads cooking blogs, I remember receiving my first kohlrabi and being completely lost as to what to do with the alien green bulb. Luckily, recipes featuring weekly produce can be found at One Veggie At a Time and most individuals picking up their shares in the parking garage had access to Google, YouTube, and enough cooking equipment to figure out how to use everything in their shares.

Unfortunately, paying to take a gamble on what produce you will receive (and whether you will like it) is a luxury that many people cannot afford. At the Franciscan Center, the Fresh Harvest CSA project provides shares to 30 such families at no cost to them. Additionally, the project provides each family with resources explaining how to use the less familiar items. On Thursday, I had the opportunity to pass out these shares and hear about these family’s experiences incorporating the fresh produce into their diets. It was inspiring to hear their excitement and plans for the bulging bags of produce they received. Hosting the Fresh Harvest CSA project is just one example of the many services provided by the Franciscan Center. I also got to participate in the lunch service, which often features donated produce from the Tuesday CSA at the School.

Encouraging individuals to expand their vegetable consumption without the ability to provide free produce is a different challenge. Taste tests are a vital tool in encouraging people on tight budgets to incorporate healthy food into their weekly groceries. Using this technique, Sheryl Hoehner, the in-store dietitian at the Food Depot in West Baltimore turned some skeptical shoppers onto broccoli slaw by having them try samples of a “MyPlate Wrap” featuring hummus (protein), broccoli slaw (vegetables), and 2 percent cheese (dairy) on a whole wheat wrap (whole grain). I had the opportunity to shadow Sheryl for an afternoon as she engaged with customers, answered their nutrition questions, and got children to enjoy eating their vegetables after a MyPlate Wrap cooking class. Sheryl is a charismatic nutrition advocate whose energy is a great testament to the healthy initiatives to which the Food Depot has committed.

This week has allowed me to observe challenges and successes in expanding and promoting access to healthy foods in Baltimore. I am inspired by the ongoing efforts of various individuals and organizations in the community.

THE DIETETIC INTERN SERIES
Trying New Things: Notes from a Dietetic Intern (Part 1) – by Khrysta Baig
Food Systems and Patient Care: Notes from a Dietetic Intern (Part 2) – by Marie Spiker
Hands On in the Community: Notes from a Dietetic Intern (Part 3) – by Bernice Chu
The Nutritional Environment: Notes from a Dietetic Intern (Part 4) – by Caitlin Krekel
Small and Big Pictures: Notes from a Dietetic Intern (Part 5) – by Candice Gormley

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