As PA Week comes to a close, The Clinical Advisor interviewed a pair of PAs from Sioux City,Nebraska who aim to combat food insecurity by growing fresh fruits and vegetables for their patients. Jill Bundy, PA‑C, MPAS, is a PA at the Siouxland Community Health Center, and David Faldmo, PA‑C, MPAS, is the quality director and PA at the Siouxland Community Health Center.
PA Faldmo: We live in a society where our lifestyle can lead to metabolic unfitness. [In our practice] we see patients with diabetes, heart disease, hypertension, and fatty liver disease, among other diseases. Addressing that, detecting symptoms early, and getting people on a better lifestyle path is key to avoiding a lot of these conditions.
PA Bundy: Playing into that is the education for our patients about how metabolic unfitness is a problem. I think there’s a lot that patients don’t quite recognize as health risks that set them up for these disorders.
What patient experiences led you to grow produce?
PA Faldmo and PA Bundy: We were intimately involved in the development of a social determinant of health screening tool created by the National Association of Community Health Centre. We were 1 of the 4 teams that developed that screening tool that’s widely used now.
We screened our patients for food insecurity and found a need. If there are insecurities noted, the care team is called in to see what we can do to help address some of the determinants identified. However, food insecurity is a frequent one that we identify in the patient population that we serve.
That’s the primary reason why we began growing produce. We educate our patients and tell them it would help their medical condition to stick to a healthy diet, which is higher in fruits and vegetables. But if they don’t have access to fresh produce, that’s very difficult to accomplish. Being able to create a way to meet that need is kind of how we ended up here.
“
Sometimes, the medical issue may not be the biggest thing that needs to be addressed that day, it could be an unsafe living environment or helping them understand that this is a safe place to be.
To help meet the need for healthy foods, we partnered with Voices for Food. We had a social determinant of health committee and we were trying to partner with community agencies to help address some of these insecurities. We thought Voices for Food would be a great organization to proactively be involved with in helping patients live a healthier lifestyle through the foods they eat.
What can you tell us about the health challenges associated with food insecurity?
PA Faldmo and PA Bundy: There are so many medical disorders that are linked to our metabolic capital and fitness. Alzheimer disease and polycystic ovary syndrome (PCOS) are among the many diseases that are related to our diet and lifestyle. Overweight and obesity also lead to orthopedic issues such as knee pain, hip pain, back pain, etc. There’s so much that we deal with day after day that’s related to being overweight or obese.
On the social side, there is a psychologic element. It’s rare for us to see food insecurity in isolation, frequently it is coupled with transportation or housing security, which can create significant stress for patients and their families.
We try to address all of those needs and to be able to help a family provide food for themselves and their children to take that stress off of them, which can help impact their mental health. We have had some patients come in who are understandably prioritizing feeding their children instead of feeding themselves or taking their medications. Being able to offer a person who has not eaten in days a meal before they leave has been a huge help for that population.
We are trying to make it more sustainable. We have a relatively short growing season here in Nebraska, therefore we partner with local food banks and try to connect patients with the local mission and shelters as a way to re-enter housing, etc.
How has educating patients about nutrition and providing them with food improved their health?
PA Bundy and Faldmo: One of the big issues is that though food is abundant, the affordable food for the majority of our patients is ultra-processed foods that contribute to health issues. Providing fresh vegetables and educating patients on the importance of a healthy diet can resolve metabolic disorders. Trying to get away from the highly processed starchy foods that unfortunately are more common and can impact cholesterol, diabetes, blood pressure, etc. Most clients are more comfortable with a low-carb diet that avoids processed foods vs a low-fat approach, which has not been successful in our patients. We advise patients to use whole foods and fresh vegetables and to stay away from anything that comes out of a box whenever possible.
We also have a weight management program that we invite patients to participate in.  This is a weekly or monthly class that they can attend indefinitely and this allows them to make healthy food choices. [The classes provide] more in-depth education on living a healthy lifestyle. We also have a diabetes prevention program that is available to anyone who may be at risk for the disease. We try to intervene before they get diabetes through the CDC’s National Diabetes Prevention Program.
What should our readers know about the weight loss and diabetes programs?
PA Bundy and Faldmo: We’re 6 months into our first cohort of patients enrolled in the weight management program. We thought it’d be good for us to have a supportive program where they are educated on lifestyle changes and all the nuances of what can happen due to their metabolic unfitness or being overweight or obese. Although we do have the availability of weight loss medicines, we pair that with more education and lifestyle changes. Â
What is one valuable lesson you’ve learned through interacting with patients?
PA Faldmo: We shouldn’t sell our patients short, they’re able to make changes, but we also have to prescribe medicine to help them overcome their health issues. There are patients out there, not everyone, who are willing to make changes and to better themselves by changing their lifestyles. It’s an important lesson to learn that we should give patients the chance to make lifestyle changes and not just prescribe medicines. Lifestyle changes can allow them to overcome the presenting complaint.
PA Bundy: Seeing the patient as a whole person. If they present with diabetes, what led to that, is there a food insecurity problem, is there a lot of stress at home or at work that leads to stress eating? Making sure that mental health needs are addressed. If that’s a concern, make sure that they have a safe place to live and that there are no other barriers to their medical care, and make sure that the patients are aware that this is a safe place where they can bring their medical concerns.
Sometimes, the medical issue may not be the biggest thing that needs to be addressed that day, it could be an unsafe living environment or helping them understand that this is a safe place to be.
