The acorn squash problem: a digestible conceptualisation of barriers to emergency food assistance.

BACKGROUND: In common narratives of emergency food assistance, donors likely believe their efforts directly manifest as people consuming their donated food. For example, a person donating canned lima beans during a canned food drive may visualise someone eventually eating those lima beans. However, cultural and socio-economic barriers often exist that prevent people from accessing and consuming the donated food. These barriers are often complex and otherwise well-intentioned donors, volunteers and organisations may not initially consider them. METHOD: This commentary article, which draws from existing US emergency food systems literature, uses the imagery of an acorn squash one might find at a US food pantry to conceptualise these barriers in a straightforward way. RESULTS: Examining emergency food assistance through the lens of the acorn squash problem can help donors, volunteers and organisations better connect with food-insecure people. The lens of the acorn squash problem also allows for deeper critiques of some practices of emergency food systems.

An Exploration of the Influences Contributing to Food Insecurity in Chester County, Pennsylvania.

Food security refers to the ideal state or condition of households that have access at all times to enough food for their members to live an active, healthy life. To better understand local food insecurity, a needs assessment was implemented to explore contributing factors and discuss solutions. A qualitative study including nine focus groups with low-income adults who receive food assistance (N = 82) and four focus groups with emergency food providers (N = 21) was conducted. Focus group data were analyzed using phenomenological methods. Five themes emerged from the residents: (1) food accessibility both contributes to and reduces food insecurity; (2) residents understand the need for and practice the act of preserving foods; (3) food shopping behaviors were similar for the residents and stores were well received; (4) benefits and barriers with food insecurity are similar; and (5) variety and quality of food and food safety of emergency foods are concerns. The food provider focus groups indicated that they recognized similar problems faced by the residents, and they stressed the need for education. Food insecure individuals should continue in the conversations around solutions, and a comprehensive look at food insecurity through local food and health care systems might determine additional needs.

Clinical and cost benefits of medical nutrition therapy by registered dietitian nutritionists for management of dyslipidemia: A systematic review and meta-analysis.

BACKGROUND: Faced with increasing health care costs, it is incumbent to discern whether managing dyslipidemia with medical nutrition therapy (MNT) by a registered dietitian nutritionist (RDN) is clinically and cost effective. OBJECTIVE: To systematically examine evidence on the clinical effectiveness and cost benefit of MNT by an RDN for the treatment of dyslipidemia. METHODS: English and full-text research articles published between January 2003 and October 2014 were identified using PubMed, MEDLINE, and the Worldcat.org site to identify literature specific to clinical and cost effectiveness of MNT for dyslipidemia. Studies were required to have at least one outcome measure of dyslipidemia: total cholesterol (Total C), low-density lipoprotein cholesterol, triglycerides, high-density lipoprotein cholesterol, and/or metabolic syndrome. RESULTS: This systematic review identified 34 primary studies with 5704 subjects. Multiple individual face-to-face MNT sessions by an RDN over 3 to 21 months led to significant improvements in lipid profile, body mass index, glycemic status, and blood pressure. Results were summarized as mean differences with 95% confidence intervals when meta-analysis was possible. In a pooled analysis, MNT interventions lowered low-density lipoprotein cholesterol, total C, triglycerides, fasting blood glucose, hemoglobin A1c, and body mass index compared to a control group. Cost effectiveness and economic savings of MNT for dyslipidemia showed improved quality-adjusted life years and cost savings from reduced medication use. CONCLUSION: Evidence from this systematic review and meta-analysis demonstrates that multiple MNT sessions by an RDN are clinically effective and cost beneficial in patients with dyslipidemia and cardiometabolic risk factors.