When Victor Sanchez’s doctor told him to revamp his diet after a potentially life-threatening diagnosis of cirrhosis of the liver, he worked hard to change his lifestyle, getting up early to walk the dog every day and eating healthier.
Food banks are popping up in wealthy enclaves. Senior centers struggle next to tech campuses. Why does this paradox exist? To understand food insecurity in the Bay Area, The Chronicle spent months with those experiencing it on a daily basis.
“They told me what I should and shouldn’t be eating,” said Sanchez. But what they didn’t tell him was how to afford the new diet.
For Sanchez, the biggest hurdle turned out to be financial: The disease had put the Hayward resident on permanent disability at age 56, with a new mandate of fresh leafy greens, whole grains and lean proteins.
In the eight years since the diagnosis, Sanchez, now 64, has struggled to keep weight off even though he has tried to add more salads to his diet and swapped big egg-and-bacon breakfasts for bowls of unsweetened oatmeal. In January, he was screened as being at risk for prediabetes. He has high blood sugar levels that could lead to type-2 diabetes, a disease that is usually diet-related and develops when the body doesn’t properly use insulin.
The Bay Area’s hidden hungry often have to contend with chronic health problems related to their inability to afford a nutritious diet. In the last decade, awareness of this link between food access and health has spurred more doctors, insurance providers and community organizations to try to find ways to get free healthy groceries in the hands of those who need them most.
“Yes, it’d be great for everyone to eat whole grains, fruits and vegetables. But if you’re hungry, it’s hard to focus on other things,” said Eli Zigas, food and agriculture policy director at the Bay Area urban planning and research organization SPUR.
Last year, SPUR co-founded a pilot program called Double Up Food Bucks, which provides a dollar-for-dollar match when CalFresh participants buy California-grown produce from certain vendors and farmers’ markets, doubling the amount of fruit and vegetables they can buy. The state just approved $9 million in funding to expand the program.
About 10 or 15 years ago, there was a big public health effort focused on bringing grocery stores into poor neighborhoods that lacked them, often called food deserts. But if neighborhood residents can’t afford to buy chard and chicken breasts, the store won’t get much traffic, said Hilary Seligman, associate professor of medicine at UC San Francisco.
“There are very, very few incentives for a food-insecure person to buy healthy food,” said Seligman, who is director of UCSF’s Food Policy, Health and Hunger Research Program.
Seligman’s aha moment was in 2005, when she asked a patient she had just diagnosed as prediabetic about his diet. He told her he ate a slice of Spam sandwiched between two cinnamon rolls for lunch every day, because it was cheap and filling.
She searched for any resources surrounding prediabetes and ways to help patients who can’t afford healthy food. Nothing came up.
Beyond diabetes, food insecurity is associated with a higher risk for many other chronic diseases, including hypertension, coronary heart disease, stroke, cancer, asthma and kidney disease, according to a 2017 U.S. Department of Agriculture report.
Hunger also lands people in the emergency room on a regular basis. Low-income Californians are 27 percent more likely to be admitted to the hospital for hypoglycemia during the last week of the month, a time when grocery budgets run out, according to a study Seligman published in 2014.
In children, hunger has been linked to delayed development, learning difficulties, behavioral issues and anxiety. That inherent anxiety can lead to eating disorders in both adults and children, such as binging when food is available, according to a 2017 study from Trinity University.
“Food insecurity is a very dynamic experience. People are cycling constantly through adequacy and inadequacy,” said Seligman. “Not knowing is really psychically challenging.”
Seligman points out that even just trying to follow the basic federal nutrition guidelines is too expensive for many low-income people. It costs $2.10 to $2.60 per person per day to follow the USDA’s recommended amounts of fruit and vegetables, according to USDA research based on 2013 national prices — which are likely higher in today’s dollars.
In comparison, CalFresh benefits, previously known as food stamps, provide the equivalent of $1.50 per person per meal, or $4.50 per day, which would only leave a couple dollars after buying the recommended amounts of fruits and vegetables.
To combat that problem, Seligman founded a program called EatSF in 2015. It gives vouchers worth $10 to $20 per month for fruits and vegetables to patients in clinics, SROs and adult day-care centers in the Tenderloin, Bayview-Hunters Point and South of Market. The program has since expanded to several other neighborhoods and reached over 6,500 patients.
Participants in the six-month EatSF program have reported reduced weight and improved blood pressure and blood sugar levels. The program also encouraged long-term changes to their diet including eating, on average, an additional daily serving of fruits and vegetables. In its most recent budget, the city approved an additional $1 million in funding for the vouchers out of proceeds from the city’s sugar-sweetened beverage tax.
In 2016, Feeding America, an association of food banks, partnered with Seligman and the Alameda County Community Food Bank to see whether giving patients with type 2 diabetes access to healthy groceries through the food bank would improve their health.
The results of the randomized control trial were inconclusive. While participants had better food stability and ate more fruits and vegetables, their blood sugar levels did not go down. That’s probably because the researchers weren’t able to control all of the factors in the participants’ diets, said Kate Cheyne, research manager at the food bank.
The Alameda County Community Food Bank has a new program called the Diabetes Prevention Project to look at how providing healthy groceries at an earlier stage of prediabetes might be beneficial for patients like Sanchez.
For the past eight months, he has received bags of fresh and canned vegetables, oatmeal and other healthy foods once a month, plus a regular bag of groceries from the food bank twice a month. So far, he’s been able to maintain his weight and stop that see-saw pattern.
“Whatever we can get, we put it to use,” said Sanchez of the groceries. “We need it.”
Tara Duggan is a San Francisco Chronicle staff writer. Email: email@example.com Twitter: @taraduggan