HOUSTON – Sherry King had lost her job as a dental assistant and was stretching her food, sometimes going without any fresh fruit or vegetables. But the suburban Houston resident didn't reach out for any help — even from her own relatives, whom she didn't want to worry.
Then she switched to a new doctor late last year. "They asked me, 'Do I have enough food? Do I have access to nutritious food?' " the 51-year-old recalled. "When they asked me that, it made me cry." That prompted the medical practice to take note of her situation, and a clinician introduced King to several food banks that carry fresh produce and some meat.
Nearly 1 in 8 Americans live with some degree of food insecurity, according to the most recent data from the U.S. Department of Agriculture.
Increasingly, doctors and nurses are realizing that they need to ask directly about food stress, said John Weidman, deputy executive director at the Food Trust, a Philadelphia-based nonprofit organization seeking to improve food access. "This is not naturally going to come up in conversations." Otherwise, he said, patients with a near-bare cupboard might buy cheaper but unhealthful food or skimp on prescriptions or other medical care to avoid going hungry.
Starting in fall 2015, clinicians at Houston-based Memorial Hermann Health System began to examine the food struggles among patients at four medical sites, including the physician practice where King gets care, as well as emergency rooms and 10 school-based clinics in areas with high rates of poverty. They've asked patients two questions: Did you run out of food in the prior month, or did you think that you would? Depending upon the location surveyed, 11 percent to 30 percent said they did.
There's been "some surprise at the numbers," said Carol Paret, the system's chief community health officer and a senior vice president. "That's one of the things that the doctors have realized — you can't tell this just by looking at somebody."
Preconceptions are being debunked, Paret said. Even obese patients might be coping with food shortages or loading up on high-calorie foods during the limited stretches when it's available, she said. Senior citizens barely eking by on a fixed income might wear their nicer clothes for an outing to the doctor's office, creating the perception they're doing fine financially.
Amid "the hidden pockets of poverty" in suburbia, someone who has been laid off might put every dollar into keeping their house and car, with little left to fill the refrigerator, Weidman said. The suburban practice where King is treated is located southwest of Houston in Sugar Land, Texas. The median household income for the surrounding ZIP code is $92,000 annually, nearly twice the statewide median of $53,200.
Before asking patients about food insecurity, most of the doctors and nurses would likely have predicted that no more than 2 percent qualified, said Dr. Laura Armstrong, a family physician in the practice, Physicians at Sugar Creek. "Then it ended up being 11 percent, which was, I think, fairly shocking to most of us."
King has learned she can visit a food bank every week, alternating between sites, rather than every other week. If the practice had never asked, she believes she'd still be limping along with processed food and little else some days. "That's something you don't talk to your doctor about," she said. "You don't tell your doctor, 'I'm running out of food the last 10 days of the month.' "
