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March 29, 2024

Weight Loss Meds

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Health Chatter

Stan and Clarence chat with Dr. Sarah Molasky - a local pharmacist - about weight loss medications.

Join the conversation at healthchatterpodcast.com

Brought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships.

More about their work can be found at http://huemanpartnership.org/

 

Research

Who is eligible for weight loss drugs?

  • if you haven't been able to lose weight through diet and exercise and your:
  • Body mass index (BMI) is greater than 30, otherwise known as obesity
  • BMI is greater than 27 AND you also have a serious medical problem linked to obesity, such as diabetes or high blood pressure.
  • Six weight-loss drugs have been approved by the U.S. Food and Drug Administration (FDA) for long-term use:
    • Bupropion-naltrexone (Contrave)
    • Liraglutide (Saxenda)
    • Orlistat (Xenical, Alli)
    • Phentermine-topiramate (Qsymia)
    • Semaglutide (Wegovy)
    • Setmelanotide (Imcivree
  • In clinical trials, people lost 15% to 20% of their body weight, depending on the drug. 
  • New and popular drugs like Ozempic, known as GLP-1 agonists, that mimic the activity of a hormone to slow digestion and help people feel full for longer
    •  Not originally intended for weight loss
    • on label use is characterized as:  as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus

Top drugs of 2023 -24:

  • Wegovy - from Novo Nordisk is a weekly weight loss injection for adults with obesity or who are overweight. The drug mimics a hormone produced in the gut called GLP-1 to suppress a person’s appetite.
    • Wegovy made history this year when it reduced the risk of serious heart problems by 20% in people with obesity and heart disease in a late-stage trial.
  • Zepbound -  from Eli Lilly is a weekly weight loss injection for adults with obesity or who are overweight. The treatment mimics GLP-1 and another gut hormone called GIP to reduce appetite and food intake.
  • Ozempic - from Novo Nordisk is a weekly injection that helps lower blood sugar levels in adults with Type 2 diabetes. The medication mimics GLP-1 to suppress appetite and help the pancreas make more insulin.
  • Mounjaro - from Eli Lilly is a weekly injection that helps lower blood sugar levels in adults with Type 2 diabetes. The drug mimics GLP-1 and GIP to curb appetite and stimulate insulin production.

Common reported Side Effects for weight loss drugs:

  • Nausea 
  • dehydration 
  • Digestion issues 
  • abdominal (stomach) discomfort and pain
  • Bowel movement changes: ranging from severe constipation to diarrhea  
  • Almost 17% of people receiving Wegovy in the trial stopped taking the drug, mainly because of gastrointestinal issues like vomiting and diarrhea

Off- label drug use and choosing to use a drug on label or off label:

  • Many patients and their doctors are choosing to use pharmaceutical drugs intended for one purpose (e.g diabetes) for weight loss → this is called off label use 
    • Off label use of drugs like Ozempic is becoming more and more common 
    • Ozempic is a once-weekly injectable medication formulated to help adults with type 2 diabetes manage their blood sugar.

Why are weight loss drugs so popular in America?

  • Significant incidence and prevalence of overweight and obesity 
    • In the United States, more than 42% of adults were estimated to have obesity in 2018 
    • Today, Approximately 70% of American adults are obese or overweight, and many of those overweight have a weight-related condition. 
    • Link between obesity and overweight with increased occurrence of premature deaths, cardiovascular diseases, hypertension, type 2 diabetes, several types of cancers, as well as mental illnesses has been substantiated in various studies
  • Besides the cosmetic concerns, undesirable health-related quality of life (HRQOL) has been consistently observed in the population with obesity 
  • Despite the profound implications of excessive weight, obesity remains an undertreated chronic disease and is often treated merely as a risk factor for other conditions 
  • Why choose weight loss drugs?
    • The combination of weight-loss medicine and lifestyle changes leads to greater weight loss than do lifestyle changes alone. 
    •  They may help you make the lifestyle changes that you need to practice to lose weight and improve your health.
    • These drugs were not designed for normal-weight people who want to get down to be super thin
  • In clinical trials, people lost 15% to 20% of their body weight, depending on the drug. 
  • Economics of weight loss drugs
    • To the patient:
      •  the list price for Wegovy is over $1,300 for a 28-day supply 
      • Ozempic can cost around $892 for a monthly supply without insurance 
      • Many people don’t meet the F.D.A.'s criteria will likely have trouble getting insurance to cover it.
    • Weight-loss drugs could increase the nation's gross domestic product by an extra 1% over the next decade, the equivalent of about $360 billion per year.

Challenges with weight loss drugs

  • Taking weight loss medications and not making lifestyle changes → Many people gain back some of the weight they lost when they stop taking weight-loss drugs. 
  • Current national shortage of weight loss drugs that is expected to persist
  • The rise in people using Ozempic off-label is exacerbating the national shortage of Ozempic → Patients with diabetes and obesity are struggling to access it.
  • Weight-loss drugs can be expensive and are excluded in many insurance plans. 
  • “Big pharma can come up with a billion dollars to take a promising drug through Phase 3 clinical trials without difficulty because the profits can be enormous, whereas researchers trying to understand the environmental and dietary drivers of obesity must manage with a shoestring budget”  - David Ludwig, an obesity specialist in the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital  and professor of pediatrics at Harvard Medical School and of nutrition at the Harvard T.H. Chan School of Public Health
  • Despite general distrust in the pharmaceutical industry, especially during Covid-19, weight loss medications are becoming increasingly popular

https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss-drugs/art-20044832

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10658190/

https://www.cdc.gov/obesity/data/adult.html

https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=166301

https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management

https://news.harvard.edu/gazette/story/2023/07/are-new-weight-loss-drugs-the-answer-to-americas-obesity-problem/

Transcript

Hello, everybody. Welcome to Health Chatter. Today's episode is on food insecurity, which is an interesting topic. We have a great guest. Get to that in a second. We have a great crew that makes all our shows successful. For you, the listening audience, we have Maddy Levine-Wolf, Erin Collins, Deondra Howard that do our background research for all our shows. Thank you to all of you. And also, just so everybody knows, our background research is available on our website. So you can, the listening audience, you can see it as well. Matthew Campbell is our production manager, gets all the shows out to you, the listening audience. And also, Sheridan Nygard does some background research and marketing for us. Thank you to everybody. You're second to none. 

Clarence is my co-host. for our show. We've been doing 85 plus shows now, and it's been a real joy. So Clarence, as always, thank you. Human Partnership is our sponsor, great community health organization, and does some great community programming out in the community. And we suggest that you check them out as well at huemanpartnership.org. I'm Stan Shanedling. One of your hosts. And let's move on to food insecurity. Today we have Sophia Linares-Coy, who is the executive director of the Food Group. And one thing I didn't check, is the Food Group just in Minnesota, Sophia? It's just in Minnesota. Okay. So she's the executive director of this group. We'll get into that in a little bit. She has worked in hunger relief her entire career. 

The Food Group is... the Director of Programs and Operations. She's been that since 2018. Prior to that, she served as the Associate Director of Hunger Solutions in Minnesota, where she worked on federal and state policies and expanded cross-sector partnerships with policymakers and farmers markets. You know, it's interesting. When I grew up, we didn't even have farmers markets. So we can talk about that a little bit too. Her favorite food. Everybody's got a favorite food, right? And hers happens to be pizza. So Clarence, what's your favorite food? Seafood. S-E-E. S-E-E. Anything you see. Well, primarily. Primarily, yeah. Mine's some good ice cream, and so I have to keep it under control, you know? Yeah. Anyway, so Sophia, thanks for being with us today. It's a pleasure having you. 

So let's start this out by, you know, again, in my career, and maybe in yours as well, Clarence, the concept of food insecurity was never there. I never had heard about food insecurity. It was probably there, but we really didn't legitimize it. per se, with programs, etc. So let's first start out with what is food insecurity? And then maybe a follow up to that is how do you measure that? How do you how do you determine if someone is food insecure and who makes that determination? So go ahead. Sure. Yeah. Well, thanks again for having me. It's great to connect and You know, there are so many important connections between food insecurity or some people call it hunger, right? And health. And so this idea of the linkages are just so important. 

So really appreciate the chance to talk about it. And I would say food insecurity tends to be defined by the USDA. And it tends to be defined by someone who is not sure where their next meal is coming from at least a couple times a week. So you're just not sure you might find it. You might be able to cut back or go to somebody else's house, right? Everyone's kind of trying to make ends meet in different ways. But it's that sense of unsureness, right? That insecurity where you're not sure if you're going to get the nutrition that you or your family needs. And it's quite prevalent. In Minnesota, it's about 1 in 10 or 1 in 11 people. Again, the numbers are always changing. 

At the height of kind of some of the pandemic, it was one in eight folks was experiencing food insecurity. So it really is significant. But to the point you raised earlier, it's not always visible. And I think that is the thing that sometimes people don't realize. A lot of people aren't going to publicize the fact that maybe one of the parents is skipping meals so the kids have enough to eat. Or You know, all sorts of things people are doing. It's not always talked about. There can still be a lot of stigma around it. But with the price of groceries, having done what it's done for the past couple of years, there's just a lot of folks who are not able to get all the food they need for the month. 

So, all right. So you mentioned one in 10 or one in eight, you know, during the pandemic. How is that determined? Are there officials that go out and, and ask this? Or are there surveys that are done? Or how is it that we get this measurement? Yeah, I mean, great, great question. I'm not an expert on that. I know USDA has different ways that they do it. I do know that a lot of healthcare institutions now ask food insecurity screening questions. So there are two questions that have kind of been validated that if you ask these two questions, you'll get a real sense of of folks who are experiencing food insecurity. And so as that kind of becomes known as one of the social drivers of health, more and more health care providers are asking those questions for patients, knowing that if they're going to prescribe a patient medicine but that person doesn't have access to food, it's not even going to solve the problem. 

So I would say there's a lot more research happening on the health care side of things than there has been in the past. But then there's also other ways to look at it, whether it be snap enrollment rates or, you know, kind of income levels at a census, you know, census tract level, those kind of things, too. So, all right. So a health care provider, let's follow up on that a little bit. So, you know, health care providers, you know, even when you go through your normal physical, ask you certain questions. And one could be around this. Yeah. Then what do they do? So let's just say they ask me and they say, Stan, you know, do you have a hard time getting, you know, meals on the table? 

And I happen to say, yes. What do they do? Do they do they then what refer you to someone, some group like like yours, for instance? What what's what might be the process? Yes. So like a lot of things, I think in that kind of social drivers of health field, there's a lot that's kind of still emergent. So there's a wide variety of things that happen. But yeah, the goal is to do a warm handoff referral. Right. And so that could either happen at the really local community level. So, you know, if you're going to a clinic in South Minneapolis, they might refer you to the nearest food shelf that serves that neighborhood. Right. Or they may refer you to a group like ours. 

We coordinate the Minnesota Food Helpline. And so we have a statewide kind of access to resources where we can do closed-loop referrals with healthcare providers and feed that data back. So there's all sorts of different groups kind of trying to solve that problem. And, you know, the thing that's challenging is we've seen visits to food shelves in Minnesota really skyrocket these past couple years. So In 2023, we had seven and a half million visits to food shelves in the state. Wow. That was up two million visits from 2022. So this idea of while we want to get everyone connected to resources, there's also this question of how do we sustain the resources at the local level too. Yeah, yeah. Clarence. Sophia, as I was reading your bio, I was intrigued. 

And my intrigueness was around the fact, how did you become involved in this? What was your epiphany? Because you have a long history of being involved with food. What happened or what did you discover? Yeah, well, I am a passionate consumer of food. So Clarence, as you described your favorite food being seafood, I can relate. I really like to eat food and cook food. And food in my family was always a way that people kind of celebrated together, right? getting to choose what was for dinner meant something. It was special. It was the way we came together. It's also a way that I grew up showing we cared for people, right? Whether someone was struggling, you had them over for dinner, right? That food has this kind of magic power to connect us, to create community, to create that feeling of belonging. 

And so I've always had that. And then after I graduated from college, I was pretty clear I wanted to get into the nonprofit sector and address some kind of social issue that was just not as... It wasn't right, right? So I was at that time in my life, I could get fired up about a lot of things, right? Whether it was educational inequity or housing policy or all sorts of things, right? But it just so ended up that my very first job out of college was at the food group. And so... I worked in a variety of different roles there in our programming, and I think the piece that has kept me in this work is food feels quite solvable. There's a lot of things in the injustice in our society that feel really kind of intractable or complicated. 

Food, to me, feels quite solvable. We have enough resources, and if we can get the right people at the table, we really can make progress and so that sense of possibility keeps me in the work let me let me probe you a little bit further you said getting the right people at the table let's talk a little bit about that who are the right people yeah well the first group of the most right people are folks who are experiencing food insecurity folks for whom food is not accessible in the way that At least at the food group, we believe it should be. We believe that food is a human right. Everyone should have access to it. And that is just not the reality for many, many folks. 

And so for us, really understanding how can we engage those folks and listen carefully to the experiences that they're having and not make assumptions about it. I think it's so easy to make assumptions. I also think that... the charitable food system, how it was designed as it rose up in the 80s to address food insecurity, it really has that old school charity mindset, right? Where people who have more are doing good to those who have less. And while there's some things about that that are okay, I think it's really trying to get more to the heart of the issue about what How do people want to receive food? Where should it be accessed? Where are the trusted places in the community that people can feel empowered and have dignity accessing that food? 

And so for me, that is a huge group that historically has been left out of some of the problem solving in this space. That's really, really critical. And then building on that, it's a lot of partnerships. It's partnerships with nonprofits, right? Partnerships with government organizations, right? Thinking about the federal programs, the state programs. But then it's also, you know, corporate partners, whether they're funding the work or even thinking about grocery stores and grocery store access, right? If you have a neighborhood where there is no grocery store, you're going to have higher rates of food insecurity. And so there's just a lot of different sectors that need to solve it together. Thank you. Let's talk about the numbers a little bit. So a research crew, and this kind of reflects what you mentioned before. 

In 2020, 13.8 million households, now this is nationally, were food insecure at some time during the year. Wow. Okay, now 44.2 million people lived in households that had difficulty getting enough food to feed everyone. And that was in 2022. And that was up 33, almost 34 million people from the year prior. So, all right, let's talk about that jump. What caused that particular jump? I'm sure part of it was the pandemic, but what caused, that's a lot. So- What caused it, at least from what we can gather? It's been really interesting because the COVID pandemic put a spotlight on food insecurity in a really interesting way. And so while needs certainly went up, the other thing that happened in kind of 2020, 2021 is there were a lot of emergency relief programs that were established. 

So whether it were things like the child income tax credit or there was a pandemic emergency SNAP where the minimum SNAP, benefit SNAP, which used to be called food support, right, food stamps, that really increased. And so while things were tough in 2020 and 2021, there were tremendous federal support programs that really buffered a lot of low-income households. And Many of those expired in the end of 2022. And so what we saw was almost kind of, some people even called it a hunger cliff, right? Where all these programs started to expire kind of one after the other. And the thing that is often, I think, a little bit of a misconception about food insecurity is sometimes people think it's for folks who don't have jobs, right? 

right? So that if you're experiencing food insecurity, you must not be working. And what's actually very, very common is for households to have two working people, right? But not having enough because of the pressures of rent, of transportation, of healthcare costs, right? And so this idea that, oh, there's low unemployment, it must be that there is not food insecurity is an issue. That's a common linkage people make. But the wage growth just has not been there for folks who are working minimum wage jobs to be able to afford the foods that they need to get through. Clarence. Sophia. Yeah, Sophia. What's your future projection for this issue? I mean, we take a look at the data. We take a look and we talk about the food cliff. 

We talk about the progression. What is the food group looking at? How are you looking at this for the future? Yes, that is the question. And so I think one thing that's really positive, especially if we zoom into kind of the Minnesota situation, is in the last legislative session, there were some really big policy wins that have good impacts on these issues. So things like we do now have a statewide child income tax credit. And I think some people might say, I don't understand what linkage there is between a child income tax credit and hunger or food insecurity. We saw at the federal level when that was instituted, the number one biggest household expense was food. So for folks with kids, You spend a lot of money on food. 

And so if you can get additional resources, you're going to spend that on food. So to have that at the state level, we think is going to really help. But things like this take time to kind of build up, to start seeing those effects on the numbers. The other thing that happened last legislative session is universal school meals in Minnesota. So all kids in Minnesota now can have breakfast and lunch at school, no questions asked. That's going to help. That That's going to take some of the pressure off of families. It's also going to take some of the pressure off of food shelves. But these things take time. So I think we see that we're headed in a better direction. But the X factor is truly what are grocery prices going to continue to do? 

Because as those go up at a higher rate than wages do, this pressure on food insecurity gets bigger. Yeah. You know, Clarence, I'm sure you'll agree with this. It seems like in general, the country has access issues. OK, big time access issues, you know, whether it be food or whether it be transportation or whether it be health care or, you know, it just seems like, you know, and maybe I don't know, but maybe part of the problem is, is that people don't know where to go. for a lot of these things okay like for instance if somebody came to me today and said you know we really are having a hard time putting food on the table i'll be honest with you and if i wanted to help i would i would have to go online yeah i would really have to go online in order as opposed as opposed to it 

This, this topic being in our psyche, you know, Oh, you should contact the food group you know you know it's just, it's like one of those types of things that i think is is is problematic um clarence hold on one second. Um, I want to follow up. How is it that minnesota ranks, I guess, if that's a fair word with others, other states or other regions of the country, are we, OK, comparatively or even though having some is not good at all. But where where do we sit? Yeah, I think, you know, generally, Minnesota, it would would have lower food insecurity rates than certainly some places where, again, it's so tied to, you know, income. And then also just to kind of the. 

attitude of the state government in terms of safety net support. So I would say Minnesota has a couple of different things going for it. There's a real culture of volunteerism in Minnesota and a kind of sense of state pride. So I do think Minnesotans like the idea of taking care of each other, coming together. So that certainly helps. But the place Minnesota has an abysmal track record is on how our food insecurity breaks down according to race. And so our racial disparities in terms of food access continue to be really, really high. And that's one thing we think a lot about at the food group of we have to talk about race head on and really think about, to your point, access. But access looks different in different cultural communities, in different geographic communities. 

So how we might address that in maybe a rural community, is going to be really different than maybe a neighborhood that has a lot of historic disinvestment. So I would say Minnesota on the whole, you could say it's doing well, but then when you start disaggregating some of that data, it's really clear that there are kind of really prevalent, almost generational food access challenges for certain of our communities, many of them being black and brown communities. Yeah, yeah. Clarence? Yeah, thank you for those comments. I know that, you know, food deserts, you know, those are the things that we talk about, food insecurity. But I want to ask you this question because this is a health chatter. What is the food security conversation with health issues? 

Recently, we saw some information in the paper that was talking about poor nutrition is a leading cause of cardiovascular diseases. How is the connection with food insecurity and health, how is that connected so that people can understand the importance of food insecurity? Yeah. So I think that is such an important connection. And it's one that when I started kind of doing some of this work, It used to be that it was one we had to kind of justify or talk about a lot, right? Like we'd cite studies that, you know, if people have access to fruits and vegetables, they'll eat more of them or, right? We'd cite studies that people know often what is healthy, but they just can't get those things. And so if folks do, we, you know, we think that rates of diabetes would go down or heart disease would go down and obesity related, right? 

Any kind of chronic diet related diseases are very much tied to food access because All sorts of studies show that when you don't have access, you have to really think about how to buy the most dense calorie foods that are available. So it often is really, really unhealthy things. So one thing that is talked about sometimes is the hunger obesity paradox, that many folks struggling with food insecurity have struggles with obesity as well. And so What's been really interesting kind of as things have evolved in the past decade is we no longer really have to make that case to funders or to healthcare partners. There's a real understanding that if you can get people really consistent, reliable access to nutritious foods, health outcomes improve. 

So there's not even a sense of, oh my gosh, we need to study it or we need to look at the dietary outcomes or whatever. It really is kind of almost now commonly accepted that access will lead to better health results. Yeah. You know, I think, and for our listening audience, we're going to have a follow-up show on this, on weight loss medications. And so, you know, we talk about food insecurity as possibly being a stigma. You know, you add medications to that to help people control obesity, for instance. There's also stigma. And stigma in general just doesn't make any situation better. It just complicates the whole thing. So, all right, I'm going to back up into some comments that you were talking about, Clarence. 

It's like, okay, are there groups that are at higher risk for food insecurity? Yeah. Yeah, absolutely. So as I mentioned, certainly there are demographic differences in food insecurity. So, you know, one of the groups with the highest rates of food insecurity are Native American folks, Indigenous. There's a really long, you know, super complicated history of how the U.S. government has used food as a tool to really kind of oppress Native communities. And so, you know, and really tore away many of their natural kind of food sovereignty ways of producing foods that were good for their community and replaced that all with commodity foods. So rates of diet-related disease, rates of food insecurity, they are off the charts for many indigenous communities. There's, you know, different kind of pockets of places to, again, certain 

Urban areas without reliable access to grocery stores are going to have higher rates of food insecurity. And then plenty of families with children. That is a group that has high rates. But then the growing group is seniors as well. So there are many, many seniors who are not always sure where their next meal is coming from. when you couple that with the fact that many of them are probably taking medication regularly, if you don't have the proper food to have that medication, do what it's supposed to do, you're going to have even worse health outcomes. Yeah. Yeah. So Maddie is curious about this whole concept of a food desert. And why don't you comment on that? It's just like, Again, this is kind of vocabulary that's kind of relatively new, you know, deserts. 

And tell us about it. Yeah, so I'm really glad that you brought that up. So it's really interesting. So generally when people refer to a food desert, they're speaking about a neighborhood that does not have access to affordable, healthy groceries. So it might have corner stores, it might have fast food restaurants, right? There might be places you can get food, but not a quality, nutritious grocery store that's affordable to residents. But one thing that's really interesting is there's been some talk around maybe food desert isn't the best way to describe that. So the Sioux chef, Sean Sherman, who is a local indigenous chef, he talks a lot about actually deserts are naturally occurring ecosystems. That they're beautiful. And if you know where to look for food or water, you can find them in a desert where actually the situation we find ourselves in is really one of political investment decisions. 

And so when we think about kind of how grocery stores are located, sometimes we talk about a little bit more as supermarket redlining. So if you're familiar with like redlining and housing where certain neighborhoods are got less access or only white folks were allowed to move into certain neighborhoods. When you look at grocery store access, if you look at communities with equal per capita income, black neighborhoods are less likely to have a grocery store than white neighborhoods. So there's a real kind of complicated context to all of this that we need to keep talking about so that we can change those outcomes. But there's nothing natural about it, right? It's really just built into kind of our built environment and our food ecosystem. 

Yeah, and it's troubling. It really is troubling that people don't have access to good supermarkets. Let me bring up the idea of farmer's markets. So I think I mentioned before our show started that As a kid, I remember growing up, and we really didn't have farmer's markets like we see today. I remember distinctly out in Los Angeles, there's the infamous farmer's market there that's been there forever. But it's not like one that crops up on a weekend or whatever. farmers markets kind of play out in all of this and how they perhaps have helped the access issue. Yeah. Well, I mean, so one kind of exciting way that there can be partnership between farmers market and folks experiencing food insecurity is there's a program called Market Box. 

And so what that does is for a participant, if you bring your SNAP card to a farmers market, you can get your money matched. So we have a state program that matches money and then there's actually a federal program that is another even match on top of that. So you could spend $10 of your SNAP card at a farmer's market and end up getting $30 worth of produce. And so again, it's really trying to incentivize folks to think about farmer's markets as a good option, to understand that they are in lots of neighborhoods and that again, that partnership produce, that local, often organic produce, can have such good health outcomes, right, for folks using the program. So that's all super exciting. I think the piece, though, that we always have to remember is in Minnesota, we have quite a short growing season. 

And so while farmers markets are great at expanding access, and there certainly are some that are open in the winter, finding other year-round grocery options is important as well. Yeah. Yeah. Sophia, I would like to ask this question because I was just thinking about this as you were talking. I saw an advertisement around ugly vegetables and fruits. And it's like, unless a fruit is looking perfect, people won't eat it. What are your thoughts? I don't even know where my conversation is going, but I remember this like, you had a bunch of ugly vegetables and fruit. Why would you eat something that's ugly? Well, so this is a really important kind of piece of the whole conversation around kind of like food waste and food rescue. 

So, you know, again, you know, in the same way that there's this paradox maybe between food insecurity and obesity and people not thinking those are linked. The other paradox we're working with kind of in our country is that we have people who don't have access to the food they need. At the same time, we have huge problem with food waste. So all sorts of people are trying to kind of think through better ways to find, prevent that food waste and get that to folks who need it. So a few things on that. One of the programs we run at the food group that I love and I think is really exciting is called Gleaning, where we bring volunteers out to farmers' fields. Because one of the most expensive parts of farming is to have the labor to pick the vegetables. 

So there are local farmers who sometimes will, you know, maybe have a bumper crop of something, but they don't have a market for it. So they're not going to pick it. Generally, it just gets tilled back under as compost for the next year. But what we do is we bring volunteers. So we might be picking apples. We might be picking squash. We might be picking, you know, green beans or peppers, things that they can't harvest but would otherwise go to waste. So that's outstanding. And then what we can do is get that to our food shelf partners. And that's top. quality foods. So that's a really, really exciting thing. But the other thing, Clarence, that you mentioned was kind of like, what about ugly foods or what about foods toward the end of its life? 

So historically, there's been a ton of food rescue that has come into our food shelf system. So whether it's the bagged lettuce that you see at your local supermarket, when that hits the date, right, you know, you still have a couple of days to eat it, but they're not going to sell it. So a lot of that tends to go to local food shelves. And that's really good. It's obviously free. It's a lot of variety. But the thing we try to talk a lot about at the food group and really think through is we want to make sure that there's always dignity in the experience. And so it's really important that while we're going to do our best to rescue food, we're going to go through that food and make it beautiful and make sure that nothing that I wouldn't eat or that you wouldn't eat is on the shelf at a food shelf too, right? 

So it's this kind of conversation. complicated dance between. And I think actually some of the movement around like imperfect foods or ugly fruits or whatever, I think that has better potential for consumers almost at a higher income level because people are willing to make that trade-off knowing my carrot could be ugly or my carrot could be pretty. It's the same carrot. I should take it. Sometimes though, folks who are really experiencing food insecurity, the last thing we want them to do is think, why am I the one getting a weird carrot? Right. You know what I mean? So it's kind of like figuring out how to think through the levels of food waste prevention, but also dignity. Wow. That's really interesting to me because as you're talking about this, I'm thinking about how sometimes when people have this high expectation as well of what I should be receiving, you know, and it's important. 

I think it's important. important to enter this conversation to say that we need to sometimes rethink about how we receive or accept food. Like I said, somebody will say, well, I don't like that fruit because it's ugly. You don't need to talk about the ugly carrot. Yeah, we need to talk about that because if you're hungry, guess what? The ugly carrot works. It has the same nutritional value as a pretty carrot. So I think that the That's a great conversation to start having with people as kind of a core conversation. But anyway, that's my thought. I'm just rambling at this point. So let me couple two themes that seem to be interwoven here. One is culture. So we all come from different cultures. 

And you mentioned towards the beginning of the show, we're sitting around the table. And there are certain culture, there are certain religious things. How does culture fit into this whole thing of food insecurity? It seems to me that if you have food insecurity on one hand, it's like maybe you put kind of your culture stuff aside for a time and really focus on just getting food. But on the other hand, I would... anticipate that there's some angst there if you're not able to assume foods that are consistent with your culture. So how do you deal with that? Yeah, I mean, that's something that we've worked on really intentionally with a lot of our partners is thinking about how we can have culturally appropriate foods, culturally relevant foods available to folks. 

Because the truth is, especially when we're thinking about health outcomes, right? You have to be able to access foods that you're going to know what to do with. And so, you know, if you're from a specific cultural community and you get handed some, you know, ravioli in a can that you might just not even eat it because you've never seen it or it means nothing to your family or right, even to your palate. And so we've done a lot around finding some key culturally relevant foods that we can help our partner source but then there's also some kind of more culturally universal foods that actually are the most nutritious foods anyway so focusing a lot on fresh fruits and vegetables yeah yeah right some things like you know you know canned tomatoes right vegetable oils some really basic staples that are going to cross cultural traditions 

And so some partners are in a position where maybe they're seeing folks from so many different cultural communities. They're not able to carry everything. But then we really encourage them, well, just focus on those things that you can add different spices to, right? And create a completely different meal with some lean protein and produce. And so I'm thinking a lot about that. And I think actually those are the kind of staples, those whole foods that lend themselves to meal preparation. Those are the things that are going to lead to to better health outcomes too. Yeah. So let's talk about health outcomes a little bit. Regardless if you're, if you're, if you're experiencing food insecurity or not, people come down with health issues. Okay. 

And so let's combine for instance, somebody who's been recently diagnosed as for instance, diabetic, And at the same time, they are dubbed food insecure. So is there work within the food group that links health-related issues with food insecurity? No, we don't do anything specifically on that topic. I know plenty of our partners do. You know, we have like partners like North Point Health and Wellness, for example, in the north side of Minneapolis. They're both a clinic and a food shelf, right? So they can see some of those linkages really well. But we do participate along with several other partners every year in something called the Minnesota Food Shelf Survey. And so that is online. And I know that that asks some people about questions around the prevalence of certain diet related diseases and just kind of what 

what people are experiencing. But yes, many, many folks who are using food shelves have either themselves or someone in their household who is experiencing a diet related disease. And so, you know, ideally, again, there's a wide variety of things at that food shelf that are going to work for what they need. And then there's other groups like Open Arms is a nonprofit that does medically tailored home delivered meals. So if somebody maybe isn't in a position where they can cook for themselves, but they need to have that meal be medically tailored, right? I know there's work in that space too. Which is great. So you've obviously talked about work that's being done in Minnesota. Can you give us some sense for our audience what might be done in other states or where they can link? 

To get assistance in other states. Yeah. So I would say there are, you know, food banks and food pantries. So it's interesting. Minnesota likes to be unique. We call them food shelves. That's the place where you can go in your local community to get free food. Many, many other states call them food pantries. But they are in every state, right? So food pantries are in every state. SNAP, which is the Federal Food Support Program. Yeah. is in every state. And I think one thing that can get lost in some of these conversations, because we do talk so much about local community resources to get free food, for every one meal that's provided in the emergency food system, SNAP provides 12. So the federal food support program is absolutely the best response that we have. 

to food insecurity and really is keeping many, many households, you know, able to afford some foods at the grocery store. So there's, you know, that program is in every state. There's local programs in every state. And then there's food banks, right, which are more at the level we are where we're aggregating food and supporting lots of different food pantries. And those exist in every state as well. So given our kind of our crazy political situations in in the united States. Are these programs like snap or um you know, WIC, you know a women infant children program or the national uh school lunch programs are they in trouble? Or can we assume that historically they've been pretty stable? Well, The last few years have taught us to assume nothing, right? 

Okay, true. You never know, right? That would be where I would say that. You know, I think that there's all sorts of research that shows the efficacy of these programs and the way that investing in these programs leads to less cost down the road. Now, that doesn't mean that all of our political debate is based on rational thinking. data. So I think that there are plenty of people who can, you know, think about the worst aspects of these programs or try to kind of find fault with them or also try to, I think, sometimes frame that the only people utilizing these programs would be people who are not working hard. And the piece that I would just say is the myth around that is that 

people are working incredibly hard, sometimes more than one job at a time. But we've just set up certain contexts in our economy that that means that food is just still not accessible. And so, you know, we do a lot to keep telling that story of how important those programs are. And I think that's something that everyone can do, whether you're super familiar with the issue of food insecurity or not, just acknowledging that it is a real thing and that we have an obligation as a I think as a country to just make sure folks have that basic need supported and covered. Are there new programs, political, you know, policy oriented programs in the wings or are these kind of this trifecta that we just mentioned? 

Are those pretty much the stable ones right now? I'd say those are the big ones. And, you know, there's always an opportunity to expand SNAP, especially make it, you know, increase the minimum benefits, right? All of those things. Hard to do politically. SNAP is part of the Farm Bill. And the Farm Bill tends to be the piece of congressional legislation that never gets done on time. So that seems to be on track to also be true to this coming Farm Bill, so. Okay, all right. Clarence, last thoughts. My last thought, Sophia, is this, is... Where are the best resources for us who don't necessarily know where to go to go to be able to help or to support others who might be in need of food? 

Yeah, so the Minnesota Food Helpline has a great find help map and you can enter your zip code and it will give you lots of different resources from farmers markets to food shelves. to the county office to get assistance with a SNAP application. So that's a really great resource if people are looking for somewhere in their local community they can go. And then the other thing I would say is all those groups, including the food group, are also always looking for volunteers. So there might be times you need to know how to get help for either yourself or for someone, or that you want to engage in volunteering. Because the truth is, this whole kind of system really operates off of volunteers pitching in and helping make the services all be available. 

Thank you. Connecting with Clarence's question, let's just say that you know nothing about this subject and all of a sudden you need to know something because either you're in need or a friend is in need or whatever. In this day and age, typically people go to the website, okay? so what would you recommend to our listening audience to put in as a search item? Like something like what food help or just something? What, what, what is it that you, because they, they obviously aren't going to know the names of all these programs etc yeah what would you put in for a search? Yeah. I think food help is an option. I think, You know, in Minnesota, we've got the Minnesota Food Helpline, so that's both online. 

But then if you call, someone will walk you through all these resources. I think many county offices, right, will walk you through services. Sometimes United Way in different communities has a hotline. So it really is kind of finding that social service kind of navigator or connector because it is overwhelming. And, you know, I think the other thing to remember is for some people, it's just a really brief moment in time that they're needing help, right? So then you might be going to go to a couple of food shelves or, you know, a hot meal program. For other people, it's really a change in their life that's going to probably get them into qualifying for a lot of different social programs. And then again, you want someone to help you walk through that whole process. 

And both things are totally fine. And there's help kind of for any different situation people find themselves in. That's great. I thank you so much. When you listen to you, you can tell the passion that you have for your work and your assistance and your help for everyone. And so if for nothing else, thank you for that. It really is special. We have good resources in the state of Minnesota and hopefully analogous ones in other states as well. So thank you for being on Health Chatter. For our listening audience, we've got great, great shows coming up. We have shows on, like I mentioned in the show, weight loss medications, narcissism, organ donation, and loneliness, and we also were able to get the new dean of the School of Public Health in Minnesota to be on their show. So we've got some great shows coming up. Thanks for listening to Health Chatter and keep health chatting away.