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Calories of Concern

The poor often face an unpleasant choice: Eat unhealthy food or go hungry

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n a nation that's becoming increasingly poor and overweight, numerous Southern Arizona organizations are doing what they can to make sure that healthier food shows up on the plates of our hungriest neighbors.

But it's not as simple as handing those with food-insecurity issues a bag of vegetables, officials said.

Those with the toughest health issues—like diabetes—struggle even harder to get the nutrition they need, health advocates complain, because emergency food boxes often contain foods that contribute to health problems.

The Arizona Department of Health Services estimates that one in nine individuals in Arizona has diabetes—with one-third of these people unaware they have it—and some of those wind up in the hands of diabetes program workers at El Rio Community Health Center.

"The typical ingredients in the food box are very carbohydrate-rich," said Dr. Sandra Leal, clinical pharmacist and manager of the diabetes program at El Rio. Carbs are not ideal for people struggling with diabetes, because they can cause blood-sugar levels to skyrocket.

"That's not to say people with diabetes can't eat carbohydrates," Leal said. However, she recommends a plate method of nutrition, where only one-quarter of the plate is carbohydrates. "The food box basically doesn't allow for that," she said.

There are two types of food boxes available to those who qualify—a federally managed box, from The Emergency Food Assistance Program (TEFAP), and a box managed in part by Pima County, called Food Plus.

The federal food boxes—which a family can get at the Community Food Bank without qualification—typically contain a box of cereal; two cans of vegetables; a can of tomatoes; a jar of peanut butter; a can of soup; a bag of dry beans; a bag of rice; a box of macaroni and cheese; a can of meat; and two cans of fruit. (Those quantities increase for a larger family.)

Food Plus boxes are offered to certain low-income individuals, including seniors older than the age of 60, children 1 to 6 years old, pregnant mothers, and mothers who have given birth within a year.

The Food Plus program is also federally funded, but the Pima County Health Department determines eligibility. Food Plus boxes contain varied quantities of canned meat; canned vegetables; canned fruit; cereal; two pounds of cheese; two pounds of pasta, rice or potatoes; evaporated milk; peanut butter or dried beans; fruit juice; dried milk; and infant formula and cereal if needed. Quantities depend on family size.

Nutritionists like Leticia Martinez, who specializes in diabetes management at El Rio, are concerned about the white rice and the macaroni.

"Pasta is a very refined carbohydrate, and it tends to get people's blood sugar very high, and it's high in fat, which is not what we want," Martinez said.

Macaroni and cheese doesn't provide great nutrition for the portion size—and no one's realistically going to follow the portion-size recommendations anyway, she said.

"How can you only eat one-quarter of a cup? You're not going to get full with this. Then half a cup of mac and cheese turns into eight teaspoons of sugar," Martinez said.

When she's giving people advice on how to use the box, she often advises them to not use the cheese, and to make soup with the macaroni.

What about the white rice? "It would be great if it could be switched. You could put in barley or lentils. They're not expensive grains," Martinez said.

However, changing what goes into the boxes can't be done on the local level. TEFAP is a gigantic government program, started in 1981 by President Ronald Reagan to get rid of excess government cheese and milk; the food was shipped to local communities to help the needy. Today, the government actively purchases food for the program, and buys surplus commodities from farmers to supplement the program—and get extra money into those farmers' pockets.

This year, Congress authorized $260 million to buy emergency food, and $48 million to store it. Congress also authorized $176 million for nationwide programs like the Food Plus boxes.

"Commodities come as they come. We'd really rather have the fresh food, but it's not always possible," said Sherry Daniels, director of the Pima County Health Department. "I'd like to see folks not hungry and getting nutritious food, but if you have to pick one, I'd prefer not to see people hungry."

Many of the health experts I spoke to for this story—both with El Rio and the Carondelet Health Network—assumed that a diabetic food box was available.

While a special food box was once offered to diabetics, this box hasn't been offered for years.

"There's nothing we can do about providing diabetic food boxes at this time," said Jack Parris, public relations manager at the Community Food Bank of Southern Arizona. "We received several grants a couple of years ago, but they've all dried up."

For example, in 2007, the Food Bank partnered with the Tohono O'odham Nation to provide 50 adults with diabetic boxes. Fifty boxes is just a sliver of the food that the Food Bank is giving out monthly in the five counties in Southern Arizona, Parris said.

"We're just scrambling. You're dealing with preparing and distributing 29,000 food boxes a month," Parris said. "We try to make it as nutritious as possible."

Nutrition is a source of frustration with agencies working to help the hungry in Arizona. Healthy food is obviously the goal, but there are many constraints—and hunger takes over as a greater issue.

"Pick a side of that hunger-versus-nutrition debate, and I'll make you feel bad. It's a rough topic," said Donald Gates, program director of Communities Putting Prevention to Work, a new grant-funded two-year initiative that works on health care in the community.

Gates said the programs that he oversees—like providing community gardens, encouraging composting, instituting salad bars in school-lunch programs, and encouraging religious congregations to educate their members about healthy snacks—work on the "nutrition side" of the issue.

The gardening program, since its start in September 2010, has created more than 300 personal gardens, 75 family gardens, and 25 to 30 community gardens that give locals access to fresh produce.

"This is sustainable," Gates said. "It's not a family getting a box or voucher every month. They're putting in their own sweat equity."

Programs like this, along with federal produce vouchers and the Community Food Bank's own farmers' markets, can help supplement the box, Gates said.

"It's about providing the community access to make healthy choices," Gates said.

Some choices, though, are ultimately up to the individual.

"People choose to eat a 99-cent hamburger because it's cheaper. Some of the poorer-quality food is less-expensive," Martinez said. "It fills you up, so you're not hungry."

Leal said that food boxes provide an essential service, but change is needed because of the health risk.

"I definitely see the challenges," Leal said. "But if you're desperate, and you're starving, and you don't have any other choice, that's all you have. But there are other ways. There are definitely opportunities to create healthier boxes."

Ultimately, Leal said, the problems with the food boxes reflect a larger trend in America.

"I think we're nutrient-poor, but we're not starving. We have an excess of calories," Leal said. "The foods that are providing extra calories are not necessarily providing nutrition."

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