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Dr Denise Holston Explains Food Insecurity and Rural Health Barriers


"If someone is food insecure for a long period of time, then they may be consuming foods that aren't as nutritious and support their health and growth as they should," Denise Holston, PhD, explains in an interview.

Denise Holston, PhD, MSc, RDN, LDN, LSU, associate professor at Louisiana State University AgCenter in Baton Rouge, explained how food insecurity and rural barriers can negatively impact health outcomes at an Institute for Value-Based Medicine® (IVBM) population health event held by The American Journal of Managed Care® in partnership with Ochsner Health.


The theme for the IVBM with Ochsner was, “Advancing Innovations in Wellness and Food Security to Address Obesity and Chronic Conditions in Louisiana.” Can you discuss how wellness and food insecurity are interrelated and how that affects overall health outcomes?

Food insecurity is when someone doesn't have regular access to affordable, healthy foods. There are two types of food insecurity, one is "very low," and then one is "low". And so typically when we see folks with low food insecurity, they may purchase foods that aren't as nutritious or aren't a complete food, they may have a lot of added sugars, things like that in there. And so typically, we won't see skipping meals among this population, we will see skipping meals among the very low food insecure folks. So with that said, if someone is food insecure for a long period of time, then they may be consuming foods that aren't as nutritious and support their health and growth as they should. And so that's when we'll see longer down the road, that people who are food insecure have a higher risk of some of those chronic diseases that are related to what you eat and how often you move such as obesity, cancer, heart disease, and even diabetes. And so there is definitely a relationship there with food insecurity and prevalence of chronic diseases.

Within Louisiana specifically and generalizing nationwide, how do health disparities impact rural patients differently compared with their urban counterparts?

In rural communities, we typically see that they experience health disparities much more than their urban counterparts and that is for a variety of reasons. We see, in most cases, lower educational attainment, not as many job opportunities, and where there are job opportunities, then you have to travel several hours—so you're sedentary for a while. But if you don't have a car you never have access to those employment opportunities. We have the lower educational attainment, high poverty levels, again, with this work, many people if they don't have a car, then they may be on food stamps or [the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)] or have to have government assistance and that can also factor into the health disparities we see in rural areas.

The other thing that we see is lack of access to health care. There is a rural shortage of health care providers, but there's even more of a shortage of specialists in rural areas for some of these chronic diseases that do take a specialist [to treat]. There's a whole cluster of factors that help us see the health disparities in rural populations.

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