Nutritional assessment of free meal programs in San Francisco

Evaluation of Community Restaurants Linked to Government Food and Nutrition Safety Programs: A Scope Review

Community restaurants linked to government food and nutritional security programs are establishments created to offer meals to the population in socially vulnerable situations. The objective was to identify the methods, approaches, criteria, and indicators used to evaluate restaurants linked to government food and nutrition security programs. A scoping review based on the Joanna Briggs Institute's methodology and the international guide's recommendations of preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews was conducted. Medline databases via PubMed, Lilacs, Scopus, Cochrane, Web of Science, and ScienceDirect were used. Primary observational studies, systematic reviews and meta-analyses, ethnographies, documentary studies, and case studies were included, with a quantitative, qualitative, and/or mixed approach. A total of 2498 studies were identified. After taking out 180 duplicated articles, another 2202 articles were excluded by the title. Among the 71 studies selected for complete reading, 10 did not correlate with the research objective, and 12 were included after analyzing the references, totaling 73 included studies. In this review, evaluative approaches were mapped and systematized on the menu, food consumption, food health, food security and/or insecurity, nutritional education, and human right to adequate food; users' profile and health, implantation, history, perceptions, senses, and meanings; handlers/workers; hygienic-sanitary quality; evaluation and monitoring; physical-functional planning, and rest-intake. The presented data provide elements that can be adapted in future evaluations and describe the panorama of academic production in this area.

Food Is Medicine for Individuals Affected by Homelessness: Findings from a Participatory Soup Kitchen Menu Redesign

Health disparities among people experiencing homelessness are likely exacerbated by limited access to healthy, fresh, and minimally processed foods. Soup kitchens and shelters serve as essential food safety nets for preventing hunger in this population, and community interest is growing in the potential of "food is medicine" interventions to improve the mental and physical wellbeing of people who receive meals from these providers. This study describes our two-phase approach to first identify and prioritize nutrition needs within an urban soup kitchen community and then test and implement new recipes and menu guidelines to help the standard soup kitchen menu better align with those priorities. We began by first conducting a nutrition needs assessment, including a collection of intercept surveys from a convenience sample of soup kitchen guests to better understand their nutrition-related health needs, dental issues, food preferences, and menu satisfaction (n = 112), as well as a nutrition analysis of the standard menu based on seven randomly selected meals. Most respondents reported at least one chronic health condition, with depressive disorders (50.9%) and cardiovascular diseases (49.1%) being the most common. Nearly all guests requested more fruits and vegetables at mealtimes, and results from the menu analysis revealed opportunities to lower meal contents of sodium, saturated fat, and added sugars and to raise micronutrient, fiber, and omega-3 content. We then applied these nutrition needs assessment findings to inform the second phase of the project. This phase included the identification of new food inventory items to help support cardiovascular and mental health-related nutrition needs, taste test sampling of new healthy menu items with soup kitchen guests, and hands-on culinary medicine training to kitchen staff on newly-developed "food is medicine" guidelines to support menu transformation. All taste tests of new menu items received over 75% approval, which exceeded satisfaction ratings of the standard menu collected during the phase 1 needs assessment. Findings from this community-based participatory research project confirm the great potential for hunger safety net providers to support critical nutrition needs within this vulnerable population through strategic menu changes. However, more research is needed on the longitudinal impacts of such changes on health indicators over time.

The determinants of the nutritional quality of food provided to the homeless population: a mixed methods systematic review protocol

BACKGROUND

Studies assessing the nutritional quality of food provided to the homeless population show deficiencies in micronutrients and excess fat, sugar, and salt. The availability of cheap, energy-dense and nutrient-poor food has changed the profile of people living with homelessness from primarily underweight to obese in western countries. Many factors influence the nutritional quality of food provided to the homeless population such as budget and time constraints, food donations and limited equipment. Nutrient intakes in this population are unlikely to be met outside of charitable meal programmes, making the nutritional quality of these meals crucial. This review will synthesise mixed methods literature with the overarching aim of understanding the determinants of the nutritional quality of food provided to the homeless population.

METHODS

This mixed methods systematic review will include English language empirical research studies from Europe, North America and Oceania. The following electronic databases have been chosen for this review: SCOPUS, EMBASE, PsycINFO, EBSCOHost SocIndex and CINAHL. The grey literature databases OpenGrey and ProQuest will also be searched. Quality appraisal will be conducted using the Mixed-Methods Appraisal Tool. Two independent reviewers will be included in study selection, data extraction and quality appraisal. A third reviewer will resolve conflicts. Thematic synthesis will be employed.

DISCUSSION

Results will be organised based on a determinants of health model, to highlight areas where change may be effective, thereby making it more likely to be useful to practitioners and researchers. The iterative steps in the systematic review process will be the focus of this article. Findings from this review will be used to develop best-practice guidelines for stakeholders such as policy makers and service providers to improve the nutritional quality of food provided in the homeless sector.

SYSTEMATIC REVIEW REGISTRATION

This mixed methods systematic review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42021289063.

The Nutritional Content of Rescued Food Conveyed by a Food Aid Organization

Background: The number of food-insecure families in the European Union has increased, resulting in an increasing number of households depending on food assistance programs. The aim in this study was to evaluate the nutrient content of food rescued by a food aid organization that rescues and redistributes fresh or freshly cooked food to low-income households. Methods: To determine the nutritional content of food hampers provided by our case study organization, we weighed all items of food hampers in three weighing rounds over a period of four months. The Food Insecurity Experience Scale (FIES) was applied to measure households’ food insecurity. Results: Our results show that, at our case study food aid organization, food donations substantially contribute to energy, macro, and micronutrient dietary recommendation intake (DRI). Conclusions: When evaluating how these nutrients contribute to alleviating food insecurity of the beneficiary households, we found that the perception of food insecurity is independent of the amount of nutrients served. To the best of our knowledge, this is the first study measuring the nutritional content of fresh or freshly cooked rescued food conveyed by a food aid organization.

Evaluation of the Effectiveness of Brazilian Community Restaurants for the Dimension of Low-Income People Access to Food

This study aimed to evaluate the effectiveness of community restaurants (CRs), managed by the Government of the State of Bahia/Brazil, for the dimension of access to food. The study used secondary data obtained from the public opinion survey Profile of users of community restaurants in Salvador. The nutritional information was accessed through the analysis of CRs’ menus. Adequate effectiveness of access to food was considered when the CR served meals to 50% to 70% of the users considered the target audience (individuals served by the two CRs located in the city of Salvador/Bahia/Brazil). The participants (n = 1464; 778 as low-income individuals) were adult CR users from Salvador/Brazil. Most of the respondents were male, 40 to 54 years old, not white, had up to 9 years of formal education, without a partner, and living in the municipality of Salvador. The evaluated CRs are effective in serving 53.1% of the target population in their total service capacity. Meal provision only reached an estimated 0.7% of the socially vulnerable community in the district. The average energy value of the meal served by the CR units was 853.05 kcal/meal, with a mean energy density composition classified as average (1.15 kcal/g). The effectiveness of the evaluated community restaurants showed that these instruments were minimally effective in promoting access to food for the low-income population within their total daily service capacity, and the current quantity of these facilities was insufficient. However, these instruments stand out in the fundamental role of promoting the daily distribution of meals to the Brazilian population with the highest social vulnerability levels.

Cardiovascular Disease and Homelessness

Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.

Improving Health while Alleviating Hunger: Best Practices of a Successful Hunger Relief Organization

BACKGROUND

Food insecurity affects millions each year in the United States. Hunger relief organizations work to reduce hunger and food insecurity; however, the foods they provide are often unhealthy.

OBJECTIVE

The objective of this article is to document the policy, systems, and environmental changes that Samaritan Community Center made to their programs in order to better serve Washington County and Benton County, Arkansas.

METHODS

With the use of a case-study approach, researchers held 17 meetings with key members of the organization and conducted >30 h of observations to document policy, systems, and environmental changes and best practices for implementing those changes.

RESULTS

Researchers identified emergent themes and grouped best practices in the following categories: 1) removing stigma and empowering clients, 2) incremental steps to increase access to healthy foods, 3) embracing multiculturalism, 4) donation policies and procurement, 5) collaboration is key, 6) organizational culture, and 7) challenges and resolutions.

CONCLUSIONS

Samaritan Community Center has successfully implemented and adopted new programs and practices in order to improve the health of their clients. To our knowledge, this is the first case study to document best practices for making policy, systems, and environmental changes by a hunger relief organization to improve the nutritional quality of foods provided to their clients.

Nutrition for homeless populations: shelters and soup kitchens as opportunities for intervention

Nutrition is a daily challenge for the homeless population in America. Homeless individuals suffer from a high prevalence of diseases related to poor diet, yet there has been little public health effort to improve nutrition in this population. Shelters and soup kitchens may have an untapped potential to impact food access, choice and quality. We offer ideas for intervention and lessons learned from ten shelters and soup kitchens around Greater Boston, MA, USA. By advancing food quality, education and policies in shelters and soup kitchens, the homeless population can be given an opportunity to restore its nutrition and health.

Food- and health-related correlates of self-reported body mass index among low-income mothers of young children

OBJECTIVE

To examine how income-related challenges regarding food and health are associated with variation in self-reported maternal body weight among low-income mothers.

DESIGN

Cross-sectional design.

SETTING

Two Northeastern cities. Seven day care centers and a Supplemental Nutrition Assistance Program outreach project.

PARTICIPANTS

Sample of 166 mothers; 67% were overweight or obese, 55% were Hispanic, and 42% reported household food insecurity (HFI).

MAIN OUTCOME MEASURES

Maternal self-reported height and weight to calculate body mass index (BMI). Independent variables were food program participation, supermarket use, 8-item food shopping practices scale, HFI, maternal depressive symptoms, and self-rated health.

ANALYSIS

Hierarchical multiple regression analysis tested relationships between maternal BMI with the independent variables of interest, adjusting for demographic confounds.

RESULTS

Shopping practices to stretch food dollars (P = .04), using community food assistance programs (P < .05), and HFI (P < .04) correlated with heavier maternal BMIs; higher self-rated health corresponded to lower BMIs (P = .004).

CONCLUSIONS AND IMPLICATIONS

Some strategies low-income mothers use to manage food resources are associated with heavier BMIs. Nutrition educators, public health practitioners, and researchers need to collaboratively address the associations between these strategies, food insecurity, poor health, and unhealthy weight.

The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations

In the European Union, more than 400,000 individuals are homeless on any one night and more than 600,000 are homeless in the USA. The causes of homelessness are an interaction between individual and structural factors. Individual factors include poverty, family problems, and mental health and substance misuse problems. The availability of low-cost housing is thought to be the most important structural determinant for homelessness. Homeless people have higher rates of premature mortality than the rest of the population, especially from suicide and unintentional injuries, and an increased prevalence of a range of infectious diseases, mental disorders, and substance misuse. High rates of non-communicable diseases have also been described with evidence of accelerated ageing. Although engagement with health services and adherence to treatments is often compromised, homeless people typically attend the emergency department more often than non-homeless people. We discuss several recommendations to improve the surveillance of morbidity and mortality in homeless people. Programmes focused on high-risk groups, such as individuals leaving prisons, psychiatric hospitals, and the child welfare system, and the introduction of national and state-wide plans that target homeless people are likely to improve outcomes.

Improving the nutritional quality of charitable meals for homeless and vulnerable adults. A case study of food provision by a food aid organisation in the UK

The prevalence of homelessness in the UK is rising, and demand for food aid through charitable meal services has increased. Charitable services make a substantial contribution to the food and nutrient intake of vulnerable people, and thus offer a platform for dietary improvement. This study examined food provision by a large charitable organisation in a major UK city. It had several objectives: Firstly to quantify nutritional composition of breakfast and lunch meals, secondly to understand factors that influence the composition of menus and meals, and thirdly to determine whether, within the context of these influences, improvements to the menu would be possible and whether these would be acceptable to clients. Mixed methods of ethnography, semi-structured interviews, quantitative nutrient analysis, recipe adaptation and taste tests were employed. The research team worked as volunteers in the organisation for a 3-week period and interviews were held with the kitchen staff. Food choice was recorded for 189 clients at breakfast and 251 clients at lunch over a 5-day period and nutrient content of these meals was estimated. Meals were weighted towards fat and sugar energy. Energy, potassium, calcium, vitamin C, vitamin A, zinc and magnesium content of meals were below Dietary Reference Value (DRV) targets for at least 20% of breakfast and lunch meals. Such inadequacies may be addressed by the addition of simple foods to the breakfast menu and adaptation of lunchtime recipes. Twelve lunchtime dishes were proposed and eight of these were seemingly acceptable to clients in taste testing. Barriers to provision of healthier meals include budget, food donations and acceptability of meals.