Healthy eating: Who can afford it?

By Jessica Strait

Mark Groah, a 54-year-old Lexington resident, knows he should eat healthier – he has had diabetes for eight years, and at one point in his life he weighed 360 pounds. On a day in late April, he picked up the phone and called someone he thought might be able to help.

On the other end, Jenny Davidson, W&L Campus Kitchen coordinator, listened sympathetically as Groah asked for more fresh fruit because he was trying to lose weight.

“It just depends on how much we have,” Davidson told Groah. “If we have it, I’ll send it, but if we don’t have it, I can’t send anything …. Yeah, I know, we all like fruit.”

Mark Groah, 54, stands outside of his Lexington home. Groah doesn't qualify for SNAP but does qualify for local food pantries, like RARA. (JESSICA STRAIT)

People below or near the federal poverty line – $908 a month for an individual – can rely on government programs including Supplemental Nutritional Assistance, or SNAP – the old food-stamp program – and free surplus food distributed at food banks.

But others, like Groah, make a little too much to qualify for SNAP. They are what social service workers call “food-insecure.” That means they don’t always know where their next meal is coming from.

Worse, when they do find a meal, it’s apt to be loaded with relatively cheap starches and fats rather than healthier proteins and the complex carbohydrates found in fresh fruits and vegetables. That makes obesity a big problem among the poor and near-poor, particularly their children. Last year in Buena Vista, more than half of all elementary school children were overweight or obese.

And often, the image of obese Americans lined up for free food contributes to the perception by critics that the poor are – literally – over-served.

The near-poor and nutrition

Local resources like Campus Kitchen that exist to help the near-poor often lack fresh produce. And despite coordination among area outreach programs, some people still fall through the cracks.  Most of them, unlike Groah, live too far out in the rural county to have access to services.

Davidson said she always hopes to have fresh fruit and produce for Campus Kitchen clients, but it depends on whether donors – including the Washington and Lee University and Virginia Military Institute dining services, Carilion Stonewall Jackson Hospital, and Wal-Mart – have any left over. So getting fresh food to the near-poor is easier said than done.

“There’s this kind of disconnect where we are receiving cakes and donuts and all of these sorts of things from Wal-Mart, and we don’t want it to just go in the trash,” said Davidson. “But we also just don’t want to promote that, so it’s about not giving those sorts of things in excess.”

Groah is an example of why someone who is food insecure is also likely to be unhealthy.

He and his wife Rita, who is deaf, applied for SNAP through social services earlier this year, but were turned down because their income was too high – the couple is currently on disability, and receives health insurance through Medicaid and another source.

But they do qualify for food from a local food pantry run by the Rockbridge Area Relief Association, because they make less than $22,000 a year, or 150 percent above the poverty level for a couple. Rita gets a ride to RARA once a month, where she gets mostly “canned foods and snacks.”

The Groahs don’t own a car. Rita also gets a ride to the grocery store every Monday with someone from the nearby mental health clinic. If they ever need something and don’t have a ride to the store, Mark makes the nearly two-mile round trip from his house to Kroger on foot.

Mark, who grew up in Rockbridge County, weighed 360 pounds at age 24. He realized he needed to go on a diet and gradually got down to 154 pounds. Now, he’s gained some back because of his medication and unhealthy eating habits.

“I’d like to get back in shape again,” Mark said, “start eating healthy foods again.”

But the foods that will help him do that – fish, strawberries, nuts, oranges and apples – are expensive. Recently, he bought exercise equipment cheap from a friend to keep in a room in his house. But a look in the refrigerator reveals eight two-liter bottles of Diet Coke.

“There’s this kind of disconnect where we are receiving cakes and donuts and all of these sorts of things from Wal-Mart, and we don’t want it to just go in the trash,” Jenny Davidson said. “But we also just don’t want to promote that, so it’s about not giving those sorts of things in excess.”

SNAP recipients have more options for fresh produce

LauraJane Baur, manager of the Rockbridge Farmer’s Market, is trying to make healthy eating easier for one group – SNAP recipients.

This is the second season that the market, held every Saturday at the Virginia Horse Center, has accepted the debit-like swipe card that SNAP recipients carry. The move is popular all over the country. According to the U.S. Department of Agriculture Food and Nutrition Service, the number of farmers markets licensed to accept SNAP benefits is increasing steadily.

At the Rockbridge Farmer’s Market, SNAP recipients simply swipe their EBT card – from any state – at the manager’s booth, specify the amount they wish to take out of their account, convert it to tokens and then trade those tokens for food at vendors’ booths. The tokens last week to week, season to season.

However, just as in a grocery store, SNAP recipients are limited in what they can use SNAP money on. They can’t buy certain items, including hot and prepared food, pet food or dog treats, or flowering plants – but they can purchase edible plants like tomatoes or herbs.

“Pretty much anything they can buy in the store, they can buy here,” Baur said.

Although converting SNAP money into farmer’s market tokens is easy enough, the biggest hurdle for local low-income residents is getting there in the first place. The horse center is about three miles from downtown Lexington, seven miles from Buena Vista, and up to 20 miles from the farthest reaches of Rockbridge County.

At the end of April, the Maury Express, a subsidized bus service that serves the two cities and part of the county, added regular Saturday stops at the Horse Center, making it easier for those without cars to access fresh, local food. Baur hopes people pay the 50 cents each way to make the trip.

Baur says the farmers market’s SNAP program was slow starting last year, but she hopes more people will take advantage of the SNAP payment option this season.

Mitch Wapner, co-manager of the Wednesday Farmers Market in downtown Lexington, has followed Baur’s example by applying for a grant to purchase an EBT card machine. The tokens are ready, and Wapner hopes that the machine is up and running within the next two months. He says there has been no resistance to the idea of accepting SNAP.

“Vendors are on board,” Wapner said. “I think everyone sees the importance of getting access of good food to everybody.”

But hundreds of Rockbridge area residents still don’t have regular access to fresh produce at either grocery stores or farmers markets. Even for those who qualify for SNAP, the lack of transportation is a crippling problem. The Maury Express serves almost none of the rural parts of Rockbridge County.

An inside look at Mark Groah's refrigerator. He qualifies for food pantries, but not for SNAP, and often has trouble accessing healthy foods. (JESSICA STRAIT)

The result is that families who are low-income or near-poor often turn to the cheapest and most accessible option – unhealthy but filling foods.


Obesity epidemic

It’s no coincidence that many of the Rockbridge area residents who suffer from obesity or diabetes are also poor or near-poor. That’s because it’s the inexpensive, unhealthy foods that can best keep people full.

“As incomes go down, starches go up,” said Andy Wolfe, a board member of  Community Table, an organization that offers a hot meal to area residents – whether or not they can pay – once a week in Lexington.  “And it’s a matter of feeling full, without necessarily being healthy about it. You know a potato can go a long way, and it can either be your friend or it can be your enemy.”

Laura Simpson, Rockbridge Area Free Clinic health assessor, agrees. It’s not just more-readily-available convenience store snacks and fast food that are the problem, she said. The free and reduced-price school lunch program often has to rely on cheap calories.

“You know, you can drink a soda and you can eat French fries and chicken nuggets and you can consider yourself fed, but really all that happens is that you just made yourself fatter,” Simpson said. “You’re still not very healthy, you still haven’t given your body the nutrients that it needs.”

Unhealthy foods can be found at any grocery store, on any aisle. But at convenience stores way out in the county that serve as primary grocery stores for residents who are unable to drive to larger supermarkets in town – if they don’t have a car or can’t afford gas – cheap, unhealthy foods might be the only real option.

Simpson recalled her recent visit to a Glasgow-area convenience store.

“The produce consisted of a bin of rotten bananas, a big bin of rotten potatoes, and in the cooler section there was one bag of carrots, a bag of celery, maybe a couple apples, and some onions,” she said.

The lack of access to healthy food has become especially apparent in student obesity rates in the Rockbridge area.

Kim Wheeler is the nurse for Buena Vista’s four schools – Enderly Heights Elementary, Kling Elementary, Parry McCluer Middle School and Parry McCluer High School. This is the second year that a Buena Vista school nurse has calculated students’ body mass index (BMI), a measure that uses height and weight to determine if they are overweight or obese.

For children, BMI is interpreted using charts for age and gender that rely on percentiles. For example, a BMI of 18 is healthy for 10-year-old boy, but a BMI of 21 is overweight and a BMI of 23 is obese.

In fall 2011, more than half the kids in the elementary schools, four in 10 at the middle school, and one-third of the high school students were obese.

The statistics are an improvement from fall 2010, when the average of the two elementary schools’ overweight and obesity rate was 88 percent.

Wheeler attributes the decrease to district-wide changes, including switching out what is offered in the vending machines, and baking cafeteria food instead of frying it.

County schools also measure BMIs, but for the most part they have lower rates of overweight and obese students. In fall 2011, 10 percent of Natural Bridge Elementary and Central Elementary students, 8 percent of Fairfield Elementary students and 15 percent of Mountain View Elementary students were overweight or obese. Maury River Middle School had 39 percent overweight or obese, and at Rockbridge County High School 37 percent had unhealthy BMIs.

Matthew Crance, a physician’s assistant at the W&L health center who grew up in the Rockbridge area, still sees a huge problem. He did a two-year rotation in pediatrics locally a few years ago.

“That was pretty eye-opening, seeing a six year old who weighed 100-plus pounds,” Crance said. “The parents just weren’t well-educated on how to deal with a child who is requesting these foods over and over again, and out of convenience, they were giving the child whatever he wanted.”


Education is key

Another roadblock to eating healthy is lack of education. Even if Groah doesn’t often act on it, he is more aware than a lot of Rockbridge residents about how important it is to eat well.

“Most people don’t really have a good understanding of nutrition,” said Holly Otsby, of   Carilion Stonewall Jackson. “We try to make it easier.”

Otsby, in charge of community outreach at the hospital, was on hand at the recent Rockbridge Fun Day with visual aids to show people the difference between five pounds of fat and five pounds of muscle. Rockbridge Fun Day featured booths set up in the Rockbridge County High School parking lot to teach people about healthy eating and exercise.

Katy Datz, communications manager at the Rockbridge Area Free Clinic, says the clinic tries to educate its low-income patients about nutrition when they come in for appointments. The clinic also provides a dietician every now and then for the diabetes group, and recently planted a community garden outside that anyone can use.

RARA, the local food pantry, also recently added a diabetic section to its food shelves to encourage diabetes sufferers to make healthier food choices.

But some parents still don’t know any better. Buena Vista schools sent home letters that explained the BMI process to parents and invited them to call Wheeler for more information.

Wheeler said that in the two elementary schools, totaling 357 students, only 15 parents called her to request their child’s BMI.

“A lot of parents just don’t care,” said Wheeler. “Or they don’t check the messages or their child’s book bag.”

Simpson acknowledges that even if all low-income people had ready access to healthy food, obesity would still be a problem. The habits of generations die hard.

“I would say many people in the county, you could hand them a box of vegetables and they don’t do vegetables,” Simpson said. “They do meat and potatoes and soda; that’s just their culture.”