Tackling the built environment to alleviate food insecurity among the poor with diabetes in Lake County, IL

BeWell Lake County (BeWell) is an evidence-based multidisciplinary clinical program for adult patients with Type 2 Diabetes receiving primary care at the Lake County, IL Health Department and Community Health Center (CHC) in North Chicago, a food desert. BeWell is their medical home and stresses lifestyle and behavior change. BeWell began in 2009, when CHC's academic partner, NorthShore University HealthSystem (NorthShore) initiated funding for BeWell team and in-kind subspecialty care. Responding to the economic downturn, clinical staff began screening all BeWell patients with the US Department of Agriculture Food Security questionnaire. Results from the first 273 patients, half of whom were obese, showed that 59% were food insecure, including 21% with hunger. Food security was not related to race-ethnic background, gender, age or body mass index (BMI). Food insecurity was not related to diabetes control as measured by hemoglobin A1C in multivariate models controlling for demographics, BMI and years with diabetes. Food insecurity was related to higher diastolic blood pressure and more symptoms of depression (PHQ9). Food insecurity, including with hunger, was extremely high in the BeWell population. Further work tests the relationship of food security to diabetes morbidity. Given the emphasis on controlling diabetes though healthy eating, BeWell now operates a seasonal community garden in partnership with area food banks and others to distribute produce. The food bank is evaluating the feasibility of distributing diabetes-appropriate food boxes year round. Proactive screening for adequate food resources is essential and patient care partnerships should be broadened to include the built environment.