Philadelphia Medicine Fall 2021 - 20

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FEATURE continued
as the habits and the type of nutrition you consume from a very
young age.
The biggest challenge, of course, is food insecurity, or what we
used to call " hunger, " and the availability of nutrition and affordable,
healthy options for individuals in the community. For people living
in poverty, there is often very limited access to healthy, fresh food
options.
From visiting many different communities across Philadelphia,
I have noticed the price differences for similar fruits and vegetables
in an urban grocery store or produce market versus a suburban
supermarket or farmers market. Sometimes the prices can be as much
as three times more expensive in urban communities.
I am very concerned about how COVID-19, as well as inflation of
consumer staples, is impacting our communities, especially families
already experiencing poverty and food insecurity.
14.4% of families experienced food insecurity in 2019. Feeding
America projected that a 30% increase happened last year, resulting
in almost 1 in 5 Philadelphia families being affected by this.
Dr. Rao: The last 18 months have been very hard on families
trying to maintain employment, working from home, supervising
children's education at home and caregiving of family members.
The American Psychological Association's Stress in America survey
tells us that 42% of Americans have gained more weight during the
COVID-19 epidemic. On average, they gained 29 extra pounds.
The survey also says that a quarter of Americans are drinking more
alcohol than before as a way of coping with their stress.
Because of different social determinants of health, many families
are using results from the Diabetes Prevention Program (DPP) to
implement great treatment plans for prevention of diabetes, which
may or may not include medications but for sure aim for modest
weight loss, which can go a long way.
In the current environment with COVID-19 and
rising inflation also impacting food costs, how is this
disproportionately affecting impoverished communities
in Philadelphia?
Dr. Gadegbeku: Obesity has a direct correlation with socio-economic
status in minority communities, where the residents have
lower education, and in families where the members have a history
of being overweight and having obesity, even as children. This is
especially true for women. According to the National Health and
Nutrition Examination Survey (NHANES) data by the U.S. Centers
for Disease Control and Prevention, their obesity prevalence increases
as income decreases, while it is the opposite for non-Hispanic Black
and Mexican American men.
I bring this up because your ability to respond to the obesity
epidemic is related to what's available in your community, as well
20 Philadelphia Medicine : Fall 2021
are challenged to maintain healthy eating patterns. This results in
relying upon fast foods, and foods with heavy preservatives and
additives. On top of this, inactivity leads to a positive calorie balance,
which is a very difficult cycle to break when you are not having a
steady income, experiencing job changes and live in a neighborhood
with food deserts which, unfortunately, is very common in our city.
Rising food prices certainly does not help these families.
The healthy corner stores and other initiatives led by The Food
Trust, local government and others have made great improvements
in this area, but about a quarter of Philadelphians continue to live
in food deserts.
Dr. Gadegbeku, how are your patients in your family
medicine practice at FIGHT Philadelphia impacted
by social determinants of health in their ability to
prevent obesity?
Dr. Gadegbeku: Social determinants of health are extremely
important to this issue. If we are to address obesity, we need to think
outside the box and manage or address these underlying factors.
I alluded to mental health issues and trauma earlier. These are
some of the most common issues that I am seeing in my office at
FIGHT Philadelphia. I feel that almost across the board with most
of my patients who are dealing with either obesity or obesity-related
In Philadelphia,
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