Patient Community Garden
Over the past, almost 15 years, Dr. Jenneffer Pulapaka’s expertise in podiatric surgery has helped thousands of patients. She opened her practice in 2005, DeLand Foot and Leg Center (DFALC), where she currently sees patients. DFALC was the first female podiatric surgeon’s office in a community where less than 10% of the surgeons were women. It is the first and longest-running female surgical practice in West Volusia County. “I believe every patient needs a physician who will be an advocate to help them regain their health”. Her surgical training has taken her to Miami for her residency and the Ilizarov Institute for her fellowship. She was the first certified Women-Owned medical practice in the United States. But, the time for reactionary medicine has ended and a proactive wellness approach with other community physicians is needed. "We need a resource of creative ideas and medical professionals who believe that healthy food matters."
Part of the answer to a healthy life lies in vegetable gardens. Community gardens can reduce barriers to healthy food associated with transportation, cost, and food preference and may increase food security. Diabetic patients, who participated in a community garden had a significant reduction in their HgA1c. Several individuals reported that the gardening efforts contributed to a sense of togetherness within the family or as a place to spend quality family time building relationships. Community gardening activities were an excellent way to pass the time, and bring relaxation, enjoyment, or reduce stress.
Why now? Because the food we eat and how we produce it will determine the health of people and planet, and major changes must be made to avoid both reduced life expectancy and continued environmental degradation.
"More than 820 million people have insufficient food and many more consume low-quality diets that cause micronutrient deficiencies and contribute to a substantial rise in the incidence of diet-related obesity and diet-related non-communicable diseases, including coronary heart disease, stroke, and diabetes. Unhealthy diets pose a greater risk to morbidity and mortality than does unsafe sex, and alcohol, drug, and tobacco use combined. "
" Current dietary trends, combined with projected population growth to about 10 billion by 2050, will exacerbate risks to people and planet. The global burden of non-communicable diseases is predicted to worsen, and the effects of food production on greenhouse-gas emissions, nitrogen and phosphorus pollution, biodiversity loss, and water and land use will reduce the stability of the Earth system."
"We define a healthy diet using food groups while taking into consideration nutritional adequacy because this most directly connects food production and health, and because most dietary guidelines are based primarily on food groups. However, a focus exclusively on food groups does not incorporate added fats, sugar, salt, and other constituents, so these will also be considered. The definition of a healthy diet is based on evidence from controlled feeding studies in humans with intermediate risk factors as outcomes, observational studies, and randomized trials. "
The problem lies with when a medical professional decides they do not want to upset a patient and handle the situation from a friendly standpoint. Dr. Suzuki is the Medical Director of the Tower Wound Care Centers at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo. He is quoted as saying, “I also warn other clinicians to ‘tread lightly’ when they talk about the patients’ weight as it is obviously a touchy subject for overweight patients." Noting he has “had a few patients who got up and stormed out of the exam room when I suggested ‘weight loss’ as a part of comprehensive treatment plans.”
Silence about weight-loss is an unacceptable answer. Dr. W. Scott Butsch is an obesity medicine physician who practices at the Massachusetts General Hospital Weight Center. He has spent more than a decade treating patients with obesity.
"Patients look to their doctors for medical and nutritional advice, and the mere acknowledgment of the body mass index is helpful for the patient’s perception of their weight and to spur more weight loss attempts.
There is a double standard for obesity and it highlights doctors' lack of understanding of obesity and the available treatment options. As a result, patients with obesity are more likely to avoid medical care altogether.
The true disservice is having a physician who doesn’t hear the long-term struggle, the numerous weight-loss attempts, and doesn't investigate reasons for the weight gain."
There is a direct connection between food insecurity and obesity, along with other food-related diseases like diabetes, hypertension, and elevated cholesterol. Some of the contributing causes are not obviously seen.
" Low-income neighborhoods frequently lack full-service grocery stores and 'farmers markets' where residents can buy a variety of high-quality fruits, vegetables, whole grains, and low-fat dairy products. Instead, residents – especially those without reliable transportation – may be limited to shopping at small neighborhood convenience and corner stores, where fresh produce and low-fat items are limited, if available at all. "
" According to USDA, 'vehicle access is perhaps the most important determinant of whether or not a family can access affordable and nutritious food.' Households with fewer resources (e.g., SNAP households, WIC households, food insecure households) are considerably less likely to have and use their own vehicle for their regular food shopping than those households with more resources."
"When available, healthy food may be more expensive in terms of the monetary cost as well as (for perishable items) the potential for waste, whereas refined grains, added sugars, and fats are generally inexpensive, palatable, and readily available in low-income communities."
"The *feast or famine* situation is especially a problem for low-income parents, particularly mothers, who often restrict their food intake and sacrifice their own nutrition in order to protect their children from hunger."
In 2019, we are looking to CSAs to help patients live a healthier life. So what is a CSA? It's an acronym for Community Supported Agriculture, CSA commonly refers to a group whose members receive shares of food from a particular farm (or garden) in their region. Each member is supporting their local agriculture, primarily, not through a retailer or market but directly, and at pop-up community locations to serve the pickup times such as schools, parks, or friendly neighborhood bars.
Dr. Pulapaka and her office team, along with Cress Restaurant, wanted to provide a resource that her patients and other local physician's patients have been missing in the Volusia Health Community. Hence, in the coming weeks, we will begin building a Patient Community Garden that is free with a supporting website that provides links to CSAs, recipes, and discounted vegetable locations in the community.
This is important because patients who become "CSA members" eat more healthy foods and they report increasing their overall intake of fruits and vegetables. They noted a greater diversity of fruits and vegetables and reported trying between one and eleven new vegetables. These patients continued to eat healthily after the summer harvest ended and increased their consumption of winter vegetables.
A universally healthy diet largely consists of vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils, includes a low to moderate amount of seafood and poultry, and includes no or a low quantity of red meat, processed meat, added sugar, refined grains, and starchy vegetables. A community vegetable garden provides healings resources through their food and activities; while being an excellent way to relax and enjoy the Earth. By applying the universal diet, the Lancet estimated that it could prevent about 23.6% of total premature deaths among adults. Quality Food Matters.
