In early 2015, Feeding America partnered with the University of California San Francisco (UCSF) and the Urban Institute (UI) to conduct a 2-year randomized controlled research study of food bank interventions on outcomes for people living with type 2 diabetes. The trial – titled “Feeding America Intervention Trial for Health – Diabetes Mellitus” (FAITH-DM) – builds on the findings from a previous study that showed improvements for people living with diabetes who participated in similar food bank programs.
The main findings from FAITH-DM were recently published in the American Journal of Public Health, highlighting key results and underscoring the importance of food bank work, the value in food bank – healthcare partnerships, and the need for research into the health implications of food insecurity.
The FAITH-DM intervention lasted six months and included healthy food packages, Diabetes Self-Management Education classes, blood sugar monitoring, and referrals to primary care. Participants were randomly assigned at enrollment to the “intervention group” (immediate participation), or the “control group” (a six-month wait period where participants received “regular” services, followed by a modified FAITH-DM intervention).
So, what did we learn?
First, we saw that FAITH-DM participants in the intervention group had significant improvements in dietary intake, tradeoffs between food and diabetes supplies, and food security. This is the first rigorously conducted study of which we are aware that demonstrates food banks can improve food security for the people they serve. The food bank intervention also supported participants in improving diet quality and reducing tradeoffs, indicating the positive impact these programs have on freeing up household resources and supporting financial stability.
Second, we did not see any differences between the intervention and control groups in any clinical outcomes, including blood sugar control (HbA1c), depression, or hypoglycemic (low blood sugar) events. A few factors may be at play. The intervention may not have been comprehensive or lengthy enough to impact clinical outcomes. Providing additional diabetes appropriate food without facilitating clinical visits (for medication adjustments) or expanding the diabetes education program (to provide more intensive support) could have blunted improvements in blood sugar to which improved food security and dietary intake may have contributed.
However, intervention group participants who fully engaged in the project did see significant improvements in blood sugar control, suggesting that the intervention might be more broadly effective if barriers to engagement are fully addressed.
Last, we learned that food banks and healthcare organizations need to invest in partnerships with tight linkages and feedback loops to be effective in addressing social determinants of health and improving outcomes. Food banks have a critically important role in addressing the food security and nutrition of vulnerable populations. But, food banks can’t alone shoulder the burden to improve health outcomes, and healthcare needs to better engage with patients – especially in vulnerable populations.
This study and the lessons we learned from it would not have been possible without the support of our partners, the tremendous efforts of the three project food banks (ACCFB, GCFB, HFB), and the participation of the 568 adults who generously shared their time and experiences during FAITH-DM.
While FAITH-DM activities have concluded, our analysis has not. Over the coming months, we will continue looking at additional outcomes and the impact of the intervention on aspects related to healthcare utilization. Stay tuned.
Addressing social determinants of health is complex work that doesn’t end with a simple solution to improving health. Feeding America’s commitment to rigorously studying and evaluating how food banks can support and improve outcomes for the people we serve contributes to the evidence base and advances our collective knowledge on how best to design effective programs.
Morgan Smith is the Interventions for Health Manager on the Community Health & Nutrition team at Feeding America. He oversees Feeding America’s health research projects on food insecurity and chronic disease, focusing on diabetes management and prevention. His work also includes supporting food banks in building partnerships with healthcare organizations, and he helps to manage Feeding America’s relationships with several national health and wellness organizations.