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Food and Nutrition Organization Heals Clients With Food One Meal at a Time

By KC Wright, MS, RDN, LD

Clients and patients living in Massachusetts with critical and chronic diseases and who may be in desperate need of good-tasting, healthful meals aimed at improving their overall health can turn to Community Servings, a Boston-based nonprofit food and nutrition organization that’s transforming lives.

Community Servings delivers medically tailored meals to individuals and families suffering from chronic illnesses. The staff believes food is medicine, and therefore food can heal, especially if it tastes good. To cater to those in need, the organization solicits and receives charitable financial and in-kind donations from corporations, foundations, and individuals.

Creative chefs use their culinary skills to develop and prepare 15 different medically prescribed diets for some of Boston’s most nutritionally vulnerable, of which 38% have diabetes. Then, the three staff dietitians analyze the nutrient content of the various diets and work with the chefs to make any necessary adjustments.

“It is somewhat opposite of what is typical,” in developing nutritionally adequate meal plans, says Valerie Machinist, MS, RDN, LDN, manager of nutrition services at Community Servings. “Our chefs have incredible talent, and our nutrition team helps them modify their recipes or develop new ones,” Machinist says.

The organization’s concept appears to be working. Research published in the April 2018 issue of the journal Health Affairs showed that clients of Community Servings who received tailored nutritious meals had fewer emergency department visits and inpatient admissions and reduced medical costs compared with controls.

“We have countless stories of clients who’ve dramatically lowered their hemoglobin A1c (HbA1c),” Machinist says. “And having proportioned meals for those who are overweight has made a big impact on their health.” Machinist recalls a newly diagnosed client with an HbA1c of 12.1%. After six months with Community Servings, the client’s HbA1c decreased to 7%. “Our goal is to get people healthier so they don’t need our services,” Machinist says.

Founded in 1990 to deliver dinners to individuals struggling with HIV/AIDS, Community Servings has evolved from a neighborhood program to a regional service providing five days’ worth of two nutritious meals to 2,300 people each year who can’t shop or cook for themselves due to critical illness.

Beth Kitzis, RDN, LDN, one of the three staff dietitians, says HIV/AIDS clients remain a significant population in need beyond weight loss, as diabetes risk is a side effect of its prescription medications.

Machinist says 94% of clients live below the poverty line, but income isn’t an eligibility factor. Rather, services are based on medical necessity for any individual who’s nutritionally vulnerable. According to Jessica Geist, RDN, LDN, the third dietitian at Community Servings, each client is reassessed every six months to determine eligibility to continue receiving meals. If their mobility and/or their HbA1c and blood glucose levels normalize, the client is no longer eligible to receive services.

For those who do receive services, Geist, Kitzis, and Machinist assign diet prescriptions based on client referrals. In response, Community Servings prepares and delivers 650,000 medically tailored meals each year. At any given time, the organization has a wait list of 100 to 150 people. To accommodate the number of people served, Community Servings is undergoing a $21 million, 32,000 square foot kitchen expansion renovation project to triple meal production.

The Meals
The standard meal Community Servings offers is the Wellness diet, which is low in sodium and saturated fat and targeted to meet two-thirds of an average 2,000 kcal daily diet. To facilitate production, the remaining diets, including diabetic, cardiac, renal, vegetarian, mild (low in spice and acid), low fiber, low lactose, high calorie/protein—are customized from the Wellness diet. The diabetes meal plan includes nutrient-dense carbohydrates and is lower in sugar and high in vegetables. According to Machinist, the difference between the Wellness diet and the meal plan for diabetes is that there are fewer starchy vegetables and starchy soups. Overall, the diabetes meal plan provides between 160 and 180 g carbohydrate daily.

Executive Chef Kevin Conner oversees the preparation of 4,000 meals per day, which are packaged, frozen, and delivered to clients weekly by a dedicated transportation staff. Machinist says most of the food is made from scratch: “It’s a rare exception when it’s not.”

Meal ingredients are sourced from a combination of purchases, donations, and fresh, local food vendors. In fact, from June to October, area farms donate about 50,000 lbs of produce seconds, which is unused, edible produce that avoids food waste. A crew of 50 to 75 volunteers works to help process the produce, cutting around bruised or cosmetically inferior fruits and vegetables. Geist recalls a recent donation of 600 lbs of butternut squash, and says these donations enable the chefs to create new recipes regularly.

To reinforce food safety, the RDs train the kitchen staff and volunteers on personal hygiene and sanitation. They also educate workers about each diet and show them exactly what should go into every meal bag for delivery. Beyond the flavorful, nutritious meals clients receive, the RDs provide extensive nutrition education through workshops, phone consults, site visits, and a monthly newsletter in addition to other independent projects.  

Client Education
Kitzis piloted a four-series monthly diabetes education class via telephone since many clients are either limited in mobility or don’t have reliable transportation. The 16 clients who participated were given practical tips on how to manage their diabetes amid real life daily challenges, such as reading food labels, preparing simple meals, or making healthful food swaps at restaurants. Kitzis received positive feedback from those clients who evaluated the class as a good adjunct to their regular services.

Each year during the growing season, a local farm donates several community-supported agriculture (CSA) shares to Community Servings for its clients. In addition to this, the RDs provide weekly food demonstrations of various recipes using some of the CSA food, “weaving in nutrition information and health benefits,” Kitzis says. Winter nutrition education classes can run the gamut from a culturally related food theme to a discussion on the importance of minimizing food waste.

Community Servings has helped to strengthen the importance and efficacy of the food as medicine initiative—25% of its client base receives coverage from six different health care providers. With good food for a good cause, Machinist says the organization “feels universally like a good place to work.”

What Kitzis finds most satisfying about her work is the ability to give clients the nutrition intervention she’d tell them about in a more traditional job. And what Geist likes best about working with Community Servings is her ability to engage with her clients and the community at large compared with her previous work in an ICU where she couldn’t interact much with her patients. Geist says, “If our meals are not appetizing, no one will eat them; we want food to heal.”

— KC Wright, MS, RDN, LD, maintains a nutrition communications practice based on her research and clinical experiences. She advocates for good food and sustainable food systems at www.wildberrycommunications.com.