Monday, January 18, 2010

Food Banks

On Vancouver Island, the number of people in food bank line-ups has increased dramatically in the past year due to the state of the economy. As the numbers increase, often the amount of food and quality of the food decreases unless a community has the resources to continue to provide enough food to meet the demand.

One of the greatest criticisms of food banks is that the food given out is not nutritious. For most food banks, due to inadequate storage space, especially refrigeration, it is difficult to give out anything perishable. Fresh fruit, vegetables and dairy products cannot be stored in large enough volumes to meet the growing demand. Consequently, food banks generally store canned fruit, canned vegetables, canned meats, and peanut butter, along with staples such as flour, sugar, coffee, tea, and grains including rice, pasta and rolled oats. Boxed dried foods like macaroni and cheese dinners, instant soups and dry cereals are also common.

In 2007, a local food bank asked me to work with them to review the foods given out and to help develop a menu system that would provide about two days worth of food according to Canada’s Food Guide. This would be especially important for the children that they were serving. We started with Canada’s Food Guide and planned how we could at least partially meet the needs of each family member based on the number of servings from each food group for a specific age. To simplify bagging the groceries, we planned to have only two types of bags. One was an adult bag, the second was a child’s bag. The family would receive one bag for each family member based on their age.

We planned a one-month menu and factored in that the food bank operates once per week. In the past, the food bank gave out a bag of donated unrelated tins and boxes of food items and there would sometimes be nothing in the bag that would combine to make a meal. To correct this, food was purchased so that each bag on a given day would be identical. For example, if pasta was given, the bag would contain the sauce with which to make a meal. If there was cereal, it was given on the day milk was available. Recipes were also included.

Another nutritional improvement was the realization that for the price of a can of vegetables, a greater quantity of fresh produce could be provided. Every week, families would get a bag of something fresh. These usually included less perishable items such as potatoes, onions, carrots, apples, oranges or bananas. Produce was delivered the day before it was needed and filled the hallways of the food bank. It was all given out the next day so there was no spoilage.

As the food bank management team became more aware of the nutritional needs of the clients they were serving, there was a greater willingness to spend a litte extra to meet these needs. For example, the need for extra vitamin D in the winter months was met with an extra milk budget so that the adults would also get some milk as prior to this, only children received milk. The amount of canned fish was also increased.

Another wonderful improvement in the quality of food for this food bank was the offer of fresh produce during the summer months. For the past few summers, a community garden has been grown with most of the produce delivered to the food bank on a weekly basis. This is a community partnership where the land was donated by a private business and the garden was planted, tended and harvested as a job skills program. On food bank day, the donated produce is placed outside the food bank on the street like a market stand and clients are asked to help themselves. At the end of the day, the boxes are empty.

This past summer, the town decided to grow lettuce and spinach instead of flowers in the municipal flowerbeds. At the first harvest, over 60 pounds of greens were put out on food bank day. Since then, a gleaning program has been started and whole orchards of produce have been donated. On food bank day, locals deliver any unwanted produce to be put out on the street in front of the food bank to fill the market stand. Surplus gleaned produce goes to a pregnancy program and to families at a toddler play program in the community.

In spite of a 30 % increase in the number of clients over the past year, this small town food bank continues to be able to meet the needs of their clients due to the generosity of the community and some careful planning with attention to good nutrition. Working together with the community to problem solve food shortages may bring some surprising solutions from unexpected sources. Preparing this article has provided me with a wonderful opportunity to invite discussion about some of the great solutions that must be happening all across Canada.


Eileen Bennewith, RD
Community Nutritionist
Vancouver Island Health Authority
Child, Youth and Family Programs
Nanaimo, BC
T: (250) 739-5845 ext 57561

Monday, January 4, 2010

Nutrition Education at the Retail Pharmacy

London Drugs is a major pharmacy retailer with 73 stores located throughout Western Canada. Of their large team of pharmacists, a number receive specialized training to attain the designation of Patient Care Pharmacist (PCP). PCPs use their knowledge and skills to provide additional services such as health clinics covering a variety of topics such as heart health, osteoporosis, diabetes, asthma, smoking cessation, and sun care. All clinics include customer assessment and education. Assessments are frequently aided with medical devices such as a blood pressure monitor or blood cholesterol meter for heart health, or a bone densitometer for osteoporosis clinics. Outputs from the device and information gathered during the health interview enable PCPs and customers to have a meaningful health conversation.

Ongoing customer interest in nutrition issues, particularly weight loss, prompted an exploration of a suitable clinic. I was part of a team of registered dietitians, pharmacists, a medical doctor, and marketing personnel tasked with creating this new clinic. We decided that weight loss per se was too complex a health challenge to adequately tackle and wanted to take a healthy lifestyle approach instead. With this in mind, we determined that body composition analysis would be a suitable assessment tool. We selected a stand-on scale that provided weight, body mass index (BMI), estimated caloric expenditure, body fat, and body muscle. Our team became familiar with the device, its technical outputs, health-related meanings, and its limitations. We felt we could tie aspects of body composition to useful nutrition interventions. We then determined eligibility criteria so as to recruit appropriate customers (i.e., adults with normal/ minimal health issues.) Customers were to be referred to local outpatient or consulting dietitians if their concerns were beyond the scope of the clinic.

We developed a training program for the PCPs that included how to set up and use the device, how to conduct a basic nutrition assessment, and how to help customers set healthy lifestyle goals. The nutrition assessment was based on a specially designed customer diet history form. PCPs were trained to scrutinize the history for meal frequency, adequacy of food groups, and use of high calorie beverages and “other” foods. PCPs were also trained to deliver nutrition messages using Canada’s Food Guide, the “plate method” of healthy eating, and other straightforward, actionable tools. Physical activity was promoted as well. Educational resources were gathered from Health Canada, the Dairy Farmers of Canada, the Heart and Stroke Foundation, and other respected sources.

The clinics were offered over the spring and summer, 2009. Analysis of clinic consultations revealed that customer encounters generally lasted 45 minutes and included body composition analysis, explanation of results, discussion of the diet history, trouble shooting, and goal setting. Follow-up visits were conducted six months after the initial visit. The clinics were well received by customers and PCPs alike. Many found the body composition analysis to be quite revealing and others found the lifestyle assessment an excellent starting point for discussion and goal setting. The PCPs enjoyed delivering the clinics and being able to convey a new health message within their scope of practice. The follow-up visit allowed PCPs to develop rapport with customers and provided positive reinforcement regarding his/ her individual goals.

This interprofessional collaboration created an opportunity for me, a dietitian, to work closely with other health care providers. I was particularly fortunate to learn much more about community pharmacists, their roles, work settings, and scope of practice. Likewise, the pharmacists got to learn about and work with dietitians, a new experience for many of them. Together we determined the appropriate areas of nutrition assessment and education to add to the PCPs previous strengths. This collaboration allowed the creation of a clinic that was custom-made for pharmacists to deliver.

We were pleased to have created a unique service in a unique setting (retail pharmacy) that raised the nutrition knowledge of pharmacists and their customers. The service also raised awareness of nutrition education materials and resources (such as Dial-a-Dietitian and Eat Right Ontario), and promoted the registered dietitian as the expert for more challenging nutrition concerns. Thus, while customer demand for “weight loss” drove the creation of the clinic, we chose to meet that demand with a more holistic message of healthy eating and physical activity.


Barbara Allan, RD
Consulting Dietitian
Richmond, BC