- Author: Mike Hsu
The buzz or chirp of an incoming text message started some San Diego County residents on the path to a healthier diet during this past year. In September 2020, most CalFresh participants in the county – more than 172,000 households – began receiving monthly text messages about the benefits of California-grown fruits and vegetables as part of a pilot program.
This novel approach to delivering nutrition messages to California food assistance program participants was developed by a partnership of the Nutrition Policy Institute of UC Agriculture and Natural Resources, the UC San Diego Center for Community Health and the County of San Diego Health and Human Services Agency, which administers CalFresh in the county.
The HHSA, which had been using its text messaging platform to send administrative reminders and alerts, was receptive to using the tool for sending nutrition-focused information. NPI and CCH partnered with ideas42, a firm that applies behavioral science to solutions for social change, to develop a series of five text messages promoting California-grown fruits and vegetables.
The text messages – originally delivered in English and Spanish, with the addition of Arabic beginning in July 2021 – were friendly and conversational in tone.
“In a text, you have very few characters you're communicating with people, so we wanted to make sure we were using cutting-edge behavioral science to construct those messages to have the most impact,” said Wendi Gosliner, NPI senior researcher and policy advisor.
Each text included a link directing recipients to a website developed as part of the project, with information on selecting, storing and preparing California-grown fruits and vegetables; health benefits; tips to reduce food waste; and recipes – including TikTok videos.
Initially running from September 2020 to March 2021, the pilot program was well-received. Nearly 90% of CalFresh participants responding to a survey said they appreciated receiving the texts. “It is very important for us to eat healthy, to teach our children to eat healthy,” wrote one participant. “I love the recipes…they're so delicious and easy to make…I'm very, very grateful for the help because without you guys, I would be struggling more and I just want a better life for my children.”
Gosliner said it was encouraging to see that two-thirds of the approximately 5,000 survey respondents reported eating more California-grown fruits and vegetables after receiving the messages, and 85% expressed a desire to see more texts.
“What we see is that there's definitely a decent-sized population of people participating in CalFresh –now this is just in San Diego County but imagine the entire state – who would benefit from having this kind of information available to them,” Gosliner said. “And there is at least a subset of people who really liked it.”
UC San Diego's Center for Community Health was instrumental in facilitating the partnership between UC ANR and the HHSA. Further, CCH, in partnership with the San Diego County Childhood Obesity Initiative, formed a community council composed of residents representing diverse communities throughout San Diego County. Together, the council facilitated CalFresh participants to take part in focus groups, which provided feedback and guidance on the messaging and design for online resources. Gosliner said the success of the text program has been a direct result of community input and involvement.
“The Center for Community Health-led focus groups were integral to ensuring CalFresh resources were accessible and informative to a wide range of CalFresh participants, and local individuals and families more broadly,” said Blanca Meléndrez, executive director at the UC San Diego Center for Community and Population Health, Altman Clinical Translational Research Institute. “In the process, the text-based campaign also placed a greater focus on the local production of nutritious fruits and vegetables, ensuring access to healthy and nutritious food in all communities, and building new streams of income for the region's farmers and producers.”
This effort also suggests a simple way to reach CalFresh participants and bridge gaps between the Supplemental Nutrition Assistance Program and programming that offers nutrition education and healthy eating resources.
“By combining UCSD and UC ANR knowledge about healthy eating with our outreach capability, we are able to reach thousands of families via text message each month,” said Michael Schmidt, human services operations manager for the HHSA. “With the click of a button, these families are provided with resources to assist them in making healthier lifestyle choices, supporting a region that is building better health, living safely and thriving.”
The effort has been so effective that HHSA has asked for additional messages, beyond the original five months' worth of texts and resources.
“The partnership between UC ANR's Nutrition Policy Institute, UC San Diego's Center for Community Health, the County of San Diego Health and Human Services Agency and San Diego County community residents brought together a great team to develop an innovative, technology-based intervention,” said Shana Wright, San Diego County Childhood Obesity Initiative co-director at CCH. “Each partner provided knowledge, resources and assets that enhanced the project beyond the initial pilot phase, exceeding preliminary expectations.”
Gosliner said the pilot program has been a “great example and wonderful experience” of partnership in action.
“You can sit with your research or program ideas for a long time but if you don't have people who can help you implement them, then they really aren't helpful in any way,” she said. “In this case, it was just a nice combination of an idea…with partners who wanted to work to make something happen.”
Contrary to the messages we are exposed to from popular culture, media, and public health about body size, focusing on how much a person weighs isn't necessarily an effective way to promote health. These messages play a role in reinforcing what some call “diet culture” and others have called “anti-fat bias.” Diet culture associates weight loss and thinness with health despite mounting evidence of the negative impacts of dieting. Anti-fat bias can persist in workplace, healthcare, and educational settings, threatening both the emotional and physical health of obese or overweight individuals.
Research is showing that weight is not a reliable indicator of an individual's health nor is a weight-centric approach helpful in improving overall well-being. Weight-centric, or weight-normative, approaches emphasize weight, body mass index (BMI), and weight loss as positive indicators of health and well-being. This type of approach values thin body types over others and can have negative consequences such as weight stigmatization, discrimination, and body dissatisfaction; consequences that are associated with weight gain, unhealthy eating behaviors, and depression.
While some weight loss interventions may reduce weight or improve health metrics in the short term, these interventions typically involve other behavioral changes such as increasing physical activity or changing eating patterns which make it difficult to attribute the cause of health improvements. Is the improvement in health due to the reduction in weight or to the increase in physical activity?
Also, while some people on weight loss diets lose weight in the first year, if followed for more than one year, people in peer-reviewed studies typically regain most of the weight back within the following five years. Repeatedly losing and regaining weight, or weight-cycling, increases the risk of heart disease and high blood pressure and is an independent risk factor for poor health outcomes, even in normal-weight individuals. Studies reveal that losing and regaining weight may be worse for a person's physical and psychological health than consistently staying at a higher weight.
Due to the issues with long-term ineffectiveness of weight-centric interventions, and increasing recognition of the relationship between racism and anti-fat bias, there is a need to shift focus to weight-inclusive or weight- neutral approaches. Weight-inclusive or weight-neutral approaches emphasize improving access to health promoting resources and reducing weight stigma. Studies have shown numerous health benefits, even in the absence of weight loss, are achievable and sustainable in the long-term using a weight-neutral approach.
One example of this approach includes Health at Every Size (HAES). HAES principles promote the acceptance of body diversity, intuitive eating not focused on weight control, support for policies that equalize access to resources, respectful care towards ending weight discrimination, and inclusive physical activity. Weight-inclusivity does not promote the message that everyone, in every body size, is healthy. What it does promote is that everyone, regardless of their body size, can be working on health-related goals without focusing on changing their body size.
Weight-inclusive approaches that are rooted in a social justice and systems-oriented framework can powerfully acknowledge the social and political roots of health inequities. To be most effective, and to avoid other forms of stigma or shame, these approaches should consider the influence of life factors such as poverty, discrimination, stigma, and job insecurity and how these factors constrain or support health behaviors and personal choice.
Research spanning the last decade has been showing that the HAES approach is associated with improvements in blood pressure, health behaviors, self-esteem, and body image and has done so more successfully than weight loss treatment. Further, studies show that interventions that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress. Results from literature reviews favor the promotion of programs that emphasize a non-restrictive pattern of eating, body acceptance, and access to health promoting resources rather than weight loss.
There is a growing body of research showing that HAES and weight-inclusive approaches are better able to address overall health and wellness than focusing on BMI or weight reduction. Shifting focus away from weight loss, thinness, obesity prevention, and looking a certain way to achieve better health could potentially make us a healthier and more equitable society. Despite these movements being met with hesitation, weight-inclusive approaches have been demonstrated to be effective health promoting strategies.
Shifting the focus of health interventions away from losing weight as an end goal is not new and it doesn't even have to be that revolutionary. Many of the governmental recommendations to be physically active and follow a balanced diet following the Dietary Guidelines for Americans that UC ANR nutrition programs and CalFresh Healthy Living, UCCE programs teach in communities across California could be used in either a weight-centric or weight-inclusive approach. In our San Luis Obispo & Santa Barbara county nutrition programs we have advocated for books to be removed from curricula if they promote anti-fat bias and have started making changes in how we talk about our work to prevent chronic disease and promote health instead of preventing obesity. Still, the idea of obesity and overweight as the central concern for public health and popular media has stayed with us longer than has proven necessary or effective for actually improving the health of individuals and society.
Do you have unconscious bias toward overweight or obese people? Consider taking the Harvard Implicit Association Test for Weight.
- Author: Pamela Kan-Rice
The University of California Cooperative Extension and its community partners have received nearly $500,000 from the California Department of Food and Agriculture to expand farm to school projects. The CDFA Office of Farm to Fork's 2021 California Farm to School Incubator Grant Program has awarded $8.496 million in grants to 60 farm-to-school projects throughout the state, including the following two UC Cooperative Extension projects.
Tuolumne Agricultural Connections Project
UC Cooperative Extension in the Central Sierra received $248,457 to work on the “Tuolumne Agricultural Connections Project” with Jamestown Elementary School District, Office of Tuolumne County Superintendent of Schools, Mother Lode Regional Juvenile Detention Center, Tuolumne County Sheriff's Office and local farmers.
UC Cooperative Extension Central Sierra will work with the sheriff's office to expand an existing farm education center on land owned by the county detention center, to provide educational opportunities for public school students and juvenile detention center students.
“We're really excited to offer more learning opportunities for young people in Tuolumne County,” said JoLynn Miller, director of UC Cooperative Extension in the Central Sierra. “At the farm, we will be able to teach students about growing food with hands-on activities and field trips and provide incarcerated residents with job training.”
UCCE and the Sheriff's Office plan to start a sustainable egg-laying operation to supply public schools and other public institutions with locally produced eggs. At the juvenile detention center, UCCE will provide monthly gardening and cooking lessons to juveniles. UCCE also will support school gardens through the School Garden Network and expand Harvest of the Month education and tastings to more public schools and to the juvenile detention center. School food service directors will get help increasing procurement of California-grown foods for their menus to reinforce the Harvest of the Month education. Through Kids' Day at the Market events, they plan to introduce public school students to farmers markets as places to buy healthy foods.
Local sourcing of food across Los Angeles
In Los Angeles County, the Urban and Environmental Policy Institute at Occidental College received a $250,000 grant. Occidental College is partnering with Los Angeles Unified School District, Los Angeles County Office of Education, Adventist Health Glendale Foundation, Big Green, Enrich LA, Garden School Foundation, Los Angeles Food Policy Council, National Health Foundation, Sage Garden Project, Seeds to Plate, Sustainable Economic Enterprises of Los Angeles and UC Cooperative Extension in Los Angeles County.
The “Farm to Classroom: Sourcing Local for Farm to School Education Across Los Angeles” project will help farm-to-school educators purchase fresh produce from local farmers markets for in-class taste tests, garden lessons and recipe demonstrations. They will also offer teachers farm-to-classroom educational materials on food systems, farmers and agriculture, featured produce items and nutrition.
"We are thrilled and excited to be a partner on the project,” said Keith Nathaniel, UCCE director and 4-H youth development advisor in Los Angeles County. “Cooperative Extension in Los Angeles County is poised to provide quality educational materials that support the farm to school learning continuum for young people. Cooperative Extension will continue to build on its expertise to develop relevant impactful materials designed to engage learners to meet their educational outcomes."
A “Los Angeles Harvest of the Month” calendar will be designed for Los Angeles Unified Food Services and be available to others in Los Angeles County to use. The calendar will feature local produce items that are highlighted in the educational materials and available to buy through a purchasing app. Coordination between school food services and teachers will help Los Angeles Unified align their lessons and garden planting schedules with foods offered in the cafeteria. The project team plans to launch a pilot of the program at select Title 1 schools, then analyze evaluation data from the pilot program and modify the program model as needed before sharing it with farm to school educators across LA County and offering an accompanying training.
The California Farm to School Incubator Grant Program focuses on supporting local and regional farm to school projects that promote nutrition education, sustainable food production and procurement, and high-quality student engagement through experiential learning.
- Author: Deepa Srinivasan
- Contributor: Mariana Lopez
Lin Fraker graduated from the Expanded Food & Nutrition Education Program in Tulare County after completing the four-week virtual curriculum, UCCE Connects 2U. Online classes were led by Mariana Lopez, UC Cooperative Extension nutrition educator.
After participating in the plan, shop and save lesson in the second class,Fraker shared that she had made a grocery list and found that it helped her save money when she went grocery shopping. She had never made a list before, and when she planned her week's menu and made a grocery list, she saw that her usual bill of almost $200 per shopping trip went down to $89! Even making small changes in grocery shopping practices can make a big impact.
In the video below, Lopez converses with Fraker, who expresses her enthusiasm for the EFNEP class in Tulare County and wants to share the information with her mother-in-law to improve her health.
- Author: Ricardo A. Vela
The CalFresh Healthy Living, UC Program, administered through UC Cooperative Extension (UCCE), works with ethnic communities to transform their environment by implementing a community garden. UCCE created three gardens in partnership with community organizations in an equal number of neighborhoods located in this populous county.
In the first one, adults and minors dug and planted seeds and various vegetable plants in a community garden located in Riverside's popular Latino neighborhood. The vegetable garden has brought people in this low-resource community together to address healthy food access and learn about healthy eating and nutrition.
Gonzalo Rodríguez, an active member of the Community Settlement Association, said, "We planted pepper plants, tomatoes and little seeds. Vegetables are an excellent food for us, and another thing that keeps children off the streets and helps them understand the process while having fun taking care of their plants."
The garden in this thriving Latino community has grown over the years and is now a place for families to get together to celebrate healthy living. Educating food-insecure families of different ethnicity, the importance of having a vegetable garden, and how to grow your own food is a goal of the CalFresh Healthy Living, UC Program, and UCCE in Riverside County.
The second garden is located on what used to be a vacant lot in the Riverside Faith Temple under Pastor Duane Sims' supervision, who spoke about his vision. "I would like to see it a complete food force, a source of food that won't cost anybody anything, and something for people that don't have anything to do, a place to put their hands in the dirt and accomplish something."
These community gardens collaborate with several programs from the University of California Agriculture and Natural Resources and partner with ethnic organizations to combat the poor eating habits that result in obesity, chronic diseases, and sometimes premature death.
"We're trying to get low-income families to eat more vegetables, and the best way to do this is to encourage them to plant their own fruits and vegetables in an orchard, and that's why we're promoting community gardens," said Chutima Ganthavorn, UCCE nutrition specialist in Riverside County.
Adela Torres and her children are involved in the project with the Community Settlement Association in Riverside. "It's beneficial for the children because they are fresh fruits or things that we can have at home," she said.
Ganthavorn reaffirmed the UCCE and CalFresh Healthy Living, UC's commitment to helping ethnic communities live a healthier diet. "We know that many people's diets today are fast food and soft drinks, and they are not consuming fruits and vegetables. We need to eat almost nine portions of fruits and vegetables a day, and most of us aren't getting close to that level. We are trying to encourage the consumption of fruits and vegetables, especially vegetables because they contain many nutrients and many health benefits," she said.