Nutrition Policy Institute researcher influenced obesity research, SNAP-Ed evaluation
Young people across California and the U.S. enjoy healthier, more nutritious food options at school, thanks to the contributions of Gail Woodward-Lopez, who retired on July 1 as the associate director of research at the Nutrition Policy Institute, a part of University of California Agriculture and Natural Resources.
Woodward-Lopez officially joined UC ANR in 2015, when she and other researchers at the Atkins Center for Weight and Health at UC Berkeley merged with NPI. But her association with UC ANR goes back much further, as her work at CWH was always directed by UC Cooperative Extension academics – including the research that paved the way for California's “junk food ban” in schools.
Two bills, signed in 2005, set nutrition standards in California for “competitive foods”– the items sold in vending machines and from food service a la carte (as opposed to federally subsidized school meals). That legislation – which inspired similar policy changes across the country – was informed by the work of Woodward-Lopez and her colleagues, who had looked at the financial impact of establishing those standards.
“Our study was so pivotal that I literally had people calling me from the floor of the Senate or the Assembly when they were debating that legislation,” recalled Woodward-Lopez.
Changing perceptions of population weight gain
Originally intending to pursue a career in neurobiology, Woodward-Lopez found that lab work didn't suit her temperament. Seeking to work more directly on social issues, she embarked on a public health path, with an emphasis on nutritional aspects that incorporated her interest in biological sciences.
Woodward-Lopez's early work focused on a challenge that was just beginning to catch the attention of researchers: the rapid rise in the Body Mass Index (BMI) among the U.S. population. In tracing the causes of this epidemic, she and her colleagues shifted academic and public attention toward the host of environmental factors that contribute to weight gain – instead of focusing exclusively on an individual's choice to eat healthy and be physically active.
“Two decades ago, Gail led groundbreaking work to identify the determinants of obesity when child obesity was emerging as a public health concern,” said Nutrition Policy Institute Director Lorrene Ritchie. “While we and other researchers across the nation were working on generating more evidence to inform action, she had the vision that we could use a variety of existing data – from trends to trials – to point to the main causes.”
Many of the researchers' conclusions, which were published in the 2006 book “Obesity: Dietary and Developmental Influences,” stand to this day.
Helping to set the identity and agenda of the Center for Weight and Health when it was founded in 2000, Woodward-Lopez moved policy and practice beyond educational approaches and public awareness campaigns. As she noted: “No one thinks sugar-sweetened beverages are good for you.”
“Education alone is not going to work if people do not have access to the healthy foods and opportunities for physical activity, if they're not safe in their neighborhoods, or if they can't afford the healthy options,” she explained.
Given her seminal role in the field, Kaiser Permanente sought out Woodward-Lopez as a “thought partner” on the organization's community-based obesity prevention programs and school health work.
“Gail brought deep rigor and expertise, of course, but also a super-practical, community-focused perspective to our work,” said Loel Solomon, professor of health systems science at the Kaiser Permanente Bernard J. Tyson School of Medicine. “Her integrity and values around health equity were evident in everything we did together, and our communities are so much the better for it.”
Elevating and enhancing CalFresh Healthy Living
At the Nutrition Policy Institute, the focus of Woodward-Lopez's work has been refining the evaluation and delivery of SNAP-Ed, the educational component of the Supplemental Nutrition Assistance Program (commonly referred to as “food stamps”). Known in California as CalFresh Healthy Living, SNAP-Ed represents the largest single source of ongoing funding for nutrition and physical activity promotion in the state – outside of the WIC program which serves women, infants and young children.
“CalFresh Healthy Living can really impact millions of people,” Woodward-Lopez said. “For county health departments, this is one of their main sources of funding and provides the backbone for everything else they do in nutrition and physical activity.”
But given the variety of interventions implemented by health departments in response to local needs, determining the efficacy of those efforts is a daunting task. Woodward-Lopez and her NPI colleagues have been instrumental in devising creative approaches that help pinpoint the most effective public health measures.
For example, NPI researchers found that combining school policy changes with increased opportunities for physical activity during the school day was the best strategy to encourage student fitness. They discovered that reductions in nutrition programs during the COVID-19 pandemic disproportionately affected communities of color. And they also continue to emphasize that interventions need to be tailored to the specific cultural and political conditions within a community.
“I think in all of the work we do, we try to come up with those practical applications – what does this mean for communities? How can we do this differently? How are our findings actionable?” Woodward-Lopez said.
Her contributions toward the evaluation of California Department of Public Health SNAP-Ed have impressed and inspired Lauren Whetstone, chief of CDPH's Research, Evaluation and Strategic Alignment Section, Nutrition Education and Obesity Prevention Branch.
“Gail and her team have elevated the quality of our evaluation work and the evaluation support that we provide to local health department grantees,” said Whetstone, who has worked with Woodward-Lopez for nearly a decade. “Gail contributed substantially to statewide SNAP-Ed evaluation as well, again working collaboratively to ensure high quality evaluation. Our work is all the stronger due to Gail's dedication to excellent SNAP-Ed evaluation.”
To the benefit of the field and community health, Woodward-Lopez said she plans to remain engaged in her life's work.
“I'd really like to get more involved in policy through advocacy and through doing things like writing letters to the editor or social media commentary,” she said. “I already have some ideas for some editorials I want to write.”
And while she looks forward to spending more time with loved ones, traveling, and pursuing her interests in art and music, Woodward-Lopez will remain a guiding voice for advancing public health.
“Gail's leadership in public health nutrition – even after she retires – is a testament to her dedication,” Ritchie said. “She not only has contributed to sustainable changes in California and nationally, she has been a mentor to me and so many others in the field who will strive to continue her legacy.”
People interested in supporting Woodward-Lopez's legacy and the ongoing work in health and nutrition can donate to NPI's Student Fellowship, which provides students from underrepresented groups the opportunity to work on NPI research and be mentored by NPI researchers./h3>/h3>/h3>
Reduction of SNAP benefit deepens crisis of inflation, high cost of living, low wages
Starting this month, many of the estimated 3 million people in the CalFresh program – California's version of SNAP (Supplemental Nutrition Assistance Program) – will be facing hunger and making difficult decisions to meet their most basic needs. In late March, participants received the last of the pandemic-related emergency aid that significantly boosted their monthly benefits. The reduction varies by household size and income; for example, in April a single-person household could see a drop from $281 per month to $23.
“The emergency food allotments had a tremendous impact in our communities and across the nation,” said Shannon Klisch, academic coordinator for the Youth, Families and Communities Program for UC Cooperative Extension in San Luis Obispo and Santa Barbara counties. “One study estimated that these allotments kept more than 4 million people out of poverty across the U.S. in the last quarter of 2021, and reduced child poverty by 14%.”
SNAP increases during the pandemic made many Californians more food-secure, with some participants reporting that their allotments finally had been enough to feed their families for the month, according to Wendi Gosliner, a project scientist at the Nutrition Policy Institute (a program of UC Agriculture and Natural Resources). But, with the benefit reductions, food insecurity is emerging again as a serious concern.
“It is inconceivable that a nation this wealthy should have so many people experiencing hunger,” Gosliner said. “And here in California, with the high cost of living, ongoing inflation and extreme income and wealth disparities, people are being forced to explore every possible avenue just to feed themselves and their families.”
To help ensure they are receiving the maximum allotment, Klisch recommends that CalFresh participants – especially those who applied during the pandemic and are relatively new to the program – double-check their information.
“If the county doesn't have your most up-to-date information, call your county worker if you've changed your address, if you've experienced decreased income, if your housing costs have gone up, or if you have new expenses – like child or dependent care expenses or medical expenses – these can help you qualify for more CalFresh funds,” she explained.
For families with school-aged children, Klisch said they can stretch their food dollars and promote healthy eating by encouraging their children to eat breakfast and lunch at school through California's universal free school meals, and all families with children under 18 can watch for the next issuance of the P-EBT (Pandemic EBT) card, worth potentially hundreds of dollars.
In addition to these options for food assistance, Klisch pointed to programs that can help people save money on other household expenses, such as California Alternate Rates for Energy Programs (CARE) and Affordable Connectivity Program. Local food banks are also gearing up across the state to handle an expected surge in clients in need of emergency food; a list of California food banks can be found at cafoodbanks.org/our-members.
“We ask a lot of low-income families and workers to navigate and piece together various programs, applications, and benefits when we don't commit to a strong safety net,” Klisch said. “On the other hand, when people have enough money for food, everyone benefits through decreased health care costs and increased economic activity.”
Gosliner also said that people should look into their eligibility for WIC (Special Supplemental Nutrition Program for Women, Infants and Children), as well as the federal Earned Income Tax Credit (EITC) and CalEITC, poverty-alleviation benefits underused by Californians.
“People should make sure they are accessing all the safety net benefits for which they are eligible,” Gosliner said.
Market Match, other nutrition incentive programs can help
Through programs like Market Match, available at about 300 farmers markets across California affiliated with the Ecology Center, CalFresh participants can have their EBT benefits “matched” by their local market (usually up to $10 or $15 per visit).
“People are looking to get creative about how to stretch their food dollars, and Market Match is one way to do that,” said Klisch, who has led UCCE efforts to help promote the program along the Central Coast since 2017.
Striving to expand access to fresh fruit and vegetables and to support local farms, UCCE and CalFresh Healthy Living, UC worked with partners to increase CalFresh redemption at farmers markets in San Luis Obispo and northern Santa Barbara counties.
In 2017, about $48,000 in CalFresh and Market Match benefits were redeemed at farmers markets in the area. In 2022, the total was more than $207,000 – a 327% increase. According to Ecology Center figures for the entire state, CalFresh and Market Match spending at farmers markets jumped 161% from 2019 to 2021, up to $13 million.
Gosliner, whose research has shown that these nutrition incentive programs are associated with increased food security, noted that “the people who use Market Match absolutely love the program and feel it is incredibly helpful.” She also added that the California Department of Social Services is developing a pilot program that would offer match incentives for purchasing fruits and vegetables at larger food retailers.
Although the biggest of its kind, Market Match is just one of the programs across California that provide “matches” for healthy food purchases under the California Nutrition Incentive Program, which in turn is primarily funded by GusNIP (the nationwide Gus Schumacher Nutrition Incentive Program).
GusNIP dollars – and SNAP overall – are governed by the federal Farm Bill, typically renewed every five years and currently being negotiated by Congress./h3>/h3>
Nutrition Policy Institute researchers contribute to studies that inform policy changes
Marcela Gonzalez, who had wanted to be a physical therapist since she was a teenager, was in the final stage of realizing her dream.
But when she started in the PT program at the University of California San Francisco in 2021, a vexing struggle of her undergraduate years came back. Academic pressures and stomach troubles, compounded by financial worries, drained her of any energy and capacity to feed herself.
“I didn't eat; I lost a lot of weight because I just couldn't eat,” Gonzalez recalled. “I was too stressed out all the time; I was a mess.”
During her first year at UCSF, Gonzalez, for whom food has “always just been hard,” discovered that she qualified for CalFresh (California's version of the Supplemental Nutrition Assistance Program, formerly known as “food stamps”). Her participation in the program – as well as the presence of a campus food pantry – helped lift a heavy mental burden and allowed her to refocus on school.
To understand the mechanisms that connect eligible students with CalFresh benefits, which could greatly improve their lives and education, University of California researchers interviewed UC campus staff responsible for guiding undergraduate and graduate students through the application process. Their recently published study, which involved researchers at UC Agriculture and Natural Resources' Nutrition Policy Institute, illuminated several major facilitators and barriers to CalFresh enrollment.
Campus-county coordination, boosting staffing key factors
Ensuring that college students have access to CalFresh is especially crucial, given that food insecurity affects that segment of the population roughly four times the rate of the general population, according to the study's principal investigator and co-author Suzanna Martinez, an associate professor in the department of epidemiology and biostatistics at UCSF.
It's estimated that more than 40% of college students face uncertain access to healthy food – and inflation, the rising cost of attending college and increasingly unaffordable housing are likely to swell those numbers.
That's why researchers say it's critical for campus staff who work on CalFresh outreach to collaborate with the financial aid office and the county office that administers the CalFresh program locally. Through close coordination, staff members can determine if students meet the necessary exemptions and help them with the paperwork.
“When that happens, it's much easier than when a student applies without their campus Basic Needs coordinator, or when they just go to the county and apply on their own,” Martinez explained. “Maybe they don't know all of the verification documents that have to be included, or they might not know their financial aid status.”
Erin Esaryk, NPI research data analyst and first author of the study published in the Journal of Nutrition Education and Behavior, also highlighted the need for increased campus staffing to help with CalFresh enrollment, as well as more outreach by campus and county staff to student populations about the benefits.
“When there's a lot of outreach, that helps alleviate some of the stigma, to normalize the receiving of CalFresh,” Esaryk said.
Helping others worry less about food
Given her own history of travails, Gonzalez, the physical therapy student, wanted to help others at UCSF “de-stress” about food. In summer and fall 2021, she served as a “CalFresh ambassador” for her cohort of new PT students, developing presentations and guides that break down how to apply for or renew CalFresh benefits.
She became the go-to person for her classmates' questions on the logistics and details of applying for the program, and also encouraged fellow health-professional students who, like herself, did not think they would qualify.
“To take out less loans, or to not worry about food a little bit every week, is a great thing,” said Gonzalez, pointing out that subtracting food costs allows students to shave down their loans.
After helping introduce her classmates to CalFresh, she transitioned to working at the food pantry at the Parnassus campus. In addition to setting up and distributing the items, Gonzalez also posts on Instagram and TikTok (@ucsf_basicneeds) to promote the “food market,” which attracts about 100 students and campus community members every Thursday afternoon.
“You never know what you're going to get, but there's so much really good, fresh produce,” she said.
Campus food pantries deliver health benefits
Researchers are also studying how campus food pantries affect students' overall health, including easing the challenges of anxiety, depression and sleep deprivation. Another recent study published in the Journal of Nutrition Education and Behavior analyzed health-survey responses of 1,855 undergraduate and graduate students at all 10 UC campuses – before and after access to a campus food pantry.
“What we found was that students reported improvements in their perceived health and sufficient sleep,” said UCSF's Martinez, the lead author. “We also found that they reported fewer depressive symptoms, compared to before having access to the food pantry.”
By 2019, all UC campuses had established food pantries, although nationwide only about 25% of four-year colleges have one. The significant health benefits reported by UC students in this study give researchers hope that campus food pantries will see additional governmental support, in California and beyond.
“It was important to evaluate whether the food pantries were actually making a difference…if you don't have numbers or evidence, then you're not going to get funded to support future programming,” Martinez said.
Research guides state policy changes
Studies of food insecurity in the college setting have already informed policymaking aimed at smoothing the application process for CalFresh – benefits regarded by Martinez as a better long-term solution than food pantries, which constitute an emergency “short-term response” to the problem.
One example of the research's impact is a law passed last year in California that requires community colleges and California State University campuses to designate a campus-county liaison who would help students procure social services, including CalFresh. A separate law expanded the list of training programs within which students would potentially qualify for CalFresh, and another bill currently under consideration by the state Legislature would make the processing of students' CalFresh applications more consistent from county to county, through more standardized training of staff.
Meanwhile, on the research front, Esaryk, Martinez and their colleagues are completing a follow-up study on students and CalFresh enrollment, this time looking at the perspectives of county staff. And while their broader goal remains clarifying and streamlining student eligibility rules and processes at all levels, they remain focused on students and meeting their needs.
“Right now, our main mission is just to try to increase awareness of CalFresh for students and to let them know they may be eligible,” Martinez said, “and then assist them through that application process so they can actually get the benefits.”
In addition to Esaryk and Martinez, NPI director Lorrene Ritchie and Laurel Moffat of Washington State University are also authors of the CalFresh/SNAP benefits study, while co-authors of the college food pantry study are Ritchie, Gwen Chodur of UC Davis, Sevan Kaladijian of UC Irvine and Michael Grandner of the University of Arizona./h3>/h3>/h3>/h3>/h3>
A U.S. federal government shutdown can represent a minor inconvenience, a delay in paychecks, or – for people living in some of the most difficult circumstances – an extended period of hunger and anxiety.
A study published recently in the journal Nutrients provides a unique glimpse into the shutdown experiences of participants in CalFresh – California's name for the federally funded Supplemental Nutrition Assistance Program (formerly known as food stamps). Currently, about 42 million people participate in SNAP across the U.S.
In focus groups conducted in 2019 with 26 low-income CalFresh participants from four diverse California counties, participants shared how the 2018-19 federal government shutdown affected their SNAP benefits, their perception of the program and their faith in government.
One of the immediate effects of the 2018-19 shutdown was that February CalFresh benefits were distributed in January. And while that meant program participants saw extra benefits that month, they then had to wait 40 to 44 days until the March issuance – much longer than the usual 28 to 31 day cycle.
“What we saw with this study is that this extended lag in benefit receipt from January to March was devastating,” said Wendi Gosliner, senior researcher and policy advisor at the Nutrition Policy Institute of UC Agriculture and Natural Resources, and an author of the study funded by UC ANR.
She recalled one participant who, despite having a gastrointestinal issue that requires a special diet, had to eat canned food from the food bank that made her sick – rather than go hungry while waiting for her March benefits. Others described cascading financial challenges after using rent money for food in February, or going into debt to pay for food and getting behind on other expenses.
The study also chronicles the experiences of a woman who was anguished to hear the suffering of her daughter, also a CalFresh participant: “She called me several times crying, ‘Ma, I don't – we don't have enough food. What am I going to do…? You know, I can't afford to this and this and this.' And I can't help her.”
For individuals grappling with food insecurity, the stress of feeding their families was compounded by the uncertainties of the government shutdown. And while many participants exercised their agency and resourcefulness in coping with the situation, they also felt a degree of powerlessness amid the “confusion and craziness,” as one person put it.
“No one knew how long that shutdown was going to last; no one knew if the March benefits were going to be paid,” Gosliner said. “And as we learned, there were all kinds of stories circulating out there about what was going on with the uncertainty – a lot of people didn't have the information about what was actually happening.”
Some participants, seeing the “double benefit” in January 2019, thought that it was the last-ever distribution and that SNAP was ending. Others described being unable to get in touch with the CalFresh agency to get their questions answered about the benefits. Most participants had not heard about the disrupted benefit schedule before receiving the benefits. As a result, many people in the focus groups shared that their overall faith in government had been shaken.
Improving customer service, boosting benefit levels and adjusting eligibility and benefit formulas to reflect high cost-of-living and expenses related to working were three recommendations that came from the focus group participants.
A fourth recommendation tackles the shutdown issue head-on: Don't let it happen again.
“Congress should do absolutely everything in their power to be sure that the program operates on the usual time schedule – even if the government is shut down,” Gosliner said.
In the context of the global pandemic, when financial and social inequities and physical and mental health disparities have been laid bare, ensuring access to healthful food is even more important. And with studies showing that hospitalizations increase with longer lags between SNAP distributions, Gosliner said the “absolute last thing” the overburdened health system needs is more people in emergency departments seeking acute care.
“It's the worst time to be having people who need money to feed their families face additional insecurity,” she said. “It's critically important that Congress acts to be sure that there is not any disruption in benefits.”
The authors of the study, “Participants' Experiences of the 2018–2019 Government Shutdown and Subsequent Supplemental Nutrition Assistance Program (SNAP) Benefit Disruption Can Inform Future Policy,” are Wendi Gosliner, Wei-Ting Chen, Cathryn Johnson, Elsa Michelle Esparza, Natalie Price, Ken Hecht and Lorrene Ritchie.
The study can be found online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353319.