Food Prescriptions to Promote Affordable Diets that Meet RDAs among Multi-Generational Latino Households

Photo of a latino boy eating
Project Period:
09/24/2021 - 06/30/2026

Principal Investigator: Deborah A. Cohen, MD, MPH, Kaiser Permanente Research

Co-Investigator: Sean Hashmi, MD, MS, FASN, Kaiser Permanente

Abstract

Latino families are disproportionately affected by obesity, type 2 diabetes, non-alcoholic fatty liver disease, and dyslipidemia. Diet is a major contributing factor and poor diet is heavily driven by environmental cues, including large restaurant portions and aggressive marketing of low-nutrient, highly processed and high sugar foods. This is especially true in low-income neighborhoods where marketing and availability of unhealthy foods is more salient. Furthermore, the marketing, discounts and promotional strategies in supermarkets often nudge shoppers to buy low-nutrient discretionary foods or buy in excessive quantities. One promising approach to address these nutritional, social, and economic contributors to disparities in chronic disease risk is the concept of food prescriptions, which includes menu planning and home-delivery of affordable and nutritious food. This approach is premised on modifying contextual cues in the home environment rather than relying on self- regulatory control. Project 3 will test the effects of a culturally sensitive meal planning and affordable grocery delivery service in a randomized controlled trial to improve diet quality, weight control and chronic disease risk among multi-generational Latino households. Food prescriptions will meet the EAT-Lancet sustainability guidelines and achieve at least 90% of the recommended dietary allowances for 23 critical nutrients for all family members, at a cost not exceeding $680/month, the current CalFresh (California’s SNAP) budget for a family of four. We will include tailored directions on portion size based on age, sex, activity level and weight goals. We will develop and validate our menus and test logistics with focus groups of Latino adults with overweight or obesity. Thereafter, we will enroll 180 Latino households of 3-5 people (n=720) from Kaiser Permanente members with at least two individuals with overweight or obesity, and at least 1 child aged 5-10 years of age, to participate in a 6-month randomized trial with a wait-list cross-over design. Based on the weekly menu plan, a grocery list will be generated, and items delivered to the home. Anthropometric measurements, blood pressure, dietary intake and blood samples for HbA1c, liver enzymes and lipids will be collected at baseline, 6, and 12 months. Each family will be expected to contribute $100/week, with the amount above this subsidized as an incentive for participation.

Specific Aims

Specific aims are:

1) Develop an affordable and culturally sensitive meal-planning and grocery delivery intervention for Latino households. 2) Determine the impact of food prescriptions and grocery delivery on parental obesity, diet quality and chronic disease risk. 3) Determine the impact of food prescriptions and grocery delivery on child obesity, diet quality and chronic disease risk. In a cross-center aim, data from this Project will be combined with Projects 1 and 2 to examine: 1) The multi-level determinants of chronic disease risk in Latino children

2) The effects of different types of family-based interventions and how social and environmental factors affect the response to intervention. If this approach proves effective, food prescriptions could provide a scalable and sustainable model to improve diet, health, and well-being in Latino families.