Chronic disease often linked to poor diet

Poor nutrition has a major impact on Georgia’s high rate of high blood pressure, diabetes and other chronic ills.

By Gracie Bonds Staples | The Atlanta Journal-Constitution

Not a day goes by that Dr. Charles Moore doesn’t see the results of unhealthy diets in his patients.

Over and over, the ear, nose and throat specialist finds himself treating the same ailments: diabetes, hypertension, obesity. And when he quizzes his patients about their eating habits, he usually hears the same list of foods that are high in fat and salt, low in nutritional value and bereft of fresh fruits and vegetables.

So the founder of the Healing Community Center, a free health clinic in southwest Atlanta that emphasizes preventive care and health education, took radical action. He began writing prescriptions for fruits and vegetables. Then he took it a step further. He began escorting guided tours through supermarkets to educate his patients on how to shop smarter and eat better. He added cooking classes to instruct them on how to prepare healthier foods and joined with local grocers like Super Giant to label healthy choices throughout the store.

Lavern Evans, 62, and his wife Bonita, 59, came to the Healing Community Center a year ago when they realized they were eating themselves into an early grave.

They were both overweight, and Bonita Evans suffered from diabetes and hypertension.

Without the center, they say, it’s hard to say what their lives might look like. Sicker. Maybe dead.

The Evans live in College Park in one of intown Atlanta’s 35 food deserts, low-income communities located more than one mile from ready access to fresh and healthy foods.

Many experts believe food deserts contribute to the high rate of chronic disease, especially among the poor, although there are detractors who believe the problem is poor food choices.

Two separate studies in 2012 — one by Helen Lee of the Public Policy Institute of California and one by Roland Sturm of the Rand Corporation — challenged the argument that food deserts are to blame.

According to their findings, it’s a fallacy that poor neighborhoods have fewer grocery stores. And they assert there is no relationship, for instance, between the type of food being sold in a neighborhood and obesity among its children and teens.

While he doesn’t disagree that there are higher obesity rates in poor and minority neighborhoods, Sturm, a professor of Policy Analysis at the Pardee Rand Graduate School in Santa Monica, said the idea that supermarkets are a solution is a leap.

“Even on face value, the idea that supermarkets would reduce obesity or improve diets seems odd: Supermarkets are good at providing cheap calories,” Sturm said. “Where they really excel is providing cheap snack foods, soft drinks, at low prices that no small store could match.”

Densely populated low-income neighborhoods tend to have fewer large supermarkets, but research does not confirm claims that distance to supermarkets predicts obesity or even diet quality, he said.

But Caroline Harries, associate director at The Food Trust, a nonprofit advocacy group in Philadelphia, disagrees.


Part 3: Turning Atlanta’s food deserts into oases, Sunday, March 15


Part 1: Starving for nutrition in Atlanta’s food deserts at

She said a 2013 review by her agency of more than 75 food environment studies over the past three years, including Lee’s and Sturm’s studies, indicates three primary findings: Access to healthy food is still a challenge for many families, particularly those living in low-income neighborhoods, communities of color and rural areas. Living closer to healthy food retail is among the factors associated with better eating habits and decreased risk for obesity and diet-related diseases. And healthy food retail creates jobs and helps to revitalize low-income neighborhoods.

Georgia spends $2.4 billion each year treating diet-related diseases, and for the first time in U.S. history, children will live shorter lives than their parents due to the consequences of obesity.

According to recent data, 21.3 percent of Georgia children are obese, the second highest childhood obesity rate in the nation. And lower-income residents like the Evans are likely to suffer from obesity and other diet-related health problems at rates significantly higher than those of the population as a whole. For lower-income children, the situation is particularly alarming.

Community health expert Michelle Eichinger says the state spends billions of dollars just on diabetes care, treatment and management, and she believes there is a direct correlation between diet-related diseases and food deserts.

“There’s no question why you see the highest rates of hypertension, diabetes, heart disease in low food access areas,” she said. “Society seems to criticize them for choosing not to eat healthy, yet healthy foods aren’t available, accessible or affordable.”

Lavern Evans serves to his wife Bonita prepare to eat at their home in College Park. The couple suffers from obesity, diabetes and hypertension. They live in one of Georgia's 35 food deserts, which experts say weigh heavily on the state's chronic disease burden. Find many more photos of the Evans, Dr. Charles Moore and Lawanna Damous and her family here.

Choice and knowledge

While it's possible to eat cheap in America, it takes resources and know-how that many low income Americans don’t have to eat healthy, say some experts.

Food preferences are established in early childhood and they don’t change overnight, said Amy Webb Girard, assistant professor in Emory’s Rollins School of Public Health.

“They can change later in life but it takes time and trial and error with trying new foods several times,” she said.

Food is inextricably linked to tradition, fellowship and family history. With that in mind, Moore looks for ways to change his patients’ diets without making it feel like it’s an obligation. One way is partnering with other organizations to distribute recipe cards and host cooking lessons.

It was a conversation he had with a 6-year-old boy that opened his eyes to the need in his community.

“He didn’t know what vegetables were,” the doctor recalled.

The Evans, both of whom grew up in Atlanta, remember when there were two or three grocery stores within walking distance of their homes. By the mid-'70s, Lavern Evans said, many of them had closed.

“Next thing you know McDonald’s and Burger Kings were taking over,” he said.

Today, the nearest full-service grocery store to the Evans’ home is Wakefield, two miles away. Although the store has undergone recent renovations, they say it doesn’t compare to grocery stores in upscale, majority white neighborhoods.

Since coming to the Healing center, the Evans have learned to shop around, even if it means making the 17-mile trip to Aldi’s, the Sweet Auburn Curb Market or Little Giants in Forest Park.

“It’s a nice one-stop shop,” Lavern Evans said, referring to Little Giants. “They have the organic and all that.”

Just two years ago, organic was as foreign to the Evans as fried chicken and pig’s feet were familiar.

Now the couple, who subsists on disability payments, regularly attends health classes at the Healing center that teach them not only how to make healthier choices but how to shop for food and prepare it. They’ve participated in classes on how to manage Bonita’s diabetes and high blood pressure. And thanks to their dietary changes, they’ve both lost weight. Lavern has gone from 380 pounds to 339.

“Instead of cooking with pork, we use smoked turkey and more herbs like sage, garlic, fresh peppers, thyme and basil,” said Lavern, who does most of the cooking. “Ninety percent of the food we eat is either baked, broiled or grilled, and we stop fooling with beef and salt, period. The deep fryer has been put outside in the closet.”

The couple also walks as often as possible.

“When we came here I was stuck at the crossroads,” Lavern said. “I had been to so many doctors, but nothing helped. It was God’s grace and mercy that led us here, and we’re better for it. Much better.”



Number of Georgians die every year due to physical inactivity and poor diet.


Percentage of adults in Georgia who are obese


Percentage of Georgia adults queried who had not engaged in leisure time activity in the past 30 days


Percentage of Georgia adults queried who did not regularly consume recommended five or more daily servings of fruits and vegetables


Percentage of Georgia adults who have been diagnosed with high blood pressure


Percentage of those diagnosed with high blood pressure who have not changed their dietary habits; 33.3 percent do not engage in exercise


Percentage of Georgia adults who have been diagnosed with high cholesterol


Percentage of Georgia adults who have been diagnosed with diabetes mellitus


Percentage of those diagnosed with diabetes who are taking insulin

Source: Georgia Department of Public Health, based on statistics from 2011

Holistic challenges

Sometimes access and knowledge aren’t enough to put healthy food on the table. There are other factors that affect eating habits.

“We need to think about what it takes to juggle healthy eating with child care, work, accessing these things using public transportation in the city of Atlanta, limited availability and access to healthy food options and to then dealing with all of these things on a very limited budget,” said Girard. “People want to do the right thing for them and their children’s health, and they do the best they can with what’s available and accessible to them.”

Lawanna Damous, a 40-year-old financial counselor at Emory Hospital, knows this. The Stone Mountain resident grew up eating fried chicken, mac and cheese and cornbread, food she still prefers.

But she worries now about her children, especially her 6-year-old daughter, who is overweight.

Even though she has attended nutrition classes at the Healing clinic, Damous still struggles with making the right food choices, especially when she was working two jobs.

“I’m so tired I don’t want to cook. I bring a pizza home or something like that. I get off work at 7:30, look at homework and get ready for the next day. Then it’s time to go to bed.”

She also struggles with the cost of feeding her family.

“The healthier the food, the more expensive it is,” she said. “You have to do what you have to do, regardless of whether it’s healthy or not sometimes. It’s stressful trying to provide for everybody.”

That’s why focusing on accessibility to fresh produce and food choices is short-sighted, says Girard. Reducing the rate of diet-related disease in Georgia requires a holistic approach to the larger environment.

Presentation by Shane Harrison.