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Today we are going to hear from Dr. Carmen Byker Shanks from Montana State University. Dr Byker Shanks joined the faculty at MSU in 2011, is an Associate Professor of Food and Nutrition and Sustainable Food Systems, and is a registered dietitian nutritionist. Carmen's research aims to develop evidence based strategies that support individuals to eat better for the health of the population and the planet. She's especially interested in promoting healthy eating patterns, positively impacting health outcomes and decreasing health disparities. In today's presentation, she'll be discussing the Center for American Indian and Rural Health Equity research project UP3 which addresses inequities in access to fresh, healthier foods and related increased chronic disease risks among rural communities when compared to urban communities. The overarching goal of this research is to develop a scalable intervention that facilitates the availability of minimally processed foods or nutrient dense foods low in added sugar, fats, salt, and additives at rural food pantries while promoting healthy diet to decrease health risks. Awesome, thank you so much for joining us today Carmen, I'm really excited to hear about your project, so I'll let you take it away. Great thank you Anna and thank you all for coming to this presentation. Today I'm going to talk about the Unprocessed Pantry Project which was a grassroots project development developed in Montana and was supported by the Center for American Indian for Rural Health Equity and an NIH grant. And I will refer to the Unprocessed Pantry Project as U-P-3. It looks like up three. But we and my collaborators and I call it U-P-3. So I want to eat healthier and lose weight, but healthy food is so expensive. My whole family gained weight and started eating a lot of processed foods when we were homeless. I don't know how to cook healthy food, I just eat a lot of canned foods. These are exemplary quotes that represent trends from hundreds of interviews and participant interactions that I have had over the last decade in Montana in my work as a nutrition researcher. Fast forward several years later, enter the Unprocessed Pantry Project, which is a partnership and a study that was planned with a grassroots advisory board in Montana consisting of researchers, staff, students, community partners and volunteers, and it was conducted in 2019 and 2020 at two food pantry sites in Montana which were Livingston Food Resource Center and Gallatin Valley Food Bank. And this project was conducted directly in response to those quotes that I shared with you and similar observations across our advisory board. So UP3 was, as I said, a collaboration and it was built because there was an identified need among our grassroots advisory board to build a program that addresses and prevents diet related chronic disease through local food pantries. There was an identified desire to partner with medical community with the local medical community to build a system that measures key health outcomes with our intervention to track progress and we also identified multi level areas of the food pantry to intervene, which included the food supply, the food environment and nutrition education. And as an advisory board and after talking to a lot of food pantry clients, we identified limiting ultra processed food at food pantries to address health disparities among clients. So what are ultra processed foods? Ultra processed food is manipulated with artificial ingredients and can be high in sodium, caloric sweeteners, and saturated fats, and they usually use new technologies that take products further from their natural state. So things that you buy in packages, canned foods and boxes. I want to say that not all packaged foods are ultra processed, it's there are foods that are high in sodium, and added sugars and saturated fats and then artificial ingredients. So ultra processed foods in general comprise over half of the American diet and are growing and diets worldwide. They're easily accessible to the general population, they're harmful to health, they have addictive qualities that are linked to excess caloric intake and weight gain, and they're linked to higher, all cause mortality. Disparities exist. Low income groups are vulnerable to consuming ultra processed food because they are more affordable to purchase in our food system, then healthy food. Low income groups carry a greater burden of diet related chronic diseases in the US. So we saw our advisory board saw food pantries as an opportunity to address ultra processed food. Food pantries across the US provide food to over 40 million low income Americans annually and this number is now growing since COVID-19. And food pantries rely on donations and purchases to stock the food supply. They have a lot of shelf stable food because of the nature of storage and distribution at food pantries, and a lot of shelf stable food can inherently be ultra process because of the you know, artificial ingredients and the added sugar, fat and sodium to enhance flavor. And food pantries have perishable food which is usually less processed food like fresh fruits and vegetables, but definitely the pantry environment sometimes has a challenge to storing and distributing fresh foods because of limitations in infrastructure or staffing. So this is a sort of description of the current cycle of food insecurity, which is low, which is related to low income. Low income individuals are less likely to have money to buy food and to which produces food insecurity. When individuals are food insecure, they are both likely to have insufficient food quantities, so the amount of food they eat and then are likely to rely on less expensive foods and in our food system, ultra processed foods are less expensive than healthy foods, leading to lower dietary quality and the development of non communicable diseases at higher rates in low income and food insecure populations. Uhm in UP3 we wanted to break that cycle and work with food insecure populations through food pantries to offer healthier food choices and which lead to higher dietary quality and better health. So our research and our study aimed to build a UP3 framework. In our intervention, we wanted to assess the impact of applying the UP3 framework on dietary quality and the health of food pantry clients and we also wanted to improve the food supply. So we wanted to improve the availability of less processed foods in the food supply at food pantries. The last two aims are linked together because obviously in order to improve the dietary quality and health of food pantry clients, you also have to improve the food supply of the foods that are available. So you can see UP3 does two things. UM, UP3 is a toolkit that is designed for food pantry staff to use to ensure a healthy food supply and food pantry clients to use to make healthy food choices at the pantry. We, as an advisory board, built a tool kit which included a guide for improving the food supply, a curriculum that had nutrition education and different tools for food pantry staff and clients to use, such as shopping lists for when food Pantry clients went into the food pantry, and then supporting materials like recipes for food pantry clients to use to make healthy foods using the ingredients that are typically available out of food pantry. So we built UP3 framework and this is what we use to talk about what is an ultra processed food and what's an unprocessed food. I won't go into this in depth but will just highlight it over all that the table is designed for food pantry staff and food pantry clients to help them to read the nutrition label and ingredients lists on packaged foods to determine the difference between an unprocessed food and an ultra processed food and it encourages individuals to eat foods with fewer and easily recognized ingredients and balanced choices between different types of fresh foods such as fruits, vegetables, whole grains, lean meats, nuts, seeds and healthy fats everyday. And so you can see that the ultra process or the continuum goes from unprocessed foods, ultra processed foods and within unprocessed foods. There are fresh foods which are foods that are in their natural state pantry staples which are usually used to cook meals such as oil, salt, vinegar, etc. There are prepared foods so thinking of food items that you can buy in a package that are prepared and ready to eat. This, this prepared food category is really important in the food pantry, because there are a lot of prepared foods donated. So helping a client to discern between what's a lightly prepared food versus a heavily prepared food. And as you look at this graphic like always trying to lean towards this category overall and include more of these foods and include less of these foods. You can see Ultra processed food is defined on your right side. Like an UM, Let's see, OK. So the intervention itself, it was conducted at two food pantry sites and in 2019 and in 2020, and in 2019 it was conducted over 16 weeks and 2020 it was conducted right with COVID, the onset of COVID and was conducted for 12 weeks. Overall we had 70 participants. We started with a control group in year 2. But we didn't finish because of COVID-19 restrictions with the control group, so we only had an intervention group. The participants shop for 50% of their household food needs each week. They were provided with a curriculum and a short nutrition education lesson, about 20 minutes that focus on knowledge, attitudes and skills to decrease ultra processed food consumption. And then participants were supported every other week with check-ins, recipes and staff to assist in shopping The check-ins where every other week, the recipes and staff for every week. Let's see, OK. So in addition to supporting participants, UP3 supports the food supply, and so the food pantry staff were worked with us to take inventory of their food, make changes in their inventory, and get support to find a less ultra processed foods to supply in their food supply. Uhm, you can see some examples of the types of foods that were inventoried within each of the categories that were commonly inventoried within each of the categories, and these are the types of foods that you'll typically find within a food pantry that are available to clients and so making sure there are more fresh foods, pantry stable staples and prepared foods and less ultra processed foods available. The curriculum has six lessons in it and they focus on what is UP3 framework teaches clients about what's in my food. So really how to read a food label and choose foods based upon the food label in the ingredient list. Making unprocessed meals. How to use pantry staples. Make ahead meals that can be stored or frozen for later. And then shopping for UP3 food on a budget. So this is an example lesson, and this is one of the first lessons that walks the client, the food pantry client, through what the UP3 framework is exactly and then has the individual practice with different foods that are available with the nutrition educator. Here is an example recipe, so all the recipes are, use typical foods that you would find in a food pantry as well as, UM, require a limited amount of time to prepare the food and if the food pantry client wants to or supplements their food at the grocery store, we also provide recipes that are very low in cost. So how did we assess the impact of UP3? We conducted baseline, midpoint and endpoint health measures as well as food inventory measures. For the health measures, we partnered with local health care and also trained our own research staff and then for the food supply inventories we partnered with the food pantries themselves. So we measure dietary quality, uh, we did a psychosocial survey, we measured HB A1C and blood pressure, total cholesterol, BMI, and waist circumference as well as food supply inventories and then we also interviewed people that were either involved in implementing the intervention or the clients themselves to assess, like what improvements needed to be made to the toolkit. Here is an example shopping list that participants use to shop with to make UP3 friendly choices and I would say that this was, is one of the most popular results from the whole toolkit and has been requested from many food pantries nationwide for use in their food pantry. And I put that shopping list there because it really did impact the food pantry clients dietary quality. So this is the healthy eating index and I'll just talk you through it because I know it's a lot of numbers. But basically clients provided their recall of what they were eating and what we found using the Healthy Eating Index was, which assesses how well a clients diet aligns with the dietary guidelines for Americans. Uhm, we found that participants increased several of their food categories significantly, and so they made significant improvements in whole greens and protein foods, as well as decreasing added sugars and calories, and then the really important one here is the total HEI. Or so overall, there diet improves significantly. And this was from year one and then we saw a similar trend in year two, except for total fruit and whole fruit increased and refined grains decreased. And so overall we found positive dietary changes and clients were very pleased with those results. We also did help measures. We found significant decreases in body mass index and we observed that in both years. The mean weight loss was 5 pounds across years one and two and cholesterol significantly decreased in year one, which it was not measured in year 2 due to COVID-19. Same thing for waist circumference and A1C and blood pressure did not significantly change in year one, although those were complementary measures and we weren't really hypothesizing, they would change because usually they take a longer amount of time than the intervention to change. My favorite results were really talking to participants who had really positive experiences with UP3 and you can see their quotes here. UM, summarizing, "veggies and fruits are now viable options. They're not just for the rich." "I'm looking at food in a different way. There are benefits to eating healthier, and it's easier than I imagined." "I'm being more mindful about what I eat." "My kids are starting to cook fresh foods with me too." "I don't need cholesterol medicine anymore." "Family togetherness is meal planning." "I read labels now." "Love you guys. You have reminded me of the joy of making my meals to my with my kids." So I'll leave it here, but uhm, some some conclusions about UP3 is that we did see improvements in diet and health of food pantry clients through this model and I really think it was because it was a total grassroots effort and community collaboration identifying a need all the way to three years in the making of the idea, to funding, then implementing it. We built a framework to improve access to healthy food at food pantries for, by focusing on a specific disparity which we identified as ultra processed foods, and we focus on identifying the most sustainable strategies that work for various food pantries and capacities and their clients. And so like I said in year two of this intervention, COVID-19 hit at the end so we did continue measuring changes in the food supply due to COVID-19. In order to help build guidance for food pantries and in the significant shifts of that food pantries had to make to increase social distancing and we are making modifications to our toolkit to help food pantries implement a UP3 that fits needs like COVID-19 or other emergencies that hopefully don't arise in the future, but might. And so with that, I'd like to thank you so much for coming to this presentation and I am really happy to answer any questions you have. Thank you so much Carmen, that was up super. I mean I I recently read this study that came out about a month. I didn't actually read this study. I saw the news headline to be honest about ultra processed foods and obesity. Recently it was just in the last few weeks then and I was, I've been thinking to myself, I really need to Google the exact definition of ultra process because I'm not 100% sure but it's not in my house and like what to do about that. So this was really personally educational for me and I just such an incredible project. So thank you for sharing with us. There's a question in this top box up. Brian asks, do you have recommendations for local Montana data sources to get spatial data for youth and mapping efforts related to food security issues and studies? Oh my goodness, I have a whole list of resources to send you Brian, if you email me. Laugh at when using the UM. The email address on the screen I just compiled this list for someone else, so I will. I will share it. Yeah, and you too Amber. There are lots of resources to bring. Bring that information together. Yeah, Carmen, if you wanted to send it to me, I'd be happy to forward it out to everybody who's in attendance today. If that would be helpful. Uhm, yeah, I think I bet they're probably I'm looking at the names on the list and dumb and thinking of what I'm the projects that I'm aware of the people who are here. And then I'm thinking that probably there's several people were like you. I'd love to see that. Yeah definitely, and I saw the story map that DPHHS is doing and was wondering how like food security is integrating with that at all, so I'm wondering if like that's what were some of the questions are coming from as well. Yeah, and that's actually Brian was participating in that. The Joy of Healthy Living Map was a group of State Health Improvement Plan partners trying to address the fact that obesity prevention is an item that's a priority interest in the State Health Improvement Plan. But we don't necessarily have a set program about obesity prevention programming. Brian, do you want to speak to that map at all? Since you're here with us? Yeah, so hopefully you guys can hear me. OK, we can. We had done a pretty significant effort over the course of of many months to kind of collaborate together on this interactive story map product that Anna had briefly introduced there and kind of one of the key things we're trying to do with that is kind of share data and maps to help people understand what was going on in their community and kind of what. What's happening out there, and so, uh throughout the course of that project, yet a lot of discussions with different stakeholders you know that could be a vote from different tribal groups and things like that. And there were questions that came up about, you know, showing food security related data and so kind of one of the things I'd like to build into that story map as we work on making it. You know, making additions and changes. Is more maps related to a food? You know, access to healthy foods and how people can. You can have access and where we need additional efforts to increase access and affordability and things like that so. Definitely would be very interested in in things that you have found through your work and I would say that would be very helpful for us. So yeah, definitely. and you know, maybe we should set up a meeting after you look through the resources just to identify like what does the data need to look like to put in that map and that would be also helpful for like you know what, what to point you towards in terms of like um how do you need to program it in order to make it fit within this story, the Joy of Living Project. OK Brian, if you have the link right at your fingertips, would you mind posting it into the chat just in case anybody who's with us today hasn't had a chance to look at it. I have a feeling you can bring it up more quickly than I can, so to share with people. Yeah, one of the coolest things that I think more Brian and his and his co-leaders did on that project is they really did a uh what we were calling a landscape analysis to find projects outside of DPHHS just community based efforts to help refer people to all of the great work going on related to obesity prevention just so to put a highlight. It's just a great example of the fact that there's lots of lots of incredible work going on out there, and so it was. It's a very cool project. Thanks for posting that, Brian. Any other questions for car wrap up today I do I have a quick question. This is Bailey. I was wondering is this I might have missed this in the beginning, but is this a program that the food banks and pantries are agreeing to and then get certain like additional funding for agreeing to work on this project? Or yeah, so this was just the development phase of the project and it was with Livingston Food Resource Center in Gallatin Valley Food Bank to develop a project together and then test it and implement it up. You know, because we don't want to share a project that's not you know, effective in what we were aiming to do, and so this was supported with funds from National Institutes of Health and through the Center for American Indian and Rural Health Equity at Montana State and we come now are, you know, going? We're doing the graphic design for the toolkit so that it can be shared out broadly. Building a website and then figuring out ways to make either all of UP3 or parts of UP3, usable by food pantries that are interested and just from like presentations that I've done nationally, you know. Like I said earlier, through pantries are like oh I want to see the food supply inventory guide, or I want the shopping list, Or I just want the nutrition education lessons so we built it intentionally so that food pantries could view. Just use pieces of it that they were interested in and then Uhm, can contact us for advice, but yeah, it's sort of a self supported guide. Now for food pantries that have capacity and interest to do this. Gotcha, yeah. I was just curious because last year I was volunteer VISTA with Anna and I went to the Food Bank for the first time and I know that they weren't accepting a lot of food because of COVID but they were buying a lot of it and some of the food I was getting was literally inedible and I was just wondering that would kind of like know. Yeah, I mean that's a huge part of it, right? Is that like a lot of food pantry staff are volunteers or they're paid staff, but they have never been trained about like what foods to choose. And so like, that's why part of the guide is just focus on this staff and the volunteers and then the other part is focused on the clients. Because it's you know, it's two parts of the story for sure. Is like making the food supply healthy and then making sure clients know what to choose. And a lot of food pantries take donated foods come now with COVID restrictions. Most, um at first, most food pantries were not, and that's where like the public has to be educated as well. Is that like these are real people eating food with health concerns and you know when we go into our own pantry at home to donate foods. We shouldn't be picking the last thing in our pantry that is about to expire or is expired. And it's been there for so long because it's ultra processed or because it's ultra processed and we're just like oh well, someone else will eat that. That's not like that's not really charitable, and it's not in my opinion, the best approach to take, even though that is like a natural approach that I have taken across my life. Just educating people that, that, like there is a person in this transaction, and it's not it's not completely, UM. Like it, it's very important to consider the health of the food products that are donated as well. Thank you. Yeah, thank you for minutes. A really thoughtful response. You guys it is 1234 and so I think I'm going to have it end on that note. Thank you so much for attending today. Carmen, thank you so much for sharing this project that you've been working on with us and I will forward out the list that Carmen has of local data to everyone who registered. So thanks so much for your time today guys and we'll get this recording posted up on the A Healthier Montana website as soon as we can. Have a great weekend. Thank you everyone. Thank you.