A mother and her teenage son approach Ana Cristina Jurczyk near the entrance of a Food 4 Less grocery store in Anaheim. Boxes of Cheetos and Frosted Flakes are stacked to the ceiling next to them.
The mother explains to Jurczyk, a registered dietitian, that her son wants to vomit when he eats vegetables.
"That's probably psychological," says Jurczyk, smiling.
She tells the pair to pick a vegetable to try each week. Then cook it different ways — roasted, grilled, steamed, sauted, even microwaved. They're bound to stumble upon something he likes, Jurczyk says.
As mother and son head toward the produce section, Jurczyk says: "I refuse to believe that people don't like vegetables."
Jurczyk is spending her afternoon at Food 4 Less as part of an initiative that stations doctors and nutritionists in supermarkets to answer questions and offer advice about healthy eating — all for free.
Sponsored by St. Joseph Hoag Health, a network of hospitals and clinics in Orange County, the Shop With Your Doc events are part of a recent wave of programs that look beyond the hospital room or doctor's office. It's become increasingly clear that people's regular eating and exercise habits have a much bigger effect on their health than the time spent at a doctor's appointment, said Glenn Melnick, a USC health economics professor.
And the healthcare system is slowly changing to reflect that reality, he said.
"The hospitals that are doing this are kind of anticipating the future," he said.
Ernie Jimenez leans over his grocery cart, reading a list of recipes handed to him as he entered the Anaheim Food 4 Less on a recent afternoon.
He says to Jurczyk: "I've never had whole-grain spaghetti. How does it taste?"
She tells him it's chewier because it has more fiber. She recommends mixing it with regular white pasta at first so he can get used to the taste. He can phase out the white pasta over time.
Workers at seven St. Joseph Hoag Health events at Ralphs and Food 4 Less stores this year have provided information to about 7,000 customers, according to hospital officials.
Medical providers often end up talking to people who've never been to a doctor. More than once they've learned after measuring someone's blood pressure that they require immediate medical attention.
Jurczyk chats with many people who don't know how to read a nutrition label, so she begins by explaining the difference between protein and carbohydrates. "It's about meeting people where they're at," she said.
Though these initiatives might resemble charity work, experts say they can benefit hospitals directly — and expect more to crop up in the coming years.
Historically, payments for doctors have been misaligned: physicians make money when patients get sick because they bill to treat them.
But under changes put into place by the Affordable Care Act, doctors are increasingly paid a lump sum to provide all of a patient's medical treatments for a year, instead of the typical fee-for-service model. So hospitals can save money when patients don't need medical care, Melnick said.
That's why they're beginning to consider new ways to improve the health of their communities, he said.
"We're starting to see movement in the right direction," Melnick said. "It isn't rocket science, but we have a $3-trillion healthcare system which never really had any incentives to do it. The incentives were the opposite."
Clinic chain AltaMed is working with corner store owners in East Los Angeles to replace candy and chips at the checkout stand with fruits and vegetables. Torrance Memorial Medical Center opened a community garden to teach people how to grow their own produce. Eisner Pediatric & Family Medical Center in downtown L.A. is offering classes about healthy eating for parents and kids and providing coupons for free produce through nonprofit Wholesome Wave.
Jennifer Bayer of the Hospital Assn. of Southern California said that clinics and hospitals have been trying to encourage lifestyle changes in patients for years, such as offering cooking classes for diabetics. But these more recent efforts are "a little more proactive" because they aren't limited to people who already have medical problems, she said.
Instead, hospital leaders are considering things like, "How do we prevent diabetes, hypertension? How do we use nutrition to prevent cancer?" she said.
Bayer said she is trying to bring hospitals together to co-manage farmers markets that would increase fresh fruits and vegetables in Los Angeles neighborhoods. Kaiser Permanente, a managed care health system that doesn't use a fee-for-service payment model, already runs weekly farmers markets at more than 50 of its facilities across the country.
Still, it's yet to be seen whether hospitals are reaping sufficient rewards from these projects to justify the investment, Melnick said.
Many of those who adopt healthier eating habits at a grocery store event may not belong to the medical group that has provided the service.
In general, Melnick said, it's difficult to get people to change their behaviors. Even if they do, the benefit of switching to whole-grain pasta, for instance, usually shows up decades later.
"We don't really know how to make this work yet," Melnick said.
While talking to Jimenez, Jurczyk picks up a bag of tortillas from the shelf next to them.
She explains that carbohydrates turn to sugar once you eat them, but fiber reduces that effect. She shows him that corn tortillas have more fiber than wheat tortillas.
Jimenez, a salesman who lives in Anaheim, says he's going to try whole-wheat pasta. He's used to looking at nutrition labels for calorie and cholesterol information, he says, "but I never knew the more fiber the better."
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