At the Mass General Research Institute, our community of 9,500+ investigators work diligently to publish peer-reviewed work and scientific findings to better understand disease and develop solutions to medicine’s most pressing challenges.

Footnotes in Science is a space where investigators bring you the behind-the-scenes details of their recently published work.

In this Q&A, we pick the brain of Anne Thorndike, MD, MPH, regarding her latest research article published in BMC Public Health, A food bank program to help food pantries improve healthy food choices: mixed methods evaluation of The Greater Boston Food Bank’s Healthy Pantry Program

Dr. Thorndike is the Director of the Cardiac Lifestyle Program at Massachusetts General Hospital and an Associate Professor of Medicine at Harvard Medical School.

What motivated you and your team to write this perspective article?

My team has been testing different types of behavioral strategies to promote healthy food choices in workplace settings, community settings, and supermarkets for the past ten years. 

We connected with the Greater Boston Food Bank (GBFB) in 2019 because they wanted to evaluate their Healthy Pantry Program and determine if it was effective for promoting healthier food choices among food pantry clients.

Working with Jenny Jia, MD, MSc, a general medicine fellow at MGH and HMS at the time, we originally planned to do a pilot randomized trial of the Healthy Pantry Program. Unfortunately, this plan was de-railed by the COVID-19 pandemic in March 2020. 

Therefore, we pivoted to do a retrospective assessment of 10 pantries that had already participated in the Healthy Pantry Program to determine the program’s effectiveness.

Can you expand on the term food insecurity and what it entails? 

Food insecurity is defined as having limited or uncertain access to food, and this is usually related to a household’s ability to afford buying enough food.

More recently, the term “nutrition security” has been used to describe a household’s ability to access nutritious food.

My team’s research has been focused on improving nutrition security by developing and assessing strategies to improve access to food and to improve dietary quality of individuals experiencing food insecurity.

What are behavioral nudges and how can they have an effect on human behavior?

Behavioral nudges are interventions that are designed to help us overcome the tendency (or bias) to make unhealthy choices. For example, placing the healthier entrees at the top of a menu might increase the likelihood that you order the healthier choice.

My team worked with the MGH Food and Nutrition Department to implement traffic light labels and choice architecture (i.e., product placement) in the MGH cafeterias starting in 2010.

By tracking cafeteria sales over time, we found that these nudge interventions increased healthy cafeteria purchases.

Nudge interventions help us change our small daily behaviors that contribute to the development of chronic disease.

What can Food Banks do to increase access to healthy food choices? 

Food pantries and other agencies purchase much of their food from food banks. Therefore, it is important that food banks have a supply of a variety of healthy options, including fresh produce, available to food pantries.

However, based on the new national guidelines, food banks should also start to implement nutrition ranking systems that help pantries identify healthier choices and that ultimately lead to food pantry clients’ having access to healthier food choices.

What can scientists, schools and other local governing bodies do to support people experiencing food insecurity?  

There is a lot of great work going on at the local, state, and federal level to address food insecurity, but of course, we can always do more.

The Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Program for Women Infants and Children (WIC) are the two most important food assistance programs in the US.  Our first goal should be to make sure that all individuals eligible for these programs are enrolled.

There are currently new initiatives at Mass General Brigham to help increase enrollment of our eligible patients into these programs.

The charitable food system (i.e., food pantries and food banks) fills a large gap by providing a safety net for those not eligible for SNAP or WIC or for those who need additional support. 

Schools provide critical meals for children experiencing food insecurity, and ensuring the nutritional quality of school meals is necessary for all children to be nutrition secure.

Our role as researchers is to determine what works and what does not work to improve access to nutritious food and reduce chronic disease.

This research will help guide programs and policies to be more effective for improving access to healthy food for all Americans.

What are the next steps in your research?

We are currently planning to test a large-scale nudging intervention in collaboration with the Greater Boston Food Bank. 

In this project, we will use different nudging strategies to increase food pantries’ purchases of healthy food from the food bank and to increase food pantry clients’ choices of healthier items.

This work is aligned with recent national guidelines for food banks and food pantries that were published by the Robert Wood Johnson Foundation’s Healthy Eating Research Program.