Hunger is just one concern of patients experiencing food insecurity. Poor nutritional habits and insufficient options for quality, healthy food can lead to serious chronic health issues, including obesity. These problems disproportionately affect minorities and socioeconomically disadvantaged families.
Boston Children’s Hospital addressed these inequities by bringing nutritional care directly to communities that needed it most. The hospital opened a dedicated gastroenterology clinic at Boston Children’s Martha Eliot primary care facility in the city’s Jamaica Plain neighborhood. Staffed by a team of specialists who live in the area and are familiar with the needs of its residents, the clinic provides families access to state-of-the-art gastrointestinal and nutritional health services, including an intensive health and behavior coaching program aimed at treating pediatric obesity.
“Often, subspecialty programs like this get siloed into satellite locations, which tend to exist in more affluent neighborhoods,” said Boston Children’s gastroenterologist Jason Zhang, MD, PhD. “We really wanted to bring the highest-quality obesity medicine — intensive health behavior therapy and access to the most effective medicines — directly to this community.”
The hospital is also seeking innovative ways to address food scarcity in the community. “Historically, a lot of these families were given the blanket statement to eat healthy and exercise,” said Allison Wu, MD, pediatric gastroenterologist at Boston Children’s. “That falls flat as a recommendation when they have limited resources or access to healthy and nutritious foods.”
To bridge that gap, Boston Children’s researchers are studying the effectiveness of a meal kit delivery program.
Healthy meals made easy
Wu and her team enlisted 30 patients from Boston Children’s at Martha Eliot for the Intervening in Food insecurity to Reduce and Mitigate (InFoRM) childhood obesity study. In the study’s first phase, researchers sent participating families healthy meal kits for six weeks. The kits included fresh, preportioned ingredients prepared by local chefs and dietitian nutritionists to suit the cultural and taste preferences of the neighborhood’s families. The kits were not intended to provide all the family’s food during this phase — each weekly kit came with two recipes that produced about 10 servings. Simplicity was key to encouraging the kids’ adoption, with recipes designed to be prepared in one pot in under 30 minutes with picture-based instructions in English or Spanish.
Overall, the study demonstrated meal kits to be an effective intervention for children with obesity living in households with food insecurity. In post-trial questionnaires, 95% of participating families said they prepared at least one meal kit, with 86% of children reporting they liked the food.
“We had some caregivers tell us they discovered vegetables they had no idea their child would like and others who said their kids were now asking them to make ‘the healthy chicken’ for dinner,” Wu said.
Future studies to build off pilot program
The research team intends to enlist a larger cohort of families in the study’s second phase, deliver a higher dose of meal kits to each participant, and extend the duration of the intervention. That trial, expected to begin in 2026, will also integrate lessons from the initial phase, including:
- Tailor to kids’ tastes. Only 25% of the families prepared more than half of the meal kits they received. In many cases, that was because the ingredients weren’t suited to the child’s tastes. “It’s difficult because part of the program’s intention was to introduce the child to new foods,” Wu said. “But we’re looking at options to allow for customization of the recipes in the second phase.”
- Improve referral process. Competing priorities and limited time during patient visits led some pediatricians to neglect referring a qualifying patient to the program. The research team is planning to streamline the referral process, including embedding it into the electronic health record.
Though the study intended to demonstrate the feasibility of a scalable meal kit delivery program offered to pediatric patients struggling with obesity amid food insecurity, the research team sees the meal kits as a temporary intervention — not unlike prescription medications. Ultimately, Wu and Zhang hope the program will serve as a bridge to long-term nutritional health.
“We’d like to see a kind of step-down program to help support families with food and nutrition security once the meal kit deliveries are over,” Wu said. “Using family food resources within the community and adopting the habits, tools, and nutrition education they've taken from the program, families can continue to put fresh, healthy food on the table for the long run.”
