The Ohio State University Alumni Association

Special Report Food Security

What can doctors bring to light?

The role of nutrition education in patient care

Stephen Koesters

Dr. Stephen Koesters interacts with a young patient at an Ohio State academic medical center that functions like a private practice.

Stephen Koesters ’98 MD presents as lighthearted with a twist of mischief. Pediatrics fits.

He treats children and their entire families at Internal Medicine and Pediatrics at Grandview, an Ohio State academic medical center that functions like a private practice. The office draws patients from all walks: university students, affluent suburbanites and, because the office accepts Medicaid, a number of medically underserved children.

It’s in this last group that he sees kids with problems common among much older patients. High blood pressure. High cholesterol. Early-onset diabetes. Anemia. And obesity, the unintended side effect of processed — but more affordable — food.

Koesters determines the quality of his patients’ nourishment first with conventional tools, such as height and weight charts. When charts signal a problem, the cause is rarely medical.

“At that point, I ask a lot of questions,” he says. “Simple questions, like, ‘Are you getting enough food?’ If they’re getting enough, I ask the parents, ‘Are they getting the right kind of food? Is there anything standing in the way of getting the right food?’”

Koesters understands, though, that for his impoverished patients, healthful food isn’t just a simple, unencumbered choice or a switch that can be flicked on. He recalls a little girl struggling with obesity. In the care of relatives while her mother works, the girl is consuming foods high in sugar, fat and sodium during critical habit-forming years. Broccoli and whole-wheat bread can’t compete.

“I do believe the mom worked hard to implement the right habits, but healthful food is expensive, and child-care costs have kept her dependent on family. It’s complicated. It’s a struggle.”

While growth charts measure the height and weight of hunger, emotional consequences are just as devastating. Children function best when they can predict their environments, and food insecurity is the antithesis of predictability.

The lack of food over and over and over can actually change a child’s brain. Hungry or undernourished children have a greater tendency toward behavioral and social problems, anxiety, depression and even suicidal thoughts.

“Food insecurity is a complex thing with so many [consequences],” Koesters says. “That is why at Ohio State, we learned not just to treat patients, but to teach them, too.”

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