Celiac Disease and Food Banks in Colorado during the Covid-19 Pandemic

ABSTRACT

Background: In Colorado, food insecurity affects about 10% of patients with celiac disease and is associated with decreased adherence to gluten-free diet. With the COVID-19 pandemic, demand for gluten-free foods from food banks increased. We sought to assess the availability of gluten-free foods at food banks in Colorado during the pandemic. Method(s) Food banks in Colorado were asked to complete a survey about general understanding of celiac disease and identifying perceived barriers to providing gluten-free foods to people with celiac disease and food insecurity. In-person visits with additional predefined questions for the director were planned. Result(s) Of the 63 food banks contacted, 27 (43%) responded and 15 (24%) completed questionnaires (Table). Some in the Denver Metro area reported no barriers as they felt well equipped with resources and information related to celiac disease. The most common barrier reported was access to gluten-free foods from both donors and from mass suppliers. The next most common barriers were volunteer training and lack of celiac community advocacy about need. Of 16 providing written responses, 8 requested written resources and 3 indicated a separate area for those with food restrictions and adequate supply of gluten-free foods. Only one food bank was visited. The others were inaccessible due to lack of resources or capacity due to the pandemic or lack of communication. The food bank visited was Integrated Family Community Services, a social service whose mission is to alleviate hunger and empower people to make health adjustments. This food bank works with hospitals and the community to support low-income families in Englewood CO, an area with population at high risk of food insecurity. The director at this food bank reported knowing what celiac disease and gluten-free are, as well as trying to provide food for those with specific food restrictions. Prior to COVID, recipients could select the food items they wanted, and gluten-free pastas, flours, breads were separated, as were low glycemic foods for those with diabetes and low sodium foods for those with hypertension. However, due to COVID restrictions, this was no longer possible;volunteers put together pre-made boxes, but not gluten-free boxes. Conclusion(s) During the COVID-19 pandemic, demand for gluten-free food items increased;however, not only was there diminished supply of gluten-free foods to food banks by large and small donors, food banks also were reduced in their capacity to sort and deliver the gluten-free foods to those in need. In addition, there was little awareness of the need for gluten-free donations and the need for volunteers at the food banks. Food insecurity is a contributing factor in adverse health outcomes for celiac disease. Discussion(s) Food insecurity is common, impacting 10%-20% of families with celiac disease and is associated with rural communities, reduced adherence to the gluten-free diet, and the burden of the higher cost of gluten-free foods on low income families. Recognizing the impact on social determinants of health, the US Preventive Services Task Force is developing a research agenda for food insecurity. Strategies celiac centers could adapt to improve access include 1) focused advocacy to increase donations to food banks by gluten-free food producers, 2) creation of areas within food pantries for special dietary needs, 3) provide expert dietitian support to food banks, 4) develop written resources about gluten-free foods, labelling and recipes for food banks, and 5) improve staffing by promoting volunteering. Limitations of this study include low participation rate by food pantries, inability to visit more than one pantry during this study, and extrapolation of findings to other areas outside Colorado. Future directions could include studies to increase health care systems awareness of and screening for food insecurity (demand side), as well as partnering with food banks and gluten free food manufacturers and suppliers to enhance the availability of these foods (supply side) and then assess any impact on health outcomes. (Table Presented).