Becca Kahn, MA, RD, LD, Nutrition Services Director
There is a creative process happening all the time at Food & Friends that produces our flagship offering: the Medically Tailored Meal (MTM). These meals are more than just freshly prepared, delicious, and comforting dishes. They are meals tailored to address specific illnesses and their symptoms. The meals support healing and wellness. They are cooked with the utmost care and delivered with compassion by volunteers and staff, but they begin with a partnership between dedicated Food & Friends Registered Dietitian Nutritionists (RDNs) and Executive Chefs.
Food & Friends currently offers 12 different meal plans. The most recent plan was designed in 2021 for the neighbors we serve living with Cystic Fibrosis (CF). Cystic Fibrosis is a genetic disorder that affects the lungs, pancreas, and other organs. Since it often runs in families, it is common for Food & Friends to provide meals for a parent and child who both have CF. But like any innovative design project, there were obstacles, breakthroughs, and collaborations needed to reach the end goal of developing this new plan.
CF treatment and medication have evolved in recent years. People with CF can take advantage of these new advancements to help manage the illness. But the importance of proper nutrition in respiratory health remains vital. So, when Becca Kahn, MA, RD, LDN, and her team of community dietitians set out to design a meal plan for people living with the illness, they were prepared for a new challenge. With the help of Executive Chef Rasheed Abdurrahman, the team created a meal plan tailored to work with advancements in treatment.
“When we learned that the Cystic Fibrosis Foundation wanted us to develop a meal plan for individuals they had identified as having an urgent need, Carrie (Food & Friends Executive Director) and our team came together to analyze the needs of people living with Cystic Fibrosis. We knew that people with CF often have a tough time maintaining their weight,” said Becca Kahn, MA, RD, LDN.
The team knew that people living with CF often need extra calories and extra sodium . CF can clog the ducts leading into and out of the pancreas, liver, and intestines. So, people with CF have more difficulty absorbing nutrients and gaining or maintaining weight.
“That means that the extra calories they need should often come from heart-healthy fats. This was a challenge for us, because we typically design all our meal plans to be lean, low in fat, exceptionally low in sodium, and very calorie controlled. We learned a lot in the process because CF treatments have improved to the point where not everyone with CF needs as much added sodium as they would have just a few years ago. Some folks still need the extra fat, extra sodium, and extra calories but since a lot of people have easy access to extra sodium and fat through the Standard American Diet – appropriately labeled with the acronym SAD – a lot of them just needed extra nutritious food.”
Not everyone referred to Food & Friends with CF needed a high-calorie meal plan, but some did. The dietitians and chefs had to find a way to keep costs, labor, and space constraints under control while creating a new meal plan with enough calories and nutrients. They were also worried about the impacts of having to purchase additional packaging or add additional kitchen shifts. The chefs and dietitians had to come together and find a solution.
“The solution we created happened by looking at some of the more high-calorie, heart-healthy items we send and adding more of those into the plan. Sometimes it was adding a little more butter to the vegetables or doubling up on the trail mix we send that has peanuts and pumpkin seeds. By including more foods that are calorically dense, like extra peanut butter, we were able to meet the nutritional requirements both healthily and efficiently.”
Executive Chef Rasheed Abdurrahman was pulled into the meal planning process with the RDN team immediately. He was clear about the planning aspects. “We cannot put an extra set of chickens roasting in the oven if there are already a set of chickens roasting because of space constraints. Rasheed helped us understand what we could add to our current meals to accomplish our goal,” said Becca.
The Cystic Fibrosis Foundation was happy with the meal plan choices. The new menu tailored perfectly to what the population they serve needed. Through designing this meal plan, an unseen benefit for other neighbors with serious illnesses emerged.
For clients living with HIV/AIDS, who may be suffering from unwanted weight loss due to HIV Wasting Syndrome, we can offer a new option instead of traditional liquid supplements. Those individuals can choose elements of the CF plan if they are losing too much weight. We can also extend this to individuals coming out of chemotherapy who have lost weight.
All this progress was possible because of an effective partnership. “The Cystic Fibrosis Foundation did a terrific job of informing us of the specific needs of individuals with CF, what the most current treatment options are and the role they play in nutrition. They helped us get up to speed on those great new treatments. We learned that we did not need to go all the way to 4,000 or 5,000 calories a day for most individuals on the meal plan,” said Becca
Since people with CF are living much longer than in decades past, we wanted to make sure that we are not just adding calories but also making sure the calories we were adding are healthy in the long term. The Cystic Fibrosis Foundation was waiting for a sustainable solution, and now they had one, so there was a sense of relief.
The Food & Friends team of RDNs also works with individuals with CF one-on-one to help them navigate their meal plans and healthy eating in general. This is a key element of what Food Is Medicine Coalition agencies like Food & Friends do and what separates us from private-sector services that only send food.
“I see the role of our team (of RDNs) as being another supportive caretaker for families dealing with CF. For people waiting for a lung transplant it is especially difficult and emotional. We are proud to not only design a meal plan that works, but also to be there for them,” said Becca.