Why does Kaiser Permanente support both farmers markets and industrial “meal replacement systems”?

I stopped by Kaiser Permanente last Friday at the same time as its weekly farmers market, which the Oakland Medical Center hosts from 10 a.m. to 2 p.m. in partnership with the Pacific Coast Farmers Market Association. It was a pretty sparse little market, with just Vital Vittles breads, a flower seller, two vegetable stands, and a vendor of jams and honeys, etc. (Since I arrived at the tail end, I thought there may have been more earlier, but no.) I bought organic, seedless mandarin oranges and some really tasty flame raisins from Farmer and the Dale and Lone Oak Ranch, based in Reedley, CA, and asked how business had been.

"Great!" said the woman, who is the sister-in-law of farmer Dale Simmons. (Now I get the name.) "We do well here." I was glad to hear that.

My experiences with Kaiser health care have been mixed — not so fabulous recently, but exemplary overall in the five years it has been my provider. Kaiser Permanente has an interesting history and an unusual corporate structure. The Kaiser Foundation Health Plans are not-for-profit, although they provide infrastructure for as well as funding to Kaiser Foundation Hospitals and the organization’s for-profit medical groups. Some experts think Kaiser’s model delivers the kind of service, and lack of red tape, that a universal health care package could and should. (The people filmed for the Michael Moore movie "Sicko" disagree.)

So what does this have to do with food?

Perhaps because of its non-profit status, the Kaiser health plans offer perhaps the widest range of prevention (a.k.a. "wellness") services among the big HMOs, from funding smoking-cessation classes and products to promoting not just healthier food, but locally grown organic fare. The farmers market I visited is one fruit of that effort. And in August 2006, Kaiser launched a pilot program to get local produce into the patient meals at 19 hospitals in Northern California. It has funded public-school gardens modeled after the Edible Schoolyard to grow some of that produce. Kaiser even created a Farm Bill taskforce to lobby for federal funding for healthier food, according to former American Farmland Trust president Ralph Grossi.

However, the for-profit side has apparently not gotten the message of what edible items constitute "healthy."

My husband received an interesting letter recently from the Health Education Department of Oakland’s Permanente Medical Group, one of the physician-owned, for-profit groups. "Dear Kaiser member," it said. "We hope this letter finds you in good health. As physicians, we want to make you aware of an elective, medically monitored treatment program now available at Kaiser Permanente, the Medical Weight Management Program. It is for people who are significantly overweight (i.e. 40 pounds or more overweight)."

So far so good; although Bart does not fall into that category, the letter diplomatically suggested "someone you care about" might. It goes on to detail the health risks associated with obesity, and how losing weight can help. But this is where he started laughing, and handed me the letter.

Turns out the Kaiser Permanente Medical Weight Management Program "uses Optifast meal replacement system, coupled with a focus on nutrition, lifestyle and activity education. Optifast has over 30 years’ experience in helping people lose weight. The shakes and bars are healthy, provide full nutrition, and have been shown to aid in weight loss."

I’d love to see those studies. Optifast is owned by Nestlé. The "meal replacement system" includes "ready to drink shakes," "powders," "soups," and "nutrition bars." Curiously, Optifast does not make the ingredients of its products easy to find on its website; I could find only one. Here are the scrumptious-sounding materials that went into the scientific-sounding Optisource Mini Nutrition Bar, Chocolate Flavor:

High fructose corn syrup, whey protein isolate (milk), soy protein isolate, sugar, maltitol syrup, glycerine, soy crisps (soy protein isolate, tapioca starch, malt extract), cocoa processed with alkali, partially hydrogenated vegetable oil (cottonseed and soybean), chocolate liquor, water, natural and artificial flavor, sunflower oil, hydrogenated starch hydrolysate, fructooligosaccharide, soybean, cocoa, soy lecithin, sucralose, salt.

Um…eww?! High-fructose corn syrup and partially hydrogenated vegetable oils, aka trans fats? Nutritious?

Elsewhere on the Web I found what goes into the "milkshake":

Caseinate, non-fat milk solids, maltodextrin, sugar, cocoa, sunflower oil, flavour natural and artificial, colour 160(a), emulsifier (322) and micronutrients.

If the ingredients themselves aren’t enough to make you lose your appetite, an Optifast Australia site has some FAQs about the side effects of constipation and halitosis. I mean, sheesh, I would lose a hell of a lot of weight too if you made me drink chemically flavored shakes that backed up my system and gave me bad breath.

Here’s a radical thought: maybe the Oakland Permanente Medical Group might want to talk to its overweight and obese patients about replacing these nasty "meal replacements" with meals made out of actual food, food like the organic bread, vegetables, and fruit they sell at the farmers market right in front of the medical building. But that might mean giving up the lucrative kickback that they’re getting from Nestlé: the fine print at the bottom of the letter my husband received says that "These services are not provided or covered by Kaiser Foundation Health Plan, Inc., and you are responsible to pay for them.…Kaiser Foundation Health Plan, Inc., and Kaiser Foundation Hospitals may receive compensation for providing facilities and/or other support in connection with these services."

The Optifast system is meant to be administered in a hospital or clinic system, so it’s hard to find prices for the stuff. On this Australian site, 21 "milkshake" sachets are AU$39, or US$19.53, for about 1 American buck a meal. That’s pretty hard for real food to beat, and you can be sure there’s a great profit margin on these suckers — for all parties involved.

As Michael Pollan writes in "In Defense of Food," his newest book, "Apparently it is easier, or at least a lot more profitable, to change a disease of civilization into a lifestyle than it is to change the way that civilization eats."

Let’s hope for the sake of its obese patients, the different sides of Kaiser and other HMOs get their acts together. Because while teaching people how to plan and shop for healthy food, cook it, and be satisfied with much less of it, probably takes tons more time and resources than throwing a few packets of powdered crap at them, I’d be willing to bet the weight comes off just as fast and stays off longer.

Which would be good for both bottom lines — Kaiser’s and its patients.


11 Responsesto “Why does Kaiser Permanente support both farmers markets and industrial “meal replacement systems”?”

  1. Rachel says:

    Brilliant Bonnie! I’d love to hear Kaiser’s response.

  2. Ali B. says:

    Kaiser, a suggestion for you:

    Next time, know your audience.

  3. Nicole says:

    Bonnie: I’m a Kaiser patient and have been very happy with their service. And like you, I was thrilled to see their little farmer’s market at a Walnut Creek campus each week. So this “replacement meal” business is disconcerting to read about. Is there a specific place we could write to express an opinion on the matter? (I wonder if those assigned to that farm bill task force might be candidates.) Thanks!

  4. I hesitate to bring this up with a lot of my family and friends (b/c it seems I get people annoyed with me), but since I have joined a CSA and switched to grass-fed, pastured meats, I have lost about 15 pounds (and I’m only 5’2″ and not excessively overweight, but did have baby weight to lose). And it has led me to want to be healthier (getting exercise…)

    This has not been just by eating only veggies. We eat less meat b/c of our ethical considerations and when we do it is always grass-fed, wild, or pastured. I buy only the necessary items at the grocery store any more (no meat whatsoever and only the produce to fill in my CSA gaps — we live in the northeast so it gets tricky in the winter) But I have been on no diet. I eat pasta and bread and the occasional dessert. Nothing low fat, nothing low carb… I love to make homemade ice cream with real cream, homemade pasta, hearty soups — basically anything.

    But very slowly the weight just keeps coming off. I wish I could convey to people how they can lose weight by eating real food — no deprivation necessary. And for all my friends that are 40 and getting put on cholesterol medication, I just want to shake you! Whole grains, fruits/veggies, nothing processed, grass-fed, organic — eat real food!

  5. Ali B. says:

    Here’s the guy who started the Kaiser farmers’ markets:


    I’ve seen him speak, and he’s all about how what-you-eat determines your health. I dunno, maybe he’d recommend meal replacement diets for the extremely overweight, but he seemed pretty darned common-sense to me. Has a weekly newsletter about what to do with farm-fresh veggies. An MD, too, so he’s got food and medical cred.

    Med cred. I like the sound of it.

  6. kristen says:

    My best friend’s mom is a simple, gifted cook. Brussels sprouts roasted with olive oil; sautéed chard from their garden; salmon, from the farmers market fishmonger, grilled on the barbecue; and pie made from the blackberries off their backyard vine are just a few of the hundreds of delicious, fresh and healthy things I’ve eaten at their house over the past several years.

    It might surprise you that although she knows how to “plan and shop for healthy food”, “cook it”, and even grow it (you didn’t mention that one) she’s enrolled in an obesity treatment program very similar to the one you speak of so derisively. It’s not just meal replacements (although they’re an important component: I’d challenge you to satisfy your daily nutritional requirements, in under 600 calories a day, on “organic bread, vegetables, and fruit”), it’s also intensive group and individual counseling around behaviour modification; and yes, regular medical monitoring to ensure participants stay healthy throughout the process.

    From my perspective, the program seems to entail a little something more than simply “throwing a few packets of crap” at participants. More importantly, and to the point, my friend’s mom is more mobile, and feeling better, than she has in years.

    So I say cheers to Kaiser for providing a whole constellation of weight loss resources that meet the diverse needs of their clientele — resources that encompass the sort of basic health education you propone above, as well as individual counseling and – of course – increased access to healthy, whole foods through on-site farmers’ markets.

  7. Bonnie P. says:

    Hey, if something works for your friend’s mom, great. I’m not discounting the importance of education and behavior modification; I’m just saddened that it apparently requires packets of powdered chemicals to fund those efforts. And I also can’t imagine someone who likes to cook the way you describe could possibly be happy eating pseudo-shakes and bars forever…or could really wind up healthier in the long run if they did. Don’t you think it would be nice if the “fresh produce” left hand of Kaiser got together with the “health education and support” right hand and shook? That’s all I’m saying.

    Well, that AND that it’s ridiculous for a medical program to sell foodlike substances in which high-fructose corn syrup is the first ingredient.

  8. As the physician who started Kaiser Permanente’s farmers’ markets, I read your posting with interest. We are a big organization nationally. It will take time and focus to examine the many aspects of our of our health care system’s relationship to food. Perhaps one of my colleagues who specifically concentrates on weight management initiatives at the national level will comment on the use of Optifast. Personally, I simply focus on good fresh food as one of the prime determinants of good health.

    We now have farmers’ markets at 30 Kaiser Permanente facilities in 6 states and D.C. We have been sourcing some of the fresh fruits and vegetables for our 19 Northern California hospital inpatients (about 6000 meals per day)from small and mid size sustainable ag farmers since August 2006. Last year, about 60 tons of our hospital food came from these farmers. Because of Kaiser Permanente’s support up front, the Growers’ Collaborative, part of the Community Alliance with Family Farmers, is also bringing food from these same farmers to local public schools and universities. We continue to look for additional opportunities to help connect these small and mid size farmers to institutional demand. Watch for a major effort to offer a “collaborative CSA” to people at work in the near future. A variety of fresh sustainably grown fruits and vegetables from these farmers will be available by subscription in a public transit friendly box.

    I’ve practiced medicine at the Oakland Kaiser Permanente Medical Center for almost 37 years and have learned to take the long view. Everything affecting my ability to take care of my patients has changed dramatically for the better over time. Same thing for our food system work. While it sometimes seems a little slow to me, we keep taking steps that move us forward.

  9. Bonnie P. says:

    Dr. Maring: Thanks for stopping by, and for all your amazing efforts on behalf of Kaiser. The “collaborative CSA” in particular sounds like a terrific new program.

    And yeah — taking the long view is good. Having worked for a large public university, I know how hard it is to turn a battleship.

  10. Sue S says:

    My husband and I have been enrolled in Kaisers Weight Loss program using Optifast. We are also organic gardeners, we plan and shop for healthy foods. There is more to why a person is overweight than just eat healthy food. Many of us have much deeper reasons for eating than hunger. Using Optifast meal replacement tempoarily takes food out of the equation and allowes us to concentrate on understanding our addictions. It is much like rehab treatment. It is a very intinsive counseling, behaviour modification program. The maintance program counselors are trained in nutrition and exercise. We have learned so much more than we ever did at a weight loss program such as Weight Watchers that focuses on food and general tips. Our health, both physical and mental,  has been improved by this program. We are ready to return to a more healthy lifestyle, with food and exercise in proper perspective.  

  11. MH says:

    Do not talk about what you have no clue about! I was thin all of my life then I got sick and have hypothyroidism which I certainly don’t expect you to know or understand which is apparent from your lack of knowledge shown in this blog. One of the many issues with hypothyroidism is that your metabolism basically shuts down – I can literally not eat anything and gain weight, I can get the flu and gain weight.  I still don’t expect you to understand because you are like so many that think anyone overweight is lazy and eats poorly. You are sorely mistaken and missing the point.  Plus, in person you are likely putting others down or making them feel bad when you have no right to.  I am a vegetarian who eats organically/ locally and I exercise with a trainer plus yoga and pilates and I am currently over weight.  It is not by choice or what I have much control over and the non-caring non-informed way you speak makes me angry.  I work out and eat better than most anyone I know – so what does that say about skinny people who don’t eat their 8 servings of fruits and veggies.  Do you put them down too?  If so what gives you the right to tell others how they should live or what they should eat.  If they are happy and healthy while over weight or even unhealthy that is still not for you to judge!  Too many people now seem to want to spend more time trying to dictate what others should or can / can not do.  Clearly there is not a lot going on in your life that you spend that much time telling others what they should do.  I used Optifast and it gave me my life back and I kept it off because the combo of that and new medicine for my disease worked.  I have food allergies that when they flare up they are very difficult to keep under control and doing this controlled fast while making sure not to deprive my body of any nutrients.  I then moved had some bad situations happen and 7 years later I am working at it again – it is a tough fight.  Legitimate health issues that you have to battle every day is hard and I hope you don’t have to experience that in your life but it may help you have some consideration for people. Maybe ask questions and talk to people rather than make assumptions.    I am desperate to find somewhere close I can get into a Optifast program. I do not have high cholesterol nor bloodpressure but those with weight problems can and Optifast helps with that as well.  I am a foodie and work for a natural food company and I would recommend Optifast to anyone that needs and wants it.  It doesn’t taste bad and sure you need to take fiber along with it because you are not eating any roughage – common sense.  As far as the bad breathe that is because your body is in ketosis and that causes bad breathe.  I would assume that most people know someone who has done the South Beach diet or any other high protein diet – same thing!  That is not that unusual anyway – if you eat too much cheese it may back you up and add a little garlic and your breathe will smell.  Take a look at all the products out there to help with both of those problems and really these are not bad ‘side effects’ as you put it.   They come with every day life for people who are not on Optifast.  So other than you may not need it and got it in the mail I don’t find it funny as you did.  There is a lot of stuff I get in the mail that no one in my household needs.  This is my life you are basically laughing at and you don’t have the right to judge me or anyone else using it or anything else that works for them.  The organic and farmers markets are more in line with offering Optifast than you seem to understand.  Try to look at a big picture and something beyond your own nose.  People who have eating problems and are overweight for that can go to a class and do Optifast and as they are adding in food can learn, be exposed and have access to a farmers market.  It is there for people who do that on a regular basis and have another location for a farmers market.    The problem is people like you who make others feel bad not a company trying to help people and provide options for different kinds of people.  Sure they make money and Optifast makes money – why not?  It makes me sad to see such closed minds in the bay area. I am not a Kaiser patient and have mixed feelings over them but I think the farmers market and weightloss programs are fabulous.  Optifast is great – it works for all kinds of reasons/ for all kinds of people. It is not fair that I have no way of getting it right now.   Your posting may discourage people or make them feel bad for trying Optifast when they are looking for a solution and it is not the ‘crap’ you say it is.  Hopefully you will look at it in a new way and understand that if they do need help in learning how to eat well and make better choices the help is there and in the meantime they will get a jump start, help their cholesterol and keep them motivated to make LIFE changes.  For others it is a health issue and from time to time when my body (and others in the same situation) freaks out I don’t feel completely helpless.  If you bag on Optifast then where is your discussion about WeightWatchers and all the others.  What about the companies out there that offer Weight Watchers to their employees – how horrible are they?  I suppose they should just offer their employees fruit and veggies – why not both?  A company that I worked for I started a program that each week we had fresh fruit delivered for the staff and it was great but the majority of them still ate candy and fast food.  It is only part of the picture.  Why not get back up on your soap box about the state of our country and many other countries with a high percentage of obese people.  Where are the parents in all this?  Why not start with them – I learned wonderful eating habits growing up and gardening and treating ALL people the same.  Have an open mind and an open heart.  Maybe you could make a positive difference in someone’s life and help them rather than put them down for the choices they made for themselves.  Don’t blame Kaiser or Optifast for people needing their service and them offering an option.  If the choice is not for you doesn’t mean it isn’t for someone else.  I don’t eat fast food or meat but I don’t go telling people that they shouldn’t.  That is their choice and how do I know if it is something they do once every 3 months or a regular habit?  If I were to be preaching to someone is not a good way to get through to them.