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.