SPECIAL REPORT: How Parkview LaGrange is using food as medicine to treat type 2 diabetes



When Jeremy Hoover of LaGrange County was diagnosed with type 2 diabetes about two years ago, he didn’t know much about the disease.

What he did know was what he liked to eat and what he did not like to eat.

“I was a meat and potatoes, fried foods kind of guy,” Hoover says. “I would hardly eat vegetables at all; I didn’t really think that I liked them.”

Today, his diet has changed by choice. Hoover regularly eats vegetables like broccoli and cauliflower, using them to supplement carbohydrates like noodles and potatoes in his meals. These healthy lifestyle changes are largely thanks to a new program at Parkview LaGrange Hospital called the Food Pharmacy.

Instead of treating type 2 diabetes patients with medication, it treats food as medicine, prescribing them with a healthy dose of eating options, a regimen of cooking classes to prepare the food, and regular meetings with other participants and Parkview specialists to support long-term lifestyle changes.

Parkview LaGrange's Food Pharmacy hosts cooking classes to help participants learn how to make healthy meals.

Adam Gehring, a registered dietitian at Parkview LaGrange Hospital, directs the program, which went into its second year in February 2019 after a highly successful pilot program in February 2018.

Stories like Hoover’s are good examples of the Food Pharmacy program’s potential.

When it comes to type 2 diabetes, a lack of information and accessibility to healthy lifestyles can be a major culprit in worsening conditions.

Data from the Centers for Disease Control and Prevention shows that one in three American adults have what is called “prediabetes”—or high blood sugar levels that could develop into type 2 diabetes, and 90 percent don’t know they have it.

However, once the disease escalates and medical intervention is needed, it becomes costly and burdensome to patients, healthcare systems, and economies alike.

In fact, the American Diabetes Association estimates that the overall cost of diagnosed diabetes has risen to $327 billion.

But in LaGrange County, change is underway to challenge these statistics, going back to northeast Indiana’s roots in farm-fresh vegetables.

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“Farmacy” is an apt word to describe what’s happening in the rural community of LaGrange.

Gehring says the conditions that lead to type 2 diabetes often come down to what we eat and how often.

“The things that we’re eating that aren’t typically helping are an excessive amount of carbohydrates, an excessive amount of calories, an excessive amount of eating times, and not limiting our portions,” he says.

What makes Parkview LaGrange’s Food Pharmacy so unique is that it was designed as a non-pharmaceutical approach to treat diabetes—and that’s especially good news for the rural cities and towns of northeast Indiana.

A 2016 Community Health Needs Assessment released by Parkview Noble Hospital identified both diabetes and obesity as significant health concerns in the region.

In LaGrange County alone, 11.8 percent of residents have been diagnosed with diabetes, according to the report, and 34.2 percent of respondents fell under the medical definition of obese, having a body mass index greater than 30.0.

“In the pharmacy field, we always advocate ‘non-pharm’ interventions,” says Ross Robison, a Parkview LaGrange Hospital pharmacist who is involved with the program. “‘Non-pharm’ essentially means non-drug interventions like diet, exercise, and lifestyle adjustments. If those don’t get you to your health goals, then we add in medication.”

Eating more vegetables and fewer sugars and carbs is part of a healthy diet.

In the case of Food Pharmacy, “non-pharm” means a food intervention, encouraging residents to eat more of the fresh vegetables they might find at local farmers markets.

When it comes to specific food types that commonly cause obesity and diabetes, Gehring cites an excess of desserts, breads, foods made from potatoes, and sugar-sweetened beverages.

“It really comes down to the balance of what we eat—how much we’re eating, when we’re eating, portion size, and what we’re eating,” he says. “Protein with carbohydrates and vegetables is a very healthy way of eating.”

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While the Food Pharmacy is more than a diet and a cooking class, learning how to prepare healthier fare from recipes is a major component of the program, Gehring says.

During the pilot, a group of 10 participants or “students”—all of whom met requirements for inclusion and were referred by their primary care doctor—met together as a class 18 times in a span of six months. During that time, students received education and care from physicians, dietitians, pharmacists, and other healthcare professionals, as well as educators.

Each participant underwent lab tests, was weighed, and had their vital signs checked at the beginning, middle, and end of the program.

The results have not been found wanting. At the end of the pilot program last year, Food Pharmacy participants lost an average of more than four pounds, saw lower hemoglobin A1c, triglyceride, and low-density lipoprotein cholesterol numbers, and enjoyed an increase in high-density lipoprotein cholesterol levels—the good kind, Robison notes.  

“The fact that we lowered A1c (a signifier of average blood sugar levels) by 1.7 is pretty significant,” he says, stressing the importance of participants being partners in fighting their disease.

“Patients want to understand their disease state, and they want to be given tools to be able to take ownership to help manage this disease state,” Robison explains. “They’re very encouraged by a program like this.”

This is all great news for Dr. Jamin Yoder, a Shipshewana family practice doctor, who is both involved with the program and refers patients to it.

“We look at the results of them changing their diets and exercise habits and how this affects long-term outcomes for diabetics,” Yoder says. “They then know that they have a disease process and have foods they are unable to eat, and they can make healthy choices.”

Gehring says it’s about dietitians, doctors, and specialists showing participants that they care about them and their conditions, too.

When he starts working with patients who have newly been diagnosed with type 2 diabetes, he starts by simply listening.

“The first thing that I do is I let them talk,” Gehring says. “I try to ask them a few questions just to get to know them a little bit better and build that rapport, because honestly, they’re not going to do anything that I say if they don’t think that I care.”

Bonding with other people who have type 2 diabetes helps patients build healthier lifestyles.

Hoover, who at first wasn’t overly excited about Food Pharmacy being conducted in a group setting, says he wasn’t the only one to be quiet and feel awkward at the first gathering. However, it didn’t take long for him to realize the benefits of having other people in the program who were in similar situations.

“Everybody kind of opened up, and we were much more comfortable talking about issues that we have with our diabetes and questions that we had,” he says. “That made it a lot easier.”

From a physician’s standpoint, having patients learn in classes is helpful, too, Yoder says, because it allows them to generate their own momentum in developing healthier lifestyles.

“The story that I think that is helpful is the people starting to get to know each other and spend time together,” he explains. “They start coaching each other and not relying so much on the experts there to tell them what to do.”

Learn more

Food Pharmacy is open to all physicians—to refer their patients—in the LaGrange County area. According to a Parkview Health spokesperson, there have been discussions about implementing a Food Pharmacy program elsewhere in the Parkview system, although a startup date has not been determined.

To learn more, visit the program's web page.

This Special Report was made possible by Parkview Health.

​​​​​​​Jared Beasley
​​​​​​​Jared Beasley
Vice President of Patient Care Services
& Food Pharmacy
Parkview Hospital LaGrange


Jared Beasley, vice president of patient care services at Parkview LaGrange Hospital, serves as administrator of the hospital’s Food Pharmacy program. He is also an adjunct professor of nursing at Goshen College.

Input Fort Wayne sat down with Beasley to learn more about the background of the Parkview LaGrange Food Pharmacy program, as well as what he envisions for the program’s future.

IFW: Why did Parkview LaGrange Hospital decide to start a food pharmacy?

JB: Every three years, Parkview Health engages in a community health needs assessment in northeast Indiana. The results of the most recent needs assessment were released in 2017, and they showed that type 2 diabetes is one of the top three health priorities in LaGrange County.

Following discussions of the results with the leadership team, the hospital’s registered dietitian, Adam Gehring, submitted a program proposal to the administration that ultimately served as the foundation of the Food Pharmacy program. Parkview LaGrange Hospital administration charged Adam and the hospital’s pharmacy manager, Brenda Armentrout, with creating an ad hoc committee to represent medical staff, food and nutrition services, nursing, and pharmacy to research successful, outcome-based programs elsewhere that were addressing type 2 diabetes. The committee found that the most successful programs used a multidisciplinary group approach as a means of combating negative effects.

IFW: What was the process to get the LaGrange Food Pharmacy program up and running?

JB: As the Food Pharmacy committee, with support from the administration, completed its review of successful programs, its members became the core of a task force that was charged with developing the Food Pharmacy program. The task force identified potential community partners who shared an interest and concern. Input and support were also sought from the hospital’s medical staff, leadership, and foundation.

Utilizing information and ideas from a multitude of successful, evidence-based programs, the team formulated a detailed curriculum. Financial support was sought and received from a variety of sources within Parkview and in the community. In late 2017, we approached Parkview LaGrange Hospital’s medical staff and invited them to recommend patients who could benefit from the program.

IFW: How have patients responded to the program so far?

JB: Prior to joining the Food Pharmacy program, students were interviewed to ensure they understood the nature of the program and the commitment they would have to make to a significant lifestyle change to achieve their goals. Each week, patients in the program worked together to learn about the disease process of type 2 diabetes. They also spent 18 of the 20 sessions cooking and eating together. The camaraderie that grew over time led to patients sharing new learning with each other. As the end of the six-month program neared, class members requested ongoing times to meet as a group and to help with future groups of students.

IFW: What measurable health benefits have you seen in patients who have participated?

JB: From the start of the program, we encouraged the students to share what they were learning with their families. Several times during the program, students were sent home with ingredients that would enable them to recreate the meal they had enjoyed in class and share it with their families. As a result, we saw an increased development in support networks that understood diabetes and the positive effect that food and nutrition can have on the management of the disease.

IFW: Looking forward, what are some of the future goals for the program?

JB: In the short term, we are hoping to add a nutrigenomics (studying the relationship between human genome, nutrition, and health) connection to the program by partnering with an academic program. This would allow the program to contribute to the existing body of knowledge around this type of wellness promotion through studies like ones taking place at Manchester University and Purdue University Fort Wayne.

From a programming standpoint, we want to increase the capacity of the program and ensure that it is accessible to all. Community partnerships will most likely be the best and most effective route to make this happen, ultimately turning it into a community-supported program.