Hospitals Lure Diabetes Patients With Self-Care Courses, But Costs Can Weigh Heavily

Published by Kaiser Health News on April 26, 2018. Written by Julie Appleby.

When a routine physical revealed mildly elevated blood-sugar levels, Michael Phillips was strongly encouraged to sign up for a diabetes self-management class.

Phillips never asked about the cost of the two half-day sessions he attended in a conference room at St. Mary’s Hospital in Athens, Ga., and doesn’t recall the instructor mentioning it.

But the 64-year-old retired bank analyst was flabbergasted when he opened his bill after attending.

“What, $1,044 for a class?” said Phillips, who fought the bill with the hospital and his insurer, Blue Cross Blue Shield of Georgia. “The hospital is charging an exorbitant rate, but BCBS is going along with it — why aren’t they screaming about being gouged?”

There are about 1.5 million Americans newly diagnosed with Type 2 diabetes each year. Unlike Type 1 diabetes, an autoimmune disease in which people produce no insulin that begins in childhood, Type 2 diabetes is a condition of adulthood, typically associated with weight and a sedentary lifestyle.

Diabetes self-management programs teach patients how to monitor their blood sugars, what to eat and the importance of exercise as strategies to delay or avoid the disease’s serious complications.

Patients like Phillips, with early or mild diabetes, can modify their habits so that their blood sugar returns to normal.

But the classes, targeting a disease that affects 30 million Americans, have also become a revenue generator for hospitals and an opportunity for marketing and branding.

“If you can get 25 in the class and charge $500 each, you can make a lot of money,” said Gerard Anderson, a professor of health policy and management Johns Hopkins University Bloomberg School Public Health. An additional incentive is that the classes bring “people into the hospital that they expect will need the hospital in the future.”

Phillips’ class had about a dozen students, who got a free lunch, free parking and a sample of Glucerna, a nutrition drink formulated for diabetics. The instructor noted that St. Mary’s operates a gym that participants could join for a fee.

Diabetes is among the costliest of medical conditions. The American Diabetes Association estimates that average medical expenditures for those diagnosed with diabetes are 2.3 times higher than those without.

The classes, say experts, are a chance to rein in some of that spending. When Harvard Law School researchers ran the numbers in 2015, they found an estimated savings of $1,309 over three years for every Medicare Advantage patient who completed an education program.

But for many patients, the cost of the classes can either become a barrier to actually attending, or leave them with unanticipated bills.

After St. Mary’s billed Phillips’ insurer $1,044 for the two half-day classes he attended, Blue Cross Blue Shield of Georgia, in turn, lowered that to $626, or the “allowed amount” it had negotiated with St. Mary’s. Because he had not yet met his $3,500 annual deductible, Phillips is responsible for the entire $626.

Phillips, who took early retirement from his job in 2005 to care for his elderly parents, said he likely would not have attended had he known the price. He’d expected the instruction to cost about $50, noting that he’d already paid $120 for a one-on-one session with one of the hospital’s certified diabetes educators or CDEs.

Medicare sets an average reimbursement of $356 for an entire nine-hour group course, with the beneficiary’s share of that amount estimated at $71.

St. Mary’s said it is proud of its fully accredited program, which helps diabetes patients manage their condition.

“Our charges are in line with other similarly recognized programs in the state,” according to a written statement from Mark Ralston, public relations director for the St. Mary’s Health Care System.

“Prior to enrollment, we send patients a letter that includes information that there will be a charge,” the statement said, noting that the amount “the patient will pay depends on the patient’s insurance coverage.”

Ralston also noted that, because St. Mary’s is a Catholic health care system, “we are always happy to work with patients who have financial difficulties, up to and including applications for charity care.”

Phillips’ charges seem high even though they were for a program that might actually save the insurer money over the long term, said William Custer, who studies health care markets as the director of the Center for Health Services Research at Georgia State University.

He questioned why the insurer didn’t drive a harder bargain.

“If the course has a benefit in terms of increasing health and reducing utilization, Blue Cross has an incentive to cover it and an incentive to negotiate,” said Custer.

Blue Cross is one of the state and the region’s major insurers, Custer said, so it should have negotiated a better price.

Colin Manning, a spokesman for the insurer said, “We do have questions about the amount charged for this class and we are reaching out to St. Mary’s Hospital to discuss reimbursement for this service.”

Diabetes management courses vary considerably in length and format, and even more so in price.

Internet searches and phone calls uncovered some cost examples, ranging from a $396, nine-hour course in Ohio to one in Wisconsin that lasted six hours and had a $420 price.

One of the most expensive — a 7½-hour diabetes self-management group course that included two-hour individual sessions with a dietitian and a diabetes educator — cost $1,700 in Washington state.

Howard County General Hospital in Maryland has decided to bypass insurance and charge patients $50 upfront for a six-hour course taught by a certified diabetes educator. That price was selected because in many cases it was less than what people with insurance would pay in copayments or deductibles under the former price, which was billed to insurers at a rate of about $1,000.

Before they made the switch about a year and a half ago, patients would often cancel after learning how much they would owe, said Mike Taylor, a clinical manager and diabetes educator who runs the hospitals program. “We would literally lose half the appointments we would schedule.”

The Maryland hospital also offers free classes by a lay instructor.

Meanwhile, thinking his original bill was in error, Phillips in late January appealed St. Mary’s $1,044 charge to his insurer. It was denied a month later as the insurer noted the bill was “coded correctly.” Hospitals can charge what they like for their services.

And after being contacted by the hospital billing office in early April to confirm he was aware of his bill’s “delinquent status,” he wrote a second appeal letter.

Phillips said the class was well-taught, though he noted that he was already dieting before he took the class. He “followed what they said” and he has lost 31 pounds. His blood sugar, he added, is also back in the normal range.

“At least now I’m well-informed about what to eat and not eat if I ever do have diabetes,” he said wryly.

10 Reasons You Might Think Food’s Gone Bad When It’s Actually Still Safe to Eat

Published by Insider on April 19, 2018. Written by Maggie Angst.

If you have trouble deciphering the difference between food safety and food quality, you’re not the only one.

Food waste not only costs American families hundreds of dollars a year, it’s also the single largest component found in landfills across the country. And most of the time, pounds and pounds of food are thrown away merely due to confusion.

How long after an expiration date can you still eat a product? Does one small spot of mold mean a cheese has spoiled? Is discoloration a sign that meat has gone bad? The answer to most of these questions is it depends.

But here are 10 things to remember next time your questioning if something is safe to eat or not.

1. “Use by” and “Best by” dates merely indicate freshness

1. PROKate Ter Haar/Flickr

Whether you’re dealing with canned vegetables, a bottle of beer or a jar of mustard, most products remain safe to eat well beyond their “use buy” or “best buy” dates. For example, canned soups can sometimes last up to five years without spoiling, according to food safety specialists.

Use by and best by dates are dates the manufacturer deems a product reaches its peak quality or best flavor. They are placed on products with very little regulation and do indicate a food is no longer safe to eat, according to the US Department of Agriculture.

2. “Sell by” is intended for retailers, not consumers


If you take into account a product’s “sell by” date while grocery shopping, it’s time to lose that habit. Just because you’re eating something with a two-month-old “sell by” date, does not mean it has expired.

“Sell by” dates aren’t intended for you. They’re supposed to help retailers ensure proper turnover so products still have a long shelf life after you buy them, according to the US Department of Agriculture.

Still, 91% of consumers occasionally throw food away based on the “sell by” date out of a mistaken concern for food safety, according to a study by Harvard Law and the Natural Defense Council. Those researchers argue this date should not even be visible to consumers because the confusion around it causes large quantities of food waste.


3. You don’t need to throw out bruised produce

3. You don't need to throw out bruised produce
Instead, you can remove the flawed section.
 Jon Bunting/Flickr

Don’t let your eyes fool you when it comes to bruised fruits and vegetables. Just because a banana or an avocado isn’t flawless, doesn’t mean it should be sentenced to the trash can.

According to Michigan State University, a bruise is simply a sign of cell damage and exposure to air. The reaction can make the fruit or vegetable softer and mushy, but it doesn’t pose a health hazard. If you want to pick away the bruised section of your banana for aesthetic reasons, go for it. But if you decide to eat it in spite of its flaws, you’ll survive just the same.

4. Meat changing colors does not indicate spoilage


If the color of a piece of meat changes color in your fridge, it may be off-putting. But it doesn’t necessarily mean it’s gone bad.

Frozen and refrigerated meat and poultry may both experience color changes, but fading and darkening do not affect the safety, according to the United States Department of Agriculture. If the meat or poultry has an off odor or is sticky or slimy to the touch in addition to the color change, those are signs the product is spoiled and should not be eaten.


5. Watery yogurt doesn’t mean it’s past its prime


If you eat yogurt, you’ve surely opened a container to find a watery substance seemingly separated from your yogurt. While separation indicates expiration for some foods, it’s not the case with yogurt.

The watery substance you see on top of your yogurt is actually a natural protein called whey, which contains calcium, Vitamin D, and potassium, according to Spoon University. If your yogurt looks and smells alright, stir the liquid back in to get the full nutrients and you can keep on eating without concern.

6. You can still dig into that freezer burnt ice cream


Nothing is worse than opening a carton of ice cream you forgot about to find it covered in freezer burn. But if you’re cravings are strong enough to see beyond the color change and frozen bits, you’re safe to indulge.

According to the United States Department of Agriculture, freezer burn is simply the result of a food’s exposure to air. The food will be dried out in spots and appear less appetizing, but it is completely safe to eat. In fact, any food frozen at or below 0 degrees should be safe to eat indefinitely, according to the USDA.


7.  Hard foods are safe to eat after removing mold

7.  Hard foods are safe to eat after removing mold
Consider Parmesan cheese, carrots, and salami.
 PROMarco Verch/Flickr

When spring cleaning time comes around and you make your way to the back of your fridge, it’s not uncommon to pull out an item sprinkled with fuzzy spots.

Generally mold is not a good sign, but hard foods like Parmesan cheese, carrots, and salami are safe to keep eating after you remove the moldy areas. That’s because mold cannot easily penetrate and spread on hard foods as it does on soft foods like grapes, bread and Brie cheese, according to Prevention.

If you see mold on a hard cheese or food product, cut about 1 inch around the damaged spot and store the item in a new food container.

8. Stale food is usually just a quality issue

8. Stale food is usually just a quality issue
You likely won’t get sick from stale cereal.

It’s probably hard to get past the missing crunch when you bite into a stale chip or a handful of cereal. But if you can move beyond the diminished taste and texture, eating stale food will pose no inherent danger to your health.

“Cereals don’t really go bad. There is not that much of a quality issue. If you leave your cereal box open, it can get stale, but you are still not going to get sick from it,” Emily Broad Leib, the director of Harvard Food Law & Policy Clinic, told TIME magazine.


9. Some people actually prefer crystallized honey

9. Some people actually prefer crystallized honey
It doesn’t have to look runny like this.
 Siona Karen/Flickr

Keep a bottle or jar of honey long enough and it’s sure to crystallize. Instead of the runny honey you’re used to, you’ll need to scrape the new thick and grainy substance out of the jar with a spoon. Nevertheless, it’s perfectly fine to eat this way and some people actually prefer it because it’s easier to spread.

The crystallization of honey is a natural and spontaneous process that preserves the product’s flavor and contents. But if you prefer the honey’s liquid state, you can heat it up to make it pour-able again, according to Cooking Light.

10. Wilting does not make fresh vegetables inedible


So you bought a head of lettuce at the beginning of the week, but by the time you get to eating it, it’s already wilted. Fear not, because portions of wilted and discolored vegetables can still be revived.

Fresh vegetables wilt because water evaporates and depletes their moisture content. Although wilting can sometimes signal plant disease or rotting, most vegetables can be saved. To revive the produce, re-hydrate it by cutting off any browned parts and submerging it in water, according to the Washington Post.

Wilted produce in otherwise good condition can also prove to be a great ingredient for soup, stew or stir-fry dishes.

2018 Farm Bill Would Extend Rural Development Grants, Establish Food Waste Liaison

Published by Waste Dive on April 18, 2018. Written by Cody Boteler.

Dive Brief:

  • The House Committee on Agriculture recently released H.R. 2, the 2018 Farm Bill, which has the potential to affect organic waste policy in multiple areas. 
  • The bill changes funding levels for some grants related to waste management programs in rural areas. It also appropriates funding for biorefining projects, and extends technical assistance programs for rural waste management programs by adding that such programs should “identify options to enhance long term sustainability of rural water and waste systems.”
  • As written, the bill would also establish a Food Loss and Waste Reduction Liaison within the office of the Secretary of Agriculture. The liaison would be responsible for coordinating federal projects and goals which are aimed at reducing food waste and for educating the public and other entities that are looking to reduce food waste.

Dive Insight 

While in large part a spending bill, the nonpartisan Congressional Budget Office says H.R. 2 would have a minimum impact on overall federal spending. It doesn’t have the kind of budget-expanding numbers some departments see, but the farm bill still provides vital funding for rural waste management projects, which can be prohibitively expensive to start from scratch.

More notable than routine spending and grant programs, however, is the establishment of a dedicated position within the federal government, which focuses exclusively on food waste and food loss prevention. The food waste liaison would be tasked with sharing information across government agencies and working to reduce food waste at the national level.

The last time food waste got much attention from the federal government was in 2015, when the Environmental Protection Agency and the Department of Agriculture announced a voluntary goal of 50% reduction by 2030

The full mandate of the liaison runs from coordinating the implementation of food waste reduction programs between USDA, EPA and the Food and Drug Administration; educating and being a resource for those interested in food waste reduction; drawing special attention to the protections enumerated under the Bill Emerson Good Samaritan Act; and making recommendations to expand food recovery efforts. The liaison may enter agreements with government research entities, institutions of higher education or nonprofits to produce material, lead workshops or conduct research.

As with many positions in the government, while the successes of the food waste liaison will largely depend on who fills the spot (and whether other officials in other agencies are willing to cooperate), it undeniably brings focus to the issue. The numbers behind food waste show it remains a critical issue, with some increase in consumer awareness, but one that hasn’t fully been addressed by state and local policymakers. Food is wasted at every level (including $15 billion-worth at farms), so national coordination could be useful in developing more effective strategies.

Emily Broad Leib, director of the Food Law and Policy Clinic at Harvard Law School, said the liaison “represents a step in the right direction,” but “we hoped to see more, and will continue to work with members of Congress to understand the importance of food waste reduction and these key ways that the farm bill can make a difference in this fight.”

Though aside from this position, the current farm bill text doesn’t go as far as many had hoped. A bill which would establish a national food waste policy is still sitting in committee. The bill would have given a boost to AD that uses food waste as a feedstock; encouraged schools to purchase “ugly” produce; standardized date labels; expanded protection under the Good Samaritan Act; and required studies about increasing the shelf life of food. 


Missed Opportunity for Food Waste in 2018 Proposed Farm Bill

On Wednesday, April 18, the House Agriculture Committee approved a draft of the 2018 Farm Bill, a recurring, omnibus piece of legislation that covers issues across our food system, from agricultural subsidies to the Supplemental Nutrition Assistance Program (SNAP). Because the farm bill implicates crop insurance, conservation, trade, rural development, SNAP, and much more in one single piece of legislation, it is bound to be highly controversial. However, food waste, an incredibly bipartisan issue with significant potential to reduce pervasive economic and environmental wastefulness, has gone almost entirely overlooked in this draft. Although the draft bill proposes the creation of a Food Loss and Waste Reduction Liaison within the USDA, an important step in the right direction, there are many other low-cost, beneficial measures that could be taken to address the issue of food waste through the farm bill.

The United States sends about 40% of food to landfills, spending billions of dollars each year on this wasted food. The farm bill is the only piece of legislation that touches virtually every aspect of the food system, and as such is the perfect vehicle for enacting legislation to combat food waste. The 2018 Farm Bill will be the first farm bill since the USDA and EPA announced their goal to cut U.S. food waste in half by 2030, and we hoped to see Congress take concrete, decisive action towards meeting that goal in this farm bill.

Anticipating this landmark piece of legislation, FLPC published Opportunities to Reduce Food Waste in the 2018 Farm Bill in May 2017. This report identified areas in the 2018 Farm Bill where Congress could improve or enact policies to reduce the millions of tons of food wasted each year in America. The 17 recommendations set forth in the report aim to prevent the devastating effects of food waste on the environment, to save businesses and government money, and to help get wholesome food that would otherwise be wasted to those in need. Yet, the bill passed by the House Agriculture Committee includes only one of our recommendations: the creation of a Food Loss and Waste Liaison in the USDA.

Included in Title XI of the draft bill, the Food Loss and Waste Reduction Liaison’s job will be to “coordinate Federal programs to measure and reduce the incidence of food loss and waste.” More specifically, the Liaison’s duties include coordinating efforts between the USDA, the EPA, and the FDA, all of whom play vital but differing roles in food waste prevention; supporting and promoting federal programs to measure and reduce food waste and increase food recovery; serving as a resource for food waste and food recovery organizations; raising awareness of existing liability protections for food donation (which is, notably, another of FLPC’s recommendations); and making recommendations for expanding food recovery and waste reduction efforts.

It is an ambitious job description, but the creation of the Food Loss and Waste Reduction Liaison position within USDA is a concrete, laudable step by the federal government against food waste, and we applaud the inclusion of this new role in the draft bill. The inclusion of the Liaison position suggests that the federal government will continue to consider and prioritize food waste reduction in years to come. 

However, other low-cost and easy-to-implement food waste solutions went overlooked in this proposed farm bill, even those that promise to have a high impact on waste reduction. The top low-cost solutions recommended by FLPC but absent in the 2018 proposed Farm Bill include standardizing date labels on food products in order to reduce consumer confusion, and strengthening the liability protections in the Bill Emerson Food Donation Act. Other top priority recommendations include funding for food recovery infrastructure and for states and localities to implement zero waste plans or organic waste diversion laws. Each of these are described briefly below.  

Date labels

Inconsistent and confusing date labels in the U.S. contribute to massive amounts of waste. Date labels on food generally are not based on safety but rather on manufacturer estimates of quality, and at this time there are no federal regulations to ensure consistency in date labels. Confusion about what date labels actually mean leads consumers and businesses to throw away millions of pounds of perfectly safe, wholesome food. FLPC recommends that Congress, in the farm bill, standardize date labels by offering manufacturers two phrases to choose from for expiration date labels: “BEST If Used By” to indicate quality and “USE By” for foods that may have a safety risk after the date. Standardizing expiration date labels in this manner is a low-cost solution to consumer food waste, and would build on a voluntary industry initiative launched last year utilizing the same two phrases.

Liability protection for donated foods

In addition to standardizing date labels, the 2018 Farm Bill should strengthen and clarify the liability protections afforded to food donors by the Bill Emerson Good Samaritan Food Donation Act. The Emerson Act provides civil and criminal liability protection to food donors and nonprofits that distribute food donations; by relieving donor concerns about potential liability, this can make them more likely to donate. However, many potential donors still say the reason they fail to donate is due to lack of knowledge about liability protections. Congress should task USDA with clarifying the scope of the Emerson Act, which is one of the roles of the proposed Food Loss and Waste Liaison in the draft farm bill. Further, the Emerson Act should be expanded to include further liability protections that match today’s food donation needs, including: reducing unnecessary labeling requirements for donated food; clarifying protection for past-date food donations; protecting donors that donate directly to final recipients; and providing protection when nonprofit recovery organizations charge the final recipient a low price.

Funding for food recovery infrastructure and for state and local waste diversion laws

Beyond these low-cost solutions, FLPC also recommends allocating further funding in the farm bill to initiatives that have been shown to be effective in reducing waste, creating jobs, and diverting wholesome food to those who need it. For example, the farm bill could support new food recovery infrastructure to help farmers and food recovery organizations prepare, process, and transport surplus produce to people in need. Another key recommendation is to provide funding to states and municipalities to implement zero waste plans and waste diversion laws. These plans are most effectively enacted at the state and local level, but can be costly to implement. Federal funding could support state and municipal planning and implementation of organic waste recycling plans, accelerating food waste reduction while building recycling infrastructure and creating jobs in food recovery and organics recycling. The most recent version of the 2018 Farm Bill does not include funding for such initiatives, missing an opportunity to further prioritize food waste.

The House Agriculture Committee has signaled commendable intent to tackle food waste with the creation of the Food Waste and Loss Reduction Liaison. However, if the U.S. hopes in earnest to meet food waste reduction goal by 2030, this step is not enough. We cannot wait for another Farm Bill to initiate meaningful food waste reduction efforts. Amidst heated controversy over some of the Farm Bill’s notoriously expensive provisions, low-cost policies to reduce food waste should be low hanging fruit. Those policies outlined above would go a long way towards ensuring more safe, wholesome food makes it to those in need and stays out of the landfill. Although this draft bill takes a step in the right direction, we hoped to see more, and will continue to work with members of Congress to understand the importance of food waste reduction and these key ways that the farm bill can make a difference in this fight.


Grocery Stores Could Be Donating Way More Food

Published on April 12th, 2018 by New Food Economy. Written by Jessica Fu.

Grocery stores could be donating way more of the food they don’t sell. What’s stopping them? A patchwork of inconsistent and unclear food safety laws.

A new report conducted by researchers at the Harvard Food Law and Policy Clinic has found that very few states give businesses any instruction on how to donate food safely. Confusion reigns supreme over everything from how to transport donations, to whether food needs to be kept cold, to interpreting best-by dates. Bottom line: Businesses get very little official or consistent guidance and ultimately, are discouraged from donating at all.

Emily Broad Leib, director of the clinic and the study’s lead author, wanted to find out exactly where companies were getting hung up.

“We kept hearing from businesses that they weren’t allowed to donate certain things, or being told that they had to follow really strict rules. Sometimes there’d be a business that said different parts of the country or even different cities in the same state have different rules.”

Broad Leib’s team interviewed food regulators in every state. They found that only 12 states have formal regulations for food donations, six of which pertain only to wild game meat.

Regulators want to make food laws more robust. They just don’t know how.

For example, in Connecticut, rules regarding the donation of wild game are codified in Title 26 of the Connecticut General Statutes, which govern fishing and hunting: “Hunted game may be donated to, and possessed, prepared and distributed by, a charitable or nonprofit organization which serves or distributes food without cost to poor or needy persons.” There is no additional guidance on what to do with food other than game meat.

Meanwhile, in California, there are no legal regulations regarding food donations. However, businesses can find general guidance from the Safe Surplus Food Donation Toolkit, a set of recommendations by three California-based public and environmental health groups.

Most other states offer nothing in the form of regulation or guidance at all.

But don’t write an angry letter to your governor just yet. The researchers also found that regulators want to make food laws more robust. They just don’t know how.

“Often, health inspectors themselves are afraid to allow certain practices without having anyone telling them that that’s a safe practice,” said Broad Leib.

As it turns out, businesses aren’t alone. The confusion may actually start a little further upstream.

Very few states give businesses any instruction on how to donate food safely. Confusion reigns supreme.

While states have jurisdiction over food safety and handling for retail businesses and restaurants, many of them model their guidelines off of the Food and Drug Administration’s (FDA) Food Code. This federal document is published every four years and offers states an example of what their food laws should look like. Local regulators adapt their own regulations from the code.

And therein lies the issue: The Food Code says nothing about food donations.

The dimensions of America’s food waste problem have been repeated ad nauseam: We waste up to 40 percent of our food (though, that number is disputed). And that’s particularly troubling given that 13.4 percent of our population is food insecure, according to the non-profit food bank network Feeding America. That includes more than 13 million children living in families who regularly don’t get enough to eat.

Could adding clear guidance to the Food Code on how companies can donate food safely really do much to change that? Broad Leib thinks so.

“When things are added to the Food Code, they make their way into state and local law,” she says. “We spoke to at least one head of food safety in every state. Across the board, they said that having some guidance would be helpful for them in order to provide better guidance and regulations for business.”

But, Broad Leib says, we also have to make sure states understand what role they’re playing in the food waste dilemma.

“Even if this were added, there’s still more work to do on educating states on why they should adopt that.”

Don’t Call it Food Waste: Entrepreneurs Turn Surplus Food into Gold

Written by Danielle Beurteaux for Civil Eats. Published on April 12, 2018.

The idea began with a bin of discarded avocado pits. Where others would see waste, Drexel University Food Lab graduate students Sheetal Bahirat and Christa Kwaw-Yankson recognized an opportunity.

After some experimenting, they made an avocado-pit tea by blanching, grating, and then dehydrating the pit. The tea has a mild, slightly fruity taste and a pleasing, natural pink color.

“Everybody throws away their avocado pits—but we can make a tea out of the skins as well,” says Bahirat. “Which is great because this country is in love with avocado.”

Food waste is a hot topic, and startups are eager do something about it. But creating a viable food product company that relies on ingredients considered waste comes with many challenges.

The Food Lab, which is part of Drexel’s Center for Food and Hospitality Management and Department of Nutrition Sciences, has become the go-to R&D resource source for culinary innovators that aim to turn food waste—or “upcycled” food, as they prefer to call it—into consumer products. The lab recently received a two-year grant from the Claniel Foundation to help expand its upcycled food research and development.

Launching a startup food brand is difficult enough, but one that sources waste ingredients faces extra difficulties, says professor Jonathan Deutsch, who founded Food Lab in 2014, which works with major consumer packaged goods companies and entrepreneurs. For instance, food safety is a big concern, he says. It would only take one big health scare involving a food waste-derived product to put consumers off. There are logistics and regulatory challenges as well.

“When you try and do surplus food work in a food system that’s not really designed to do that, you reach additional hurdles,” he says. “What we’re doing is helping our clients through those hurdles.”

The hurdles Deutsch notes are not insignificant: A recent report published by the Food Law and Policy Clinic at Harvard University explores food-safety laws in all 50 states covering food donations—like foods that could be used for upcycled food products instead of becoming food waste. The results suggest that food producers across the country can be hesitant to donate food for fear that they could be liable for any food safety issues that arise.

Ingredients First

Like Bahirat and Kwaw-Yankson, many other upcycled food entrepreneurs first see waste, and then think of a way to use it.

Daniela Uribe grew up amongst the coffee farms of Colombia. She remembers piles of cascara—the husk of the coffee cherry—that would either be used as fertilizer or dumped in the river. Her idea lightbulb went off when she saw Starbucks offering a cascara latte, and together with her co-founders, Erik Ornitz and Drew Fink, started experimenting with cascara tea in her kitchen. Lazy Bear Tea—a translation from ozo perozoso, Spanish for sloth—sells a drink made from dried cascara, which when steeped in hot water tastes not like coffee but like a smooth black tea. Lazy Bear Tea launched in 2017 and is now sold in 30 stores in the greater Boston area, with plans for expansion.

Daniela Uribe and Drew Fink visiting coffee farmers to discuss sourcing cascara. (Photo courtesy of Lazy Bear Tea)

Daniela Uribe and Drew Fink visiting coffee farmers to discuss sourcing cascara. (Photo courtesy of Lazy Bear Tea)

Apart from removing cascara from the waste system, the company offers a potential revenue stream for coffee farmers, most of whom, despite all those expensive coffees crowding store shelves, live in poverty. “That highlights how broken the coffee supply chain is in our agriculture and the system in general,” she says. “We’re using our tea as a vehicle for addressing some of those inconsistencies.”

Similarly, San Francisco’s ReGrained uses flour made from spent brewer’s grain—the used grain that’s left over after brewing—to make snack bars. Spent brewer’s grain is nutritious, and there’s billions of pounds of it produced every year—every 6-pack uses 1 pound of grain. While it can be used as animal feed, much of it is dumped. It spoils quickly, so ReGrained invented and patented a process that deals with the spoilage and transport. They collect the grains from mid-sized brewers, who welcome another source of revenue as well as the associated feel-goods.

“We’re creating economic value out of none and it’s also great story for them to tell to their customers about sustainability,” says co-founder Daniel Kurzrock.

Kurzrock and co-founder Jordan Schwartz launched ReGrained in 2013, and settled on snack bars because they’re a relatively easy entry point into the market. The company plans to launch new products and expand nationally this year. “We want to get to point where we’re the solution for brewing industry to handle this stream,” says Kurzrock.

Food Lab connected Kriti Sehgal, founder of Philadelphia’s Pure Fare restaurant group, with a provider of rescued sweet potatoes that are dehydrated and powdered. It’s used to make a sweet potato custard, one of their most popular offerings. Upcycling is a founding principal of the company, Sehgal says. But she cautions that there’s no point in using a surplus product just for the sake of it—that could mean more ingredients used to save one. “If I have to add more to that, how pure is that to the upcycling piece?” she asks.

Food Banks as Upcycling Entrepreneurs

Not every food waste entrepreneur is a hopeful experimenting in her kitchen. Drexel’s Food Lab has partnered with Philadelphia’s Philabundance, the largest food bank in the Delaware Valley region, to create products from foods that might otherwise go to waste for both their clients and retail.

This is partly driven by necessity and partly because they’re moving away from the canned goods food pantry model, says Philabundance’s deputy director of sustainability Kait Bowdler. They often receive large shipments of fresh produce requiring quick action before it spoils. Last year, that included 10 million pounds of produce over 4 months from the Port of Philadelphia alone, most of it one or two items; 2017 was a big year for grapes and melons.

As milk sales are decreasing, dairy farms are being left in dire economic straits. To address this issue, one of Philabundance’s first partnerships was with three dairy farmers in Lancaster, Pennsylvania.

Philabundance and other area food banks partnered with farmers who now make cheese under the group’s Abundantly Good brand. Local gourmet retailer Di Bruno Bros sells several varieties of the cheeses for $5.99 for 8 ounces; they pay a subsidy of one dollar per pound of cheese sold so that the farmers can continue providing free cheese to Philabundance—an arrangement that has supplied the food bank with 3,000 pounds of free cheddar to date. “It sort of uplifts the farmers and uplifts the clients as well,” says Bowdler.

Mennonite farmers prepare cheese for Philabundance (photo courtesy of Philabundance)

Mennonite farmers prepare cheese for Philabundance (photo courtesy of Philabundance)

The same farmers became upcycle fans and also now use the skim milk left over after butter production to make skim milk yogurt, which Philabundance buys at low cost for its clients. “It lowers his cost of production and allows us to get a product as every time he’s making the butter for sale he can make a skim milk yogurt for us,” Bowdler says.

Food Lab is also helping Philabundance use its own culinary job training program to teach the skills needed to use surplus food. The goal for both Philabundance and Food Lab is to go beyond raising awareness about food waste, says Deutsch. “I hope the students are proficient in this field so that we’ve sort of trained an army of food waste preventers.”

Upcycling to Market

Identifying an ingredient with high upcycle potential doesn’t mean getting it is particularly easy. Bahirat and Kwaw-Yankson say their requests for ingredients usually go unanswered. “We reach out to these companies and say, ‘Hey, we’re doing something with it, so can we collaborate?’ and we never hear back,” says Kwaw-Yankson.

That may be because there’s pervasive myth about liability, says Food Lab founder Deutsch. Restaurants, stores, and the like also don’t often have the resources to keep and package waste.

Uribe, of Lazy Bear Tea, knew that getting sufficient cascara wouldn’t be easy, simply because it’s not considered valuable by farmers. But by creating a product, she hopes they’ll be incentivized to process and sell it. Her company has worked on creating relationships with coffee farmers in the hopes of encouraging them to become suppliers.

Uribe says she and her co-founders also benefited from mentorships. They were accepted to entrepreneurship programs at the Harvard Innovation Lab and the Rock Accelerator at the Harvard Business School. They also joined Commonwealth Kitchen, a Boston organization that helps food entrepreneurs start and run their businesses.

ReGrained bars and their ingredients (photo courtesy of ReGrained)

ReGrained bars and their ingredients (photo courtesy of ReGrained)

ReGrained partnered with the U.S. Department of Agriculture (USDA) to get outside assurance that ReGrained’s process was operating safely and efficiently (the USDA co-invented the company’s grain-stabilization technology). Co-founder Kurzrock also advises asking for help. “Everyone in this industry was helped at some point and they’re willing to pay it forward.”

The Semantics of Waste

But simply labeling a product as upcycled isn’t enough to win long-term customers. ReGrained focuses on taste and nutritional benefits over waste messaging. “Some consumers will buy our products because they’re upcycled, but they’ll only come back if it tastes great,” Kurzrock says. “The mass market is not necessarily seeking something that’s upcycled.”

Lazy Bear Tea’s Uribe agrees—taste first, messaging second. “If you have something that tastes really good with a really compelling story, people will become really loyal,” she says. “Especially if the upcycled waste-to-food story is something that resonates with them.”

While all these food innovators champion using otherwise-unwanted ingredients, one thing you won’t find on their labels is the term “food waste.” Consumers want to feel that they’re helping solve a problem, but framing is important. “If you put ‘food waste’ on package they’ll feel like they’re getting trash,” says Kurzrock.

Philabundance's Fresh For All program – A free farmers’ market-style program that delivers fresh produce and products including the upcycled cheese directly to people in need. (Photo courtesy of Philabundance)

Philabundance’s Fresh For All program – A free farmers’ market-style program that delivers fresh produce and products including the upcycled cheese directly to people in need. (Photo courtesy of Philabundance)

Research published in The Journal of Consumer Behavior found that study subjects were receptive to a new category of food—they call it Value-Added Surplus Products—if it’s framed as upcycled. And the assumption that food surplus is equivalent to trash is something that all these upcycling champions are eager to dispel.

For one thing, much of it is hardly trash. Some food is rejected because of a market glut, or because of small things like strict weight specs—Philabundance has received bags of grapes that were only 2 ounces short of store requirements.

Upcycling isn’t about foisting off garbage to low-income populations, says Deutsch, but about closing the holes in food supply chains and using what we have. “We have one planet, we have all this beautiful abundance of food, let’s celebrate it both for people who need good nutrition and need food and people who want to enjoy a quality food experience,” he says. “And those are all the same people.”

Top photo: Daniela Uribe with a mountain of cascara (photo courtesy of Lazy Bear Tea).


FLPC Welcomes Visiting Scholar Alana Mann

Dr. Alana Mann is Senior Lecturer and Chair of the Department of Media and Communications in the Faculty of Arts and Social Sciences (FASS) at the University of Sydney, Australia. She is a key researcher in the Sydney Environment Institute, an interdisciplinary humanities and social sciences center, and leads the Sydney Policy Lab Participatory Food Planning Project which aims to inform the development of resilient and inclusive local food economies in the City of Sydney and beyond.

Alana is keen to use her time at FLPC to research how local food policies operate in the US, and particularly to understand the role individuals and communities can play in their co-creation.

Her Ph.D., completed in 2012 following a career in the media, addressed the political economy of food systems with a strong focus on the discursive struggles between civil society actors, governments, and corporations regarding the solutions to hunger and malnutrition. Published as Global Activism in Food Politics: Power Shift (Palgrave, 2014) this work explores the dynamics of small-scale farmers’ movements campaigning for food sovereignty in Third Wave Democracies including Chile and Mexico.

A forthcoming book titled Resisting Corporate Capture presents cases of transformative ethical practice, pedagogy, and policy that offer alternatives to the industrial or ‘conventional’ food system in countries including Cuba, where she has recently visited urban and rural farms.

Alana has presented her research at institutions including Chiang Mai University in Thailand, Aarhus University in Denmark, and the Universities of Delhi and Jawaharlal Nehru (JNU) in India. She has worked as a consultant and media advisor for the Food First Information and Action Network (FIAN International) in Heidelberg, Germany, and served on the Executive Committee of the Australian Food Sovereignty Alliance (AFSA) for two years. In 2017, she was a member of the committee to appoint an Australasian representative to the Civil Society Mechanism of the World Committee for Food Security at the UN Food and Agriculture Organisation (FAO).


FLPC Releases 50-State Survey of Legislation, Regulations, and Guidance on Food Safety for Food Donations

Today, FLPC releases Food Safety Regulations and Guidance for Food Donation: A 50-State Survey of State Practices, a report analyzing the current landscape of state-level regulations and guidance on the topic of food safety for food donation.

Forty percent of food in the United States goes to waste. Meanwhile, over 42 million Americans suffer from food insecurity. Donation of safe, wholesome surplus food to those in need can play an important role in both reducing food waste and addressing food security. However, uncertainty about the proper food safety procedures to follow when donating food creates confusion among businesses, food recovery organizations, and health inspectors. This confusion can deter potential food donors from donating, leading to unnecessary food waste.

To learn more about this barrier to donation, FLPC conducted a  survey of the top officials regulating food safety at food service and retail food establishments in every state in the country. The survey was conducted by FLPC on behalf of, and with the support of, the Food Safety for Donations Working Group, a coalition of people and organizations committed to promoting an understanding of safe food donation practices in order to reduce food waste and increase food recovery. This survey provides the first comprehensive data on this topic at a national level.  

The survey results confirmed that confusion about food safety procedures for food donation stems at least in part from a lack of comprehensive and consistent regulations or guidance on this topic at the state level. The survey found that most states do not have any regulations or guidance that address food safety for food donation. Even in the states that do have regulations or guidelines, the existing laws often pertain to a very narrow topic. These results were not surprising because all fifty states have adopted some version of the FDA Food Code, a model food safety code and reference document released by the FDA, which itself does not address food safety for donations.

The survey found that a lack of staffing and resources was a common barrier states faced in developing regulations and guidance on this topic. The vast majority of survey respondents believed model language would be a helpful resource to support states in creating their own guidance on food safety for food donations. All but two respondents said model language would be helpful in supporting state efforts to develop guidance.

This report builds on FLPC’s previous work analyzing opportunities to reduce food waste and increase food recovery. In March 2017, FLPC and the Natural Resources Defense Council released Don’t Waste, Donate, a report outlining policy opportunities for the federal government to better support food donation. That report included recommendations for improving the dissemination of information about food safety for food donations.  Food Safety Regulations and Guidance for Food Donation: A 50-State Survey of State Practices provides data that reaffirms the need for clarity around food safety for food donation and helps identify avenues for supporting state efforts to implement regulations and guidance on this topic.

Read the full report here.

View a recording of the April 11th webinar on the survey findings.

CHLPI to present at Second annual “Food Is Medicine” symposium in Indianapolis

Meals on Wheels of Central Indiana will hold the second annual “Food Is Medicine” state symposium Thursday, April 12  in Indianapolis. The symposium will take an in-depth look at how medically tailored food plays a essential role in outcome-driven, cost-effective health care models.  

Medically tailored food is prepared under the direction of a physician to individuals who are chronically ill with the individual patient’s specific nutritional needs in mind.

The symposium, which is in its second year, stems from Meals on Wheels’ involvement in the Food Is Medicine Coalition, a national association of medically tailored food and nutrition service providers. Meals on Wheels  joined the coalition in 2015 as part of an effort to strengthen its services to critically and chronically ill individuals.

“By partnering with medical providers, community organizations, and chronic disease experts to ensure low-income Hoosiers with critical and chronic diseases have access to medically tailored meals and more customized nutritional plans, we have the potential to positively impact their overall health while lowering health care costs,” said Barb Morris, CEO of Meals on Wheels of Central Indiana.

According to a study by The New England Journal of Medicine, food insecurity is one of the top ten causes for costly hospital readmissions. With a food intervention upon discharge, studies show this number can be reduced to as low as eight percent.  The problem is further exacerbated when patients are discharged from the hospital and return home to a bare pantry.

The symposium will bring together leaders representing health care organizations, state and local policymakers, elder care experts, academic and statewide advocacy groups.




Coupling Up: Are Crop Insurance And Conservation Compliance Mated For Life?

Written by Sarah Munger for FBLE

This is the final installment of a three-part series devoted to conservation compliance under the farm bill. The first post explained what “conservation compliance” is and why it matters, and the second post highlighted how lack of enforcement undercuts effective protection for soil and water resources. Rounding out the series, this post explains why maintaining the link (or “coupling”) between crop insurance eligibility and conservation compliance is critical for our food security.

Under the current farm bill, if farmers fail to adhere to conservation compliance provisions, they risk their eligibility for crop insurance premium subsidies. While other farm bill benefits, like disaster assistance payments, are also at stake, crop insurance is noted as the “most important component of the farm safety net.”

While other farm bill benefits, like disaster assistance payments, are also at stake, crop insurance is noted as the “most important component of the farm safety net.”

The Rise of Crop Insurance

Since its humble beginnings in the aftermath of the Dust Bowl, crop insurance has grown to cover more than 297 million acres and over 130 commodities—from grapefruit to wheat. As of 2015, crop insurance covered almost 90% of acresdedicated to major commodities (e.g. corn, wheat, and soy). Given the ever increasing breath of the federal crop insurance program, crop insurance benefits provide a vital incentive for complying with farm bill provisions that aim to protect soil and water quality.

In the 1996 Farm Bill, Congress “de-coupled” crop insurance eligibility from the conservation compliance requirements. Consequently, between 1996 and 2014, the risk of losing direct payments provided the main incentive for farmers to abide by conservation compliance. The USDA Economic Research Service (ERS) reasons that, at the time, linking conservation compliance to direct payments made more sense because the crop insurance program was small with relatively low participation.

Source: USDA/RMA, The Risk Management Safety Net, September 2017; deductible calculated by FCA-ORP using RMA data. *Includes corn, soybeans, wheat, cotton, sorghum, barley, rice, peanuts, potatoes, and tobacco.


This calculus had changed when negotiations over what became the 2014 Farm Bill began. Increasing subsidy rates and participation in crop insurance motivated re-coupling crop insurance and conservation compliance. In addition, the direct payments that kept many farmers in compliance were facing increasing political unpopularity, and environmental advocates who saw the writing on the wall fought to tie conservation compliance back to crop insurance.

Conservation Compliance Is Risk Management

Tying crop insurance benefits to conservation compliance makes sense because federal crop insurance is a tool to manage riskfor losses in yield and revenue. Yet, poor soil management practices and destruction of wetlands impact long term sustainability and resilience of agricultural systems. Failing to adhere to conservation compliance provisions creates inherent risks that affect yield and revenue.

Source: USDA Economic Research Service

Farmers should not be rewarded with taxpayer dollars for these risky practices, especially when taxpayers subsidize nearly 65% of total premiums. In 2016 alone, this amounted to over $59 million in federal expenses. Those subsidies should not benefit those who violate conservation compliance provisions; thus, linking crop insurance and conservation compliance underscores the importance for a strong enforcement program, discussed in prior posts.

Absent a link to crop insurance, compliance rates would decline and further undermine the bargain between farmers and the public. The public provides a financial safety net for farmers, and in return farmers provide a food safety net to the public. The resilience of our nation’s food system hinges on soil and water quality, making conservation compliance a linchpin of this bargain. It is critical that crop insurance remain coupled with conservation compliance in the next farm bill.