Hunter Eby recalls a time when his life centered around figuring out how he was going to feed himself the next day.
As an undergraduate at the University of Toledo (UToledo) in Ohio, he was unable to drive for a couple of years when he and his doctor decided to stop his epilepsy medicine. Without a way to get to the grocery store, he came to rely on meals he could pick up at a convenience store: cereal and milk, pasta and tomato sauce, and canned and prepackaged foods filled with sugar and other additives.
Eby gained weight and began to struggle in school.
And despite his parents instilling in him the importance of strict budgeting, the high prices at the convenience store would often leave him worrying that his debit card would be declined toward the end of each month after his scholarship funds and loans had run out. Still, he was too ashamed to ask for help.
“[I was] telling myself, ‘This is the college diet,’” Eby says. “‘You eat ramen and Taco Bell.’ But I think that does a lot of damage.”
Now a student in UToledo’s master of science in biomedical science program who is in the process of applying to medical school, Eby can safely drive again and is better able to take care of his nutritional needs, but the experience of struggling to access nutritious food has stuck with him.
It inspired him to volunteer at a food pantry on UToledo’s campus, which has opened his eyes to how many students — not only undergraduates but also those in the health professions programs — worry about where they will find their next meal.
Research suggests that between a third and a half of college students experience food insecurity, meaning they struggle to access affordable, nutritious food. Though little data has been gathered on the prevalence of food insecurity among medical students, those who have studied the issue believe these students face similar challenges.
“[I was] telling myself, ‘This is the college diet. … You eat ramen and Taco Bell.’ But I think that does a lot of damage.”
Master of science student at the University of Toledo in Ohio
Jodi DeMunter, MD, medical director of the Student Health and Wellness Center at Oregon Health & Science University (OHSU) in Portland, led one of the few publicly available surveys exploring access to food for students in the health professions.
The 2018 survey revealed that 1 in 4 students at OHSU — which includes schools of medicine, nursing, dentistry, pharmacy, and public health — experienced some level of food insecurity. One in 5 students reported that lack of food had impacted their academic performance.
“We recognized, ‘Woah, this is really an issue,’” DeMunter says.
It’s an issue that has intensified during the COVID-19 pandemic as students have lost jobs and access to some campus resources during shutdowns, according to an article published in the Journal of Nutrition Education and Behavior.
Administrators and students at academic institutions across the country have responded by mobilizing to connect students with food through a variety of interventions, from food pantries and grocery delivery programs to student discounts at on-campus cafeterias and apps that alert students to free, leftover meals. Hundreds of colleges have on-campus food pantries, many of which serve graduate students as well as undergraduate students, but some universities like OHSU and UToledo are expanding targeted outreach to health professions students who might have been overlooked in the past.
“In order to really put our money where our mouth is around supporting our students to be academically successful … we really do have to look at providing resources, including food,” DeMunter says.
Supporting vulnerable students to help them succeed
Students in medical school and other health professions programs are not typically seen as vulnerable, but as schools increasingly recruit disadvantaged students, it is not uncommon for students to lack the resources to meet their own basic needs and those of their families, wrote DeMunter and her colleagues in an article in the Journal of Student Affairs Research and Practice about the survey results.
The impacts of food insecurity on this population are particularly concerning, they say, as lack of food and anxiety about accessing food can increase risk for depression — which already impacts medical students at a higher rate than their peers who are not in medical training programs— and further disadvantage students coming from less affluent circumstances. A 2016 study linked food insecurity among students to missing classes and study sessions, not buying required textbooks, and not performing as well as they could have because of hunger.
“Providing basic needs support, including food security, within health professions programs will likely play an important role in helping disadvantaged students succeed,” the authors wrote in the OHSU study. “Therefore, understanding and addressing barriers like food insecurity in this population is critical in supporting the academic success of these students and is directly tied to other ongoing, critical conversations including the effects of increasing student debt, the call to increase the diversity of our health care workforce, and our nation’s projected health care worker shortage.”
Time and access as barriers
While many health professions students face food insecurity because of limited resources, finances are not the only barrier to accessing healthy food.
When medical students are spending much of their time on their studies and clinical work, they may not have time to go grocery shopping — instead resorting to cheap, unhealthy fast food or skipping meals, according to Mary Flynn, PhD, a dietitian and associate professor of medicine at Warren Alpert Medical School of Brown University in Providence, Rhode Island.
“They don’t think they have time to cook, so they’re buying pizzas for $20,” she says.
Flynn, who teaches classes on how to cook healthy meals on a budget, went to her medical school administration to ask to study the prevalence of food insecurity among medical students.
“I thought, ‘No one has looked at the well-being of students from the standpoint of food,’” she says. “People are just missing that step.”
The study she conducted at Alpert Medical School in 2019 found that, in addition to not being able to afford food, students named the inability to get to a grocery store that met their needs, a lack of time to grocery shop, and not knowing how to cook as top barriers.
In addition, many health professions school campuses, including Alpert Medical School and OHSU, are considered food deserts, which means there is no grocery store within a mile.
Food insecurity among students at UToledo was already high before the COVID-19 pandemic, leaving some students having to choose between buying bread or textbooks, says Sammy Spann, PhD, associate vice president and dean of students.
The pandemic has doubled the need, he says, with the food pantry serving an average of 150 undergraduate and graduate students per week.
UToledo had opened its on-campus food pantry more than a decade ago, but it didn’t have a location on the university’s health sciences campus — which is three miles from the main campus — until November 2019. The new location was shut down just a few months after opening as the pandemic pushed students off campus in the spring. Food pantry facilitators instead consolidated efforts to the main campus pantry as they adapted to a COVID-19 distribution model.
“You’re really taking away a lot of stressors … a lot of things that are holding [students] back. It allows them to put their best foot forward in class or in the lab.”
Master of science student at the University of Toledo in Ohio
With many usual resources out of reach for students, university administrators sent out a survey to check in on how they were coping, says Randall Worth, PhD, associate dean of student affairs and admissions at UToledo.
“We were shocked and saddened by the number replying [that they were struggling] with food insecurity, depression, [and] alcohol abuse,” Worth says. “We had to look at more creative ways to help them out.”
For instance, the university made emergency funds available and sent out gift certificates for DoorDash, the food delivery app.
And as health professions students prepared to return to campus for research and clinical work last August, Eby reached out to Spann with a plan for reopening the second food pantry location. He saw it as an opportunity to give back, especially given his own experience with food insecurity.
“Being able to relate to that struggle of not wanting to actually go to the food pantry — of feeling you’re taking from someone,” Eby says. “I wanted to be a friendly face.”
He also knows that the burden of student debt and loan interest can add to the weight graduate students carry as they decide how to pay for meals. Simply providing nutritious food can help lighten that load.
Eby organized a holiday food drive that collected almost 5,000 pounds of food, and faculty and staff donated over $30,000 to the food pantry efforts in 2020 — which was all on top of a U.S. Department of Agriculture grant awarded to the university to provide boxes of fruits and vegetables.
“You’re really taking away a lot of stressors … a lot of things that are holding [students] back,” he says. “It allows them to put their best foot forward in class or in the lab.”
Two students at OHSU School of Medicine, Madi Egan, a third-year medical student, and Gina Calco, who is earning her PhD in an MD-PhD program, saw the pandemic as an opportunity to expand outreach to health professions students on their own campus who needed help accessing food.
“Times during rotations … I felt like I was eating poorer quality food, grabbing whatever was cheapest. … I could feel that taking a toll on my body and my stress levels. … [The grocery box program] gave me a sense of security, I think, a little bit more comfort.”
Third-year medical student at Oregon Health & Science University in Portland
“From what we heard from students, [food insecurity was having] an impact on grades, ability to focus, on test taking, on their ability to stay in class and be prepared and not be thinking constantly on where they’re going to get their next meal,” Calco explains.
In the spring when campus shut down, Egan and Calco started a grocery box delivery service with funding from the university. Running the operation from their own homes, they organized a group of volunteers to go shopping at local grocery stores, assemble the boxes, and deliver them to those who requested them. Students had the freedom to choose which 10 items they wanted and didn’t have to meet any criteria to qualify.
For Kyle Haggerty, a third-year medical student at OHSU School of Medicine, the grocery boxes helped her to feel more confident in her work during clinical rotations. Not having to worry about affording groceries and finding time to go shopping took a weight off her shoulders.
“Times during rotations … I felt like I was eating poorer quality food, grabbing whatever was cheapest,” she says. “I could feel that taking a toll on my body and my stress levels. … [The grocery box program] gave me a sense of security, I think, a little bit more comfort.”
The program has since grown and is transitioning to a food pantry model, which Egan and Calco are calling a food resource center to avoid any stigma.
Egan and Calco say they encourage medical students to step up and start programs at their own schools — if they don’t already exist — to help reduce the burden of food insecurity among their classmates, and they hope that institutions will be willing to invest in those programs.
“[Food insecurity is] something that impacts many more students than you might anticipate,” Egan says. “I hope that it’ll come to the forefront and medical schools will start focusing on and creating resources for students to make sure they can access healthy, reliable food throughout their training so they don’t have to have that as an additional worry on top of their schoolwork.”