For decades, Minnesota food shelves focused on providing enough food to people in need.
But these days, food shelf directors are aware that some of their clients are obese or have diseases related to their diet. With that in mind, they increasingly focus on providing not just enough calories but the right kind of calories.
The need is clear at Keystone Community Services, which runs three foods shelves in Ramsey County. In 2011, the organization conducted a survey of its clients and the results startled Christine Pulver, its director of basic needs.
"Our clients have twice the national average incidence of diabetes," she said. "They also show high blood pressure rates, cardiac issues. Some of those issues are diet related."
Pulver is among those who recognize that food shelves can play a critical role in improving their clients' health. She wants to offer more produce, and fewer pastries -- but that's not as easy as it sounds. Healthier food is expensive.
Last summer, Pulver reduced the amount of food she gives each client to spend more on healthy items. But she doesn't have enough money to go to the grocery store and must rely on donations and what she can buy at the local food bank. That explains the sugar cereal Coco Roos in her food shelf.
Still, Pulver said, the food shelf has been able to make a big switch to healthier items, with more fruits and vegetables and low-sodium and low-fat products.
"If you were to compare what you saw on our shelves five years ago to what you see now, it's a night and day difference," she said. "We have apples, tomatoes, salad greens."
Like Pulver, a growing number of food shelf directors want to improve the nutrition of their offerings.
Among those trying to help is University of Minnesota associate professor Susie Nanney. Concerned that food shelves don't have a way to evaluate the food they offer, she recently conducted a pilot study of six food shelves -- including Keystone.
Nanney, who works in the university's Department of Family Medicine and Community Health, took a clipboard and shelf by shelf, conducted an inventory of every food item. She then calculated a score using the Healthy Eating Index, a widely used measure of diet quality that employs a 100-point scale.
“As a registered dietician and a researcher in this area, we do know it's not enough just to add healthy foods to the environment... We have to reduce the less healthy foods as well.”Susie Nanney, University of Minnesota associate professor
"Our food shelves scored a score of 67," Nanney said. "This is higher than the McDonald's dollar menu, so that's a plus."
The food shelves also scored better than the average American diet, which earns a 53. But Nanney said there is lots of room for improvement. One of the main problems, she said, is high levels of sodium. The biggest offenders were canned soups, bakery items, and boxed macaroni and cheese.
"As a registered dietician and a researcher in this area, we do know it's not enough just to add healthy foods to the environment," she said. "We have to reduce the less healthy foods as well."
That's something the Minneapolis Health Department is working on.
The Minneapolis Healthy Food Shelf Network, launched by the city's health department last spring, helps food shelves procure and distribute more healthy items. The network connects food shelves with new sources of food, such as famers markets. It also gives food shelves makeovers, displaying the healthy food prominently so clients notice it.
"It's the first thing they see when they walk in the door, so they're more inclined to choose those particular items," said Kristen Klingler, a senior public health specialist who oversees the network. "They don't have to go searching in the back corner to find those items. They're front and center and nicely labeled, so they look appealing."
Klinger wishes unhealthy items were not there at all. But she said food shelves have trouble saying no.
"One of the reasons why we started this Healthy Food Shelf Network was because food shelves wanted to talk about how they could collectively say no to these types of unhealthy donations," she said. "They find that's really difficult to do individually, because they don't want to jeopardize future donations of food by saying, 'no we don't want these donuts or these packages of chips.'"
She said food shelves largely rely on what's available at the food banks. She wishes those food banks would talk to their donors, which are often big companies.
Healthy food at the food bank level also has exploded, said Rob Zeaske, CEO of Second Harvest Heartland, a food bank that supplies most Twin Cities food shelves.
"We gone from roughly about a half a million pounds that we distributed in 2008 of fresh food to 26 million pounds of food that was fresh/perishable," he said. "That's meat, dairy, vegetables, fruits."
But Zeaske said the food bank doesn't turn down unhealthy offerings.
"We are not going to be the food police on this and decide what our clients shouldn't take from us," he said.
At Keystone, Christine Pulver focuses on convincing clients to choose healthy options, even if there are doughnuts around the corner. Videos in the lobby tout the value of nutrition. When volunteers approach clients, they suggest whole grain pasta.
"Some of them think they don't like the brown stuff," Pulver said. "But if we can just convince them to try it, they'll see it's quite acceptable."
The aim of healthy food initiatives, she said, isn't to force people to take healthy food, but to provide the option.