She was just 24 years old, but in the span of just one year of eating an American diet, Tiffany Uhila-Hautau's patient had gained 75 pounds.
Rapid weight gain -- and the diabetes it causes -- are becoming epidemic in low-income communities, where immigrants who once gardened and walked in their native country villages have fallen into the American way of life: fast food, fast cars and a waistline to match their new lifestyles, health professionals said.
This cultural shift is having a devastating effect, and it's not the elderly who are affected, said Uhila-Hautau, a health educator at Ravenswood Family Health Center in East Palo Alto. Younger people, including children, and younger adults such as Uhila-Hautau's 24-year-old patient, are increasingly afflicted with diabetes.
The effects can be devastating: amputations, blindness, chronic nerve damage, stroke and heart attacks and early death.
But a two-year, $182,000 Tides Foundation grant that combines gardening, health education and cooking classes is helping patients shift to healthful diets and to control their diseases. The grant was given to Ravenswood's Chronic Disease Management Program -- Patient Health Navigation and East Palo Alto's Collective Roots gardening program and is part of Tides' Food Systems Change initiative for community clinics.
In the 12-week program, dubbed "Chef in the Garden," patients learn about healthful food and eating, from seed to plate and from plate to composting, to raise food in the back yard or purchase wisely at the supermarket, Uhila-Hautau said.
Of Ravenswood's roughly 9,000 patients, 950 have diabetes, said Will Cerrato, director of chronic diseases. About 20 percent are Pacific Islanders, 65 percent are Latino and 15 percent are African American. Patients' ages range from 25 to 65.
Since first starting a healthy-eating program in 2008, the number of patients partaking in the program has increased from three to four per class up to 15 to 20. That's 65 percent of the patients, he said.
Getting control of their food and maintaining it is critical to patient health, he said.
"Some patients have lost their feet. We have a husband and wife who each lost a foot. The consequences of diabetes are most devastating," he said.
The program's benefits are measurable, Uhila-Hautau said.
"Blood sugar levels for some patients have decreased by 5 to 10 points -- that's huge. And losing one pound a week is a lot. Some patients have decreased their blood pressure by using a lot of garlic, onions and ginger," she said.
The first thing patients see at a class at Ravenswood's Center for Health Promotion on Bay Road is the film "Food Inc.," a documentary that shows the often inhumane way that food is raised in this country by agribusiness. Following the unappetizing introduction, patients learn how to garden and prepare fresh meals that maintain cultural relevance but also change ingrained cooking habits, such as deep-fat frying.
The gardening component is taught by Collective Roots, a nonprofit that educates students and residents about healthful food and works to provide them access to it.
In the garden at East Palo Alto Charter School, patients learn how to select seeds for seasonality, to grow crops organically, how to compost and how to make economical choices, Executive Director Kris Jensen said.
Participants can take home seedlings they have planted and take seeds from the "seed library" Collective Roots has helped set up at East Palo Alto's public library.
At the end of the program, patients can choose the kind of garden they'd like at home, and a volunteer team will install it. It doesn't have to be fancy.
"You can grow a lot of food in a very small space," Jensen said. A 20-bed modular garden will be installed for patients on Sept. 11 at the site of the planned new Ravenswood health center, Jensen said.
Cooking classes are half of the program. Chefs and nutritionists teach the classes through Cooking Matters, a nationwide nonprofit group that teaches families at risk of hunger how to make healthful and affordable meals.
Patients make an entire meal from culturally appropriate recipes. The dishes maintain the flavor and appeal of foods residents are used to eating but alter the style of cooking, such as switching away from deep frying to sautÈs and using olive oil, Uhila-Hautau said.
"We are trying to break some barrier of cultural diets and to add more foods that are higher in nutrients," she said.
Everything is prepared with produce from the local farmers market.
But economics play a big role in the health crisis, and patients often don't think they can afford to eat healthfully, she said.
"In this bad economy many people are unemployed or living with family members. They don't have any say about what's in the fridge," she said.
It's a myth the program tries to dispel.
To help residents purchase fresh fruits and vegetables of their own, patients are given Fresh Checks vouchers from Collective Roots to buy organic produce from the farmers market.
On a recent Wednesday afternoon patients learned to make red lentil soup, a dish that costs just $1 for a bag of the beans, she said. Red snapper, potatoes and a vegetable saute are served on the side, she said.
"We keep it really simple. We want patients to see the longevity of usage of one ingredient such as olive oil. A lot of times it's just something they don't know about," she said.
At the end of each cooking class patients receive a free bag of groceries along with the recipe to go home and cook. When they return the following week, they'll discuss any challenges they encountered, she said.
Patients also apply their new knowledge during a shopping trip.
"With $10 for a family of four, tell me what you're going to buy. We go to the 99-cents store where you can buy half canola and half olive oil. You can make a buck go a long way," Uhila-Hautau said.
Robert and Martha Perez have attended the cooking and gardening classes. Robert, 54, has diabetes. He has lost 13 pounds since starting the classes, he said.
"The classes have been a lot of help. It's something that was needed in East Palo Alto. We learn how to eat healthy foods and to control our portions. Most importantly, we learn how to reap all of the benefits from bread, rice and cereals and how to balance what we eat," he said.
Before, Perez said the couple had no control over their eating. But he and his wife have learned how to read food labels and to decipher what the labels really mean.
"The companies are very tricky," he said.
Although he lives in an apartment, he has developed a container garden to grow fresh cilantro, string beans and zucchini.
The 12-week course has had a lasting impact on the couple's lifestyle, he said.
"We are motivated more to cook for ourselves. It triggers your brain not to go for the fast-food stuff," he said.
Patients and their families are often shocked by what they learn about food, Uhila-Hautau said, finding pleasant surprises in the unknown.
"There's a myth out there that healthy food doesn't taste good," Jensen said, recalling the reaction of a 9-year-old boy after tasting crunchy, freshly made kale chips.
"They're a lot better than hot Cheetos," the boy said.
Jensen laughed. "Plus your fingers don't get orange," he said.