A new survey from Food Research and Action Center points to the need for much greater communication between healthcare centers and hunger relief organizations when it comes to food insecurity screening and intervening.

Only 25% of healthcare providers refer their food-insecure patients to a food bank or pantry for food aid, according to the survey, which polled 144 healthcare institutions regarding their interactions with patients aged 50 years or older. 

Healthcare providers can be a valuable resource for identifying cases of food insecurity, since many of the diseases their patients suffer from stem from poor nutrition. Virtually all of the survey respondents (99%) agreed or strongly agreed that screening for food insecurity in a clinical setting is important.

While the majority (88%) screen all or some of their patients for food insecurity, far fewer have interventions in place to address food insecurity once it’s discovered (see chart above). Their most common responses are to refer food-insecure patients to a social worker (44%), help them apply for SNAP (41%), or provide referrals (27%). Referring patients to a food bank or pantry was the fourth-most common intervention (see the 25% mentioned above).

“The ability to carry out effective referrals on an ongoing basis are challenged in different healthcare organizations,” affirmed Joe Arthur, CEO of Central Pennsylvania Food Bank, which has been working with at least 20 healthcare partners and federally qualified healthcare centers in the food bank’s 27-county service area for the past eight years.

Over the years, the food bank has moved from small-scale, grant-funded food as medicine projects into more strategic agreements with providers that involve everything from basic screening and referrals, to tailored food boxes, to distributions at on-site health-center pantries. Referrals, in particular, suffer from widespread issues such as staffing challenges and the difficulty of doing follow-up to ensure referrals were acted upon, Arthur said.

Smooth referral processes will become even more important as the healthcare industry responds to a stipulation from the Centers for Medicare and Medicaid Services that all hospitals and clinics in federal payment programs screen their patients for social determinants of health, including food insecurity. The ruling is sure to result in the detection of many more food-insecure households. (See how some food banks are responding here.)

Healthcare providers most often execute referrals by providing information on food resources via a paper hand-out (41%) or verbally (35%), according to the FRAC survey. Walking patients to an on-site pantry (31%) or making notes in electronic medical records (28%) happen with less frequency.

At Central Pennsylvania Food Bank, two SNAP outreach team members funded by two different healthcare partners currently receive referrals of food-insecure patients from those centers. One partner is particularly effective at executing the referrals, pointing to the importance of each individual healthcare center’s procedures. “How you set up the referral processes and operations really, really matters,” Arthur said, adding, “We’re working intensively to get the challenges in front of the decision-makers who can actually make some changes.”

About five years ago, the food bank hired a Health Innovations Manager to oversee the food bank’s healthcare partnerships. Initially, the position reported directly to Arthur, to “give it the weight that it needed in our organization to get things done,” Arthur said. Now, the position is integrated with the team that supports all of the food bank’s partner agencies. 

Often, healthcare centers don’t know if a patient has followed up on a food-bank or other type of referral. According to the FRAC survey, nearly one-third (32%) said patients tell them whether they followed up on a referral, while 23% said they often don’t know what happens with referrals, and 20% said they need help closing the referral loop.

Healthcare providers see the anti-hunger community as an important partner. When asked about support needed to better address food insecurity among patients, 45% cited funding for hunger relief organizations to help patients connect to resources. The only support ranked higher was training for healthcare professionals on how to connect patients to resources like SNAP and food (62%). 

Despite the rise of tools like Medicaid 1115 waivers and produce-prescription programs, these interventions are among the least likely ways healthcare providers are currently seeking to help their food-insecure patients (see chart, above left).

Proving the efficacy of healthy food for food-insecure patients continues to be a challenge and is an area where Central Pennsylvania Food Bank is paying extra attention. Rather than chasing one-off grants, it is looking to work with major strategic programs at the federal or state level that are committed to food as medicine endeavors. “We’ve got to get strategic about it,” Arthur said. “That requires solid agreements, reporting efficacy and getting paid for the work.” – Chris Costanzo

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Micro-tears

When you first begin exercising or start a new sport, your muscles often feel sore for 24 to 48 hours after a workout due to tiny tears created by healthy strain on muscle fibers. As those tears heal, the muscle gets stronger, which is a good thing. However, in order to heal, your body needs to retain extra water. Muscles are already approximately 76% water, so that healing process can make a noticeable difference on the scale.

Inflammation

That same process of stress and recovery can also create inflammation after an intense bout of exercise. Again, water retention helps your body heal after a hard workout, but research shows exercising regularly can reduce inflammation in the long run.

Glycogen

Glycogen is the energy our muscles use for power. When we exercise more, we need to store more of it in our cells. Glycogen also needs water to fuel the muscle. Each gram of glycogen is stored with at least 3 grams of water. However, with consistent exercise, muscles become more efficient at using glycogen, so they need to store less of it—and less water as well.

Muscle Mass

A month or two after you start exercising, your body composition may begin to change. You will likely gain muscle mass and may begin to lose some fat mass. Muscle weighs more than fat, but it also burns more calories. Closely tracking your weight during this window can be confusing—your clothes may feel looser while the number on the scale stays the same or even goes up a few pounds. How strong or energetic you feel could be a more meaningful measure of your progress at this stage than your weight.

Appetite

Research is mixed on whether exercise increases appetite, but many studies show that exercise actually decreases hunger hormones, especially in the immediate aftermath of a workout. The result is a delay in hunger cues, but over the course of a day, calorie intake often remains the same regardless of whether people exercise. This news may be motivating if your goal is to lose weight. If the amount you’re eating is stable and you’re burning extra calories by running, you could see slow, steady weight loss over time.

However, I do have one note of caution on appetite. Anecdotally, as a coach, I’ve seen lots of people follow long run days with burgers and fries they wouldn’t have eaten otherwise. Lots of factors influence appetite—physical, environmental and psychological. If you’re exercising more than usual, make sure to fuel your body regularly with high-quality carbohydrates, protein and healthy fats. A little goes a long way. You might find a small snack before or after running could help curb overeating later in the day and even deliver you more power for your workouts.

One of the biggest drawbacks to morning workouts involves sacrificing sleep. Sleep debt—the difference between the amount of sleep you need versus the amount of quality sleep you actually get—is associated with an increase in catabolic hormones, which break down muscle, and a decrease in anabolic hormones, which build muscle. This negatively affects muscle adaptation and recovery after exercise.

Some say exercising first thing in the morning, before you can talk yourself out of it, is a good strategy, but Brisby disagrees. Having a nervous system primed and ready to perform is essential, he says—especially when completing complicated movements like agility drills and powerlifting.

Brisby also notes that eating before exercising—something you might skip if you’re trying to squeeze in a workout before work or other obligations—is important in order to avoid depleting energy stores during your workout. He suggests allowing enough time to eat a simple meal in the morning, such as a hard-boiled egg or serving of yogurt, to help you power through your workouts. Overeating can make you feel sluggish and full, though, so keep portions small.

Ideally, save high-intensity and neurologically demanding exercise for a mid-morning session or an hour or two after you wake up, Brisby suggests. This timing allows you to not only have a small meal before your workout, but also to be more alert and neurologically prepared for a challenging workout, promoting better focus, coordination and, ultimately, a better workout experience.

Thanks to social media, “men’s bodies are on display more than ever, and these pictures may be heavily filtered, photoshopped, or the best one out of hundreds of different shots and angles that didn’t make the cut,” Dr. Nagata says. In other words: If you’re constantly comparing yourself to muscular models, influencers, or celebs, it’s no wonder you feel like shit. And in the case of your IRL connections, you shouldn’t feel like you’re being judged or objectified by your own pals or dating partners.

So don’t be afraid to set boundaries (by changing the subject or flat-out telling someone you’re not cool with negative body talk), or to unfollow or mute anyone who leaves you feeling self-conscious, ashamed, or guilty, Dr. Nagata advises. The people you choose to surround yourself with should make you feel inspired and accepted, not like you’re in a never-ending competition and falling short.

Be honest with yourself about how your exercise and/or food routine really makes you feel.

Exercise has numerous health benefits and isn’t in and of itself an indicator of a problem, of course. However, an obsession with working out—to the point where you feel anxious or guilty when you take one rest day or use a trip to the gym as “punishment” whenever you eat certain foods—can signal that your regimen is actually hurting, not helping, your well-being, according to Dr. Nagata.

“You should be engaging in workouts that are fun or stress-relieving, but with eating disorders or muscle dysmorphia, exercise can be taken to the extreme and cause worry or preoccupation instead,” he says. The same goes for your diet: There’s nothing wrong with trying to incorporate a variety of nutritious foods in your meals, but if the way you eat is leaving you feeling drained or constantly hungry, health clearly isn’t the motivation.

That’s why Dr. Nagata suggests a more realistic routine that you can sustain in the long run—rather than “quick fixes” or extreme programs that zap your energy and make you miserable. That may look like learning to follow your body’s cues when it comes to hunger and fullness, or taking more days off when you’re feeling sore or just need a break. It can also be helpful to engage in a mix of different activities (like hiking, yoga, or swimming)—instead of sticking solely to strenuous strength training. Because underfeeding or overworking your body (and hitting the gym for the wrong reasons) kind of defeats the purpose of your “healthy” habits.

If you can’t get things under control on your own, call in the experts.

Asking for help and admitting that you’re struggling is easier said than done—especially for men, who have historically been taught that vulnerability is a sign of weakness. Bottling everything up, however, won’t do you any favors, because self-critical thoughts and behaviors thrive in the shadows, Dr. Nagata says.

“Speaking with a health care professional or therapist who specializes in body image issues can be incredibly beneficial, as difficult as it can seem,” Dr. Nagata says, adding that these experts are trained to be empathetic and offer personalized treatment plans to fit your individual situation. “Plus, they’re bound by confidentiality and will keep any information you share private.”

Headaches suck, no matter how you slice it. Some of the time, at least, you can clearly point out what brought one on: Maybe you had one too many happy hour drinks, went hard during a run in the heat, or skipped lunch to tackle a deadline at work. (Side note: Let’s all try our best not to do that last thing again.) But if your headache feels especially heinous, or you’ve had one after another recently, you might wonder: Is it possible I have migraine—or maybe some other health condition?

When you’re in the throes of a headache, it’s not actually your head that’s throbbing. Rather, the pain is your brain’s way of sending a warning bell that something else probably needs your attention—more than 300 potential “somethings,” or medical issues, to be precise, Lawrence C. Newman, MD, director of the Headache Institute at St. Luke’s-Roosevelt Hospital Center in New York City, tells SELF. (So, in the cases outlined above, dehydration, hunger, and stress are possible underlying culprits—your brain is just loudly suggesting that you address them.)

If you’re wondering why your head is giving you grief, try to get specific about how it and the rest of your body feels, Kiran F. Rajneesh, MD, director of the Neurological Pain Division at The Ohio State University Wexner Medical Center and College of Medicine, tells SELF. He says that where the head pain is located, how intense it feels, and if it’s paired with other symptoms can help you understand whether you’re experiencing a headache versus a migraine attack, or something more. Here’s how to make sense of what you’re going through so you can seek out the right treatment and put an end to hellish brain pain ASAP.

If your head is pounding, there’s a good chance you have a tension headache.

When people say, “I have a headache,” they’re often referring to a tension headache, the most common type of headache, Dr. Newman explains. According to the US National Library of Medicine, a tension headache usually feels like a band is “squeezing,” or wrapping tightly around, your forehead, with pain that can extend to the scalp and neck. “It’s a pressure-like sensation that’s mild or moderate, it often doesn’t interfere with [a person’s day-to-day life], and there’s generally no nausea or light, sound, and smell sensitivity,” Dr. Newman says.

In other words, you probably won’t feel super energetic if you have a tension headache, but you might still be able to push through whatever you have to get done that day (ideally with at least one power nap along the way). That’s not to say a tension headache can’t suck; they can last anywhere from 30 minutes to a few days and, in rare cases, for 15 or more consecutive days and for several months at a time.

Some medications, like over-the-counter (OTC) pain relievers, can alleviate the tension, but you might want to use them sparingly—no more than two to three days over a seven-day period: “Don’t take [OTC medications for head pain] too frequently, as they can sometimes worsen headaches, leading to rebound headaches from overusing medication,” Joy Derwenskus, DO, associate professor of Neurology and head of the General Neurology Division at Vanderbilt University Medical Center, tells SELF. She recommends starting with other relief methods, like ice or heat packs, meditation, and generally just getting rest. If those options don’t get rid of your headache, you should see a neurologist about getting on preventive medication.

Migraine symptoms can involve a lot more than just head pain.

Like tension headaches, migraine is considered a primary headache (meaning the head pain itself is the main problem, not something else), but it’s a bit more complex. According to Yale Medicine, migraine is a neurological disorder affecting 15 to 20% of adults in the US that usually requires ongoing treatment.¹ While doctors don’t know exactly why people develop migraine, genetics is one significant factor that might play a role: Roughly half of all people with migraine have a close relative who has it too.