Cohorts: Jane Kaull MD’28

Jane is a Portsmouth, RI native with an interest in studying gastroenterology. Her passion for nutrition and health led her to develop an ongoing research project, which aims to study the effects of delivering fresh fruits and vegetables directly to the doorsteps of people facing nutrition insecurity and obesity. Jane’s interest in such preventive aspects of medicine comes from her childhood, growing up with a mother who works as a dietitian.

What first brought you to Brown?

This is home for me, so Brown was definitely on my mind when applying to schools. I think Brown provides so many different opportunities to take part in things outside of school, like my summer project. During my interview, I mentioned that I wanted to do something to help address nutrition inequalities in the Providence area so I think my interviewer will be proud that I actually followed through! I love the area and it’s nice being back and close to family and friends after studying at Northeastern University for a bachelor’s in health science. I’m definitely interested in studying gastroenterology here, but I don’t have my heart set on a specific specialty at this time.

How did you develop your produce-based prescription study?

I was greatly interested in nutrition coming into medical school, and my discussions with my mentor, Bryce Perler, MD [assistant professor of medicine, clinician educator] made such a project a natural fit. My interest in nutrition goes back even beyond my undergraduate years—my mother is a registered dietitian, so I’ve always been interested in it and I realized while growing up that not everyone has that sort of knowledge. While at Northeastern University, I became more aware of the different nutritional disparities throughout the US, so I pursued a minor in nutrition.

When I reached out to Dr. Perler about working on some sort of preventative piece in medicine that aligned with nutrition, he actually already had a few grants in place for potential research. One of them was for a produce prescription program, and he offered to let me take the idea and run with it. We still had to build the study from the ground up, which has been a little time consuming, but it’s something that’s important and meaningful so I’m happy to do it.

We had considered a few different organizations to work with, but he had a connection or two with Farm Fresh Rhode Island. We proposed a few ideas to give them a sense of how we wanted the program to work, and we were fortunate because they’ve done things like this before. They had the tools and resources to get us up and running, so we’re very happy to work with them.

How does the study work?

We opted for a delivery system as we thought that made the most sense for the patients we’re working with. Some of the barriers for healthy eating we identified included transportation alongside cost, so if we can deliver it straight to patients’ doorsteps, we could better position them for success. Farm Fresh Rhode Island worked with us to develop subscription boxes for our patients, of which we have about a dozen recruited so far. We’re designing the study to have boxes of fruits and vegetables sent to patients every other week for six months. All of the produce is local and seasonal, so participants unfortunately won’t have the ability to choose what goes in their box.

We aim to have 20 people for this pilot study with the potential to expand it if it goes well. These patients are mostly Providence-based with diagnoses of obesity or BMI over 30 and have expressed some measure of nutrition insecurity. They might not have access to transportation, can’t afford certain healthier foods, may suffer from a disability, but have a demonstrated need for better access to healthy foods. We are recruiting patients from the Gastroenterology Clinic at the RI Hospital Center for Primary Care & Specialty Medicine, but we have been careful to identify patients who don’t have an inflammatory condition happening at that time. For example, for people with Crohn’s disease having an active flare-up, you likely don’t want to be eating fiber so in that case it would probably be more detrimental to give them fruits and vegetables in the short term. The recruitment process has slowed down with our return to classes and exams, but I have recruited a few other team members to finish as soon as possible.

The first patients we’ve recruited will likely have their first follow-up visit around February or March, but the process overall would go on until six months from the time the final patient is recruited, and then we would be able to gain post-intervention data. Beyond ensuring patients are more nutritionally secure, we will take clinical measurements, including blood pressure, weight, and other aspects, alongside labwork. One of the novel measurements we’re using involves the use of a Veggie Meter, which sounds fake but is definitely real! It’s a light spectrometer that serves as a skin carotenoid measurement device, which gives us an objective idea of how many fruits and vegetables the patient has eaten on a daily basis over the previous few weeks or so. We are also measuring bioelectrical impedance data with a smart scale, which can tell us body composition measurements like muscle mass, fat mass, and other things that are more predictive of health than solely BMI.

What makes this research important to you?

I completely buy into the idea that food is medicine. Nutrition is such a fundamental part of our health and I don’t think that it’s emphasized enough in our health care system or medical education. We always learn about the social determinants of health and the national obesity epidemic, but there are so many different circumstances that make it challenging for people to stay healthy. It's easy for people to assume obesity is the result of choices you made in your life, but the reality is that obesity is a result of several factors - many of which may be out of peoples’ control. For example, with the high food costs and lower incomes many Americans are facing, people may be driven to eat cheaper and more processed foods. These diets put people at risk for chronic metabolic disease, which contributes to poorer health outcomes among lower-income households. Poor health overall may also negatively impact other factors such as the ability to work, perpetuating this cycle of inequities leading to poor health outcomes. As health providers, we need to find creative solutions to address these barriers to healthy eating because it’s an essential part of wellness. Recommendations to eat fruits and vegetables only go so far if the patients don’t have the resources and knowledge to follow those recommendations. We need to give patients the tools to be successful while empowering them to make these decisions in the long-term, as well.

What do you enjoy doing outside of your work at Brown?

I played soccer throughout undergraduate school and got into running once that career was over. I’ve run in a handful of half marathons and actually just ran in one this past October. I also love to read and go to the beach.