How Findings from SuperWIN May Shape the Future of Dietary Education

Dylan Steen, MD

Positive findings from the the Supermarket and Web-based Intervention Targeting Nutrition (SuperWIN) Trial show the potential of dietary interventions in grocery stores in improving nutrition education.

In the second part of an interview with HCPLive, Dylan Steen, MD, Director of Clinical Trials and Population Health Research, University of Cincinnati Heart, Lung and Vascular Institute, provides perspective into the lasting changes from nutrition interventions and what is coming next, on a potentially larger scale.

This transcript has been edited for clarity.

Do you think that a more actionable item like providing education in the grocery store does more than that guidelines for individuals?

I mean, guidelines play a role. But, patients don’t read guidelines. Lots of physicians don’t read guidelines. The reality is, how do you really change things for the person? The most obvious thing is and I’ll give an analogy, if you want to learn how to swim, you sign up and you jump in the pool. It’s an obvious thing.

If you think about dietary education, you’ve got to get right to where people are making the vast majority of their food choices for themselves and their families. What is so cool about retail is there model is based around convenience, access, customer centricity, and lower cost. If you’ve been following what the US population and other populations want in terms of healthcare, that’s exactly what they’re asking for.

Retail has been very good at delivering that. The synergies between traditional medical settings and retail is going to create a very nice marriage of care going forward.

Would it be possible to broaden the system to other retail locations across the country?

Well, you know I’m not employed by a retailer, I am not part of that industry. I’m just a scientist. But, I can tell you this, and I said this during my main presentation: if you can show the data, the dollars usually follow. There are many ways that one could think that this could become sustainable and something where companies actually want to implement SuperWIN right in the real world, across enormous footprints.

Part of it could be that payers are interested because now there’s an evidence base, that’s key. Obviously, we don’t expect drugs to be reimbursed without showing our efficacy and safety first. It is also possible that if you can help people eat better, that is a way to differentiate one’s brand.

The hope is that there will be as many SuperWIN-like interventions out there as broadly as possible. Even beyond US borders. Remember, retail is global and no matter what continent you’re on, retail sits in your community.

In thinking about the role of food deserts or food swamps in lower income areas, how can that be addressed?

It should be addressed because it’s the ethical thing to do. From a population health standpoint, many of these folks living in these areas have a higher cardiovascular risk and all kinds of other risks. If you can help them, you can have big impacts on population-wide outcomes. It’s not just a supermarket or something that doesn't exist within these areas, but many of these patients do not have cars and don’t have access to it.

Or, they may be living with disabilities that prevent them from taking a bus to a grocery store and carrying home groceries. I’m a cardiologist. I take care of patients with diabiishing heart conditions. It is impossible to think that they’re going to go to a store and carry home the groceries themselves, they simply are not physically able. What something like online shopping does is allow patients from home to get the groceries they need.

I’ll tell a funny story. In SuperWin, home delivery was provided by a company called the Grocery Runners, where Grocery Runners would go to a store and pick up the groceries there and drive it to the home. What is interesting is the founder of the company started it when he saw his mother couldn’t shop well for herself. He actually referred to her and her generation as “Silver Surfers.”

This ended up being a mechanism for her to get the foods that she wanted, to keep shopping in the supermarket, without necessarily support from the family. My personal presidection is that retail is going to have a hard time charging for delivery in the future, because there’s going to be so much competition. That reduces the economic barrier for low income communities.

What is coming next?

For SuperWIN, we presented the primary results and we will now do further analyses to really understand who benefits the most, who benefits the least, and why or why not. The goal with any trial to enchance things with the next iteration. If we’ve come up with a SuperWIN 2.0, that of course, would be ideal.

In terms of the trials, we will have to see. We could now integrate a medication adherence type intervention on top of this, we could integrate other types of interventions. Or, we could figure out an even better dietary education intervention and study that in a broader population.

There are a million ways to go, this is just the start. But, for our team and for others, this is wide open in terms of the opportunities.

Link to Part 1 of the Q&A.