Fighting hunger through science

She grew up sheltered from poverty in her comfortable home in Ghana. But when Irene Hatsu came face-to-face with extreme hunger, she decided to do something about it. At Ohio State, the associate professor of nutrition teams up with a top researcher to help a vulnerable population in novel ways.

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Transcript of Podcast

Robin Chenoweth: People who commit themselves to the work of helping others can very often pinpoint the moment that inspiration struck them. In that instant, they saw something that hooked them, met someone whose story captured them. Quite often, that interaction happens when those people insert themselves into situations and surroundings that aren’t their own. They put themselves out there, into shaky, unfamiliar territory. And once there, everything they’ve known and seen takes on a new shape, a different hue. That’s where Irene Hatsu found herself in 2001, when she and a youth group visited a home for orphaned and indigent children in Accra, Ghana, about 90 minutes from where she grew up.

Irene Hatsu: So, these were very, very poor environments, because these homes depended on donations and so besides food, where they slept, whether they had running water, whether they had good amenities for toilet, for showers and all of that were all based on donations that people made monetarily.

Irene Hatsu: And, so, a lot of these children, their sleeping places were not clean. They were horrible. They were taking showers outside. A lot of them looked skinny and they had big bellies.

Robin Chenoweth: And these were small children, some infants, none older than 10 years.  Hatsu, though she had lived in Ghana her entire life, had never seen poverty like that. She didn’t know it then, but that moment would launch a calling that would bring her to The Ohio State University and allow her to collaborate with researchers compelled to do similar work. It would also foster in her an abiding need to actively create solutions for people experiencing food insecurity. In short, that moment pushed Hatsu to become not just an observer, but a driver of change. This is Inspire, a podcast by Ohio State Universities’ College of Education and Human Ecology. Carol Delgrosso is our audio engineer. I’m Robin Chenoweth. Having spent time in African slums and orphanages, I can tell you: Once those images of children in extreme poverty are fixed in your mind, you don’t easily forget them. Irene Hatsu never did. But her home on Lake Volta was different: Idyllic, sheltered from hunger, absent of need.  

Irene Hatsu: Well, it is a beautiful place so let me just give you a little bit of a visual description. I lived in an area with the largest man-made lake in the world, and that is what was used in power generation. And, so, my father happened to be working with a company that produced electricity. It was surrounded by mountains. So, my house was actually at the base of one of the mountains. And I went to school on top of the mountains, so we had a school bus that will pick the kids up daily and take us to school.

Robin Chenoweth: The bus was air conditioned. Her mother worked outside of the home. Hers was the kind of middle / upper middle-class household that most American’s don’t envision when they think of Africa. But that life has become more common for many, particularly in west Africa.

Irene Hatsu: That was the kind of life that I had growing up.  Everybody around me was an engineer or a lawyer or a doctor or pharmacist. So the expectation was that I would grow up to be an engineer. My dad would always encourage us to get education, to strive as high as we could, because he always said, with that certification, you can take care of yourself and you don't need to depend on a man to take care of you. So I heard that a lot growing up and education was a big deal in my house.

Robin Chenoweth: But then…she saw those kids…with their brittle, reddish hair. Their bloated stomachs. Tiny arms and legs.

Irene Hatsu: At the time I didn't know what it was. Now I know it is kwashiorkor.

Robin Chenoweth: Kwashiorkor. A Ghanaian word that means the disease the first child gets when the second child is born. The term was borrowed from the Ga language, in coastal Ghana, by the researcher who first documented the condition in 1935. It’s a textbook term in nutrition science today but was used for generations in Hatsu’s home country.

Irene Hatsu: It happens because the first child is basically weened. Immediately, they are taken off the breast, irrespective of how old they are, when the second one is born, and they then tend to feed on a lot of carbohydrate intense foods that do not have any proteins. It will be something like porridge made out of corn.

Robin Chenoweth: The lack of protein very suddenly jeopardizes the child’s health. But when she first saw this, she didn’t know any of that.

Irene Hatsu: And so, for me, my thinking was, what can I do to change this? What is this and what can I do to change it? That is what birthed my interest in maternal and child nutrition.

Robin Chenoweth: In college, Hatsu studied biology, with the idea that she would become a doctor — one of the four professions of which her father approved and for which he was willing to pay for college. But she came to dislike the subject — particularly the animal dissections she was required to do.

Irene Hatsu: I would get really lightheaded, to the point of feeling like I was going to pass out. I did not think that going to medical school where I totally had to deal with dissecting cadavers, which was part of the requirement, was going to be a path that I could take.

Robin Chenoweth: After seeing the kwashiorkor, and at several points during her undergraduate studies, she told her parents she wanted to study human nutrition. To which, her father expressed an emphatic ‘no’. So, she continued on, getting her undergraduate degree in biology.

Robin Chenoweth: A few decades earlier, halfway around the world, Natasha Slesnick’s parents also had a lot to say about her education. Her father, Irwin Slesnick, got his PhD in education at Ohio State in 1963. After serving as a Japanese interpreter in World War II, he had become a pacifist, and gave lectures about prejudice and anti-discrimination. Though a multi-millionaire, he didn’t want his children to take anything for granted.

Natasha Slesnick: We would go around the world. And he would take us to the more impoverished areas of those cities, just so that I would be exposed to the non-privileged life of most people in the world. And not think that everybody lives the way we live when I was growing up, which was pretty comfortably.

Natasha Slesnick: My father didn't believe in people having inordinate wealth, even though he had inordinate wealth. He gave a lot of it away. And he tried to spend it all before he died, to charities and whatnot, and on himself, traveling, but he didn't believe in passing wealth down to other generations either.

Robin Chenoweth: Which meant he didn’t pay for her siblings’ education, and only paid for Slesnick’s because her mother insisted so when the couple divorced.

Natasha Slesnick: But he only paid for the tuition. And I still had to work to pay for everything else. But the respect that her parents instilled in her for people in poverty — and seeing that need up close — impacted Slesnick much the same way it would Irene Hatsu in that children’s home. So 13 years after Hatsu saw those hungry kids, that common passion would cement the two faculty members’ aspirations and allow for research that no one else was doing. Irene Hatsu first came to the United States in 2003, to visit an exchange student whom she befriended in Ghana. She hit it off with the woman’s family, becoming so close with them that she still calls them today …. her American family.

Irene Hatsu: And I shared with my American dad that I wanted to do an MBA.

Robin Chenoweth: A master’s degree in business administration.

Irene Hatsu: And his question to me was, is that what you really want to do? …. What is your passion?

Robin Chenoweth: Her passion was human nutrition for marginalized children and their mothers. But her father back home was never going to go for that, she told her American mom and dad, because he thinks it’s just home economics. Not a serious or well-paying profession. Not something a woman can do to support herself.

Irene Hatsu: And their reaction was ‘Do whatever you want to do. We will support you.’ And so I applied to grad school, they encouraged me to write the GRE, paid for my GRE actually, encouraged me to go to grad school and were even willing to pay for my grad school education. So yes, that is how close I became with the family.

Robin Chenoweth: But she wouldn’t need them to pay, because when she applied to University of Georgia, the program offered her a graduate assistantship. She got her master’s in maternal and child nutrition, began working for WIC, the Special Supplemental Nutrition Program for Women, Infants and Children in Atlanta. Then she went to Florida International University to get her PhD, hoping to work overseas with women and children who are HIV-positive. But when that grant ran out, she studied instead ways to help adult HIV patients in Miami to better manage their disease through nutrition.

Irene Hatsu: I was trying to get them to improve their nutritional status. In the midst of that one gentleman plainly told me, ‘I like everything you are teaching us but I just don't have enough money to purchase all the foods that you're talking about’. And so this introduced me to the concept of food insecurity.

Robin Chenoweth: Food insecurity — inconsistent access to nutritious food that could jeopardize an individual’s health — looks different for different people. In Miami, the population of HIV-infected residents was large. They were sick, often without insurance and sometimes experiencing homelessness. Money to buy leafy greens and fresh fish was not in their wallets. But in 2013, when Hatsu took her first job as an assistant professor at the College of Education and Human Ecology, she discovered that the situation in Ohio is very different. With a dual appointment as an ag-extension agent, she looked at how access to food affected those in poverty.

Irene Hatsu: Although Ohio is an ag-heavy state, a lot of the crops we grow are not for consumption, but they are for export. And so we have very high food insecurity rate compared to other state(s). Now that has gotten a lot better in the last couple of years. But, basically, it just means that people do not have adequate nutritional foods to consume that would help them live a healthy life. In extreme cases, people go to bed hungry.

Robin Chenoweth: That situation has worsened during the COVID-19 pandemic. Food insecurity rates have tripled since March, with food costs increasing sharply and use of food pantries spiking. But even before, grocery stores had closed in high-poverty areas, making access to healthy food harder than ever, and causing obesity in populations as they eat starchy, nutrient-poor foods available to them. Once at Ohio State, Hatsu researched how nutrition impacted cancer patients. But she still had in mind helping people in the margins. And then she met Natasha Slesnick. The professor of human development and family science is internationally known for her pioneering research on homeless youth populations — kids 14 to 24 years old living on the streets. The two researchers clicked.

Natasha Slesnick: We bonded right away.

Robin Chenoweth: Natasha Slesnick.

Natasha Slesnick: Because she is dynamic and smart and interesting. And she shared similar interests to me which is with vulnerable populations. She worked with other vulnerable groups in Florida during her graduate training… with homeless adults at risk for HIV. So we bonded both personally and then professionally. And then we started to think about ways that we can work together.

Robin Chenoweth: Slesnick had discovered years before that there were many more teenagers and young adults living on the streets of American cities than anyone knew. Youth experiencing homelessness blend in — looking just like the college students on campuses. She has conducted 15 federal studies examining causes and solutions. Under her direction, Ohio State in 2006 opened the Star House, a drop-in center for youth experiencing homelessness. The Star House has since become a separate non-profit organization, but Ohio State continues to conduct research there.

Irene Hatsu: Natasha was also serving as the associate chair for human sciences, for research. And so she was guiding the junior faculty at the time, on how to get grant funding and how to get our research going. I was just brainstorming with Natasha one day and she knew I had a focus on vulnerable populations. I remember her saying very clearly, ‘Irene, I do not think anybody has studied nutrition in this population and how that affects the disease conditions they live with’. So, I said, ‘Okay, sure, I'll look at the literature in this area’. And so I did.

Robin Chenoweth: She discovered that very little, if any, research had been done studying how homeless young adults’ and teenagers’ nutrition was affecting their health. And then she looked at their prevailing health conditions.

Irene Hatsu: I saw there was a huge mental health challenges that they lived with. And then I went to look at the connection between nutrition and mental health. And I said, ‘Voila. This, this is an up and coming field.’

Robin Chenoweth: She got a seed grant from the college to begin studying the issues of mental health and nutrition. And she began spending a lot of time with the youth. She was surprised to hear why many emancipated themselves from their homes.

Irene Hatsu: I realized that some of them had become homeless because they were separated from parents who disagreed with them about maybe their sexual orientation. Or there was something of substance abuse. Or it could be that the substance abuse of the parent themselves, that led to the child being on the street.

Robin Chenoweth: Others were in foster care, and then aged out, finding themselves on their own, with nowhere to go. None of them were “bad” kids, Hatsu realized. Circumstances often out of their control had put them on the streets. And once there, they had become VERY vulnerable.

Irene Hatsu: The thing that surprised me is the amount of victimization that they go through. And I guess I shouldn't have been surprised because these are children who are trying to take on adult responsibilities in a world that they are not protected against people who could take advantage of them sexually and in other forms. And so, they live with a lot of mental health challenges. And that for me was a surprise.

Robin Chenoweth: Given all the difficulties they face, their nutrition is among the last of their concerns.

Irene Hatsu: Yes, they would do anything to get food. But security and shelter — those are forefronts on their minds especially when they have been sexually victimized. Unfortunately, a lot of the nutrients that we need for a healthy lifestyle, including mental health — a healthy mind — comes from the food that we eat. And so even though food is not what is forefront on their minds it is integral to their health and their well-being.

Robin Chenoweth: Studies show that diets high in vegetables, nuts, fish and Omega-3 oils, for example, provide building blocks for neurotransmitters — such as dopamine and serotonin — which can do things like aid cognition and help regulate mood and emotions. So the question might be — how do food choices contribute to improving the overall mental health of young adult and teens experiencing homelessness? Could improving their nutrition improve their overall well-being? While there are no studies to support that poor nutrition is a cause for behaviors that might contribute to homelessness, there is evidence that lack of food can lead to behavioral problems.

Irene Hatsu: We've seen that children who are food insecure turn to have conduct problems or turn to be agitated a lot. They show a lot of anger, which makes sense, because for even an adult, when you skip breakfast or lunch, and you're hungry, and you have to concentrate, you realize that maybe you cannot, and you become irritable. And so there is that association between having enough food to eat and some behavioral problems.

Robin Chenoweth: Hatsu began studying which foods youth were eating at the Star House Drop-in Center, which receives donations, grants for food and has a full kitchen where the youth can cook for themselves.

Irene Hatsu: We looked at the foods that were available at the Star House to the homeless youth and also tried to see if there was some consistency between what the what was available to them and what they were eating.

Robin Chenoweth: So, what are they eating?

Irene Hatsu: Basically, they eat a lot of junk food, and they eat whatever they can lay their hands on. And even though Natasha, through funding, had tried to provide them with healthy foods, the youth were eating ready-made foods, highly processed foods like cereals. What do they eat a lot of is processed meat like hamburgers and hot dogs.

Robin Chenoweth: And here’s the catch. Even though fruits and vegetables were on hand, the youth weren’t eating those. The bananas went untouched. The broccoli and baby carrots went bad. Why? It mostly comes down to comfort, Hatsu said.

Irene Hatsu: They were eating what was comfortable to them, what they had grown up with, and what was cheap. Because if they couldn't make it to the Star House and they had to fend for themselves, I'm sure those were the kinds of foods that they were eating because they were cheap.

Robin Chenoweth: And though they had a kitchen available to them, most do not know how to cook, other than nuking a frozen entre or heating a hotdog. These were eating behaviors that no one had researched among this population, Natasha Slesnick said.

Natasha Slesnick: So, she was really identifying a niche in our understanding, in terms of nutrition for youth who are homeless. I mean, homeless youth have limited choices for food, you get your food from a food bank, you get food from a drop-in center or a shelter, you don't have much choice, but at least at the drop-in center, there are you can choose from what's available. But it was that question that she had, amongst the choices that are available, what are youth choosing?

Robin Chenoweth: To determine what youth ate outside of the Star House, Hatsu did what she calls the “24-hour recall” with them, recording their intake. Blood tests indicated where youth were nutrient deprived.

Irene Hatsu: I was so blind. I have never really tried to do an intervention with a youth population that was as transient as these youth were, and I knew nothing about the nutritional vulnerabilities.

Irene Hatsu: I went in not knowing a lot of the population, but also they also had to learn about me and be able to trust me that I had their best interest at heart for that relationship to be able to work.

Robin Chenoweth: That trust was built over hours of conversations, gathered around the kitchen and common areas of the Star House. She began to know not just their eating patterns, but their challenges. Many were overweight. And mental health difficulties touched all aspects of their lives. To see if proper nutrition, or even vitamin supplements, could help, Hatsu would need to do an intervention. And that was tough, because youth are in the Star House one day, sleeping on a friend’s couch the next, or outdoors in tents, eating what they can scrape together.

Irene Hatsu: The population is transient, and we've not been able to show how we can get them to get adequate doses of the intervention that we intend to provide to help alleviate the symptoms of mental health at the experience.

Robin Chenoweth: Science demands consistency, and that is difficult to achieve. And so she began looking for answers elsewhere as well — with another group of children.

Irene Hatsu: I have been doing nutrition and mental health work with children who live at home with their parents, whose parents can make the decision in terms of helping them improve their nutritional status, basically clinically improving the doses of specific nutrients in their bodies and seeing if that has an effect on mental health and in this case, we are focusing on symptoms associated with ADHD and that includes the depression and anxiety that our homeless youth experience.

Robin Chenoweth: So she’s looking to see if improving nutrition for children with ADHD and living at home affects, among other things, their anxiety and depression. And that could lead to better outcomes for youth experiencing homelessness. And Hatsu discovered, just when you think you’ve taken another path, life has a way of calling you back.  

Irene Hatsu: One thing that we noticed is that a lot of the homeless, young ladies have younger children; they do get pregnant. And so I was interested in looking at the nutritional vulnerabilities of the children they have and how that relates to some extent with substance use that is also common in the population. And what kinds of interventions we could develop to help the infants and also their mothers?

Robin Chenoweth: And it just so happened, Slesnick has a study looking at substance use among young mothers.

Natasha Slesnick: We used that data from that pilot for an administrative supplement, it was a diversity supplement for an ongoing research grant that I had funded through the National Institute on Drug Abuse with mothers experiencing homelessness, who had young children in their care. And in that project, she continued that same work looking at nutritional intake, and height and weight of the mothers and their children.

Robin Chenoweth: Hatsu had orbited back to her original goal.

Irene Hatsu: A colleague actually reminded me of that. Earlier in the year, we were having a conversation, and she said, ‘You thought you had gone away from Maternal and Child Nutrition but here you are, full circle, doing that again.’

Robin Chenoweth: And the nutrition researcher from Ghana, who made her mind up years ago that she would do something to help kids in need, hasn’t done it like everyone else, Slesnick said.

Natasha Slesnick: She's amazingly intelligent, and complex in her thought processes, and many people have a very hard time doing what she does. She's filling a niche that is the nexus between substance use research and nutrition and psychology. And I think that's really hard for people to do. Because you have to be able to manipulate, in your mind, different fields of study. And that's hard for people to do. She's not someone who does parallel work. She actually tries to integrate concepts from other fields into her work. And I think that's what is going to move the world forward.

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