On a Tuesday morning in late autumn, dietitian Rachel Watkins stands in the produce section of a corner store on Syracuse’s South Side, holding a bruised apple that costs twice what it would at the Wegmans eight miles north.
The fluorescent lights flicker above a sparse display of wilted lettuce, overripe bananas, and a few dusty cans of green beans. This is what passes for a grocery store in this neighborhood, where nearly one in three residents lives below the poverty line and the nearest supermarket with fresh vegetables requires two bus transfers and forty-five minutes each way.
Watkins, a registered dietitian at Sarah Lynn Nutrition, has spent the past several years working with families in Syracuse’s most underserved neighborhoods. Her mission – helping people make healthier food choices – confronts a fundamental problem: what happens when there are no healthy choices to make?
Syracuse, a city of 146,000 in upstate New York, is a study in contrasts. In the northern suburbs, supermarkets overflow with organic kale, grass-fed beef, and imported quinoa. But, in neighborhoods like the South Side, the Near Westside, and parts of the North Side, residents navigate what researchers call food deserts – areas where access to affordable, nutritious food is severely limited.
According to the USDA, more than twenty percent of Syracuse residents live in such areas, unable to reach a supermarket without a car and facing stores where fresh produce is either absent or prohibitively expensive.
The term ‘food desert’ has been criticized for its metaphorical imprecision – deserts, after all, are natural formations, while these neighborhoods are the result of deliberate economic and policy decisions.
But the lived experience of food scarcity remains starkly real. Maria Rodriguez, a mother of three who lives on Syracuse’s West Side, describes walking past three convenience stores to reach a bus stop, then riding twenty minutes to a grocery store where she can afford vegetables. ‘By the time I get home, I’ve been gone two hours,’ she says. ‘And the lettuce is already wilting.’
This is the landscape where Sarah Lynn Nutrition operates. The practice focuses on chronic disease prevention and management – helping clients with diabetes control their blood sugar, assisting families in reducing sodium intake, teaching people how to read nutrition labels. But each recommendation runs up against the same obstacle: the food environment itself.
‘I can tell someone they need to eat more leafy greens,’ Watkins explains, sitting in her office on a gray December afternoon. ‘I can explain why it matters, give them recipes, teach them how to prepare it. But if they can’t buy leafy greens where they live, we’re not having a conversation about nutrition. We’re having a conversation about access.’
The challenges are multiplicative. Limited access to healthy food is compounded by economic precarity – the median household income in Syracuse’s food desert neighborhoods is less than thirty thousand dollars, compared to nearly fifty thousand citywide.
Time poverty matters, too: working multiple jobs makes meal planning difficult. And then there’s transportation. Sixty percent of South Side residents don’t own a car. When your commute to the grocery store takes longer than your lunch break, convenience stores become the only viable option.
For dietitians like Watkins this reality requires a fundamental recalibration of practice. Traditional nutrition counseling assumes a certain baseline of access. In food deserts, these assumptions collapse.
Sarah Lynn Nutrition has adapted by meeting their clients where they are, both literally and figuratively. Watkins conducts virtual visits and teaches clients how to maximize nutrition from shelf-stable foods: canned beans instead of fresh produce, frozen vegetables when available, strategies for stretching food budgets without sacrificing nutrition.
But these interventions, while necessary, feel like treating symptoms rather than causes. ‘I’m constantly thinking about what I can’t fix,’ Watkins admits. ‘I can’t bring a grocery store to someone’s neighborhood. I can’t increase their income. I can’t give them more hours in the day. Sometimes the best I can do is help them make slightly better choices within an impossible situation.’
On a Tuesday morning, Watkins sits across from a client newly diagnosed with Type 2 diabetes. The standard advice is clear: reduce refined carbohydrates, increase vegetables and lean proteins, monitor blood sugar regularly. But the client lives in a food desert, works two jobs, and takes the bus.
Watkins opens pulls up a map of the client’s neighborhood. Together, they identify every store within walking distance and discuss what’s available at each one. They talk about canned tomatoes instead of fresh, frozen broccoli when the store has it, dried beans that can be cooked in bulk. They develop a plan that accounts for bus schedules, food costs, and the reality of limited choices.
It’s a plan that might prevent the worst outcomes 0f uncontrolled blood sugar, hospital visits, the cascade of complications that follow untreated diabetes. But it’s not ideal.
The distance between those two realities is measured not just in miles, but in the gap between what nutrition science says people should eat and what structural inequality makes possible.
For Sarah Lynn and her team of dietitians working in America’s food deserts, bridging that gap is the work of a lifetime, perhaps of a generation.
