Biodesign NEXT Facilitates Student Plans to Help Low-Income Californians Eat Healthy

The NuLeaf teamThe NuLeaf team (from left to right): Akshay Chaudhari, Alejandro Aguirre, Ryan Brewster, Taylor Sihavong, Leo Shaw, and instructor Marta Gaia Zanchi.

It’s a common tale at Stanford, where hands-on, project-based courses are growing in popularity: a team of motivated students tackles an important health-related challenge, makes substantial progress in developing a solution, and then is forced to set the project aside when they reach the end of the quarter. Despite their hard work and good intentions, the team’s solution never makes a difference because the students run out of time, resources, and support before they can get it into the hands of the people who need it most.

To address this issue, Stanford Biodesign recently launched Biodesign NEXT, a program that enables students to keep working on promising projects from select Biodesign courses. NEXT provides continued mentorship, funding to develop prototypes and advance the project, and academic credit to help keep the students engaged for another one to two quarters. The program is geared primarily, but not exclusively, to undergraduate students.

The first team to benefit from the program came from the Biodesign for Mobile Health course, an experiential, multidisciplinary class in which undergraduate and graduate students work in teams to create innovative technology solutions to mobile health needs. Early in the class, the students form teams based on shared interests. For Alejandro Aguirre and Ryan Brewster, both first year medical students; Taylor Sihavong, an undergraduate student in product design; and Akshay Chaudhari, a graduate student in bioengineering, that interest was in using mobile technology to expand the services and resources available to underserved populations.

Specifically, they decided to tackle the health problems experienced by low-income communities, which include numerous regular users of the Supplemental Nutrition Assistance Program (SNAP). SNAP provides food purchasing assistance to low-income Americans with the goal of reducing hunger, economic strain, and food insecurity. CalFresh, the California state implementation of SNAP, serves over four million Californians each year.  

According to Biodesign for Mobile Health course instructor Marta Gaia Zanchi, the team’s original idea was simple yet powerful: “If healthcare services are failing these communities, why not help people in the target populatoin instead by redirecting their food purchases?”

 “We chose the nutritional space because it is an area in which low-income communities are severely disadvantaged, and because of the power of diet to shape health and disease,” said Brewster. “We believed that a digital solution was particularly appropriate because it could broaden access to services and resources that wouldn’t otherwise be available to our target population.”

According to Brewster, SNAP and CalFresh are successful in enabling lower income populations to obtain the same caloric intake as the general population. “However, because most of those calories come from pre-packaged, nutrient-poor foods, most recipients don’t meet nutritional guidelines, especially with regard to fresh fruit and vegetables, dairy products, and whole grains,” he said.

As a result, CalFresh and SNAP recipients have elevated blood sugar levels as compared to the general population, and the majority are overweight or obese. This combination leads to a high rate of diabetes, metabolic syndrome, and cardiovascular disease. Moreover, the inability to help manage these conditions through diet exacerbates their poor health outcomes.

Through conversations with recipients, nutritionists, and other stakeholders, the team learned that key barriers to healthier eating were cost and time. “Fresh food is more expensive,” said Brewster. “And it takes a lot more time to plan meals in advance, shop, and prepare them throughout the week.”

To address these issues, the team began designing a mobile app that would provide culturally sensitive recipe recommendations tailored to user preferences, guidelines for the dietary management of health conditions, and localized, up-to-date grocery price and availability data. The team, which named itself NuLeaf, envisioned partnering with food retailers and distributors, and generating revenue by creating a “white label” app that their partners could customize and distribute as their own.

The team made significant progress over the ten-week academic quarter, including conducting user focus groups and initiating a promising relationship with Second Harvest Food Bank. “Second Harvest is closely connected to the population that NuLeaf is trying to reach,” said Chaudhari. “They provide food to over 1,000 clients in Santa Clara and San Mateo Counties each month.” With the project gaining momentum, the team was eager to keep developing their solution beyond the duration of the course.

NuLeaf qualified for Biodesign NEXT when a team of independent judges at the final project presentations awarded them the highest marks in the class. “We are continually failing our underserved populations when it comes to healthcare, and the NuLeaf team might just have found the way to reach them,” observed one of the judges on the panel.

Under the auspices of NEXT, the team created a second-quarter workplan that included solidifying relationships with key partners, conducting more focus groups, building a minimally-viable first generation product, and preparing to seek external funding.

“Biodesign NEXT requires the students to define their own milestones and objectives and to work towards those goals under the advisement of faculty,” said Zanchi. “They have the benefits of our continuous mentoring and a semi-structured environment that helps them grow as a team and de-risk their project.” Zanchi met with the team weekly to review their progress and help them prioritize their ideas.

To begin building the NuLeaf app, the team looked to Zanchi for help recruiting an additional team member with technical expertise in prototyping mobile applications. After a few weeks, a new team member was identified: Leo Shaw, a graduate student in chemical engineering.

After a productive quarter, the team is continuing product development and actively nurturing its partnership with Second Harvest Food Bank. And while the ultimate future of NuLeaf remains uncertain, the team members are very clear about the learnings they have acquired and the impact that participation in the program has had on their future careers.

“I came to Stanford medical school hoping to explore opportunities to use technology to solve the needs of underserved patient populations,” said Aguirre. “This program has given me confidence that the opportunities I envisioned are valid and supported.”

“I’ve gotten, at the very least, a broad overview of creating a company,” said Sihavong. “I’ve honestly never been so excited about a project, or felt so motivated by my team members and mentors.”

“This program has provided our entire team with a knowledge and a process for how to take promising ideas and try to make them a reality,” said Chaudhari. “I’ve also learned that if you have an idea that can potentially do some good in the world, there are people who want to help you succeed.”