Nutrition Notes: Envisioning Food as Medicine

written by Bi-sek Hsiao, PhD, MS, RD, LDN | September 20, 2024
Bi-sek Hsiao smiling in front of a tree
Bi-sek Hsiao, PhD, MS, RD, LDN

“Food as Medicine,” or “Food is Medicine,” has been gaining popularity in recent years. However, it is not a new concept—the understanding that food and adequate nourishment play a key role in optimizing our health and well-being, and that certain foods and ways of preparing food can support healing when ill, is as old as humankind and practiced in traditional healing systems such as Ayurveda and Chinese medicine. So what is this new buzz about?

It seems that we need a serious reminder about the importance of food and nutrition for our health, and a push for changes in healthcare, health insurance, government programs, and food marketing, to support healthier diets and healthier people.

A strong focus of the Food as Medicine movement has been about integrating food and nutrition into healthcare, via food-based interventions offered to patients such as medically tailored meals, medically tailored groceries or food packages, and produce prescription programs.

The rise of diet-related health issues in the U.S. is staggering. The Department of Health and Human Services estimates that about half of American adults have a health condition that could be prevented with better diets and more physical activity, including cardiovascular disease, high blood pressure, type 2 diabetes, some cancers, and poor bone health. Statistics from Tufts University’s Food is Medicine Institute indicate that among U.S. adults, 1 in 2 have diabetes or prediabetes, 3 in 4 are overweight or obese, and 14 in 15 have suboptimal cardiometabolic health (with conditions such as high blood pressure, high cholesterol, and insulin resistance). Among teens, 1 in 4 have prediabetes, 1 in 4 are overweight or obese, and 1 in 8 have fatty liver disease. These health conditions no doubt put a huge burden on individuals and families, as well as the healthcare system.

A strong focus of the Food as Medicine movement has been about integrating food and nutrition into healthcare, via food-based interventions offered to patients such as medically tailored meals, medically tailored groceries or food packages, and produce prescription programs. While the process is different for every Food as Medicine program, usually medical providers are expected to discuss with patients who are at risk of or coping with diet-related illness about the importance of food for disease management. Providers then prescribe patients healthful foods by referring them into programs where they can receive health-supporting food delivered to their home or picked up at farms or stores.

Patients in medically tailored meal programs receive prepared meals designed to address the dietary needs of their medical condition. For example, patients with diabetes might receive meals with a controlled amount of carbohydrates, particularly from added sugar. Patients in programs providing medically tailored groceries receive healthful grocery items which they can use in preparing meals at home, often with the guidance of nutritionists, cooking classes, and recipe ideas. Patients participating in produce prescription programs are given access to more fruits and vegetables, through boxes or shares of fresh produce from local farms, vouchers to use at farmers markets, or a pre-loaded card to use for purchasing fruits and vegetables from participating stores. Registered dietitians are commonly involved as well, designing meals and food packages, and providing nutritional counseling, cooking classes, and other types of education to help patients learn how to use the food they receive.

Several Food as Medicine programs have been initiated in Massachusetts. Community Servings, an organization based out of the Boston area that takes pride in sourcing many of their ingredients locally, is a pioneer of medically tailored meal programs. Since 1990, they have made more than 10 million meals and have expanded to other cities including Lowell and Worcester. LifePath, as well as other Area Aging Agencies in Massachusetts, also offer medically tailored meals which are nutritionally customized to meet the needs of people with different health conditions. At LifePath, older adults who are not able to access healthy meals can receive home delivered meals Monday through Friday, and with a physician’s approval, can choose from therapeutic meal options including carbohydrate controlled, renal, cardiac, and low lactose meals, as well as meals that are ground, pureed, or chopped soft for people with chewing or swallowing issues.

Produce prescription programs are also becoming more common in western Massachusetts. The Springfield Prescription Produce Collaborative in Springfield, MA, partners with Baystate neighborhood health clinics to provide patients with diabetes, hypertension, and obesity, and who are at risk of food insecurity, with opportunities to access local fruits and vegetables from a mobile market and farmers markets, and to participate in nutrition classes. Other similar partnerships between healthcare institutions and local farms and food vendors are being piloted in Holyoke and the Hilltowns, paving the way for food to play a more central role in healthcare.

Most Food as Medicine programs are funded by grants, allowing people to participate without cost. However, grants are time-bound and don’t last forever. For long-term sustainability of Food as Medicine programs, many are pushing for health insurance companies to cover food costs associated with the programs, similar to medication coverage. With expected improvements in health outcomes and lower health care costs, future investment from health insurance companies is plausible.

While Food as Medicine programs offer a promising way for our society to pay closer attention to food and our diets for managing illness, there is still much work to do to establish systems and structures of illness prevention through nourishing, healthful food. We need to support people in utilizing Food as Medicine before they get sick, not just after. We need to be able to see and afford fresh, healthful food more often than candy, soda, and other ultra-processed food. Rather than becoming overly reliant on convenience foods, we need to appreciate opportunities to move our bodies when growing, gathering, and cooking food, and slow down our eating habits to become more aware of how food makes us feel.