The Global Challenge
While healthcare is becoming more patient-centered, there remains a significant gap in accessibility to nutrition interventions.
Millions worldwide suffer from food insecurity, lacking access to enough healthy food to sustain an active and healthy life. The concept of ‘food as medicine’ underscores the role of nutrition in promoting health and preventing diseases. Food insecurity and the inability to access affordable, nutritious food are associated with adverse health outcomes and pose an enormous burden of diet-related chronic diseases such as Obesity, Diabetes, Cardiovascular diseases, Hypertension, and Hyperlipidemia.
Shockingly, an inadequate diet is associated with one in every five deaths globally, surpassing tobacco as a risk factor.
Food Insecurity and Health Conditions
Food insecurity also appears to be strongly correlated with diabetes, which is highly sensitive to diet, whereas hypertension and hyperlipidemia are highly sensitive to medication adherence. Diabetes increases the risk of food insecurity, often due to out-of-pocket healthcare expenditures associated with chronic diseases and their management. The co-existence of food insecurity and diabetes, therefore, has a significant implication for the sustainability of healthcare systems. Food insecurity among children has adverse health effects, including a higher incidence of iron-deficiency anemia, acute and chronic illnesses, and developmental and mental health conditions. As nutrition interventions directly improve clinical and socioeconomic outcomes, patient-centered care is incomplete without integrating nutrition care.
Inequities in Access
Racial and ethnic minorities and financially disadvantaged populations bear the brunt of diet-related chronic illnesses, often due to limited resources for managing their conditions. In 2021, 10.2% (13.5 million) of households in the United States experienced food insecurity, with nearly 12.5% being families with children. This problem disproportionately affects different racial and ethnic groups, with 20% of Black/African American households, 16% of Hispanic/Latino households, and 7% of White households experiencing food insecurity.
Food as Medicine
Food as medicine recognizes the importance of medically tailored meals (MTMs), medically tailored groceries (sometimes known as food "farmacies”), and 'produce' prescriptions.
These medically tailored meals (MTMs) provide intervention for small but high-needs groups- those with complex medical comorbidities who cannot afford, shop, or have limitations in activities of daily living. All eligible Americans receiving MTM interventions in the healthcare system each year would save an estimated $13.6 billion, equating to $185.1 billion in savings over ten years and a reduction in hospitalization by 18.3 million.
Medically tailored groceries are appropriate for patients, those with diet-related chronic and acute medical conditions, and those who can prepare food at home.
Produce prescriptions can be used for various patients for disease prevention and management. Modeling studies indicate that a subsidy incentive of 30% on fruits and vegetables would prevent 1.93 million cardiovascular disease cases and save approximately $39.6 billion in healthcare costs over a lifetime.
The new study from Tufts University Friedman School of Nutrition Science and Policy shows that the produce prescription offered to people ages 40-79 with diabetes or food insecurity could generate 260,000 quality-adjusted life years (QUALYs or years lived in good health).
Through these health gains, estimated savings of $39.6 billion in healthcare spending and $4.8 billion in lost productivity costs. At the same time, nationally implementing the program would cost $44.3 billion, including all expenses for screening patients, providing food and nutrition education, and necessary administration.
Considering all costs, a national produce prescription program for patients with diabetes and food security would be highly cost-effective, costing $18,000 per quality-adjusted life year. This metric is on par with other interventions in health care, like blood pressure screening and control, cholesterol screening and control, and cancer screening.
Steps Forward for Health Care Professionals
We have known for decades that most chronic diseases and premature deaths worldwide are entirely preventable.
Three such health factors that improve health are avoidance of smoking, physical activity, and optimum diet. Functional foods that enhance nutritional status are the only variable element. We can position ourselves as leaders in the food-as-medicine fight with the proper focus on nutrition-based therapies.
We must invest in data-driven research to continuously evaluate the impact of this initiative on patient outcomes and overall healthcare costs. By collecting and analyzing data, we can refine and optimize our approach to maximize the benefits for our patients. Moreover, this research will contribute to the growing evidence supporting the efficacy of nutrition therapies and interventions.
Partnerships and Innovation
Many healthcare systems are venturing into new partnerships to expand 'food as medicine' services. For example, Boston Children's Hospital in Massachusetts has recently launched a virtual pharmacy with the help of Instacart Health Care Carts. Instacart will deliver provider-selected food to patients with specific dietary needs as a part of this program. Other partnerships include the digital platform Good Measures with WellCare of Kentucky, About Fresh with Veterans Health, food solutions, the care management platform NourishedRx with health plans, and digital nutrition services such as Foodsmart.
Integration of food in healthcare
Patient-centered care (PCC) requires a shift in focus from the traditional disease-focused, clinician-centric model of care to a system that empowers and enables patients to participate in shared decision-making and self-management. So far, various modeling studies have shown promising results of food as medicine integration into healthcare having an overall impact on cost-effectiveness leading to relevant and meaningful quality-adjusted life years (QUALYs); however, ongoing research is needed to support the evidence and outcomes.
Integration of food in healthcare, though it sounds simple, does require commitment and strategic vision from a healthcare system for improved and ongoing research, clinician training, referral capacity, and integration of tools and technology within the existing Electronic Health Records (EHR) Software to identify the at-risk population, integrate SDOH (Social determinants of health) data and provide a 360-degree patient view. With increased financial support, payer alignment with providers and healthcare, and coordinated care across the continuum of care through patients' journeys, it will be possible to integrate food effectively in care delivery models.
Nutrition as a Covered Benefit by Payors:
One crucial aspect of our vision for integrating nutrition into healthcare is the need for nutrition to be recognized as a covered benefit by payors. This essential step will ensure that individuals from all walks of life have equitable access to nutrition interventions. By making nutrition a covered benefit, we can break down financial barriers that often hinder individuals from seeking the care they need. When nutrition services are considered a vital part of healthcare, it promotes wellness and helps reduce the financial burden on individuals and healthcare systems. This recognition is a significant stride toward truly patient-centered care and the holistic well-being of our communities.
Conclusion
A "Food as Medicine" initiative represents a transformative vision that intertwines the worlds of healthcare and nutrition. By recognizing and leveraging the profound link between health and food, we can empower our patients to take control of their well-being and revolutionize the healthcare landscape.
Pioneering this initiative provides the potential to make an indelible impact on the health and happiness of our community. Let us embark on this journey to reshape healthcare through the power of food.
