The Surest And Safest Way To Maximize Your Health: Food As Medicine

Forbes March 11, 2024

Lifestyle

The Surest And Safest Way To Maximize Your Health: Food As Medicine

I am a doctor, board-certified in two clinical specialties, and I’ve personally written thousands and thousands of prescriptions for patients to treat and prevent disease. But in my years of practice I never wrote a prescription for food. That is about to change. Why? Because food, we now know, can be a powerful medicine.

 
The landscape of obesity and related diseases that define American health

We are facing an obesity epidemic in the U.S. And it’s not new. This health crisis has significantly and negatively impacted our nation’s wellbeing for decades, placing tremendous strain on our bodies, our health, and healthcare sector. People are living less fulfilling and less productive lives. Today’s science tells us that there is one fix, too long ignored, that is convenient and affordable. And there are policy steps that we have identified that will accelerate its adoption.

Recent data show that nearly 42% of adult Americans are obese. And the impact is clear: obesity and other diet-related diseases – like cardiovascular disease, hypertension, and type 2 diabetes – are a leading cause of death in the U.S. This is our number one health challenge.

Beyond the direct impact to our health and wellbeing, diet-related disorders are also extremely costly. These chronic conditions cost our combined healthcare and food system $1 trillion per year. The Centers for Disease Control and Prevention (CDC) estimates that the 2019 medical costs attributed to obesity alone were $173 billion. For diabetes, the total estimated medical costs in 2022 were $412.9 billion. And for hypertension, reports estimate that the U.S. spends anywhere from $131 to $198 billion each year. Exorbitant costs like these simply cannot be sustained.

We need to start moving the needle in the right direction. To do that we must prioritize both prevention and treatment.

Recently we’ve seen progress in clinical treatment options. Last year, for example, Semaglutide (glucagon-like peptide-1 or GLP-1 class drugs), known by brand names Wegovy and Ozempic, became FDA-approved to treat obesity. These drugs, which originated to treat diabetes and control blood sugar, mimic hormones that curb appetite and have been proven to help patients lose weight (and reduce heart attacks and strokes). These treatments, though, are expensive for patients and payors. And because Medicare Part D does not cover weight loss drugs, they are inaccessible to many Americans who need them. As a final caution, we do not yet know the long-term side effects or implications of GLP-1 class drugs.

We do know, however, that what we eat every day has a direct impact on our wellbeing. And we know that making informed choices regarding our food and nutrition intake will definitely lead to a reduced burden of chronic disease including obesity, better physical and mental health, and improved productivity and overall quality of life. Yes, food is a powerful driver of our health; food is medicine.

But despite knowing that a nutritious diet is fundamental to living a healthy life, many of us fall short of following science-based dietary guidelines. As we look to comprehensively expand treatment options for diet-related diseases, including obesity, and key in on prevention, we all need to prioritize going back to the very basics: the food we put in our bodies every day.

 
What do we mean, food is medicine?

Recognizing the role that nutrition plays, the current “Food as Medicine” movement advocates for using whole, unprocessed, and nutritious foods to both prevent and treat illnesses. It includes improving access to nutritious foods, supporting our environment and healthy farming practices, and educating our communities on how to make informed decisions when it comes to our diet. The movement specifically calls on our healthcare providers, doctors and nurses alike, to more deliberately collaborate with nutrition experts to effectively engage with and educate patients on dietary needs. It empowers patients to take control of their own health.

Food as Medicine interventions include medically tailored food packages, medically tailored meals, and produce-prescriptions programs; they focus on providing patients with individualized and nutrient-dense diets, successfully merging food and nutrition science with clinical practice. These interventions lead to better health and less disease. And many clinicians have already begun turning to them to treat diet-related conditions such as obesity, diabetes, and high blood pressure.

It makes sense. If food is the root cause of obesity and so many diet-related diseases, then it also has the power to treat and heal them. But so far, the uptake of Food as Medicine interventions has been slow. One major challenge has been inadequate provider education on nutrition-focused treatment options. Many healthcare providers simply lack adequate training and education on nutrition and food science. Studies show that medical students, surprising given the dramatic advances in scientific understanding, receive less than 20 hours of nutrition specific training throughout their entire four years of medical education!

And when it comes to broader policy, Food as Medicine interventions face substantial obstacles of insurance coverage, payment, and coordination among health providers and organizations that provide nutrition-based services. Reimbursement is a big hurdle. Both public and private payers still offer only limited coverage. To scale access, we should look to expand reimbursement for medically tailored meals and groceries, and other proven interventions. And we should collect more comprehensive data on food is medicine interventions to further substantiate its effectiveness. For this, the agility and innovation of the private sector is playing a major role.

For example, the Iowa-based company Mom’s Meals delivers more than 70 million medically tailored meals across every state in the nation each year (mostly to vulnerable populations). Through their platform, they help patients manage chronic disease as well reduce emergency room visits, hospitalizations, and readmissions. For example, a Mom’s Meal program with Inland Empire Health Plan (IEHP) in California saw a 50% reduction in emergency department visits and hospitalizations when individuals with congestive heart failure received medically tailored meals, fresh produce, healthy pantry staples and nutrition education. In addition, the initiative showed sizable medical cost savings. Cost to care for those in the program fell from $7.2 million to $5.4 million, an annual savings of $1.8 million (or $19,355 per member).

“There is growing evidence showing the clear health benefits as well as cost savings of food as medicine programs for high-risk individuals - including people recovering from a hospital stay or struggling to manage a chronic condition like diabetes, heart failure or kidney disease,” said Chris Choi, Chief Executive Officer of Mom’s Meals. “Public and private sectors have the power to work together at a greater scale to combat this health care crisis. Thanks to the food as medicine movement, we are seeing the profound impact that medically tailored meals can have on improving the health of our most vulnerable populations.”

Another company, Elevance Health, is also seeing great success in this space with a significant impact on health outcomes. Elevance recently started the Elevance Health’s Life Essential Kits program to address social risk factors like nutrition insecurity. Many families in this program receive medically tailored groceries. In 2022, these families saw a significant reduction in preventable hospitalizations and emergency department visits, and Elevance saw a 216% reduction in total emergency department related costs.

 
Policies will accelerate adoption

To manage diet-related diseases, an individual’s healthy eating is one of our easiest and most affordable tools. And it’s a tool that can be greatly accelerated by the adoption of smart, comprehensive policies that address current hurdles such as provider education and affordability.

Last year, I joined the Bipartisan Policy Center as co-chair on the Food is Medicine Working Group that produced the report, Healthy Eating Rx: Improving Nutrition Through Health Care. This report, which brought together multi-sector perspectives from healthcare, insurance experts, patient advocacy organizations, and food retailers, outlines 10 actionable policy recommendations to enhance nutrition education and accelerate access to proven Food is Medicine interventions. Each of these recommendations is worth consideration, but here are five to get us started:

  • The Biden administration should issue an executive order to educate healthcare providers on nutrition science, and to more comprehensively screen patients for nutrition security and diet quality.
  • Undergraduate and graduate medical programs should establish and implement clinically meaningful nutrition focused competencies.
  • Independent organizations should set baseline nutrition education standards for clinicians (and implement accountability measures).
  • Congress should provide funding to more effectively disseminate and translate dietary guidelines.
  • The Centers for Medicare & Medicaid Services (CMS) should extract data on nutrition interventions and the benefit of Food is Medicine.

These recommendations lay the groundwork for comprehensive change when it comes to how we approach our food and nutrition challenge, especially for treatment and prevention of chronic disease. Though they alone won’t solve our diet-related challenge in its entirety, they are a necessary – and long overdue – step forward.

 
Now is the time for providers to step up

As a physician, I recognize that providers play a fundamental role, and thus have a special responsibility, particularly with screening and disseminating accurate information. To this end, healthcare providers (doctors, nurses, dentists, pharmacists, physician and occupational therapists, and all others delivering healthcare services) must much more deeply incorporate nutrition counseling and education into their clinical practices. As a healthcare sector, let’s also consider the following:

  1. Nutrition screening and assessment: Providers should screen each patient for food access and insecurity, dietary habits, and food preferences within routine patient assessments, similar to screens they do for allergies, smoking history, and family history of disease.
  2. Nutrition education: During clinic visits for whatever reason, clinicians should capture the teachable moment to educate patients about the impact of nutrition on health outcomes. Even providing patients with tools and resources to educate them on portion control and how to effectively read food labels can help many make more informed dietary choices.
  3. Collaborative and comprehensive care: Working in partnership with nutrition experts and dietitians can help healthcare providers develop more comprehensive treatment plans. If successfully implemented, this more active collaboration can ensure that nutrition counseling is specifically tailored with each individual’s specific health goals and medical needs.
  4. Integration into electronic health records (EHR): Clinicians should more seamlessly integrate nutrition-related information into their EHRs. Not only will this help track critical dietary information and monitor progress, but also will serve to compile more comprehensive data that leads to better research and, hopefully, innovative pilot interventions.

Broader uptake of the Food as Medicine movement and interventions is dependent on improved education, policy, and private sector innovation. With better clinician education on food and nutrition science and with more intentional policy at institutional and corporate levels that increases access to and the affordability of these interventions, we will dramatically cut costs, reduce the disease burden on our healthcare sector, and greatly improve our health and wellbeing.

The food we eat directly impacts our health and wellness. And it’s time we use food to heal. Food as medicine interventions are proven to prevent and treat diet-related diseases. Implemented at scale, these interventions provide a powerful tool to tackle our number one health challenge — obesity— and all its related chronic diseases. And that’s a prescription that can change all of our lives.


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