FOOD AS MEDICINE: DIGESTIBLE BITES – AUGUST 2024 

In this month’s Digestible Bites, we find an abundance of nutrition-related documentaries available and a number of reasons and ways we need to do more to successfully implement food as medicine.

Food As Medicine – The shorter version:

Food as Medicine – The longer version:

Hack Your Health: The Secrets of Your Gut (running time: 1 hr 19 mins), Netflix’s newest nutrition documentary, stresses the importance of a healthy gut as the foundation for a healthy life. It gives a very good and clear explanation of why fiber is such an essential part of our diet (btw, Americans exceed their protein consumption by 35% BUT only 7% of Americans eat enough fiber!)

You Are What You Eat: A Twin Experiment  (four episodes ranging from 44-60 mins each) follows a group of identical twins who change their diets and lifestyles for eight weeks in a scientific experiment designed to explore how foods impact the body in more ways than physical [Spoiler: a healthy diet makes a huge difference on every single fitness/health measurement!].

Alarming trends call for action to define the future role of food in nation’s health

According to a new national poll of public attitudes on food and nutrition, nearly 7 in 10 (68%) respondents recognize healthy eating habits as an important factor in improving a person’s chance for a long and healthy life. Yet more than half (53%) say the United States is not making enough progress for nutritious food to be more accessible and affordable.

• More than 6 in 10 U.S. adults are projected to have some form of cardiovascular disease by 2050 – up from about half of all adults currently.
• Obesity rates will increase nearly 40% in adults – from 43.6% to 60.6%, and by more than 60% in children, from 20.6% to 33% by 2050.
• The highest growth of obesity prevalence is expected to be among adults 20-44 and 45-64 years old. In children, a steep growth of obesity is projected in all age groups.
• By 2050, more than 150 million people (close to half of the nation’s population) will have a poor diet – the most prevalent factor affecting health conditions such as hypertension, obesity and diabetes.

Study aims to understand the barriers of food prescription services

Study aims to understand the barriers of food prescription programs

Earlier this year, the Centers for Medicare and Medicaid approved an amendment to New York state’s Medicaid 1115 waiver. Public Health researchers say it means Medicaid will start paying for social needs, including food, transportation, housing and other things that could affect their medical outcomes.

The highlight for those in public health is that people covered by Medicaid will be able to get fruits and vegetables prescribed to you like you would medicine. Jill Tirabassi, a principal investigator of the study, says “Primarily in behaviors that we choose to do every single day: what we eat, how we sleep [and] how we exercise. And so a study like this really focuses on the integration of how the healthcare system can actually help us make healthier food choices.”

Why Current ‘Food Is Medicine’ Solutions Are Falling Short

This is not new news but this article explains and dissects the issues and challenges surrounding Food as Medicine approaches. It outlines five major food problems that are impeding the effectiveness of this movement and strategic plan:

• Food Problem 1: Food Recommendations Contradict Food Subsidies

The federal government’s nutrition recommendations contradict the types of crops it subsidizes. The message to eat more produce has been promoted by the federal government for decades through campaigns such as “5-A-Day” in the early 1990s and “MyPlate” in the 2000s. At the same time, the federal government subsidizes agricultural production through commodity and crop insurance subsidies to maintain farmers’ revenue, control levels of food production, and keep costs of foods such as corn, soy, and wheat (and processed foods made from them) low. Unfortunately, the types of foods that receive most of the subsidies contradict the promotion of fresh produce, with nearly one-third of subsidies directed to the production of industrialized meat and dairy and only 4 percent going toward fruits and vegetables. 

• Food Problem 2: Food Acculturation And Assimilation Can Lead To Poorer Health

The concept of “food acculturation” describes the adaptation of migrants’ dietary habits to their new environments; this can involve finding new ways to prepare traditional foods, eliminating certain foods that are no longer available to migrants, or adopting entirely new foods. While food acculturation is a natural response to changing environments and is crucial for survival, it can become a concern when the new environment’s dietary and lifestyle practices are potentially harmful. 

“The cause of obesity and associated diseases has as much to do with the human reaction to overfeeding as it does with the production of foods that are being overfed and ultra-processed.”

• Food Problem 3: Culinary Education Is Effective But Time Consuming

Modern education empowers students to engage with material through hands-on experiences and activities to improve memory, retention, and application of the material. Unfortunately, innovations in pedagogy do not always translate into health care. Patient education around diet often consists of a printed handout and, sometimes, a referral to a registered dietitian. But even with a referral, nutrition counseling may be limited to a duration of just a few months. 

Group cooking classes help build community, provide peer support, and create extrinsic motivators to enhance learning. However, most culinary medicine programs are only available on a limited basis (for example, once per week), and many people face barriers to regular participation such as time, transportation, and family responsibilities.

• Food Problem 4: Medically Tailored Meals Are A Temporary Fix

The use of medically tailored meals, another FIM method, has been well-documented and associated with reductions in health care use. However, this approach does not allow for developing new culinary skills or forming (and then maintaining) new dietary habits; when the service ends, consumers may revert to their former eating patterns. Moreover, medically tailored meal programs are costly—which is burdensome to patients if not covered by insurance.

• Food Problem 5: Food Funding Is Not Sustainable

A final problem is the lack of clinical integration and sustainable funding sources for FIM services. In traditional health care models, services delivered are documented in medical records and coded for billing either at the individual’s expense or reimbursed by a third-party payer (that is, an insurer). However, there is currently limited standardization in screening, documentation, and medical billing codes for FIM services (such as culinary medicine or medically tailored foods). Most health systems charge patients out of pocket for these services or offer them for free thanks to philanthropic fundraising. Despite many examples of creative workaround solutions, there lacks a turn-key approach that can be systemized and scaled across health care settings.

To reach a solution that can address the five problems described above and be integrated into daily living while cultivating lasting behavior, several changes are needed:

• While current efforts mentioned above should continue and expand, new innovations should focus on making individual efforts easier and fit better into daily living through a spectrum of services, from prepared meals to hands-on learning. Programs can exist in health care, community and faith-based organizations, technology, and so forth.
• FIM interventions should be integrated into clinical care models, supported by ACOs, and reimbursed through third-party payers to enhance the efficacy of services.
• Locally sourced and sustainable ingredients must be the foundation of FIM. All efforts should help mobilize local businesses and create economic growth—especially among marginalized populations.
• The descriptors “personalized” and “culturally appropriate” should be incorporated into FIM. Initiatives should be defined by lived experiences and designed and evaluated based on community members’ input—thereby creating a paradigm shift from a top-down to a bottom-up, community-led approach.

To offer a real-world example that meets at least two of those criteria, Boston Medical Center has invested into Nubian Markets, a Black-owned venture, to create a local grocery store offering fresh foods sourced ethically and primarily from within New England, scratch-made prepared meals, and a café. Patients can be referred to the market for medically tailored foods, and culinary skills are taught through a women-founded mobile application.