Food as medicine? It’s not as simple as it sounds.
That recently changed in California and a few other states, where Medicaid now covers some foods for patients with nutrition-related conditions. As a result, I now prescribe “Medical Supportive Food,” or MSF, for some patients — a weekly bag of groceries or up to three meals a day — paid for by insurance as if it were medicine.
This move to embrace “food as medicine” is being supported Research showing that food prescriptions by medical professionals can reduce health care costs and improve well-being, especially for those without the means to access healthy foods.
In a recent studyresearchers estimated that offering a “medically tailored meal” nationwide to people with conditions such as heart disease, cancer and diabetes could save $185.1 billion in medical costs and prevent more than 18 million hospitalizations over a 10-year period.
For those who see food as an integral part of treatment, this is a huge step forward. But prescribing food is not as simple as it sounds.
Food is more complex than any pill. This makes it difficult for doctors and patients to know which medically adapted foods are the best medicine and which suppliers can best deliver these edible therapies.
First, it is a real challenge to identify which suppliers offer nutritious food. A pharmaceutical drug, whether generic or brand name, has an almost identical composition regardless of who makes it. But foods vary dramatically in nutrient content depending on it seed, season, cultivation and the way it was processed and how long it was stored before it was eaten. Combine foods to make a meal and the variability of nutrients becomes even greater.
The lack of standardization made it difficult, for example, for Dennis Hsieh, a physician and chief medical officer of the Contra Costa, California-based health plan, to choose among food vendors competing to fill food prescriptions for his plan members.
Hsieh has extensive experience in contracting with pharmaceutical companies to supply drugs and other healthcare products, but this is his first foray into the food sector. He said he received little guidance from the California Department of Health Services on what he should buy. His policy the guide only suggests offering “appropriate dietary therapies based on evidence-based nutrition practice guidelines.”
“At the end of the day, my basic criteria [for vendors] is that they deliver food to patients, not give them McDonald’s and charge us for that,” he said.
Ultimately, Hsieh contracted with six suppliers. He said he hopes these retailers will offer meals and groceries that replicate the cost savings and health benefits.”food is medicine” studies, but does not have the “experience” to judge which suppliers will achieve this.
Michelle Kuppich, Registered Dietitian and Director California Food is Medicine Coalition, he is also concerned about the quality of some foods entering this growing medical market.
“There are a lot of new companies coming into this space because there is money involved and people want health care dollars,” Kuppich said. She said that she suspected that some of them “started selling ready meals for weight loss and then changed the brand”.
Kuppich found it difficult to get information on the nutritional value of some of the foods being sold. “There is a lack of transparency about the ingredients,” she said.
Some of the vendors offer food that is the same ultra-processed as fast food meals that Hsieh wants to avoid. Ultra-processed foods are linked to chronic disease and a higher risk of early death.
For example, GA Foodsa Florida-based retailer of medical support foods, offers more than 50 “nutritionally balanced” meals that they contain additives, including corn syrup and other sweeteners, food colors, flavor additives, hydrolyzed proteins and preservatives. “We follow guidelines from leading organizations for each disease state and update guidelines as they are released,” said Mary O’Hara, senior marketing manager for GA Foods. “Our medically tailored meal portfolio is constantly evolving to meet patient needs and new innovations related to health and wellness.”
And Tracy Smith, vice president of marketing for mom’s meals, the Iowa-based company, which serves more than a million meals a week nationwide, said some of its meals include a micronutrient blend of magnesium, zinc, iron, calcium and vitamins C, B1 and B6 to “ensure that the meal fully meets one – a third of a person Dietary reference intake. We do this instead of including extra servings of food that would then have that meal above the recommended calories, sodium or carbohydrates per serving, for example.”
Fortifying food with vitamins and minerals can prevent anemia and other diseases associated with the lack of certain nutrients, but it cannot reproduce the more complete nutrition offered in whole foods. Carrots, for example, have all the nutrients in the Mom’s Meals mix, plus dozens of additional disease-fighting compoundswhich together affect our health.
Cathryn Couch, Founder and CEO Ceres Community Project, a nonprofit MSF supplier based in Sonoma County, Calif., said, “We use high-quality, nutrient-dense foods and don’t need to add anything to meet our clients’ needs.” Couch said sourcing food regionally and limiting storage and transportation time helps ensure higher nutritional quality. (It can also help support the local economy and reduce environmental impact.)
Healthcare providers also face the challenge of determining which vendors offer foods that appeal to the taste buds—and the soul.
“None of these food interventions work if people don’t want to eat the food,” said Seth Berkowitz, a researcher who led some pilot studies on food and medicine and is now an associate professor of general medicine and clinical epidemiology at the University of North Carolina School of Medicine. . He described food as an offer of gastronomic pleasure, cultural connection and family memories.
Berkowitz said national vendors offer “economies of scale” that keep costs down, but the pilot studies he participated in in Boston that showed positive results got their food from a nonprofit group that says it serves “scratch-made” meals and buys from local farmers.
“Mission-driven organizations can offer benefits,” Berkowitz said. “It remains to be seen whether the secret sauce that made these small efforts succeed can be scaled.”
Diet and lifestyle coaching
In addition to providing food, MSF suppliers in California are expected to offer nutrition and lifestyle training to their clients, because Research shows that combining food assistance with education is more likely to promote healthy eating patterns.
As with food, these services vary. Some vendors give enrollees access to brief nutritional counseling or a healthy eating app, while others offer real-time cooking and shopping classes.
“The number one thing I hear from our clients is ‘I learned how to use a knife,'” said Sarah Nelson, CEO 18 reasons, MSF service provider in the San Francisco Bay Area. She found that her clients were more likely to try a new vegetable if they were given a recipe and practiced preparing it in a group setting.
“Nutritional education and counseling are just as important as food, so people can prepare healthy meals after their prescription runs out,” Kuppich said.
How it works in the doctor’s office
I recently wrote a food prescription for a 50-year-old woman with poorly controlled type 2 diabetes. She was enrolled in MediCal, California’s health insurance program for children and adults with limited income and resources.
I did my best to direct her to a vendor who would deliver the tastiest, most nutritious and culturally relevant food. But even with my knowledge of nutrition, it was a challenge to figure out which one it might be.
She eventually chose a non-profit group that sources most of its food locally and delivered meals to her doorstep. Two months after getting the prescription, her blood sugar improved and I called her to tell her the good news. I asked her what she thought about the meals. “They are so beautiful, it’s really nice to see them,” she said.
It took me a moment to realize that she meant the delivery person, not the food.
Her comment made me wonder what caused the positive change in blood sugar. Was it food? Social connection? Both?
Regardless, it was a heartening reminder that food is not a pill, but a much more complicated medicine.
Daphne Miller is a family physician and clinical professor at the University of California, San Francisco, and a researcher at the University of California, Berkeley School of Public Health. She is also the founder of the Health From the Soil Up Initiative.