Food as medicine? It’s not as simple as it sounds.


Ever since I was a doctor fresh out of residence, I have prescribed food to my patients to prevent and treat chronic health problems such as diabetes and heart disease. But health insurance has never covered the cost of a healthy meal, which means some patients cannot afford the healthy diet I give them.

That has changed recently in California and a handful of other states where Medicaid now covers certain foods targeted at patients with dietary-related conditions. As a result, I now write “Medically Supplementary Food” or MSF to some patients – a weekly pack of groceries or up to three meals a day – paid for by insurance as if it were a drug.

This move to adopt “food as medicine” is supported by research showing that food prescriptions by medical professionals can reduce health care costs and improve well-being, especially for those who do not have the resources to access healthy food.

In a recent study, researchers estimated that providing a nationwide “medically adapted meal” benefit to individuals 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 recovery, this is a monumental step forward. But prescribing food is not as easy as it seems.

Food is more complex than any pill. This makes it difficult for doctors and patients to know which medically tailored foods are the best medicine and which suppliers can best offer these edible treatments.

First, there is a real challenge in determining which suppliers provide the most nutritious food. A pharmaceutical drug, whether generic or branded, has almost the same structure no matter who makes it. However, the nutrient content of food varies considerably depending on the seed, the season, the farming and processing method, and how long it is stored before being eaten. Combine foods to make a meal, and the nutrient variability increases even more.

The lack of standardization has made it difficult, for example, for Dennis Hsieh, physician and chief medical officer for California-based Contra Costa Health Plan, to choose from among food vendors bidding to fill food prescriptions for people enrolled in his plan.

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Hsieh has extensive experience contracting medical supply companies for drugs and other healthcare products, but this is his first entry into the food industry. He said he received little guidance on what to get from the California Department of Health Services. The policy guide recommends offering only “appropriate dietary treatments based on evidence-based nutrition practice guidelines”.

“My main criteria at the end of the day [for vendors] “They don’t deliver food to patients and they don’t give them McDonald’s and they don’t charge us for it,” he said.

Ultimately, Hsieh contracted six vendors. He said he hopes these vendors “food is medicine” will deliver meals and grocery products that reproduce the cost savings and health benefits of their work, but he doesn’t have the “experience” to decide which vendors will achieve this.

Michelle Kuppich, a registered dietitian and director of the California Food Is Medicine Coalition, is also concerned about the quality of some foods entering this growing medical market.

“There are a lot of startups entering this space because there is money involved and people want healthcare dollars,” Kuppich said. He said he suspects that some “started selling ready-to-eat meals to lose weight and then switched brands.”

Kuppich found it difficult to learn about the nutritional value of some of the foods sold. “There is a lack of transparency in terms of materials,” he said.

Some vendors offer as much over-processed food as the fast-food meals that Hsieh hopes to avoid. Ultra-processed foods have been associated with a higher risk of chronic diseases and premature death.

What are ultra-processed foods? What should I eat instead?

For example, GA Foods, a Florida-based medically supportive food vendor, offers more than 50 “nutritionally balanced” meals that contain additives, including corn syrup and other sweeteners, food coloring, flavor additives, hydrolyzed protein, and preservatives. “We follow the guidelines of top organizations for each disease state and update the guidelines as they are released,” said Mary O’Hara, senior marketing manager at GA Foods. “Our portfolio of medically tailored meals is constantly evolving to meet patient needs and new innovations in health and wellness.”

And Tracy Smith, vice president of marketing at Iowa-based Mom’s Meals, which serves over a million meals a week nationwide, said some of her meals contain a micronutrient blend of magnesium, zinc, iron, calcium, and vitamins C and B1. and B6 “to ensure that a meal fully meets one-third of a person’s Dietary Reference Intake. We do this, for example, instead of adding additional servings of food that would raise it above the recommended amount of calories, sodium or carbohydrates per serving.

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Supplementing foods with vitamins and minerals can prevent anemia and other diseases due to deficiencies of certain nutrients, but cannot reproduce the more complete nutrition offered in a whole food. A carrot, for example, has all the nutrients in Mom’s Cooking mix, plus dozens of additional disease-fighting compounds that work together to affect our health.

Cathryn Couch, founder and CEO of Ceres Community Project, a nonprofit MSF supplier based in Sonoma County, California, says, “We use high-quality, nutrient-dense foods and we don’t need to add anything to meet the nutrients. requirements for our customers.” Sourcing food locally and limiting storage and transport times helps ensure higher nutritional quality, Couch said. (It can also help support the local economy and reduce its environmental footprint.)

Healthcare providers also face the challenge of determining which vendors offer food that appeals to the palate and the soul.

“None of these food interventions work if people don’t want to eat the food,” said Seth Berkowitz, a researcher who has led some food-medicine pilots and is now an associate professor of general medicine and clinical epidemiology in the US. North Carolina School of Medicine. He described food as gastronomic pleasure, cultural bond and family memories.

Berkowitz said national vendors offer an “economy of scale” that keeps costs low, but the pilots he was involved in in Boston that showed positive results got their food from a nonprofit group that said it offered and bought meals “without scratch.” from local farmers.

“Task-oriented organizations can benefit,” said Berkowitz. “We’ll see if the secret sauce that makes these small efforts work can be scaled up.”

Nutrition and lifestyle coaching

MSF vendors in California are expected to offer nutrition and lifestyle coaching to their customers beyond sourcing food, as research shows that combining food assistance with education is more likely to promote healthy eating patterns.

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As with food, these services vary. Some vendors provide enrollees with access to a short nutrition consultation or healthy eating app, while others offer real-time cooking and shopping lessons.

“The first thing I hear from our customers is ‘I’ve learned to use a knife,'” said Sarah Nelson, executive director of 18 Reasons, an MSF provider in the San Francisco Bay area. She discovered that when customers are given a recipe and practice preparing them in a group setting, they are more likely to try new vegetables.

“Nutrition education and counseling is just as important as eating, so people can prepare healthy meals when their prescriptions run out,” Kuppich said.

How does it work in a doctor’s office?

I recently wrote a recipe for a meal for a 50-year-old woman with poorly controlled Type 2 diabetes. Enroll in MediCal, California’s health insurance program for children and adults with limited income and resources.

I did my best to direct her to the vendor who would deliver the tastiest, most nutrient-dense, culturally relevant food. But even with my nutritional knowledge, I had a hard time figuring out which one it could be.

In the end, he chose a nonprofit group that provides most of their food locally and delivers it to their door. It’s been two months since his prescription, his blood sugar has improved, and I called him to tell him the good news. I asked him what he thought of the food. “They’re so beautiful, it’s really good to see them,” she said.

It took me a while to realize that he was talking about the delivery person and not the food.

His comment made me wonder what produced the positive change in blood sugar. Was it food? Social connection? Both of them?

Regardless, it was a refreshing reminder that food isn’t a pill, it’s a much more complex drug.

At any age, a healthy diet can prolong your life.

Daphne Miller is a family physician and clinical professor at the University of California, San Francisco, and a research scientist at the University of California, Berkeley School of Public Health. She is also the founder of Health From the Soil Up Initiative, she.


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