Food as Medicine: Give it Staying Power

Cate Collings, MD

Imagine writing a prescription for a new medication without understanding the drug’s mechanism of action, foundational research, or its potential side effects. Pharmacology is powerful stuff, and that’s why medical school and postgraduate training include extensive education on the topic, as they should. The same should apply when prescribing food as medicine (FAM). FAM is a powerful treatment that should be prescribed by educated clinicians to achieve full healing potential. But most physicians leave medical school unprepared to put this into practice.

Make no mistake: I’m thrilled that the concept of FAM has everyone’s attention. Lifestyle medicine clinicians, registered dietitians, and some other healthcare professionals have long advocated for the use of nutritious food to address health, but now policymakers, health systems and even payors have joined the conversation. US Department of Health and Human Services, the Food is Medicine Institute at Tufts University, and the World Economic Forum are among the many organizations to host recent events with focused discussion on FAM.

It is even more encouraging that there is action (and money) behind the talk. The Biden Administration convened the first White House Conference on Hunger, Nutrition and Health in 50 years and announced public-private partnerships with Instacart, the Rockefeller Foundation, and Feeding America to expand research and access to food as medicine services. Investments in FAM models — medically tailored meals, produce prescriptions, and farmer’s market vouchers, to name a few — are being made with the realization by payors that more healthful calories must be used to address nutrition insecurity for the goal of prevention, and that food can be used as medicine, through intensive intervention, to treat existing disease.

But critical next steps around education need to occur, and quickly. Providing someone nutritious food, such as a 2-week prescription for medically tailored meals for a patient being discharged from the hospital, is effective for those 2 weeks but does little to support what we are really after: a long-term change in lifestyle behavior. Food delivery must be accompanied by the “how and the why” of FAM, so that patients learn to shop for and prepare nutritious, tasty, and affordable meals on their own. That’s how the health behavior continues if and when the prescribed meals stop. As the old saying goes, “Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.”

Physicians who prescribe FAM services need to understand the mechanisms of action and the foundational research and be able to share the “why” with patients along with their FAM prescription. Fortunately, the only side effects of nutritious food are positive, so that conversation can be short. Resources exist for clinicians to start building a foundation of knowledge in nutrition now. The American College of Lifestyle Medicine (ACLM) is offering 5.5 hours of complimentary CE/CME coursework in FAM and lifestyle medicine to 200,000 physicians and other health professionals in collaboration with the White House Conference on Hunger, Nutrition, and Health. ACLM also offers a repository of other FAM education courses and resources, such as the Food as Medicine Jumpstart Guide.

With further training and board certification in lifestyle medicine, clinicians can assess dietary patterns, identify deficiencies and prescribe the appropriate dietary interventions, as well as understand what members of the health team, such as registered dietitians and health coaches, are needed to bring the practice of FAM to life. Clinicians and their teams can offer culinary medicine classes through shared medical appointments that teach patients cooking skills and identify appropriate food partners to help patients navigate the social drivers of health, such as lack of transportation and financial instability.

Powerful examples exist to demonstrate how institutions have effectively infused FAM and lifestyle medicine into practice. Eskenazi Health in Indianapolis pairs comprehensive nutrition education with the delivery of nutritious food through a mobile grocery store/food pantry hybrid, veggies boxes, produce prescriptions, and more. The education services include multidisciplinary teams that host cooking classes and teach patients how to eat to help prevent, control, and reverse chronic conditions such as type 2 diabetes and hypertension. These programs have achieved substantial success in biometric outcomes and blood pressure over 12 months.

The momentum for FAM is an opportunity to demonstrate the potential of nutritious food to make a lasting impact on health and chronic disease. We need to wrap around this effort a healthcare workforce educated and trained in nutrition as a therapeutic intervention. That is how we can give FAM staying power.