That recently changed in California and a handful of other states, where Medicaid now covers certain foods targeting patients with diet-related conditions. As a result, I now prescribe “Medical Support Foods,” or MSF, to some patients — a weekly bag of groceries or up to three daily meals — paid for by insurance as if it were a drug.
This tendency to adopt “food as medicine” is reinforced by research To show that dietary prescriptions by health professionals can reduce health care costs and improve well-being, especially for those who lack the resources to access healthy diets.
In a recent to studyresearchers have estimated that providing a nationwide “medically appropriate meal” to people with heart disease, cancer and diabetes could save $185.1 billion in medical costs and prevent more 18 million hospitalizations over a 10-year period.
For those who see food as integral to healing, this is a monumental step forward. But prescribing food is not as simple as it seems.
Food is more complex than any pill. This makes it difficult for doctors and patients to know which medically appropriate foods are the best medicine and which vendors can best provide these edible therapies.
First, it is very difficult to identify suppliers that provide the most nutritious foods. A pharmaceutical drug, whether generic or brand name, is nearly identical in composition regardless of who manufactures it. But the nutrient content of foods varies greatly depending on seed, season, agriculture and method of processing, and how long it was stored before consumption. Combine foods to make a meal and the variability of nutrients becomes even greater.
The lack of standardization has made it difficult, for example, for Dennis Hsieh, a physician and chief medical officer of the California-based Contra Costa Health Plan, to choose among food vendors bidding to fill the food prescriptions of his plan enrollees.
Hsieh has extensive experience contracting with medical supply companies for drugs and other health care products, but this is his first foray into the food business. He said he received little guidance from the California Department of Health Services about what he should buy. His Politics guide simply suggests that it offers “appropriate dietary therapies based on evidence-based nutritional practice guidelines”.
“At the end of the day, my basic criteria [for vendors] it’s that they give food to the sick and they don’t give them McDonald’s and they don’t charge us for it,” he said.
In the end, Hsieh entered into a contract with six vendors. He said he hopes these vendors will offer meals and groceries that replicate the cost savings and health benefits of “food is medicine studies, but he “doesn’t have the experience” to judge which sellers will succeed.
Michelle Kuppich, Registered Dietitian and Director of California Food Like Medicine Coalition, is also concerned about the quality of certain foods entering this growing medical market.
“There are a lot of new companies coming into this space because there’s money involved and people want the health care money,” Kuppich said. She said she suspects some of them “started out selling prepared meals for weight loss and then changed brands.”
Kuppich found it difficult to obtain information on the nutritional value of some of the foods sold. “There is a lack of transparency in terms of ingredients,” she said.
Some vendors offer dishes just as ultra-processed as a fast food meal that Hsieh hopes to avoid. Ultra-processed foods have been linked to chronic disease and a higher risk of premature death.
For example, GA Foodsa Florida-based medical support food provider, offers more than 50 “nutritionally balanced” meals that contain additives, including corn syrup and other sweeteners, food colors, flavors, hydrolyzed proteins and preservatives. “We follow leading organizations’ guidelines around each medical condition and update guidelines as they are released,” said Mary O’Hara, senior director of marketing 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 for mom’s meals, an Iowa-based company that serves more than a million meals a week nationwide, said some of their meals include a micronutrient blend of magnesium, zinc, iron, calcium and vitamin C , B1 and B6 to “ensure that the meal fully meets one-third of that of a person Dietary Reference Intake. We do this instead of including extra servings of food which would then take that meal above the recommended calories, sodium or carbs per serving, for example.
Fortifying foods with vitamins and minerals can prevent anemia and other diseases linked to specific nutrient deficiencies, but it cannot replicate the fuller nutrition offered by a whole food. A carrot, for example, contains all the nutrients of a Mom’s Meals mix, plus dozens of additional disease-fighting compoundswho work together to influence our health.
Cathryn Couch, Founder and CEO of Ceres community project, a non-profit MSF supplier based in Sonoma County, California, said, “We use high-quality, nutrient-dense foods and don’t have to add anything to meet the nutrient needs of our clients. .” Couch said regional food sourcing and limiting storage and transit time help ensure better nutritional quality. (It can also help support the local economy and reduce the environmental footprint.)
Healthcare providers also face the challenge of identifying vendors who offer foods that appeal to the taste buds — and the soul.
“None of these dietary interventions work if people don’t want to eat the food,” said Seth Berkowitz, a researcher who has led pilot studies of food is medicine and is now an associate professor of general medicine and epidemiology. clinic at the University of North Carolina School of Medicine. He described the food as providing gastronomic pleasure, cultural connection and family memories.
Berkowitz said domestic suppliers offer “an economy of scale” that lowers costs, but the pilot studies he participated in in Boston that showed positive results received their food from a nonprofit group that says that it serves “homemade” meals and shopping. from local farmers.
“Mission-driven organizations can deliver benefits,” Berkowitz said. “It remains to be seen whether the secret sauce that made these small efforts work can be scaled.”
Nutrition and lifestyle coaching
Beyond providing food, MSF vendors in California are expected to provide nutrition and lifestyle coaching to their clients, as research shows that coupling food aid with education is more likely to promote healthy eating habits.
As with food, these services vary. Some providers give registrants access to a brief 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 learned how to use a knife,'” said Sarah Nelson, executive director of 18 reasons, an MSF provider in the San Francisco Bay Area. She has found that her customers are more likely to try new vegetables if they are given a recipe and practice preparing them as a group.
“Nutritional education and counseling is as important as food, so people can prepare healthy meals after their prescription is finished,” Kuppich said.
How it works in a doctor’s office
Recently, I wrote a dietary 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 the vendor who would provide the tastiest, most nutrient-dense, and culturally relevant food. But even with my nutrition know-how, I found it difficult to know which one it might be.
She eventually chose a nonprofit group that sources most of her food locally and delivered meals to her doorstep. Two months into her prescription, her blood sugar improved and I called her to tell her the good news. I asked her what she thought of meals. “They’re so sweet, it’s really good to see them,” she said.
It took me a moment to realize she was referring to the delivery guy, not the food.
His comment left me wondering what had produced the positive change in blood sugar. Was it the food? The social connection ? Both?
Either way, it was an invigorating reminder that food isn’t a pill, it’s a much more complicated medicine.
Daphne Miller is a family physician and clinical professor at the University of California, San Francisco, and a research scientist in the School of Public Health at the University of California, Berkeley. She is also the founder of the Health From the Soil Up initiative.
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