Much of the public’s perceptions around food as an intervention for health are dated. So are the U.S. government’s perceptions and its health care policies. Not by a matter of years, but by decades.
The last time the nation focused on food — from the top — was the 1969 White House Conference on Food, Nutrition, and Health. Among the important programs that were created or improved based on findings from that landmark summit are what is today called the Supplemental Nutrition Assistance Program (SNAP); the Women, Infants, and Children (WIC) program; school breakfast and lunch programs; the national approach to creating dietary guidelines; and the now-ubiquitous nutrition facts label.
Without a doubt, these programs have fed those in need, saved lives, and improved the overall health of Americans. But we face a new reality in the 21st century: Poor diets are a leading cause of death, contributing to high rates of heart disease, diabetes, and some cancers. About 50% of U.S. adults have diabetes or prediabetes, 75% are overweight or obese, and more than 90% are not in ideal cardiometabolic health. Among U.S. teens, 25% have diabetes or prediabetes, and the same percentage is overweight or obese.
Those most affected are lower-income Americans, people living in rural areas, and individuals from historically marginalized racial and ethnic groups.
Chronic diseases are damaging not only the health of people, but of the economy as well. Health care spending has spiraled from 5% as a share of the gross domestic product in 1960 to nearly 18% in 2020 — and poor nutrition must shoulder some of the blame.
It’s past time to recognize that better nutrition and access to healthy foods can help prevent and treat critical and chronic illnesses, improve health equity, and save money.
As experts in medicine, nutrition, public health, and community intervention to improve food and nutrition security, we are delighted by President Biden’s recent announcement that it’s time for a second White House Conference on Hunger, Nutrition, and Health, to be held on Wednesday, September 28. It offers a historic opportunity to catalyze “food is medicine” interventions — bringing food to the forefront in addressing the nation’s health crisis.
In the 53 years since the last White House conference, and especially over the past decade, providers, clinicians, nonprofits, and academics have explored a number of nutrition interventions and programs in health care. One of them is medically tailored meals programs, an approach that one of us (D.B.W.) has been advancing for more than three decades. It involves providing people with severe, complex illnesses fully prepared meals designed specifically for them. Another food is medicine intervention is produce prescriptions, by which medical providers can issue vouchers, debit cards, or make referrals to meal services so their patients can get fresh fruits and vegetables.
These and other strategies represent real innovation in addressing food and nutrition insecurity. For the first time, the health care system — the single largest sector of the American economy — is entering the fight not only to get calories to people but also to ensure citizens’ diets are rich with nourishing foods to advance well-being, prevent sickness, and even treat disease.
These programs are effective. Medically tailored meals reduce inpatient hospital admissions by half and emergency department visits by nearly two-thirds among sick, lower-income people — improving their lives and saving money overall, even accounting for the cost of the programs. Produce prescriptions make it easier for broader swaths of individuals and families to improve their diets. A national produce prescription program could save $40 billion in health care costs and prevent nearly 2 million heart attacks, strokes, and other cardiovascular disease events over the lifetime of current U.S. adults.
A number of proposals are already on the table for the White House conference, including calls to modernize Medicare and Medicaid to include medically tailored meals and other interventions as a covered benefit, and to require more nutrition education for health care providers. U.S. medical schools, for example, dedicate to nutrition education a shockingly dismal 1% of total lecture hours, even though primary care and other physicians serve as go-to sources for patients seeking guidance about diet and food.
At the very least, the conference should support continued study of food is medicine programs. For example, thanks to newly awarded funding from the National Institutes of Health, Community Servings, where one of us (D.B.W.) is CEO, and the Tufts Friedman School of Nutrition Science and Policy, where one of us (D.M.) is dean, along with the UMass Chan Medical School, will further assess the impacts of medically tailored meals. This research, and Medicare pilot programs like the one introduced by U.S. Rep. Jim McGovern (D-Mass.), are essential to garner more insights into how medically tailored meals programs can best be deployed to those in need.
Unfortunately, access to food is medicine programs is currently limited to a small number of Americans through demonstration projects by private payers in a handful of states. So most Americans who could benefit from medically tailored meals and produce prescriptions can’t get them.
If nutrition is being viewed as a social driver of health, more should be done to increase access to these programs.
The U.S. is at a seminal moment in the fight against hunger, nutrition insecurity, and diet-related illness. No longer is good nutrition for all Americans just a theoretical “nice to have.” It’s an achievable must have — to increase well-being, treat disease, improve the lives of those with serious illnesses, advance health equity, and reduce the ever-rising health care costs that are bankrupting the nation.
The health care system should be a central asset in leading the fight for more medically tailored meals and produce prescription programs, as well as more robust nutrition education for clinicians and appropriate insurance coverage for counseling by registered dieticians.
The Biden administration, congressional leaders, and all stakeholders convening at the White House nutrition conference should recognize and elevate these interventions as vital, life-saving tools.
Dariush Mozaffarian is a cardiologist and professor and dean for policy at the Tufts Friedman School of Nutrition Science and Policy, and a co-chair of the Task Force on Hunger, Nutrition and Health, an independent group created to help inform the White House Conference on Hunger, Nutrition and Health. David B. Waters is the CEO of Community Servings, a Boston-based nonprofit provider of medically tailored meals and nutrition services. Mozaffarian reports research funding from the National Institutes of Health, the Bill and Melinda Gates Foundation, the Rockefeller Foundation, Vail Innovative Global Research, and Kaiser Permanente; and has advised Acasti Pharma, Barilla, Beren Therapeutics, Brightseed, Calibrate, Danone, Day Two, Discern Dx, Elysium Health, Filtricine, HumanCo, Motif FoodWorks, January Inc., Perfect Day, Season Health, and Tiny Organics, and owns stock in Calibrate and HumanCo.