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Rates of cardiometabolic illnesses among American adults have reached an astonishing 50%. For diabetes, cardiovascular disease, and related inflammatory conditions, the root cause often boils down to poor diet. Nearly 45% of all deaths from cardiometabolic diseases are attributable to unhealthy eating. Clinicians know they should be giving diet advice, but some programs are taking it a step further, showing it works better to provide patients with the food itself.

Enter Food Is Medicine initiatives. These programs are based on the concept that improving access to healthy food is cheaper and more efficient than paying for the inevitable results of a lifelong poor diet. They target segments of the population struggling with purchasing and preparing healthy food due to social, economic, and other barriers.

Features typically consist of:

• Produce prescriptions, designed to increase access to fruits and vegetables either through vouchers or by providing specific produce items.
• Medically tailored groceries, a prepackaged selections of unprepared foods often selected by nutritionists or dietitians to address the specific nutritional needs of the individual.
• Medically tailored meals, similar to medically tailored groceries, but consisting of fully prepared, ready-to-eat meals.

How well do Food Is Medicine programs offset the cost of caring for cardiometabolic diseases? The answer, in short: a mixed grocery bag.

The American Heart Association (AHA) recently issued a scientific statement based on a systematic review of these programs in the US. The review, published in the journal Circulation, analyzed randomized controlled trials of Food Is Medicine programs to quantify how such services can influence health outcomes — in this case, noncommunicable diseases.

The researchers assessed 14 randomized controlled trials, concluding the evidence is strong to justify current efforts to implement and disseminate Food Is Medicine programs. However, they acknowledged that the benefits of Food Is Medicine can be difficult to generalize across studies because of the broad variations in population, intervention design, duration of the program, and intensity of the intervention.

“A nutritious diet improves health outcomes; we know that clearly,” said Hilary Seligman, MD, MAS, a professor of medicine and epidemiology at the University of California, San Francisco, and lead author of the AHA statement. “We are still trying to figure out the best way for healthcare to help support patients in getting a healthy diet in a way that improves health outcomes, especially in the short term. Who should we be giving healthy food to? How, and for how long? These are some of the outstanding questions.”

Cheaper Than a Trip to the Emergency Room

“We can say with confidence that Food Is Medicine programs help people manage chronic illness and diet-related diseases, reduce emergency visits, reduce amputations from diabetes, and beyond,” said Devon Klatell, MA , vice president of Food Initiatives at the Rockefeller Foundation, a national philanthropic organization.

Robust studies are starting to show well-designed, effectively implemented programs can bring down costs and reduce the need for expensive healthcare services. A recent study from Cleveland Clinic showed patients receiving medically tailored meals had fewer visits to the emergency department (ED) and inpatient hospital days, resulting in an average cost saving of about $12,000 per patient.

Another study of Medicaid beneficiaries in Massachusetts found nutrition support led to 23% fewer hospitalizations and 13% fewer ED visits. Among adults enrolled in the government-funded program for over 90 days between 2020 and 2023, average healthcare costs dropped by an average of more than $2500 per person.

“I think all clinicians are aware that problems like food insecurity and poor nutrition can harm health, but we’ve had few tools to be able to address these problems in clinical care,” said Seth Berkowitz, MD, MPH, an associate professor of medicine and vice chief for Research at the University of North Carolina at Chapel Hill.

Berkowitz, who is deputy scientific director for the AHA’s Health Care by Food initiative, said referring patients to these programs “really should be no different than placing a referral to a registered dietitian or nutritionist, or similar collaboration that clinicians engage in regularly.”

Grocery Bills in the Healthcare Budget?

A recent Rockefeller Foundation survey showed nearly 80% of the American public would be personally interested in Food Is Medicine programs. “We know that Americans want these programs,” Klatell said.

Patients and clinicians who participate in these programs like and recommend them, she added. The catch is getting policymakers to endorse the approach.

“Integrating food into healthcare delivery can improve health, help to manage costs, and in many ways is common sense — but it’s also a new ‘muscle’ that the healthcare system needs to build and adapt to,” she said.

“For some reason, programs in healthcare that are prevention-oriented or address social needs are often held to a cost standard,” Seligman said. “This is a double standard because we approve new medications for use based on whether they work — not whether they save money,” she said. “Healthy food can be more effective than medication in preventing and treating chronic disease, at least over the long term. This should be all we need to know to justify their cost.”

Seligman reported receiving honoraria from the AHA’s Feeding America program. Berkowitz reported receiving research grants from the National Institutes of Health, the North Carolina Department of Health and Human Services, the AHA, the American Diabetes Association, and Feeding America; personal fees from the Rockefeller Foundation and the Gretchen Swanson Center for Nutrition; and royalties from Johns Hopkins University Press.

Katherine Wandersee has more than 30 years’ experience as a medical writer for professional medical audiences.