Targeted food and nutrition strategies, such as medically tailored meals and discounts or free produce such as fruits and vegetables, should be an integral part of healthcare at a national level, say experts.

Researchers at the Food is Medicine (FIM) Institute at Tufts University, point to the possibilities of introducing medically tailored meals and discounts or free produce such as fruits and vegetables for patients with chronic diet-related disease.

“This [the two interventions] is a rare outcome in medical care as few, if any, other interventions in healthcare are both cost effective and cost saving,” said the report’s senior author, Dariush Mozaffarian, a cardiologist and director of the Food is Medicine Institute.

“Despite these proven and estimated benefits to patients, healthcare systems, and the economy, FIM interventions are not universally available to health care providers as a prescribable intervention, nor to patients as a covered intervention. As a result, FIM is largely unavailable to individuals who might benefit.”

Quantifying the potential health and economic benefits of FIM efforts

The True Cost of Food: Food is Medicine Case Study details the urgent need for alternative approaches as remedies in reducing around 1.6 million hospitalisations and saving $13.6bn in health care costs in the first year alone.

Presented as two case studies, the report initially focuses on Medically Tailored Meals as the most intensive intervention for a smaller number of patients with more severe, complex medical conditions.

Here, the approach centres on preparing 10-21 weekly meals personalised by a Registered Dietitian Nutritionist (RDN) in combination with nutrition and culinary education.

The hope is that the meals will help promote improved food security and disease management, lower hospital emergency room, and nursing home admissions, and lower net health care costs of patients with diabetes, heart failure, cancer, kidney failure, and HIV.

The other intervention is produce prescriptions, in which foods such as fruits and vegetables (and sometimes also nuts, seeds, beans, whole grains, dairy, and eggs) are made more freely available to patients with at least one diet-sensitive health risk or chronic condition.

This could be achieved by electronic benefit cards or paper vouchers redeemable at grocery stores or farmers markets; picked up in the healthcare setting or by home delivery; in combination with nutrition and culinary education.

Ensuring access to nutritious food for those with the greatest need

“This case study suggests that implementing produce prescriptions nationally for patients with diabetes and food insecurity could improve health, reduce healthcare costs, and be highly cost effective in the United States,” the report said.

“Findings support the testing, scaling, and evaluation of produce prescription programs for patients with diabetes and food insecurity for both public and private payers; with a focus on ensuring access to those with greatest need.”

Chronic conditions are a particular area of concern due to the long-term economic costs to society, wher suboptimal diets contribute to health care spending and lost productivity estimated at $1.1tn each year — equalling the economic output of the entire food sector.

Devon Klatell, vice president of The Rockefeller Foundation’s food initiative, which provided support in the report’s creation said: “The true costs of our food system—the environmental impact of how food is produced, the working conditions of the people who grow our food, and the impacts on our health, health care spending, and health equity are too often left off the price tag.

“This report can assist governments, companies and consumers in better evaluating the value of Food is Medicine interventions by considering not just the price paid for food, but the return on investment in improved health outcomes they can deliver.

“We look forward to working with all sectors to further advance our collective knowledge and understanding of the potential of Food is Medicine interventions.”

Science should be a basis for food-based interventions

Commenting on the report’s findings, Dr Steven Novella, an academic clinical neurologist at the Yale University School of Medicine added: “there are many potential interventions that have a huge impact on health that are not traditional medical interventions, such as poison control, public safety, and sanitation.

“We should add to this list things like optimal nutrition, gun safety, and addressing health misinformation. And as always, such interventions need to be as evidence and science-based as possible.”