BOOK of the Month

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 Medicaid Nutrition Supports Associated With Reductions In Hospitalizations And ED Visits In Massachusetts, 2020–23:  Dr. Kurt Hager, Et al

The Massachusetts Medicaid and Children’s Health Insurance Program launched the Flexible Services Program to address food insecurity through partnerships with social service organizations under its Section 1115 demonstration waiver. We evaluated the effects of Flexible Services Program nutritional services (or Food Is Medicine programs) on health care use and costs during the first three-year program cycle (January 2020–March 2023). Our analyses pooled data on 20,403 Flexible Services Program participants from seventeen accountable care organizations. 

Program participation was associated with a 23% reduction in hospitalizations and a 13% reduction in emergency department visits,  Health care costs were $1,721 lower among participants after the COVID-19 emergency (2022–23) and $2,502 lower among adults with more than ninety days of enrollment during all study years (2020–23).  

West Palm Beach, FL and Boston, MA, October 5, 2024— A research study evaluation completed by Tufts University researchers on the Healthy Food Prescription, a food is medicine program and health intervention. The study population included participants of two 24-week medically tailored grocery programs administered by Living Hungry, a charity organization dedicated to addressing food insecurity in Florida’s high-risk communities. The programs provided a healthy grocery bundle every two weeks during the intervention period,  containing an estimated 28 meals worth of produce, whole grains, legumes, proteins, and healthy  fats for diabetic patients based on research-based reference levels (15,16) 

At the end of the program, HbA1c  significantly declined by -.60 percentage points (95% CI: -1.16, -0.04), however changes in BMI  (<0.01 kg/m2 95%CI: -0.88, 0.88) and total cholesterol (10.14 95% CI: -27.38, 7.09) were not  significant. The results of the sensitivity analysis including only participants with HbA1C  >=8.0% were similar to the overall analysis. Among participants with HbA1c>=8.0%, HbA1c  declined by -.80 percentage points (95% CI: 1.50,-0.10).  

View the video presentation by the Research Team: 

Dr. Kurt Hager, UMass Chan Medical School,  Maura Plante, Living Hungry, and Elsa Konieczynski, Tufts University, Friedman School of Nutrition Science and Policy

 22 produce prescription locations in 12 US states from 2014 to 2020. No programs were previously evaluated. The study included 3881 individuals (2064 adults aged 18+ years and 1817 children aged 2–17 years) with, or at risk for, poor cardiometabolic health recruited from clinics serving low-income neighborhoods. Programs provided financial incentives to purchase F&V at grocery stores or farmers markets (median, $63/months; duration, 4–10 months).  For Adults starting out with 8.0 HbA1C, -0.58 drop post program. 

 The food movement has arrived. While trends and fads like superfoods and gut health have long been in the spotlight, the importance of healthy, nutritious foods as a pillar of health and well-being is finally entering the national conversation about what health means for Americans. Promising solutions like Food Is Medicine are gaining traction and accelerating adoption among patients, retailers, community-based organizations, government, employers and more. There is an immense opportunity to continue integrating food and nutrition into prevention, management, and treatment of chronic diseases. The appetite is strong, the evidence is available, and innovative technologies and partnerships are poised to disrupt outdated models. This panel will bring together food-system leaders from across sectors to discuss where the future of Food Is Medicine is going next and what it will take to get there. 

Holly Freishtat,Athena Rae Roesler,andJulia Hesse-Fong

 Sitting at the intersection of produce production and Food Is Medicine, Feeding Change is uniquely positioned to highlight opportunities that link resilient food production—specifically fruit and vegetable production—with improving overall health in the US. This brief focuses on four priority policy areas: promoting healthy soils, improving risk protection, investing in a modern agricultural workforce, and integrating fruit and vegetables into health interventions. 

Feeding Change worked with key stakeholders to inform the policy priorities and recommendations in this brief. These stakeholders represent 20 experts from across the food system, including farmers, distributors, producers, retailers, health systems, researchers, investors, and members of the Feeding Change Business Council. View a full list of Feeding Change Business Council members.
 

 Employers are increasingly recognizing how food can promote whole-person health by addressing physical well-being, resilience, disease prevention, and mental health. “Food as health” emphasizes the critical role of food in maintaining and improving health, both within and beyond the health care setting. With 160 million adults in the US workforce—many of whom have one or more preventable, diet-related chronic diseases or face food insecurity—employers are uniquely positioned to craft policies, systems, and environments to improve employee health. While many employers have expressed interest in leveraging food as health strategies, they are overwhelmed by the volume of solutions available and are uncertain about where to start.

A Blueprint for Employer-Led Food as Health Strategies highlights nutrition-focused strategies that employers can implement to support the health of their employees, organizations, and broader communities. The report outlines a step-by-step roadmap that guides employers in selecting and implementing food as health strategies aligned with their organizational priorities and employee needs. Each section provides evidence to support decision-making at every stage of readiness and outlines key considerations for employers as they work through the details of crafting their benefits, leveraging evidence and best practices from the experts interviewed and the literature. By prioritizing food as health, employers can contribute to better health outcomes, reduced health-care costs, and a more engaged, satisfied workforce, ultimately benefiting society at large.

Authors: 

Anna Lin-Schweitzer,  Associate Director, Feeding Change, 

Athena Rae Roesler, Director, Public Health

Hoyll Freishtat, Senior Director, Feeding Change, Milken Institute Health

Download the Summary of Recommendations

 The American Heart Association’s Health Care by Food™ initiative is coordinating scientific research, public policy advocacy and stakeholder education to advance food is medicine interventions that incorporate healthy food into health care to treat, manage and prevent diet-related diseases.

The need is great: An estimated 90% of the $4.3 trillion annual cost of health care in the U.S. is spent on medical care for chronic diseases, and for many of these diseases, diet is a major risk factor. Millions of people in the U.S. have low diet quality—a major driver of chronic disease and health inequities, especially among communities of color and those with low income. Health Care by Food is keenly focused on removing barriers to nutritious food through research and community solutions. In 2024, Health Care by Food awarded research grants to fund 23 small-scale clinical trials focused on rapid cycle innovation, adaptive designs and attention to lived experiences. Results of these studies will enable testing of the scalability and sustainability of large comparative effectiveness trials

 The Advances in the Food Is Medicine Field annual report highlights new research, the current policy landscape, lessons from collaborations, adoption, implementation and community involvement, as well as priorities for food is medicine to have lasting impact. This premiere edition, prepared by the Health Care by Food team (HCXF) is designed to inform and equip stakeholders with the insights needed to drive the next phase of action—turning evidence into practice, and practice into lasting systems change. This report will be updated annually by HCXF to track progress, highlight new evidence and capture emerging opportunities shaping the future of the field.

View the Advances in the FIM Field Annual Report

Conclusions: The rapid growth in understanding, implementation, and evaluation of FIM interventions has been remarkable, with programs and policy changes now underway across the country. The United States leads globally in this arena, with FIM projects only starting to be piloted in other nations.97 In the face of large health, economic, and equity impacts of poor nutrition and food insecurity, FIM programs represent a compelling health care innovation to help address these burdens. Renewed attention on MNE in undergraduate, graduate, and continuing medical education is occurring and will be relevant for success and scaling...Much of the initial programmatic focus and evidence has been on cardiometabolic health, making it important for clinicians in this area to understand the current landscape and coming directions. Experiences to date are promising, but current FIM programming reflects a patchwork of approaches, geographies, and payer coverage. Broader integration of FIM into health care to reach patients in need will require additional multiparty collaboration—among researchers, payers, clinicians, health care systems, patient advocates, community-based organizations, the private sector, research funders, and policy makers—to assess, optimize, and scale the interventions with greatest effects on nutrition, health, health disparities, and corresponding economic and societal burdens.

Source:   

Impact of Produce Prescriptions on Diet, Food Security, and Cardiometabolic Health Outcomes: A Multisite Evaluation of 9 Produce Prescription Programs in the United States, Kurt Hager, Mengxi Du, Zhongyu Li, Dariush Mozaffarian, Kenneth Chui, Peilin Shi, Brent Ling, Sean B. Cash, Sara C. Folta and Fang Fang Zhang

Originally published 29 Aug 2023 Circulation: Cardiovascular Quality and Outcomes. 2023;16 https://doi.org/10.1161/CIRCOUTCOMES.122.009520

August 29, 2023: Fruit and vegetable ‘prescriptions’ may lead to better heart health  by Teddy Amenabar, Washington Post 

PRx are medical treatments or preventive services that provide access to healthy fruits and vegetables for patients with diet-related health risks or conditions who are food insecure or face documented challenges in accessing nutritious foods.

The first report in the series, Mainstreaming Produce Prescriptions: A Policy Scan, provides a high-level overview of current opportunities to sustain and scale PRx via U.S. health care and food policies. Mainstreaming Produce Prescriptions: A Policy Strategy Report then builds on this framework by providing policy recommendations addressing five core challenges limiting access to these vital programs: Funding, Research, Patient Data and Privacy, Infrastructure, and Advancing the Field.

Source:

Kristin Sukys, Erika Hanson, Katie Garfield & Emily Broad Leib, Center for Health Law and Policy Innovation, Mainstreaming Produce Prescriptions in Medicaid Managed Care: A Policy Toolkit and Resource Library (June 2023).  

This one report from the Center for Health Law and Policy Innovation is the foundation to all Florida Health & Nutrition Coalition members work and research. Food and Society at the Aspen Institute’s Food is Medicine Initiative aims to expand access to proven interventions through  research. The Food is Medicine Research Action Plan  publishes a comprehensive set of recommendations for creating an evidence base that will advance health care integration, build a holistic understanding of effectiveness, and engage communities, providers, and researchers.  Food and Society, working  with its expert Food is Medicine Advisory Board,to establish concrete steps to build on existing efforts and engage new actors, advancing research across the full spectrum of interventions, from prevention to treatment. The Research Action Plan serves as both a catalyst and framework for government and philanthropic investment in the field. In our view this is a must-read for all FiM Researchers.