The food-as-medicine movement is gaining momentum, but health care providers on the frontlines say the novel approach to preventive health programs poses myriad challenges in scaling effective solutions for patients.
Representatives of nonprofits, food assistance programs and insurance companies discussed the topic Lessons Learned from the Front Line of Food as Medicine in early March at the Food As Medicine summit in Chicago, Ill.
Among the biggest challenges to scaling food as medicine are the long-term investment needed to show results, the wide variation in patient needs and infrastructure that often fails to match real-world access and user needs, experts said on the panel.
Perhaps the biggest challenge is getting buy-in from patients.
“The intervention has to be based on that individual and how willing they are to accept an intervention, whether or not it’s scaled to them, and whether or not it’s actually informed by the community that it is intending to serve,” said Ipyana Critton, chief health officer, Meals on Wheels America.
Community input and buy-in is critical and can pose its own challenge because “it means different things in different communities,” according to Critton.
“That’s probably the thing that’s most frustrating, because you have to layer on top of that a reimbursement system that needs consistency,” she said.
One size doesn’t fit all
Meals On Wheels is active in most communities across the US, and developing programs to feed people can be vastly different in terms of need, Critton said.
The food security nonprofit operates food as medicine programs across the country, such as the Medically Tailored Meal (MTM) program run by the Portland, Ore.-based Meals On Wheels People. The MTM program provides meals for those with severe or chronic conditions, based on an assessment of their nutrition needs.
“Every rural community is not the same, and every frontier community is not the same,” Critton said. “You have some communities that are very proud and have a ton of need, but do not expect outsiders to come in and help them.”
The long game
Buy-in from patients is only part of the battle in advancing food-as-medicine initiatives. Buy-in from federal lawmakers poses another substantial challenge, as the preventive programs can take years to show results, and “prevention always blows up the budget initially,” Critton said.
“You have to make that investment to see that long-term translation,” she said. “And so from a policy perspective, when you’re at the system level, time is not on your side in that regard.”
Allison Collins, director of Lifestyle & Culinary Medicine at Kaiser Permanente, said the health care provider keeps many of its clients for the long-term, enabling the organization to see the benefits of their work years down the road.
The organization operates a range of food-as-medicine programs, including the culinary medicine programs to teach clients to prepare food in addition to healthy nutrition.
“It’s really critical, but getting organizations on board with that long-term mindset of how can we impact one child? Can we impact their family? Can we impact the community?” she said.
Collins said immediate action and strong leadership are needed to address the health crisis unfolding across the US.
“If we continue to not act, it is just unfathomable, as a clinician, what is going to continue to happen, and our kids are so much sicker today than they were even 10 or 20 years ago,” she said.
Collins suggests a strategy of integrating components of food-as-medicine programs into existing programs over time as a way to institutionalize them. “How can we layer it in to really make it something that can really scale and continue to push the boundaries,” she said.
