- Two Utah programs are part of the "Food Is Medicine" movement.
- Research shows food can impact the physical and mental health of an individual.
- Learning about and actually eating a healthy diet can lower health care costs.
Alma Rivera, 35, is expecting her first child next month. But during the pregnancy she developed gestational diabetes, so her doctor decided she and her baby would benefit from specialized nutrition counseling and access to food that’s good specifically to counter diabetes. The doctor sent her with a prescription to the University of Utah Health Food Pharmacy.
Oswald “Oz” Hutton, 60, of Salt Lake City, has battled hypertension, arthritis and chronic pain. What you eat makes a difference there, too, so the U.S. Marine Corps veteran opted into nutritional education and access to high quality produce courtesy of a program that’s a partnership between the Rockefeller Foundation and the Veterans Health Administration.
Those two programs — and scores of others — are part of the “Food Is Medicine” movement, the belief that what people eat helps determine their health on many levels.
“If you think about the drivers of health, dietary risk factors are shown to be the most important modifiable risk factor for chronic disease and death. Yet in health care, we don’t really talk about that much,” said Dr. Amy Locke, whose many titles include chief wellness officer at University of Utah Health, professor and co-director of the Driving Out Diabetes Initiative at the Osher Center for Integrative Health.
Locke said modifiable health risk factors are about 20% clinical, 30% behaviors like getting enough sleep or eating well, roughly 10% physical environment and 40% socioeconomic.
“If you have good health care and you have good socioeconomic status, it’s easier to eat a healthy diet,” she told Deseret News. “What we want to do is use the health care space to leverage those other buckets as much as possible, so we are doing a bunch of ‘Food Is Medicine’-related things.”
The federal government, health care providers, nonprofits, academics and others are embracing the concept that you can be healthier or sicker depending on what you eat.
The 2022 White House Conference on Hunger, Nutrition and Health firmly tied together food and health in its call to end hunger and reduce chronic disease by 2030, as the Office of Disease Prevention and Health Promotion reports. The office said 60% of U.S. adults have some diet-related chronic disease that the right food — and avoiding the wrong ones — can impact. At the same time, there are 18 million people whose households experience food insecurity. The result is an estimated $4 trillion in health care spending.
Deseret News looked at two of the dozens of examples of “Food Is Medicine” programs. How programs operate and who they target varies. But many of them — including the University of Utah Food Pharmacy and the pilot project funded by the Rockefeller Foundation involving Salt Lake area veterans who receive services at the VA — share certain traits: The beneficiaries like Hutton and Rivera have medical conditions that food impacts. Participants are considered food insecure and meet income qualifications.
The programs also both have strong education components to help those benefiting understand why food matters, how to make good food choices and even how easy it is to make good meals.
They also both provide actual food.
Helping veterans get healthy
The Veterans Health Administration hosted a bipartisan Congressional event last week to tout its partnership with the foundation, which just made a $100 million commitment to Food Is Medicine programs, building on its prescription pilot projects in Utah and Texas.
Projects are being launched in Maryland and New York, with partners including the VA, Instacart, Syracuse University, University of Utah, 4P Foods, as well as in North Carolina, Duke University and Reinvestment Partners. The programs have different designs to meet needs in the areas they serve. But the classes, resources and prescriptions are tailored specifically to patients and their chronic conditions.
Hutton is one of 275 veterans in the Utah pilot; the programs combined hope to help 2,000 veterans, while gathering research and looking for ways to tackle diet-related diseases like diabetes, obesity and high blood pressure among U.S. veterans.
Along with food education, veterans in the program are given gift cards worth $100 a month that can be used to buy fruits and vegetables at participating stores. The program lasts 12 months.
Retired four-star U.S. Navy Admiral James Stavridis, foundation board chair, said access to healthy food improves mental and physical health while lowering the cost of health care.
The National Institutes of Health has reported that three-quarters of veterans returning from Iraq and Afghanistan were overweight or obese when they first went to a VA clinic.
Noah Cohen-Cline, director of the Rockefeller Foundation initiative, said the program uses Food Is Medicine initiatives like produce prescriptions, meals tailored to medical needs and groceries that can be prescribed by a clinician as part of medical treatment, “with the big-picture goal of seeing these interventions formally integrated into health care as a covered medical benefit.” These pilot projects are testing programs and measuring outcomes.
The foundation would love to expand it to all eligible veterans, including 116,000 in Utah, but Cohen-Cline said philanthropies alone can’t meet the need; that requires funding from other sources, including health care systems and insurance companies.
He said it saves money and improves quality of life, making it a great investment.
What is a food pharmacy?
The University of Utah Health System teaches students in health-related fields how to talk about food as a wellness tool and also how to eat a healthy diet themselves.
“Food is the most significant modifiable risk factor. You should not show up at a medical facility and not have the opportunity to talk about food,” Locke said.
In the food lab, future health providers learn that good food needn’t be expensive and can be delicious, said Locke. “We have a whole college of health on this campus, which is amazing. We’ve got a dietetics program that’s been teaching people to cook since 1940, so they have a lot of practice. So getting these other health profession students, nurses, physicians, pharmacists in that lab experiencing food in a fun and healthy way is really important.”
Locke said discussion of food as medicine empowers people to be healthier.
The Food Pharmacy program itself is for those in the University of Utah health care medical network who are food insecure and have a food-changeable chronic condition.
“What’s really cool about the food pharmacy program is that it not only helps people understand what a healthy diet is, but it provides some actual food,” Locke said.
The coaching piece paired with food and resources, ”that’s where the magic of the food pharmacy program really is.”
The food pharmacy is “embedded in a clinical space.” A care provider refers patients for nutrition education and provides a prescription for foods that will help.
That sends the patient into the program for education, followed by up to six visits to the food pharmacy truck, which alternates between the Greenwood Clinic in Midvale and the Redwood Clinic in Salt Lake City. The truck operates on a limited basis twice a week.
Resources, education, coaching
Ellen Maxfield, associate director of clinical operations for the integrative health center and director of the University of Utah’s diabetes prevention program, said they don’t try to meet all of a person’s food needs, but rather coach and supplement. Unlike the VA program, it’s not just produce. At the truck, for instance, Rivera chose two dairy items (they had 2% milk, almond milk and yogurt that day), three veggies from a selection of fresh and canned, two proteins (offerings were pinto beans, tuna and peanut butter), two fruits (fresh and canned) and two starches (brown rice, spaghetti, oatmeal and bread).
Food pharmacy patients are given information packets in English and Spanish on resources to community food banks and other programs like farmer’s markets that also help with food.
“Food resources, education and coaching,” said Maxfield.
The food pharmacy itself looks like a food truck with lots of refrigerator space and room for Sarah Zou, the pharmacy’s registered dietitian, and health-field students who help fill orders. They’re trained to think about and talk about food as medicine, plus they get experience working with patients. Thanks to translation services, they can help people speaking a wide variety of languages.
On the way from a Food Is Medicine appointment, patients can visit the truck and pick their food. Rivera opted for a variety of fresh and shelf stable items; Maxfield said they learn to use both well.
Follow-up visits can be done in person or by telehealth to reduce the transportation and scheduling burden. Those following up remotely use a gift card that’s specific to the program to choose certain foods. Kroger provided the cards.
The program is still small, Maxfield and Locke said, but has served nearly 400 people. They’re learning what works and its impact. But they believe treating food as medicine and helping people understand how what you eat impacts health will have lifelong — and quality of life — effects.
Said Locke, “This is a piece of a much bigger sort of initiative of, how do we help improve health, and specifically nutrition of people in Salt Lake and in Utah, from school-based programs to teaching kitchens?”
Food to share
The food pharmacy project is housed in the Osher Center for Integrative Health and the Driving Out Diabetes initiative. Patients can get food six times on a doctor’s referral and can repeat if they want, Maxfield said, for a year total.
Part of what makes both programs successful is buy-in by local grocers. In Utah, for instance, several grocery stores — including Kroger (Smith’s in Utah) and Lucky have teamed up with the foundation to accept the cards to pay for produce. Maxfield said the university health program is all collaboration, from the student piece to the funding piece.
The food comes from University Hospital’s Nutrition Care Services, the Utah Food Bank, and Dairy West provides dairy resources and helps fund the truck. Others contribute, too. The program also buys farm shares during the growing season from the International Rescue Committee’s New Roots program. Kroger provides grocery gift cards. And the Driving Out Diabetes Initiative supports the program, too.
Without all that collaboration, neither program could operate.
Eating your way to better health
Hutton, who recently graduated from the program, said he’s not only learned what to eat, but what not to eat to maintain healthy blood pressure numbers. “Part of my goal is to eat my way to better health,” he said, noting he not only has had high blood pressure, but arthritis and chronic pain that can be helped by food choices.
He was already a cook. But he said looking at food as medicine is different. And the cooking class was amazing, he added.
“But classes only take you so far if you can’t afford to buy the produce you want,” the foundation’s Cohen-Cline said. It is in pairing access with knowledge that there’s “a lot of power.”
“By eating better, I have energy,” said Hutton, who admits he has a tendency to self isolate. “Now, when I go outdoors, I want to stay outside and do things, to socialize. So one of the least talked about benefits is positive mental health and overall well-being.”
It was Rivera’s first Food Pharmacy appointment, so it’s too soon to say how it will help her. But the goal is clear: A healthy baby and a lifetime of food-related health.