"Food Is Medicine" Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review

Leveraging Health Policy Solutions to Address Obesity in Rural America

Rural America faces an alarming obesity crisis, with residents experiencing significantly higher rates of obesity due to socioeconomic disparities, limited access to healthcare, and structural challenges such as food deserts and insufficient healthcare infrastructure. This perspective addresses these pressing issues by proposing targeted, evidence-based interventions to reduce obesity in rural communities. Our recommendations include (1) increasing the number of multidisciplinary healthcare professionals in rural areas through initiatives such as the Rural Medical Scholars Program, the Rural Community Loan Repayment Program, and the Conrad 30 Waiver Program; (2) expanding coverage for essential obesity services via H.R. 1577, the Treat and Reduce Obesity Act, to alleviate financial barriers to treatment, including intensive behavioral therapy and pharmacotherapy; and (3) leveraging community-based programs, including the National Rural Obesity and Chronic Disease Initiative, the CDC's High Obesity Program, and the Delta Body and Soul initiative, to improve access to healthy foods and promote physical activity through local collaborations, education, and infrastructure enhancements. By implementing these comprehensive strategies, we aim to make obesity treatments and healthy lifestyle choices more accessible, ultimately reducing obesity rates, improving health outcomes, and enhancing the overall quality of life for rural residents across the USA.

Food as medicine, community as medicine: Mental health effects of a social care intervention

OBJECTIVE

To assess mental health related outcomes of Recipe4Health, a multisectoral social care partnership implementing produce prescriptions with or without group medical visits (GMVs).

STUDY SETTING AND DESIGN

Recipe4Health was implemented at five community health centers from 2020 to 2023. Primary care teams referred patients with food insecurity and/or nutrition-sensitive chronic conditions (e.g., diabetes, depression) to 16 weeks of Food Farmacy (produce prescriptions) with the option of GMV participation. We used a convergent mixed-methods design including survey and interview data.

DATA SOURCES AND ANALYTIC SAMPLE

We conducted (1) participant surveys pre- and post-intervention and (2) semi-structured interviews with Recipe4Health participants and partner organization staff. Linear mixed effects models examined changes in mental health and related outcomes. Interviews were analyzed using codebook thematic analysis.

PRINCIPAL FINDINGS

Program participants were middle-aged, primarily women, and from diverse racial/ethnic backgrounds (majority Latine and Black). At baseline, moderate or severe depression and/or anxiety symptoms were reported by 77/188 (41%) of Food Farmacy-only participants, and 113/284 (40%) of Food Farmacy +GMV participants. Among Food Farmacy-only participants, post-intervention depression and anxiety symptoms significantly improved only among those who did not have baseline depression/anxiety (PHQ9: -1.7 [95% CI: -2.8, -0.6]; GAD7: -1.8 [95% CI: -2.9, -0.8]). Among Food Farmacy +GMV participants, mental health symptoms improved regardless of baseline mental health; among those with baseline depression/anxiety: PHQ9: -2.4 (95% CI: -3.6, -1.2); GAD7: -0.9 (95% CI: -2.0, 0.1); among those without: PHQ9: -2.2 (95% CI: -3.2, -1.2); GAD7: -2.2 (95% CI: -3.1, -1.2). Improvements in social needs (food insecurity, loneliness) and health-related behaviors (fruit/vegetable intake, physical activity) varied by intervention arm and baseline depression/anxiety symptom level. In interviews, staff and patients endorsed produce prescriptions for improving nutrition and food insecurity, and GMVs for increasing social support.

CONCLUSION

Social care interventions providing vegetables and fruit, with or without group medical visits, may concurrently address mental health symptoms and social needs.

Evaluation of a Fruit and Vegetable Voucher Program in a Prenatal and Pediatric Primary Care-Based Obesity Prevention Program

Background: Maternal consumption of fruits and vegetables can reduce future childhood obesity risk. Health Bucks, a fruit and vegetable voucher program redeemable at New York City (NYC) farmers' markets, supports access to fresh produce. Methods: In a cross-sectional analysis within a cohort study, we evaluated the integration of Health Bucks into the prenatal expansion of a primary care-based obesity prevention program. We analyzed data from 176 pregnant Latina participants at a NYC public hospital, with vouchers given to 114 (64.8%) participants. Later in infancy, we measured maternal outcomes (fruit and vegetable intake, stress) and food access (food environment, household food insecurity). We performed adjusted regression analyses to evaluate outcome differences between those who received vouchers and those who did not. Secondary analyses assessed whether voucher redemption or first-trimester timing of distribution were associated with outcomes. Results: Receipt of vouchers was associated with higher daily fruit and vegetable intake (incident rate ratio [IRR] = 1.3 [95% confidence interval [CI]: 1.1, 1.6]), and lower stress (B = -1.9 [95% CI: -3.7, -0.1]). Voucher redemption was associated with higher daily fruit and vegetable intake (IRR = 1.3 [95% CI: 1.04, 1.6]). First trimester receipt was associated with a favorable view of the neighborhood food environment (adjusted odds ratio = 5.5 [95% CI: 1.04, 28.6]) and lower stress (B = -3.8 [95% CI: -7.5, -0.1). We did not detect associations with food insecurity. Conclusion: Integrating Health Bucks into a prenatal obesity prevention program was associated with favorable outcomes. Subgroup analyses showed that voucher redemption and first-trimester receipt were associated with positive outcomes, guiding strategies for fruit and vegetable voucher distribution.

Produce prescription to improve health among adults with type 2 diabetes in Australia: Protocol for a randomised controlled trial

BACKGROUND

'Food is medicine' programs such as Produce Prescription (PRx) aim to integrate food-based nutrition programs into healthcare, for the prevention, management and treatment of diet-related diseases, typically for those experiencing food insecurity. However, the impact of PRx on health indicators in Australia has never been tested in a randomised trial.

OBJECTIVES

To determine the effect of PRx on blood glucose control and other health indicators in adults with type 2 diabetes experiencing hyperglycaemia and food insecurity and/or financial hardship in Australia.

METHODS

Using a parallel design randomised controlled trial, n = 224 participants will be randomised (1:1) to PRx or usual care. Over 26 weeks, the intervention group will receive a weekly delivery of fruits, vegetables, wholegrains and nuts, and up to 3 sessions with an accredited dietitian. Controls will receive usual care. The primary outcome is change in mean HbA1c over 26 weeks, comparing the intervention and control group. Secondary outcomes include between-group differences at 26 weeks in change in blood pressure, body weight, blood lipids, food and nutrition insecurity, person-reported outcome measures, medication use, and diet quality. Implementation outcomes assessed will include feasibility, acceptability, scalability and cost effectiveness.

DISCUSSION

This Australia-first PRx trial will provide novel and rigorous data for an intervention that may be feasible to improve health and health equity as part of the Australian healthcare system. We anticipate PRx will lead to a clinically meaningful reduction in HbA1c, contribute to improved health equity and long-term health benefits for adults with type 2 diabetes and food insecurity.

Advances in Food-As-Medicine Interventions and Their Impact on Future Food Production, Processing, and Supply Chains

Food-as-medicine (FAM) is an emerging trend among medical doctors, health insurers, startups, and governmental public-health and nongovernmental organizations. FAM implies using food as a part of an individual's health plan to prevent or help treat acute and chronic health conditions and diseases. We highlight trends and hurdles in the FAM intervention pyramid. Our viewpoint is to indicate how interventions might change the future demand for specific food groups, their transport in supply chains, and the technologies used to process them. On the basis of national guidelines, dietary interventions can help to prevent and treat many diseases, including cardiovascular disease, cancers, type 2 diabetes, and obesity. FAM R&D and services offer more individualized treatments. This is challenging given the interindividual variability and complexity of the body's response to food and related factors, such as dietary habits, genetics, lifestyle, and biosphere. Quantifying health improvements is essential to prove the added value of more individualized FAM interventions compared with adopting a general healthy diet. It is unclear which level of individualization of interventions produces the largest health benefits at the lowest costs for the patient, healthcare system, and climate. FAM interventions can support and complement conventional medical treatment. They will require a shift to producing more health-promoting foods, including whole foods, minimally processed foods, and selected processed foods. The food processing industry and supply chains must adapt to these new scenarios. Auxiliary technologies and methods are enablers, including delivery services, wearable technology, health-monitoring apps, and data-driven consumer behavior analysis.

A New Approach To Guide Research And Policy At The Intersection Of Income, Food, Nutrition, And Health

Income distribution, food and nutrition insecurity, and poor diet quality contribute to diet-related disease, which is a major threat to population health and health equity. Based on our review and synthesis of the empirical evidence, we provide a new conceptual model for understanding the interrelationships among income, food security, nutrition security, diet quality, and health. We identify directions for future research and discuss the policy and program implications of the model. Overall, interventions that address income and food security can facilitate, but do not ensure, nutrition security and better diet quality, although they can improve health in other ways. Importantly, even people who are food and nutrition secure and have adequate income frequently have unhealthy diets. Addressing these challenges will require innovative policies to improve nutrition security, diet quality, and health. Such policies should include efforts to increase the availability and accessibility of Food Is Medicine interventions in health care. Health insurance coverage for evidence-based, clinically indicated Food Is Medicine programs is critical to the success of these efforts.

States' Use Of Medicaid Managed Care 'In Lieu Of Services' Authority To Address Poor Nutrition

In response to rising health, economic, and equity burdens of suboptimal nutrition, health care stakeholders are increasingly integrating nutritional supports into health care delivery and financing. In January 2023, federal guidance clarified that states may use "in lieu of services and settings" (ILOS) authority to address health-related social needs, including nutrition, in Medicaid managed care. However, few data are available regarding ILOS implementation. This analysis reviewed ILOS policies based on managed care documents from forty states as of October 1, 2024. Thirty-five states have authorized ILOS to address behavioral health, and fourteen states have authorized ILOS to address general medical needs. Twelve states use ILOS to address health-related social needs; of these, only ten address nutrition. In addition, fewer than half of the forty states provide robust guidance regarding evaluation or establishment of new ILOSs. We examine the policy implications of these findings and provide recommendations to strengthen the role of ILOS in improving nutrition, health care costs, and health equity.

'Food Is Medicine' In The US: A National Survey Of Public Perceptions Of Care, Practices, And Policies

Poor nutrition in the US causes more than 600,000 deaths and an estimated $1.1 trillion in health care spending and lost productivity annually, as well as profound health disparities. Food Is Medicine interventions, which incorporate nutrition-related services in medical care as part of a care plan to prevent or treat disease, can advance nutrition security, health, and equity. But little is known about public awareness and perceptions of these interventions. We conducted the first national survey on knowledge, perceptions, and experiences around Food Is Medicine during February-April 2023. Fewer than half of respondents said that they received clear food- and nutrition-related advice from their primary health care providers, but a majority expressed interest in participating in Food Is Medicine interventions. More than two-thirds felt that Medicare and Medicaid should help pay for Food Is Medicine programs in health care, and more than half said that private insurance should do so. These results suggest a need for increased nutrition-related training of health care professionals, development of Food Is Medicine accreditation standards for health care organizations, and new regulatory incentives and contract requirements for Medicare Advantage and Medicaid managed care plans to encourage Food Is Medicine interventions in care delivery.

Cultural And Place-Based Wisdom For Implementing 'Food Is Medicine' Programs In North Carolina

The Food Is Medicine movement integrates food-based interventions into health care to address diet-related health conditions and food insecurity. Both the food and health systems that are a part of Food Is Medicine, however, have a history of contributing to health inequities through discriminatory policies and practices. Community-based organizations (CBOs) play a vital role in bridging these systems with their communities by centering their cultures, histories, and relationships in their Food Is Medicine programs. This Commentary highlights the work of six North Carolina CBOs that emphasize cultural safety and authentic relationships. By integrating local traditions, such as Black cultural heritage and Southern Appalachian farming, these organizations foster belonging and trust while addressing systemic inequities. As Food Is Medicine expands, larger businesses and institutions are delivering services that often prioritize efficiency and standardization over cultural and care-centered approaches, threatening to sideline the essential contributions of CBOs. Policy makers and health systems must ensure that CBOs remain central to the movement, preserving their role in delivering holistic Food Is Medicine solutions that honor local histories and truly serve the unique needs of their communities.

Next Steps in Efforts to Address the Obesity Epidemic

Obesity prevalence continues to rise globally at alarming rates, with adverse health and economic implications. In this state-of-the-art review, we provide an analysis of selected evidence about the current knowledge in the obesity literature, including a synthesis of current challenges in obesity and its determinants. In addition, we review past and current efforts to combat the obesity epidemic, highlighting both successful efforts and areas for further development. Last, we offer insights into the next steps to address the obesity epidemic and advance the field of obesity through both research and practice by (a) adopting a systems perspective, (b) fostering cross-sector and community collaborations, (c) advancing health equity, (d) narrowing the research-to-practice and research-to-policy gaps with multidisciplinary approaches, and (e) embracing complementary approaches for concurrent obesity prevention and treatment.

An Urban Farm-Anchored Produce Prescription Program's Impacts On Weight Reduction

In 2016, the Chicago Botanic Garden and Lawndale Christian Health Center collaborated to develop the Farm on Ogden, a 20,000-square-foot agriculture facility in a historically disinvested food desert in Chicago, Illinois. The partnership's VeggieRx produce prescription program refers patients to the Farm on Ogden for free produce boxes, nutrition counseling, and cooking classes. We first describe this unique cross-sector collaboration and then report on our evaluation of the VeggieRx program for the period January 2016-December 2021, using a retrospective propensity score-weighted cohort design. The overall sample included 680 VeggieRx participants and 978 weighted controls. At eighteen months, the VeggieRx group experienced a mean body weight difference of -6.71 pounds and percentage body weight difference of -4.7 percent relative to control. Our results suggest that Food Is Medicine interventions that anchor produce prescriptions to place-based strategies can improve health outcomes while investing in local communities.

Reclaiming Ancestral Abundance

This article tells the story of a generation of actions taken by the residents of the working-class Honolulu, Hawai'i, neighborhood of Kalihi Valley to merge the efforts of a federally qualified health center with Indigenous and cultural knowledge and practice to address diet-related illness. It recounts the narrative of Captain James Cook's arrival in 1778, which marked the beginning of resource extraction and the decline of traditional sustainable practices in Hawai'i. Fast forward to 2023, when alarmingly high rates of food insecurity in Native Hawaiian and Pacific Islander populations highlighted the ongoing effects of this history. Kōkua Kalihi Valley Comprehensive Family Services (KKV) has taken a proactive approach to addressing these challenges. Through community engagement and culturally relevant practices, KKV emphasizes the importance of ancestral knowledge and Hawaiian values, promoting a decolonized understanding of leadership and health. The initiative includes community food systems practices that foster connections to the land and encourage the revitalization of traditional Polynesian food practices, ultimately aiming to enhance the well-being of both individuals and the community.

Estimated Impact Of Medically Tailored Meals On Health Care Use And Expenditures In 50 US States

Medically tailored meals (MTMs) can reduce health care use among high-risk patients with diet-related conditions. However, the potential impact of providing coverage for MTMs across fifty US states remains unknown. Using a population-based, open-cohort simulation model, we estimated state-specific one-year and five-year changes in annual hospitalizations, health care spending, and cost-effectiveness of MTMs for patients with diet-related diseases and limitations in activities of daily living, covered by Medicaid, Medicare, or private insurance. Assuming full uptake among eligible people, MTMs were net cost saving in the first year in forty-nine states, with the largest savings seen in Connecticut ($6,299 per patient). The exception was Alabama, where MTMs were cost-neutral. The number of treated patients needed to avert one hospitalization ranged from 2.3 (Maryland) to 6.9 (Colorado). These findings can inform state-level policy makers and health plans considering MTM coverage through state-specific strategies.

Lifestyle Medicine, the USDA and the Land-Grant University Cooperative Extension System: A Call to Action at the Intersection of Personal, Public and Planetary Health

Increased collaboration between Lifestyle Medicine (LM) practitioners and the Cooperative Extension System (CES) presents a powerful opportunity to improve community well-being. Implementing community education programs enables residents to gain a deeper understanding of the importance of lifestyle changes-such as proper nutrition, physical activity, and stress management-in preventing and managing chronic diseases. These initiatives, coupled with regular clinical visits with trained LM practitioners, can help individuals assess their health risks and connect them with the resources and support needed for disease prevention, treatment, and reversal.

Community-Engaged Codesign and Piloting of the FOOD4MOMS Produce Prescription Program for Pregnant Latina Women

Background

Eating plenty of fruit and vegetables is key for maternal-child food and nutrition security. In the United States, fruit and vegetable consumption is lower among low-income families. Produce prescription programs (PRx) provide monetary benefits to low-income individuals to buy fresh produce or directly provide the produce itself to improve their food and nutrition security.

Objective

To codesign the FOOD4MOMS PRx (F4M) program for low-income Hispanic pregnant mothers and to test its feasibility through a pilot study using the Program Impact Pathway framework.

Methods

The participants for the codesign phase and the feasibility phase were recruited from the Hispanic Health Council Maternal Health Programs and the Special Supplemental Nutrition Program for Women, Infants and Children program. Listening sessions (LSs) with adult Hispanic pregnant and nonpregnant women with children aged <3 y were conducted and transcribed for thematic analysis to inform the F4M codesign. The pilot feasibility study only included adult pregnant women enrolled during the first 2 pregnancy trimesters.

Results

The 3 codesign LSs (n = 21 participants) showed that participants thought good nutrition was very important during pregnancy and were very interested in having skill-building nutrition classes as part of the PRx. Most participants preferred receiving incentives through the Fresh Connect card to allow them to choose their produce. They also recognized that some participants with limited transportation options may benefit from a produce box delivered at home. All pilot study participants chose the electronic benefit transfer card as their incentive redemption channel. The redemption rate of benefits by pilot participants was 70% and they felt that F4M helped them and their families consume more produce. Pilot participants reported high levels of satisfaction with F4M.

Conclusion

The community-engaged codesign approach likely explains the successful piloting of the feasibility of F4M and the strong satisfaction of the clients participating in it.

"Food Is Medicine" Strategies for Respiratory Health: Evidence From NHANES 2005-2012

OBJECTIVE

Compared with other diseases with similar global burdens, little is known about how lifestyle factors other than smoking affect respiratory health, and few studies have systematically investigated the combined associations between diet and respiratory health. The aim of this research was to examine the Dietary Inflammation Index (DII), Healthy Eating Index (HEI)-2015, and individual food and nutrient associations with multiple respiratory outcomes.

METHODS

This study combined a cross-sectional study with a prospective cohort study to systematically evaluate data from adults aged 40 years or older (N = 13,227) from 4 National Health and Nutrition Examination Survey cycles (2005-2006 through 2011-2012) with lung function measures in a subset (n = 6337). DII, HEI-2015, and individual foods and nutrients were evaluated for their associations with respiratory symptoms (cough, phlegm problem, wheezing, and exertional dyspnea), chronic lung disease (asthma, chronic bronchitis, and emphysema), lung function (percentage of predicted forced expiratory volume in 1 second [FEV1pp], percentage of predicted forced vital capacity [FVCpp], forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC), obstructive or restrictive spirometry patterns), respiratory cancer, all-cause mortality, and respiratory disease mortality.

RESULTS

For each point increase in DII, the odds of cough (adjusted odds ratio [aOR], 1.036; 95% CI, 1.002-1.071), wheezing (aOR, 1.044; 95% CI, 1.013-1.075), exertional dyspnea (aOR, 1.042; 95% CI, 1.019-1.066), emphysema (aOR, 1.096; 95% CI, 1.030-1.166), and restrictive spirometry patterns (aOR, 1.066; 95% CI, 1.007-1.128) increased and FEV1pp (adjusted mean difference [aMD], -0.525%; 95% CI, -0.747% to -0.303%) and FVCpp (aMD, -0.566%; 95% CI, -0.762% to -0.371%) decreased. HEI-2015 scores were similarly associated with these respiratory outcomes. Each point increase in the DII was associated with an increased risk of all-cause mortality (adjusted hazard ratio [aHR], 1.048; 95% CI, 1.025-1.071) and respiratory disease mortality (aHR, 1.097; 95% CI, 1.013-1.189); each increase in the HEI-2015 score was associated with a decreased risk of all-cause mortality (aHR, 0.994; 95% CI, 0.991-0.997). The multiple adequacy components recommended in the HEI (fruits, vegetables, whole grains, seafood and plant proteins, and monounsaturated fatty acids) were associated with better respiratory outcomes; the moderation components of restricting refined grains, sugars, and saturated fats were associated with better respiratory outcomes, but restricting sodium intake was associated with increased respiratory symptoms.

CONCLUSIONS

The results of this study suggest that a low-inflammatory diet and a healthy diet are consistently associated with better respiratory outcomes. These findings support the potential benefits of a "Food Is Medicine" strategy for respiratory health.

Registered Dietitian Nutritionists as Leaders in Lifestyle and Culinary Medicine

Registered Dietitian Nutritionists (RDNs) are uniquely positioned to lead in Lifestyle Medicine, Culinary Medicine and Food is Medicine, overlapping initiatives currently gaining momentum in health care. To become a credentialed practitioner, RDNs must demonstrate competency as outlined in The Scope and Standards of Practice defined by the Commission on Dietetic Registration (CDR), the credentialing agency for the Academy of Nutrition and Dietetics. Many CDR competencies align with the interventional and operational components necessary to deliver and direct effective Lifestyle Medicine (LM) and Culinary Medicine (CM) initiatives. Capitalizing on the skills and expertise of RDNs trained in LM and CM is an effective strategy to address the Quintuple Aim of better health care outcomes, lower cost, improved patient satisfaction, improved provider wellbeing and the advancement of health equity. Successful examples like Cooking with Plants, Trinity Health Ann Arbor's virtual CM series, showcase the positive impact of RDN-led CM initiatives on culinary literacy and health behavior change. This article provides an overview of the Cooking with Plants program and practical guidance for initiating similar programs at other institutions. Guidance includes strategies for assessing community needs, identifying funding sources, engaging stakeholders, and developing and evaluating curriculum.

Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives

Introduction

Medically tailored meals (MTMs) are home-delivered, nutritionally tailored meals for individuals living with complex or advanced diet-sensitive medical conditions. In 2020, Massachusetts Medicaid implemented the Flexible Services Program (FSP) through a Section 1115 Demonstration, which funded novel nutrition programs, including MTMs, for high-risk patients through Accountable Care Organizations (ACOs). Little is known from the practitioners' perspective regarding the facilitators and barriers to reaching and enrolling patients in MTM programs.

Methods

We interviewed 19 staff across four ACOs that had implemented MTM interventions. Interviews were conducted from Feb to Aug 2023 and included staff who participated in patient screening, referral, or enrollment. The interview guide was informed by the Health Equity Implementation Framework. Interviews were recorded and transcribed and coded using NVivo software. We used directed qualitative content analyses. The study team identified and discussed common themes and presented them back to our ACO partners.

Results

Staff described facilitators of and barriers to reach and enrollment related to several domains of the Health Equity Implementation Framework. For program (innovation) factors, facilitators included perceived positive effects on patient health outcomes and a relative advantage over both the status quo and other nutrition assistance programs; outreach by care team members rather than other staff; the eligibility criteria, which were viewed as appropriate and evidence-based; and the simplicity of the program, which aided communication with patients. Patient-related facilitators included patients being more in need of the program due to more severe illness and being more motivated to change dietary behaviors. Patient-related barriers included lacking a working phone or stable housing and concern about meals meeting taste and cultural food preferences. Staff-related barriers included limited time and especially knowledge about the MTM program.

Discussion

This study highlights the perspectives of front-line staff during the implementation of an MTM program in a state-wide 1,115 Demonstration. Staff may require multiple trainings to gain full knowledge about the program and increase self-efficacy in describing it with sensitivity. These new findings elevate voices from front-line healthcare staff in MTM delivery and can help inform strategies for effective, equitable implementation of MTM programs.

Connections between redlining, food access, hypertension, diabetes, and obesity in Boston

This paper explores how redlining has disproportionately impacted the Boston neighborhoods of Dorchester, Roxbury, and Mattapan. Initiated in the 1930s, the discriminatory practice of marking these neighborhoods as high-risk for lending has led to significant health inequities today. The paper focuses on how limited access to healthier foods in these areas contributes to a higher prevalence of chronic diseases such as hypertension and obesity, compared to wealthier neighborhoods. Additionally, the paper examines interventions aimed at reducing health disparities by improving affordability and access to nutritious foods. The findings underscore the need for comprehensive policies and interventions with community-based involvement to address food insecurity and health disparities that originated from redlining in Boston.

Association Between Healthful Plant-Based Dietary Pattern and Obesity Trajectories and Future Cardiovascular Diseases in Middle-Aged and Elderly: A Prospective and Longitudinal Cohort Study

We aimed to explore the association between plant-based dietary (PBD) patterns and obesity trajectories in middle-aged and elderly, as well as obesity trajectories linked to cardiovascular disease (CVD) risk. A total of 7108 middle-aged and elderly UK Biobank participants with at least three physical measurements were included. Dietary information collected at enrolment was used to calculate the healthful plant-based diet index (hPDI). Group-based trajectory modeling identified two trajectories for each adiposity measure: BMI Low-Smooth and High-Growth-Decline; FMI Low-Smooth and High-Growth-Decline; WHR Low-Growth and High-Growth. Logistic regression showed that participants in the medium and high hPDI groups were less likely to follow the BMI High-Growth-Decline (OR = 0.72, 95% CI: 0.60-0.87; OR = 0.49, 95% CI: 0.39-0.61), FMI High-Growth-Decline (OR = 0.71, 95% CI: 0.60-0.84; OR = 0.55, 95% CI: 0.46-0.66), and WHR High-Growth (OR = 0.73, 95% CI: 0.61-0.87; OR = 0.52, 95% CI: 0.43-0.63) trajectories. After a median follow-up time of 3.88 years, Cox regression showed higher CVD risk for participants in these trajectories (HR = 1.70, 95% CI: 1.37-2.11; HR = 1.68, 95% CI: 1.37-2.06; HR = 1.30, 95% CI: 1.04-1.63). A healthy PBD pattern was associated with the maintenance of a healthy BMI classification. Furthermore, the long-term stabilization of a healthy BMI classification may be linked to a reduced risk of CVD.

Produce prescription benefits redemption and activity in an observational study of 2680 Massachusetts Medicaid members

BACKGROUND

Food is Medicine interventions are increasingly employed to address food and nutrition insecurity and diet sensitive conditions, and advance health equity. Produce prescription (PRx) programs hold particular promise, providing funds to purchase fruits and vegetables as part of a treatment plan. Despite early evidence, key knowledge gaps remain regarding redemption and activity rates, identified as critical but understudied factors with research, clinical, and policy implications.

OBJECTIVES

This prospective observational study investigates benefits utilization in a population of 2680 Massachusetts Medicaid members enrolled in the Fresh Connect PRx intervention between July 2020 and December 2022.

METHODS

We examined trends overall, by duration of participation, alongside program changes, and by individual-level characteristics, providing a more complete picture of key correlates to benefits utilization.

RESULTS

Participants enrolling during program periods with access to larger number of stores had ≤14.5% absolute higher redemption rates [95% confidence interval (CI): 10.4, 18.7] and, separately, 5-fold greater likelihood of shopping each month (odds ratio 5.0, 95% CI: 3.7, 6.7) than those enrolled with fewest locations. Within individuals in the program 24 mo, participation increased with time, with active shoppers rising from 65% in month 1 to 75% in month 12 to 85% in month 24; and redemption rising from 31% to 68% to 88% over the same period. Redemption was also higher for females compared with males (5.9% higher, 95% CI: 3.0, 8.7), Asian compared with White participants (18.3% higher, 95% CI: 10.6, 26.1), and for participants reporting Spanish as their preferred language compared with English (13.9% higher, 95% CI: 10.9, 16.9).

CONCLUSIONS

Activity and redemption can each be high in PRx, and may be positively associated with more shopping locations, longer participation and program implementation experience, and specific participant demographic factors. These findings inform interpretation of prior and design of future research on PRx, health outcomes, and healthcare utilization.

Obesity Phenotypes, Lifestyle Medicine, and Population Health: Precision Needed Everywhere!

The worldwide prevalence of obesity is a key factor involved in the epidemic proportions reached by chronic societal diseases. A revolution in the study of obesity has been the development of imaging techniques for the measurement of its regional distribution. These imaging studies have consistently reported that individuals with an excess of visceral adipose tissue (VAT) were those characterized by the highest cardiometabolic risk. Excess VAT has also been found to be accompanied by ectopic fat deposition. It is proposed that subcutaneous versus visceral obesity can be considered as two extremes of a continuum of adiposity phenotypes with cardiometabolic risk ranging from low to high. The heterogeneity of obesity phenotypes represents a clinical challenge to the evaluation of cardiometabolic risk associated with a given body mass index (BMI). Simple tools can be used to better appreciate its heterogeneity. Measuring waist circumference is a relevant step to characterize fat distribution. Another important modulator of cardiometabolic risk is cardiorespiratory fitness. Individuals with a high level of cardiorespiratory fitness are characterized by a lower accumulation of VAT compared to those with poor fitness. Diet quality and level of physical activity are also key behaviors that substantially modulate cardiometabolic risk. It is proposed that it is no longer acceptable to assess the health risk of obesity using the BMI alone. In the context of personalized medicine, precision lifestyle medicine should be applied to the field of obesity, which should rather be referred to as 'obesities.'

Association of Dietary Intake with Chronic Disease and Human Health

Eating habits are among the major determinants of health, and in most countries in the world part of the population suffers from one or more problems related to malnutrition, by default (due to an acute or chronic lack of micronutrients) or by excess (energy, sugars, and fats, and deficiencies in important micronutrients) [...].

A Narrative Review of Cardiometabolic Profiles among U.S. Adults: Temporal Trends and Implications

PURPOSE OF REVIEW

To provide a narrative overview of trends and disparities in the cardiometabolic profiles of U.S. adults by synthesizing findings from nationally representative studies conducted between 1999 and 2020.

RECENT FINDINGS

During the study period, the cardiometabolic profiles of U.S. adults displayed a complex mix of trends. While there were notable improvements in specific risk factors, such as reductions in total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels, other aspects of cardiometabolic health worsened. The mean body mass index and hemoglobin A1c levels increased, accompanied by significant rises in the prevalence of obesity, type 2 diabetes, and metabolic syndrome. Despite some progress in blood pressure and lipid profiles, the overall cardiometabolic health of the population declined, with only a small percentage of adults maintaining optimal health by 2018. Furthermore, significant disparities persisted across racial and socioeconomic groups, with non-Hispanic Black participants and those with lower education and income facing higher cardiometabolic risks compared to their counterparts. Despite improvements in certain aspects of cardiometabolic profiles among U.S. adults, significant challenges remain, particularly with the rising rates of obesity, type 2 diabetes, and metabolic syndrome. Persistent disparities in cardiometabolic health across sociodemographic groups emphasize the need for comprehensive public health strategies that address medical care, lifestyle factors, and social determinants of health. Future efforts should prioritize reducing these disparities and enhancing health equity to mitigate the overall burden of cardiometabolic disease.

Improving Cooking Skills, Lifestyle Behaviors, and Clinical Outcomes for Adults at Risk for Cardiometabolic Disease: Protocol for a Randomized Teaching Kitchen Multisite Trial (TK-MT)

BACKGROUND/OBJECTIVES

This protocol describes a study to investigate the feasibility and preliminary efficacy of a novel Teaching Kitchen Multisite Trial (TK-MT) for adults with cardiometabolic abnormalities. The TK-MT protocol describes a hybrid lifestyle intervention combining in-person and virtual instruction in culinary skills, nutrition education, movement, and mindfulness with community support and behavior change strategies. This 18-month-long randomized controlled trial aims to evaluate the feasibility of implementing a 12-month, 24 class program, assess preliminary study efficacy, and identify barriers and facilitators to implementation.

METHODS

The intervention program includes 16 weeks of intensive hands-on culinary and lifestyle education classes followed by eight monthly virtual classes. Psychometric assessments and biometric data will be collected at baseline, 4, 12, and 18 months. Semi-structured interviews and open-ended surveys will be conducted during the 12-month follow-up assessment.

RESULTS

Feasibility will be assessed through recruitment, attendance, and fidelity data. Secondary outcomes will analyze changes in health behaviors, biometric data, and anthropometric measures using mixed-effects regression models. Qualitative data will undergo thematic analysis.

CONCLUSIONS

As envisioned and described in detail in this manuscript, this study will inform the development and implementation of reproducible, scalable teaching kitchen interventions. The protocol described here is intended to set the stage for future investigations to evaluate evidence for the impact of teaching kitchen interventions on dietary habits, physical activity, and overall health and well-being.

Development of a statewide network hub for screening, referral, and enrollment into food as medicine programs across Kentucky

Widespread recognition of food as medicine interventions' role in reducing food insecurity and improving health outcomes has recently emerged. Several states have released In Lieu of Services, state-approved alternative services that may be offered by managed care organizations in place of covered benefits, or 1,115 Medicaid waivers, which may allow for expanded nutrition services to reduce food insecurity and improve health outcomes. However, there are significant gaps in understanding how to create a statewide system for delivering "healthcare by food" interventions. The University of Kentucky Food as Health Alliance first piloted the development of a statewide hub facilitating referral to, enrollment in, and evaluation of food as medicine programs across two healthcare providers (one urban and one rural). We then used a quasi experimental study design to examine effects on systolic and diastolic blood pressure in a target population of Medicaid eligible individuals aged 18-64 with high blood pressure and/or type 2 diabetes in rural and urban areas. Participant allocation was based on geographic location for each program arm with no control group. This feasibility case study aims to: (1) outline the development of a referral system between healthcare and food as medicine providers; (2) describe gaps in referral and enrollment; (3) summarize lessons learned from a statewide network as a blueprint for other states; and (4) present clinical outcomes across three food as medicine programs. Ninety-two referrals were received from UK HealthCare with 21 enrolled in medically tailored meals and 28 enrolled in a grocery prescription (53% enrollment rate). Thirty-two referrals were received from Appalachian Regional Healthcare with 26 enrolled in meal kits (81% enrollment rate). On average, the reduction in systolic blood pressure was 9.67 mmHg among medically tailored meals participants and 6.89 mmHg among grocery prescription participants. Creating a statewide system to address food insecurity and clinical outcomes requires key support from a host of stakeholders. Policy steps moving forward need to consider funding and infrastructure for screening, referral, enrollment and engagement hubs for improved health outcomes.

Clinical trial registration

ClinicalTrials.gov, NCT06033664.

Differences in US Adult Dietary Patterns by Cardiovascular Health and Socioeconomic Vulnerability

Background

Naturally occurring dietary patterns, a major contributor to health, are not well described among those with cardiovascular disease (CVD) - particularly in light of socioeconomic vulnerability. We sought to identify major dietary patterns in the US and their distribution by CVD, social risk factors, and Supplemental Nutrition Assistance Program (SNAP) participation.

Methods

This was a cross-sectional study among 32,498 noninstitutionalized adults from the National Health and Nutrition Examination Survey (2009-2020). We used principal component analysis to identify common dietary patterns. Individuals were assigned to the pattern for which they had the highest component score. Using multinomial logit regression, we estimated the percentage whose diets aligned with each pattern in population subgroups stratified by CVD, social risk factors, and SNAP. Analyses were adjusted for age, gender, race and ethnicity, total energy intake, and year, with sampling weights to provide nationally representative estimates.

Results

Four dietary patterns were identified among US adults: American (33.7%; high in solid fats, added sugars, and refined grains), Prudent (22.6%; high in vegetables, nuts/seeds, oils, seafood, and poultry), Legume (15.8%), and Fruit/Whole Grain/Dairy (27.9%), that together explained 29.2% of dietary variance. More adults with prevalent CVD (37.1%) than without (33.3%, p=0.005) aligned with the American Pattern, with no differences among other patterns. Each additional social risk factor associated with more adults aligned with American (2.5% absolute increase) and Legume (1.3%), and fewer aligned with Prudent (-1.9%) and Fruit/Whole Grain/Dairy (-1.9%) patterns (p<0.001 each). Analysis of dietary patterns across SNAP participation showed higher proportion of SNAP participants and income-eligible SNAP non-participants compared to non-eligible adults for the American (40.2% [38.1, 42.3%], 35.1% [32.7, 37.5%], 31.9% [31.0, 32.8%], respectively) and Legume patterns (17.2% [15.6, 18.8%], 17.8% [16.1, 19.5%]), 15.4% [14.6,16.1%], respectively) and less for Prudent (17.0% [15.5, 18.6%], 20.2% [18.2, 22.3%], 24.2% [23.3, 25.1%], respectively) and Fruit/Whole Grain/Dairy Patterns (25.6% [23.8%, 27.3%], 26.9%[27.6%,29.5%], 28.6% [27.6%, 29.5%], respectively).

Conclusions

Empirical dietary patterns vary by CVD and socioeconomic vulnerability. Initiatives to improve nutrition in at-risk individuals should consider these naturally occurring dietary patterns and their variation in key subgroups.

Implementing Food as Medicine During COVID-19: Produce Prescriptions and Integrative Group Medical Visits in Federally Qualified Health Centers

Background

Food as Medicine is a rapidly developing area of health care in the United States, aimed at concurrently addressing nutrition-sensitive chronic conditions and food and nutrition insecurity. Recipe4Health (R4H) is a Food as Medicine program with an integrative health equity focus. It provides prescriptions for locally grown produce ('Food Farmacy') with or without integrative group medical visits, alongside training for clinic staff.

Objectives

To describe the initial implementation of R4H in four Federally Qualified Health Centers in Northern California, using a convergent mixed-methods approach.

Methods

We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) implementation science framework to assess the first two years of R4H (2020-2022). We draw from 40 interviews (26 partner organization staff, 14 patients) and program data on reach and adoption. Qualitative data were analyzed using codebook thematic analysis.

Results

Reach: From January 2020 to August 2022, 3255 patients were referred to the program; 1997 of those referred (61%) enrolled in the Food Farmacy only (N = 1681) or Food Farmacy + integrative group medical visits (N = 316). Participating patients included a wide range of ages (mean age 41.4, [SD 20]; 18% < 18 years old) and racial and ethnic backgrounds (3% American Indian or Alaska Native, 6% Asian or Pacific Islander, 19% Black, 57% Hispanic/Latine, 7% white). 69% were female; 43% primarily spoke Spanish. Adoption: 84% of trained clinic staff referred two or more patients to R4H. Implementation: Elements of successful implementation included: (1) support from county government leadership, (2) centralized coordination of the multi-sector partnership, and (3) a flexible approach responsive to organizational and COVID-related shifts. R4H implementation informed statewide Medicaid policy changes. Maintenance: To date, all four clinics continue to participate in R4H.

Conclusion

Centralized implementation, training, and administration of Food as Medicine programs can strengthen community health centers' capacities to concurrently address chronic conditions and food insecurity. Multi-sector partnerships can support Food as Medicine program sustainability.

Integrating food is medicine and regenerative agriculture for planetary health

The urgent need to address both human and environmental health crises has brought attention to the role of food systems in driving climate change, biodiversity loss, and diet-related diseases. This paper explores the intersection of Food is Medicine (FIM) and regenerative agriculture (RA) as an emerging approach with the potential to help address the interconnected challenges of human and ecological health within healthcare and food systems. FIM programs, such as produce prescriptions and medically tailored meals, aim to improve health outcomes by increasing access to nutritious foods and promoting nutrition equity. RA, focusing on soil health, biodiversity, and reduced reliance on synthetic inputs, offers more sustainable agricultural practices that can align with FIM goals. This paper highlights key opportunities, recent policy developments, and evidence gaps, calling for concerted efforts to clearly define RA practices and foster collaboration between community, healthcare, agriculture, and policy stakeholders. Strengthening these interconnections could lead to more resilient food systems and improved health outcomes at both individual and population levels.

Comparing models that integrate obstetric care and WIC on improved program enrollment during pregnancy: a protocol for a randomized controlled trial

BACKGROUND

Low-income, rural pregnant women are at disproportionate risk for adverse pregnancy outcomes as well as future cardiovascular risk. Currently, less than half of eligible women enroll in the Women, Infants, and Children's (WIC) Program. This study aims to evaluate whether integrating clinical care and social care may advance health equity and reduce health disparities by directly linking women receiving obstetric care to the Special Supplemental Nutrition Program for WIC and/or a Registered Dietitian/Nutritionist (RDN).

METHODS

This pragmatic study is situated in real-world care and utilizes a randomized controlled trial design. A total of 240 low-income, rural, pregnant patients will be recruited from Geisinger (Pennsylvania, USA) obstetric clinics and randomized to receive one of four models: (1) Clinic; (2) Clinic-WIC; (3) Clinic-RDN, or (4) Clinic-WIC-RDN. Participants provide consent for electronic referrals that directly link their contact information from the electronic health record to WIC and/or RDN. Patients in the Clinic model receive standard prenatal care, which includes provision of basic information about WIC. The Clinic-WIC model includes a clinical decision alert to queue clinical staff to ask about WIC interest and place a referral to WIC using a social health access referral platform. In turn, WIC staff contact the pregnant woman about enrollment. The Clinic-RDN model includes a referral to an RDN for telehealth counseling to promote heart healthy eating and food resource management. The Clinic-WIC-RDN model includes referrals to both WIC and RDN. The primary outcome is difference in WIC enrollment between the Clinic and Clinic-RDN models versus the Clinic-WIC and Clinic-WIC-RDN arms at 6-months post-baseline. Secondary endpoints include WIC retention and adherence, change in participant behavior, skills, and food security, preterm delivery, birthweight, and maternal and child health outcomes. Implementation outcome measures include acceptability, appropriateness, and feasibility from the perspective of clinic and WIC staff.

DISCUSSION

Study findings will inform system models that integrate clinic care and social care to improve health equity among a high-risk population. Specifically, these findings will advance implementation of strategies to increase enrollment in a widely available but underutilized food provision program during pregnancy.

TRIAL REGISTRATION

ClinicalTrials.gov identifier (NCT06311799). Registered 3/13/2024.

Food Is Medicine: The Time Is Now

Virtually every professional society globally now endorses a plant-forward diet that is lower in fat and processed foods as key components of disease prevention and health promotion. It is characterized by whole grain foods, and predominantly made of fresh foods. With healthcare expenditures at record levels across the globe, implementing a treatment plan that has larger magnitude health improvements than nearly any known medicine, that is extremely inexpensive, and has the power to not only improve human health but also planetary health is critical. That plan is Food is Medicine (FIM) which will be explored in this manuscript.

Food is Medicine National Summit: Transforming Health Care

Food is Medicine (FIM) interventions reflect the critical links between food security, nutrition security, health, and health equity, integrated into health care delivery. They comprise programs that provide nutritionally tailored food, free of charge or at a discount, to support disease management, disease prevention, or optimal health, linked to the health care system as part of a patient's treatment plan. Such programs often prioritize health equity. On 26-27 April, 2023, Tufts University's Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy and Food & Nutrition Innovation Institute held a 2-day National Food is Medicine Summit with leaders, practitioners, and individuals with diverse lived experiences in health care, research, government, advocacy, philanthropy, and the private sector to identify challenges and opportunities to sustainably incorporate FIM services into the health care system and at scale. This report of a meeting describes key themes of the Summit, based on presentations and discussions on momentum around FIM, incorporating FIM in health care, tradeoffs and unintended consequences of various FIM models, scaling of programs, financing and payment mechanisms, educating and engaging the health care workforce, and federal and state government actions and opportunities on FIM. Speakers highlighted examples of recent public and private sector actions on FIM and innovative cross-sector partnerships, including state Medicaid waivers, academic and philanthropic research initiatives, health care system screenings and interventions, and collaborations including community-based organizations and/or entities outside of the food and health care sectors. Challenges and opportunities to broader implementation and scaling of FIM programs identified include incorporating FIM into health care business models, educating the health care workforce, and sustainably scaling FIM programs while leveraging the local connections of community-based organizations. This meeting report highlights recent advances, best practices, challenges, and opportunities discussed at the National Summit to inform future actions on FIM.

Will a Programmatic Framework Integrating Food Is Medicine Achieve Value on Investment?

Diet-related chronic diseases account for seven out of the ten leading causes of death in the USA. Food is Medicine (FIM) interventions can be effective adjuncts to standard medical care to address this cost burden. While the Food is Medicine Pyramid recommends some culinary skill development when integrating FIM into healthcare, the emphasis is on medically tailored meals and food provision. Hence, there is a practice gap to ensure patients develop the necessary skills to apply nutrition recommendations into improved food behaviors to achieve positive long-term health outcomes. This paper presents a theoretical framework for optimizing existing clinical services to provide FIM interventions, tracking associated improvements in patient outcomes, and identifying healthcare cost saving/revenue generation that can lead to a net value on investment. It describes how these interventions can and have been used in a clinical setting as adjuncts to clinical care. While there is published evidence for each modality individually, the literature lacks evidence of the value of an integrated approach. The framework therefore provides a roadmap to both identify best practices and evaluate outcomes that will inform viable financial models.

Health outcomes reported by healthcare providers and clients of a community-based medically tailored meal program

BACKGROUND

Medically tailored meal (MTM) programs provide home-delivered meals to people living with serious illness and poor nutritional status. Client outcome studies have found evidence of decreased healthcare utilization and cost savings associated with MTM program participation, and inconclusive evidence of change in health measures. The purpose of this study was to use a novel observational framework to describe the client profile and change in health outcomes using routinely collected health and program data from a community-based MTM program at MANNA (Philadelphia, PA).

METHODS

Clients reported their self-rated health and experiences of food insecurity and malnutrition. Healthcare providers reported clients' body mass index, systolic blood pressure, and hemoglobin A1C. These health outcomes, measured at program intake and 3-6 months later, were linked with administrative data for 1,959 clients who completed at least two months of MTM services in 2020, 2021, and 2022.

RESULTS

Clients exhibited substantial heterogeneity in demographics and health status at intake. Self-reported malnutrition risk decreased significantly over program duration (p < .001). Nearly one-third of clients with poor health reported improvement over time. Over 60% of clients with obesity experienced stable BMI. Clients with hypertension experienced significant improvements in systolic blood pressure (p < .001). Clients with diabetes and available data (n = 45) demonstrated significant reduction in hemoglobin A1C (p = .005).

CONCLUSION

We found evidence that participation in MANNA's MTM program was associated with favorable health outcomes for clients with serious illness and nutritional risk. Community-based organizations can maximize the completeness of their data by focusing on routinely collected internal data like validated health screeners and surveys.

Opportunities for General Internal Medicine to Promote Equity in Obesity Care

The number and complexity of obesity treatments has increased rapidly in recent years. This is driven by the approval of new anti-obesity medications (AOMs) that produce larger degrees of weight loss than previously approved AOMs. Unfortunately, access to these highly effective therapies and to integrated team-based obesity care is limited by intra-/interpersonal patient, institutional/practitioner, community, and policy factors. We contextualized these complexities and the impact of patients' social drivers of health (SDOH) by adapting the social ecological model for obesity. Without multi-level intervention, these barriers to care will deepen the existing inequities in obesity prevalence and treatment outcomes among historically underserved communities. As General Internal Medicine (GIM) physicians, we can help our patients navigate the complexities of evidence-based obesity treatments. As care team leaders, GIM physicians are well-positioned to (1) improve education for trainees and practitioners, (2) address healthcare-associated weight stigma, (3) advocate for equity in treatment accessibility, and (4) coordinate interdisciplinary teams around non-traditional models of care focused on upstream (e.g., policy changes, insurance coverage, health system culture change, medical education requirements) and downstream (e.g., evidence-based weight management didactics for trainees, using non-stigmatizing language with patients, developing interdisciplinary weight management clinics) strategies to promote optimal obesity care for all patients.

Stakeholder Perspectives on the Acceptability, Design, and Integration of Produce Prescriptions for People with Type 2 Diabetes in Australia: A Formative Study

Produce prescription programs can benefit both individuals and health systems; however, best practices for integrating such programs into the Australian health system are yet unknown. This study explored stakeholders' perspectives on the acceptability, potential design and integration of produce prescription programs for adults with type 2 diabetes in Australia. Purposive sampling was used to recruit 22 participants for an online workshop, representing six stakeholder groups (government, healthcare service, clinician, food retailer, consumer, non-government organisation). Participant responses were gathered through workshop discussions and a virtual collaboration tool (Mural). The workshop was video-recorded and transcribed verbatim, and thematic analysis was conducted using a deductive-inductive approach. Stakeholders recognised produce prescription as an acceptable intervention; however, they identified challenges to implementation related to contextuality, accessibility, and sustainability. Stakeholders were vocal about the approach (e.g., community-led) and infrastructure (e.g., screening tools) needed to support program design and implementation but expressed diverse views about potential funding models, indicating a need for further investigation. Aligning evaluation outcomes with existing measures in local, State and Federal initiatives was recommended, and entry points for integration were identified within and outside of the Australian health sector. Our findings provide clear considerations for future produce prescription interventions for people with type 2 diabetes.

The Role of Food and Beverage Environments in Child Health and Weight-Related Behaviors

This article explores how food and beverage environments influence child health and obesity risk and addresses institutional settings, retail environments, food assistance programs, and food and beverage industry marketing. It emphasizes social determinants of health, evidence-based interventions, and policy recommendations to promote healthier food options and reduce inequities. Pediatric health care providers play a critical role in addressing the need for systemic changes to eliminate inequities in food environments and the systems that support these inequities.

Estimating the impact of addressing food needs on diabetes outcomes

Objective

To estimate the association between food needs and diabetes outcomes.

Research design and methods

Longitudinal cohort study, using a target trial emulation approach. 96,792 adults with type 2 diabetes mellitus who underwent food need assessment in a network of community-based health centers were followed up to 36 months after initial assessment. We used targeted minimum loss estimation to estimate the association between not experiencing food needs, compared with experiencing food needs, and hemoglobin a1c (HbA1c), systolic and diastolic blood pressure (SBP and DBP), and LDL cholesterol. The study period was June 24th, 2016 to April 30th, 2023.

Results

We estimated that not experiencing food needs, compared with experiencing food needs, would be associated with 0.12 percentage points lower (95% Confidence Interval [CI] -0.16% to -0.09%, p = < 0.0001) mean HbA1c at 12 months. We further estimated that not experiencing food needs would be associated with a 12-month SBP that was 0.67 mm Hg lower (95%CI -0.97 to -0.38 mm Hg, p < .0001), DBP 0.21 mm Hg lower (95%CI -0.38 to -0.04 mm Hg, p = .01). There was no association with lower LDL cholesterol. Results were similar at other timepoints, with associations for HbA1c, SBP, and DBP of similar magnitude, and no difference in LDL cholesterol.

Conclusions

We estimated that not experiencing food needs may be associated with modestly better diabetes outcomes. These findings support testing interventions that address food needs as part of their mechanism of action.