How Food Is Medicine Screens and Treats Food Insecurity

According to the U.S. Department of Agriculture (USDA), 17 million households struggled at least once in 2022 to provide enough food for all its members due to a lack of resources. They lacked food security, putting them at risk for chronic, diet-related diseases, such as diabetes and hypertension, not to mention severe, sudden conditions like stroke.

Mass General Brigham uses its Food is Medicine strategy to treat, and prevent, diet-related diseases by addressing poor nutritional options. But how exactly do patients enter a clinic and walk away with reliable access to healthy foods?

“It’s not enough to hand someone vegetables, fruit, and brown rice to eat. That might help for one day, but then what?” says Jacob Mirsky, MD, MA, DipABLM, a Mass General Brigham primary care doctor. “We need to understand what’s preventing patients from accessing those foods in the first place and connect them with resources that will help them overcome barriers to eating and enjoying healthy foods every day.”

Dr. Mirsky, who also heads the MGH Revere Food Pantry at MGH Revere HealthCare Center and Priscilla Wang, MD, MPH, a Mass General Brigham internal medicine doctor and associate medical director of primary care health equity, describe how Mass General Brigham providers screen patients for food insecurity and refer them to food services at partner community organizations.

Together, they outline the patient journey.

How are you screened for food insecurity?

Patients at Mass General Brigham primary care clinics receive screenings before certain routine visits about social drivers of health (social conditions that can affect your health). Patients admitted to Mass General Brigham hospitals are assigned these screenings as well. Staff who work directly with patients, like community health workers or care managers, also may screen patients as part of their workflow.

These screenings ask patients to answer two food-related questions:

1. Within the past 6 months, how often have you worried about running out of food before you can access money to buy more?
2. Within the past 6 months, have you felt like the food you just bought didn’t last as long as it should have and that you didn’t have enough money to buy more?

A provider can sometimes spot food insecurity without asking either question.

“Maybe they’re talking with their provider and mention how hard it is to eat healthy or that they can’t afford fruits or vegetables like they used to,” says Dr. Mirsky. “This raises a red flag.”

What happens if you screen positive for food insecurity?

Screening results enter your electronic medical record, where your care team can see positive results and act on them. You may be referred to a community health worker or another care team member to follow up on this.

Your care team may then ask if you’re enrolled in one of two federally-funded health and nutrition programs:

1. Supplemental Nutrition Assistance Program (SNAP): Offers participants a monthly dollar amount on a preloaded Electronic Benefits Transfer (EBT) card. This benefit used to be referred to as “food stamps.”
2. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): Instead of providing a dollar amount for food items, participants receive a WIC card that allows them to buy select foods from authorized grocery stores. WIC chooses select foods based on nutritional value and standards from the United States Department of Agriculture (USDA).

Unfortunately, social stigmas can discourage many patients from using these services.

“I’ve had patients tell me that they’ll never use ‘food stamps’, and they might even say, ‘Well, I don’t want to take away help from someone else who needs it more,’” says Dr. Wang. “But actually food benefits are underused, and can really make a big difference in improving health and wellness.”

What food-related services are you referred to?

Providers can use several tools to treat food insecurity.

Any member of the care team can refer you to community-based organizations partnered with Mass General Brigham. These organizations span across Massachusetts and offer programs that make healthy, plant-based foods more accessible to at-risk community members.

Programs include:

• Food pantries, where patients can access consistent sources of healthy, plant-based foods
• Teaching kitchens, where patients can learn how to transform plant-based foods into delicious meals
• Food prescriptions, which enable people to buy foods they need to stay healthy or receive pre-packaged foods tailored to a medical condition

“One of the most important things we can do as a health system is serve as a connector between patients and these resources that are critical for their health,” says Dr. Mirsky. “It’s just like a prescription for medication; it’s something that a trusted member of the health care team is recommending you do to improve your health.”

Food pantries

The MGH Revere Food Pantry at MGH Revere HealthCare Center is one of several food pantries providers can refer patients to.

In 2020, Mass General Brigham opened the food pantry for patients screening positive for food insecurity. The pantry supports a limited number of patients, however, due to extraordinary demand, and only accepts new referrals if space allows.

Those accepted to the pantry join a patient roster and receive free plant-based foods every week for the entire household. Workers at the pantry assign a pick-up time and day. Staff members pre-package bags of donated plant-based foods and hand them to patients at the door. Vans can also deliver bags to patients who cannot readily access the pantry.

How much food do patients typically receive?

The amount of food in someone’s package depends on the size of their household. The more members of the household, the more food that is provided. This can be anywhere from 20 to 60 pounds weekly, which is enough to feed the entire household daily.

Bags only contain plant-based foods, including:

• Leafy greens
• Fresh fruit
• Canned beans
• Brown rice
• Pasta
• Tomato sauce
• Peanut butter
• Cereal
• Apple sauce

Where do the plant-based foods come from?

Every 2 weeks, the Greater Boston Food Bank delivers approximately 8,000 to 10,000 pounds of food to the pantry. The pantry supplements its supply with a few more thousand pounds of food from Fresh Food Generation via the MassHealth Flexible Services Program, a program used to address food and housing stability across Massachusetts, as well as the non-profit Boston Area Gleaners.

On special occasions, the pantry may receive special foods, like tofu. Depending on the foods they receive, staff can substitute certain items for those more aligned with a patient’s cultural preference. A family with Caribbean roots, for example, may prefer plantains and black beans instead of chickpeas and pasta.

Teaching kitchens

The MGH Revere Food Pantry also offers a teaching kitchen where patients can learn how to make healthy meals from plant-based foods. Recipes taught in the kitchen require inexpensive, simple ingredients found at most grocery stores. They can range from stir fry to sweet potato peanut curry.

Featured recipes usually only require ingredients found in the pantry’s pre-packaged bags.

Lessons from the teaching kitchen

Cooking and meal prep classes can teach you:

• Basic ingredients for a quick, healthy meal. Leafy greens and vegetables can boost the immune system, the body’s main defense against disease. They also make for a tasty snack.
• Alternative utensils and ingredients. If you don’t have a wok, you can use deep pans or skillet for a stir fry meal, several servings of which can feed an entire family. Simple ingredient substitutions, like choosing whole wheat pasta instead of white pasta, can help patients eat healthier, too.
• Health literacy and kitchen safety: Reading the percentage daily value of ingredients, such as sodium, fats, and added sugars, can help patients limit excess. Learning how to hold a knife by its handle when cutting carrots or peppers can also save a trip to the Emergency Room.

Food prescriptions

Several partner organizations offer food “prescriptions” that empower you to purchase healthy foods on your own.

“I think we have to be careful not to play into the stereotype that people who don't have enough — those who lack economic resources to purchase food — are somehow ignorant or not aware of what foods are good for them,” says Dr. Wang. “I think most people can say, ‘Yes, I know vegetables are healthy and fruits are healthy, but can you believe how much a box of blueberries costs?’”

Payment cards

The company About Fresh provides technology that helps healthcare organizations cover the cost of food for the people they serve. Mass General Brigham providers can enroll qualifying patients in the company’s Fresh Connect program, which provides a prepaid card that people can use to buy fresh produce.

According to the company, the prepaid cards work at:

• Grocery stores
• Farmers’ markets
• Mobile markets

Custom meals

Providers can also connect eligible patients to Community Servings, a regional program offering meals tailored to the nutritional needs of thousands of people across Massachusetts and Rhode Island. Patients who cannot shop or cook for themselves or their families due to a critical illness can enroll in this program.

The program offers 16 medical diets for people living with specific conditions. One example: the Kidney Kind diet, which provides food for people with end-stage kidney disease or diabetes who need to limit the vitamins they eat (sodium, potassium, and phosphorous, to name a few) and fluids they drink.

Evolving Food is Medicine for future patient needs

According to Dr. Mirsky, the Food is Medicine program will evolve with the needs of its patients. The MGH Revere Food Pantry, for example, began inside a small, renovated closet months before the COVID-19 pandemic.

The pandemic left the U.S. economy in crisis. Unemployment, increased rents, and inflation left millions of more Americans questioning where they may find their next meal.

The food pantry responded to the needs of Massachusetts residents accordingly. Its operations expanded dozens of square feet and now features a walk-in freezer to accommodate several more tons of food. By the end of 2024, Dr. Mirsky says the pantry will increase its number of accepted patients by 50%.

Dr. Wang believes community care providers and social workers can help further streamline the patient journey. While clinicians may know generally about food and nutrition resources, community health workers and other role groups with expertise in these areas may more effectively be able to connect the right patient to the right resource.

“The more seamless we can make the transition from screening a patient to seeing them eat a nutritious plant-based diet, the sooner they can see the impact of those foods in their daily life,” she says. “That impact might be the difference in enabling them to live a fulfilling and healthy life years from now.”