Food is Medicine Treats Chronic Disease

We are what we eat, and not enough Americans eat foods that promote health and wellness. According to the United States Department of Agriculture (USDA), poor nutrition is a leading cause of illness in the United States. It’s also associated with more than half a million deaths each year.

Healthy foods can help. But they only help those with access to them, a privilege seemingly made rarer each year. Wages, housing, and even racial disparities too often determine who has access and who doesn’t.

Mass General Brigham has introduced its “Food is Medicine” strategy to make healthy foods a reality for millions of Americans facing food insecurity, or those living without enough access to foods for an active, healthy life.

“Creating a healthier America shouldn’t be limited to developing a new medication or a new medical procedure,” says Elsie Taveras, MD, MPH, chief community health and health equity officer at Mass General Brigham. “Not only do we want to use what we eat to stop chronic diseases linked to poor nutrition from progressing, but we want to use those foods to prevent those conditions from developing in the first place.”

According to Dr. Taveras, Lauren Fiechtner, MD, MPH, director of the Pediatric Nutrition Center at Mass General for Children, and Priscilla Wang, MD, MPH, associate medical director of primary care health equity at Mass General Brigham, Mass General Brigham uses Food is Medicine to combat institutional barriers standing between patients and healthy foods.

They explain how the strategy works and how it can ultimately serve as a model for preventing chronic diseases nationwide.

What is Food is Medicine?

Mass General Brigham’s Food is Medicine strategy encourages health care providers to view food the same way they view any other medical care, especially when treating diet-related conditions. Providers can refer these patients to sustainable sources of healthy food — a food pantry or a cooking course, to name a few — and observe how they respond.

“Like many medications, it’s not enough for a patient to eat a single healthy meal and expect to feel better instantly,” says Dr. Fiechtner. “Patients with chronic diseases need to know how they’ll find their next healthy meal tomorrow, next month, or next year. As a health system, it’s up to us to present that path.”

How do health care providers identify food insecurity?

Patients who visit a Mass General Brigham primary care clinic receive screenings for food insecurity as part of a broader screen for social drivers/determinants of health (SDOH). These screenings are administered prior to routine primary care visits, and also to patients admitted to the system’s hospitals.

Mass General Brigham Community Care Vans, which bring providers into at-risk communities for screenings and treatment, offer screenings for food insecurity, too.

Mass General Brigham encourages providers to consider social drivers of health during their evaluation. These reflect how social conditions and environments affect a patient’s health, including impacting access to nutritious food.

Social drivers of health include where people are:

• Born
• Live
• Learn
• Work
• Play
• Worship

Barriers to healthy foods

Food security and nutrition security are not the same. People with food security have enough to eat. Those with food security may have consistent access to foods. But certain drivers of health may prevent them from accessing nutritious foods that can that promote well-being and prevent, or even treat, disease.

“You can have plenty of food security but little-to-no nutrition security,” says Dr. Taveras. “You can have all the sugary drinks and processed meats in the world, but if you don’t have access to vegetables, dairy, grains, and healthy fats, then what good is that?”

Many Americans do not know where they will find their next meal, never mind whether that meal exceeds their daily limit for added sugars or fats. In fact, ultra-processed foods — foods altered with unhealthy additives and preservatives — make up nearly 60% of what adults eat, according to research on American food consumption.

Common barriers that make it hard for some people to access healthy foods include:

• Finances: Food insecurity is directly related to financial insecurity and poverty, according to Feeding America. People trying to balance rising costs of basic needs like groceries and rent, with low or unstable wages, may be forced to make difficult decisions about the foods they buy.
• Location: In 2020, the USDA reported that about 19 million people nationwide live in food deserts, or areas that lack access to affordable, healthy foods. The National Institutes of Health (NIH) reports that food deserts exist in urban or suburban neighborhoods without grocery stores that offer healthy foods options, or in rural areas where the nearest grocery stores are too far away.
• Structural racism: According to the USDA, Black families are twice as likely as white families to experience food insecurity. According to the NIH, food deserts are more common in neighborhoods with a majority of ethnic or racial minority residents, due to factors like structural racism.
• Social isolation and stigma: Older adults who live alone may depend on food deliveries from family and friends. Additionally, many who experience food insecurity may not feel willing to speak up. According to Dr. Wang, individuals may not feel comfortable sharing this information with their health care providers directly, or experience stigma from others if they are accessing food-related benefits (formerly known as “food stamps”).
• COVID-19 pandemic: School closures prevented children from participating in federally funded meal plans. Closed businesses, disrupted supply chains, and inflation led to unemployment and skyrocketed the cost of food.

“The financial repercussions of the pandemic will last at least 5 to 10 years,” says Dr. Fiechtner. “People have less money and are less willing to donate to food banks while lines at food pantries are only growing longer.”

How does food insecurity affect chronic health conditions?

According to USDA’s 2020-2025 Dietary Guidelines for Americans, nutrition-related chronic diseases, or long-term illnesses from unhealthy eating habits, affect about half of American adults. A few of the most common chronic health conditions linked to poor nutrition include:

• Cardiovascular disease
• High-blood pressure (hypertension)
• Type 2 diabetes
• Obesity

Food can also impact:

• Memory
• The risk of stroke
• Cholesterol
• Parkinson’s disease
• Polycystic ovary syndrome (PCOS)

Can foods prevent chronic conditions?

Yes. All foods contain nutrients, or chemicals that help the body function. Generally, there are two types of nutrients:

1. Macronutrients: Large nutrients made of complex molecules, such as fats, proteins, and carbohydrates
2. Micronutrients: Small nutrients, such as vitamins and minerals, that help the body grow and develop

Plant-based foods — foods from the ground or trees — possess the right balance of both nutrients. For people 2 years and older, the U.S. Departments of Agriculture and Health and Human Services recommend making fruit and vegetables, especially whole fruits and vegetables of different colors, one half of their total food eaten.

They recommend the other half consist of:

• Grains
• Dairy
• Protein
• Oils with lower saturated fat

Can foods increase the risk for chronic conditions?

Certain foods can heighten the risk for chronic diseases or worsen existing conditions. These include foods and drinks high in:

• Added sugars, such as sugary drinks (sports drinks or soda, to name a few)
• Saturated fat, such as butter, beef, and some baked or fried foods
• Sodium, such as deli meat sandwiches, pizza, and egg dishes
• Alcohol, such as beer, wine, and liquor

Moreover, processed foods and certain red meats can trigger inflammation — the immune system’s response to damaged tissue — throughout the body. Numerous studies link diets with lots of red and processed meats with colorectal cancer.

“I’ve had patients tell me that when they eat a ‘cleaner’ diet, they physically feel better,” says Dr. Wang. “There is a connection between our environment, what we eat, our gut microbiome (the bacteria that live in our gut), and overall gut health.”

How does Food is Medicine address food insecurity?

Mass General Brigham relies on partnerships with the Greater Boston Food Bank and food services from community organizations across Massachusetts to dismantle barriers to healthy foods.

The Greater Boston Food Bank

The Greater Boston Food Bank sources food for more than 600 agencies statewide. Much of the food includes produce just as fresh, if not fresher, than the fruit and vegetables found in a grocery store, says Dr. Fiechtner, who serves as Health and Research Advisor at the Greater Boston Food Bank.

“A lot of people think of food pantries and immediately think of canned foods, but this couldn’t be further from the case,” she adds.

Dr. Fiechtner works with the food bank to conduct a statewide survey on food access and equity. The survey measures:

• Statewide food insecurity
• Barriers to healthy foods
• Participation in government-funded food assistance programs, such as SNAP and WIC
• Students enrolled in federally funded school meals

She hopes her research can persuade insurance providers to treat food more like medicine. MassHealth, a program that can help pay for, and provide, health benefits for Massachusetts residents, may cover the costs of food for several months. However, such coverage may not last long enough to meet a patient’s need.

“Food insecurity is a chronic condition,” Dr. Fiechtner adds. “It can last years, which is why we need to better understand how long coverage for food should last, the long-term effects of these healthy foods, and what kinds of upstream levers affect the foods people eat.”

Community-based organizations

If a patient screens positive for food insecurity, clinical and social care teams can refer them to any one of several partner organizations, many of which receive food from the Greater Boston Food Bank. They can also refer patients to the food pantry and teaching kitchen at MGH Revere HealthCare Center (if the patient receives care at MGH Revere), a Mass General Brigham dietician, or several government-subsidized food programs.

Not everyone receives the same referral.

“Think of the referral as a prescription,” says Dr. Wang. “Not all medications treat the same disease. A patient who needs a medically tailored meal for their diabetes may need the services of an organization that won’t necessarily meet the needs of another individual. Our team members can help find the right match.”

Mass General Brigham funds several food programs offered by partner organizations, including:

• About Fresh: They offer a “Fresh Connect” program and a “Fresh Truck” program. “Fresh Connect” helps health care organizations cover the cost of healthy foods. The “Fresh Truck” program operates school buses turned into mobile markets that deliver fresh good across Boston neighborhoods.
• Community Servings: They provide medically tailored meals for approximately 264 people with chronic, but preventable, diseases. They provide 10 meals per week for up to 6 months with a focus on communities impacted by racial inequities.
• La Colaborativa: At this community-based kitchen in Chelsea, Massachusetts, staff prepare and serve healthy community meals. They host healthy meal prep demonstrations and nutrition courses.
• GreenRoots: A teaching kitchen next to Chelsea’s Urban Farm and Community Garden where residents can gather, build community, learn how to grow their own produce, and cook fresh, healthy meals. The kitchen focuses on medically tailored classes for preventing and managing chronic diseases.
• MGH Revere Food Pantry: The food pantry opened at MGH Revere HealthCare Center in 2020. It provides pre-packaged plant-based foods to families facing food insecurity. It also offers a teaching kitchen where patients can learn how to create healthy meals from the food they receive.
• The Food Bank of Western Massachusetts: The food bank prepares and delivers medically tailored meals and other services, including nutrition education and referrals to social service organizations.
• Salem Food Pantry: In partnership with the North Shore Physicians Group, the Salem Pantry provides access to free, weekly mobile pop-up markets across the Salem community. Families receive fresh, free produce from the markets.
• Phoenix Food Hub: A collaborative project spearheaded by Greater Lynn Senior Services (GLSS) as part of the Lynn Food Security Task Force. The project brings together nutrition-related supports from organizations across the city of Lynn within a single 4,800-square-foot space.

Next steps in the Food is Medicine strategy

In 2022, the Biden-Harris Administration hosted the first White House Conference on Hunger, Nutrition, and Health in more than 50 years. In collaboration with the conference, Mass General Brigham committed $8.4 million to double down on its Food is Medicine strategy.

The financial commitment helps Mass General Brigham scale operations among its community-based partner organizations. It has already inspired researchers across the health care system to validate the profound impact food can make.

Their latest work includes:

• Plant-based food: Mass General for Children researchers observed a decrease in the body mass indexes (BMI) of children whose families received weekly plant-based food packages from the MGH Revere Food Pantry. BMI estimates body fat levels based on height and weight.
• Ultra-processed food: Mass General researchers found that eating ultra-processed foods can increase the risk of stroke and impair brain functions.

Drs. Taveras and Fiechtner also have launched the Healthy Weight Clinic with the American Academy of Pediatrics (AAP) to make evidence-based pediatric weight management care available to patients nationwide . The program encourages families to prioritize a daily hour of activity for their children, as well as meals balanced with fruits and vegetables. It also trains providers how to address unmet social needs in their community. It is one of six programs of its kind recognized by the Centers for Disease Control and Prevention (CDC) and AAP.

“Our goal with every service is to meet patients where they are,” says Dr. Taveras. “The more social drivers of health we can identify and address, the more we expect the health and wellness of patients to improve.”