‘Food as medicine’ gains more traction

The proverbial saying, “You are what you eat” has been around for centuries, but it’s gained new meaning and support in recent farm bills. You can expect even more discussion about the important linkages between food, disease prevention, and overall health as lawmakers continue their work on a new farm bill in 2023.

These more recent legislative efforts are commonly referred to as “food as medicine” or “produce prescriptions” and are widely billed as ways to not only improve health but save federal dollars.

“Eighty percent of healthcare dollars in this country are allocated to preventable chronic disease, yet nine out of 10 Americans don’t meet the government’s own recommendations for fruit and vegetable consumption,” said Cathy Burns, CEO of the International Fresh Produce Association, during a recent Agri-Pulse Ag & Food Policy Summit. “There is a clear and significant role for food interventions in the healthcare system.

She argued that produce prescriptions are a practical and scalable solution, which are already demonstrating positive outcomes through federally funded pilot programs.

“You go to the doctor, you get a diagnosis, and they give you a prescription for fruits and vegetables to treat your condition. Imagine a world where your diagnosis is being treated by what’s on your plate, not by what’s in a pill,” Burns added. “This could be transformational for the trajectory of human health in this country.”

The first produce prescriptions were funded in the 2014 farm bill and further expanded through the Gus Schumacher Nutrition Incentive Program of the 2018 farm bill. Up to 10% of the $250 million allocated over five years was earmarked for produce prescriptions.

But these types of pilot programs are gaining steam from coast to coast.

Most recently, Agri-Pulse reported that Department of Veterans Affairs health care systems in Houston and Salt Lake City will provide veterans with fresh fruit and vegetables as well as nutrition coaching to test whether produce prescriptions can improve the health of people with diet-related health conditions. 

Some 500 veterans will get produce benefits worth $100 a month for up to a year through the Fresh Connect program, which provides debit-type cards to beneficiaries. The research is expected to take another year to complete, according to a VA official. 

The pilot projects are co-sponsored by the VA and The Rockefeller Foundation.

The National Produce Prescription Collaborative, of which IFPA is a member, estimates that over 200 organizations administer PRx interventions.

“A growing body of evidence, including 30-plus studies in peer-reviewed scientific and economic journals in the past five years, suggests that PRx improves intake of fruits and vegetables, improve overall dietary quality, and importantly for clinical care, improve weight, blood pressure and lower Hemoglobin A1C among patients in poor cardiometabolic health,” NPPC said in a letter urging continued adoption of produce prescriptions.

GusNIP funded 108 pilot projects in 32 states to validate that an increase in fruits and vegetables can reduce body mass index, reduce weight, and improve blood sugar levels. Over 1,000 Medicare and Medicaid managed care plans also validate the data of the effectiveness of produce prescriptions, IFPA said.

These initiatives could significantly expand the amount of fruits and vegetables consumed in the U.S., but some “food as medicine” advocates want to expand these programs to other types of “healthy” foods as well.

For example, Sen. Roger Marshall, who is an obstetrician by training and from Kansas, is unusually positioned on the agriculture committee to make the case that nutrition, including adequate amounts of iron and vitamins D and B6, is critical to maternal and fetal health.

Marshall’s pitch wasn’t just for fruits and vegetables. Two foods that meet the “food as medicine” definition, according to Marshall, are whole milk, for vitamin D, and “lean Kansas beef,” for iron.

The potential economic impact of more “food as medicine” programs looms large, especially if embraced by more health insurance programs.

Burns pointed out that 150 million Americans are covered by federal healthcare when you factor in Medicare, Medicaid, Children’s Health Insurance Program, the Department of Veterans Affairs, Indian Health Service and others.

“If you take Medicare alone, we can approximate that around 30 million enrollees would be eligible to participate due to diet-related disease and food insecurity,” Burns said.

“Assuming a modest $40 per month for a produce prescription benefit per person, this could translate to $14.4 billion annually in fruits and vegetables just in Medicare. If you replicate that across federal healthcare systems and then have private insurers mimic that because they see the benefits, we are talking about something transformational.”

Looking at the next farm bill, Burns said it’s not likely to provide the resources for scaling up produce prescriptions over the longer-term, but current pilots could provide “the data needed to show positive health outcomes for healthcare to scale on its own.

“And while that is happening, outside the scope of the farm bill, we need states to take advantage of these Medicaid 1115 waivers to use food-based intervention in their states.”

Burns makes a strong case for changing the high rate of diet-related diseases and obesity in the U.S.

“If we don’t change the trajectory of how this next generation eats, they will be the first generation that doesn’t live as long as its parents.”

Editor’s note: Sara Wyant is publisher of Agri-Pulse Communications, Inc., www.Agri-Pulse.