Food is Medicine expert urges policymakers to advance nutrition interventions

At the Food is Medicine (FIM) Advocacy Day on Capitol Hill, US, the FIM Institute and stakeholders met with members of Congress to help advance the movement. The institute says there is a public demand for food and nutrition-based interventions, encouraging policymakers and healthcare providers to expand their implementation.

Nutrition Insight discusses how the institute envisions expanding FIM policies with Ronit Ridberg, Ph.D., a research assistant professor at the FIM Institute at the Friedman School of Nutrition Science and Policy at Tufts University, US. 

“We are encouraged by support at the highest levels of government for food and nutrition as a key driver of health and political will to advance solutions highlighting the role of food and nutrition. We hope that FIM can retain the historically bipartisan support it has enjoyed so far,” says Ridberg.

However, she notes that the movement also faces challenges, including “federal efforts to deeply cut spending; competition with other related spending priorities; and challenges inherent with asking for new funding (e.g., pilots).” 

In addition, Ridberg explains that it is not uncommon to conflate FIM with existing federal food assistance programs, some of which are “politically divisive.” For example, the Supplemental Nutrition Assistance Program has come under threat due to House Republicans’ proposed budget changes. 

“Therefore, it is important to explain how FIM interventions such as medically tailored meals, medically tailored groceries, and produce prescriptions are distinct and serve a different (yet complementary) purpose.” 

FIM advocacy

The FIM Institute’s second annual Advocacy Day on Capitol Hill included nearly 200 attendees from at least 28 states and the D.C. area, says Ridberg. 

“This represented a wide cross-section of voices invested in FIM — patients and participants in FIM programs, physicians, registered dietitians, food industry representatives, food banks, providers of FIM services and products (medically tailored meals, medically tailored groceries, and produce prescriptions), healthcare systems, life insurers, researchers, nonprofit organizations, and more.” 

Produce prescription programs enable patients with food insecurity or diet-related health risks to access healthy produce.Although FIM enjoys support across sectors, Ridberg says that in some cases, there are variations in definitions or perspectives on how best to operationalize the concept of FIM and prioritize its related policy goals. 

The FIM Institute aims to inform and drive the development and implementation of federal policy solutions to advance the movement. 

“A key way we do this is by disseminating and translating the Institute’s research so that policymakers and related stakeholders can understand the results and the potential implications for program and policy change.”

Driving federal policy

Ridberg highlights several options for policymakers to advance the implementation of FIM interventions and meet the public demand for such programs. 

For example, she suggests using Medicaid 1115 demonstration waivers or passing the Medically Tailored Home-Delivered Meals (MTM) Demonstration Pilot Act. Ridberg explains that MTM was led by a bipartisan group of legislators in both the House and Senate in the prior (118th) Congress and is anticipated to be re-introduced during the current (119th) Congress. 

She also calls for continued funding of the Gus Schumacher Nutrition Incentive Program, which comprises three competitive grant programs in nutrition incentives, produce prescriptions, and training and technical assistance.

In addition, she says the institute would like to see the movement advance “through appropriations for FIM and nutrition research at National Institutes of Health, for the Department of Health and Human Services FIM initiative, and for produce prescription pilots at the Veterans Health Administration and Indian Health Service.”

Growing public support

Ridberg was the lead author of a recent study assessing US public awareness of FIM and support for such interventions. The results show that a majority of US adults would be interested in food-based nutrition interventions, although FIM awareness was much lower — under 30% of respondents. 

Medically tailored meals are prepared and nutritionally customized meals for people with specific diseases or diet-sensitive conditions.The surveys for this research were conducted between February and April 2023, so Ridberg says they do not reflect FIM awareness that may have occurred since — “a time when we’ve seen incredible momentum in federal and state-level policies as well as private sector engagement.” 

“Our results, even from two years ago, indicate strong interest in participating in FIM programs, such that it may be time to consider consumer-facing awareness-raising efforts. We know consumer demand drives policy and program implementation, even when evidence generation is still underway.”

“The proportion of respondents expressing familiarity with FIM might be different if we conducted the survey today,” she adds. “Any gap we see represents a great opportunity for education and awareness building, which is what we were aiming for on the FIM Advocacy Day on Capitol Hill.”

Time for greater uptake

Ridberg calls for greater uptake of FIM as US citizens are suffering immensely from the physical and mental effects of diet-related chronic disease. 

“They understand the role of nutrition in their health, are eager to engage in conversations with their healthcare providers about their diets and to participate in opportunities to consume healthier food, and many need support to do so.” 

“FIM programs are designed to address the most challenging barriers people face to healthy eating, including access, affordability, nutrition education, and integration into other elements of health care treatment plans.”  

Ridberg urges policymakers to advance the implementation of FIM interventions and meet the public demand for such programs.“Members on both sides of the aisle have echoed the administration’s attention to the high prevalence of diet-related chronic conditions that comprise many of the leading causes of death and disability and the highest costs to the healthcare system, as well as the role that our food system can play in mitigating these conditions.”

Beyond the burden of proof

Ridberg highlights that there is sufficient scientific evidence for the benefits of FIM interventions. She details that research supports that increasing fruits, vegetables, whole grains, legumes, nuts, seeds, and fish and seafood can improve the health of individuals based on a range of diet-related chronic diseases such as obesity, heart disease, type 2 diabetes, and some cancers. 

“We as researchers want to move beyond the burden of proving that healthy food provided in FIM interventions has beneficial health outcomes and instead work more strategically to pursue questions regarding program components like ideal dose and duration, or, household spillover effects (e.g., how an individual’s participation in an FIM program might contribute more broadly to improving household dietary habits or health outcomes).” 

Ridberg urges researchers, clinicians, and policymakers to continue to work together to advance and, importantly, evaluate policies and translate and interpret results clearly for multiple audiences across policy and practice.

“We need to work together to improve workflow for screening and referral into FIM programs, and we need to establish resources to support individuals if and when their FIM program ends.” 

“We have used food for millennia to improve our health daily — and we also use food to celebrate and enjoy our families, history and culture,” she says. “FIM programs offer a powerful opportunity to bridge the gaps we’ve created over time between what we choose to eat and how best to support our health.”