The following are key points to remember from a state-of-the-art review about strategies for nutrition security and cardiometabolic health equity:

1. “Food is Medicine” (FIM) initiatives are defined as food-based nutritional interventions integrated within health systems to treat or prevent disease and advance health equity. These initiatives address food-related risks such as poor nutrition, food insecurity, and nutrition security. Strategies range from prevention targeting a broad patient population to treatment of specific patients with known chronic health conditions.
2. FIM programs highlight the importance of interdisciplinary team-based collaborative care. Registered dietician nutritionists can provide custom food recommendations based on a patient’s medical conditions and preferences. Social workers can assist with navigating eligibility and referrals to the multitude of available social programs and FIM programs for patients.
3. Population-level health food policies and programs target adults and children in the general population with or at risk for poor metabolic health by addressing systems and environmental barriers to equitable health food in populations. Examples include ensuring nutrition standards for school meals and early childcare systems, food service nutrition standards, information on package labels, restaurant menus, and warning labels, taxes on unhealthy foods or beverages, and regulatory standards on additives such as sodium or added sugar.
4. Government nutrition security programs target adults and children from lower income households who often have food or nutrition security or other social needs. Examples include SNAP (Supplemental Nutrition Assistance Program), WIC (Special Supplemental Nutrition Program for Women, Infants, and Children), school breakfast and lunch programs, and nutrition programs for older adults.
5. Medically tailored groceries (delivered to the home or obtained by direct pick up) and produce prescription programs (patients redeem benefits directly at grocery store or farmers market) target patients with a diet-sensitive health risk or chronic condition who can still prepare and cook their own meals and are combined with nutrition and culinary education. A national modeling study of produce prescriptions was assessed for approximately 6.5 million adults with diabetes and food insecurity and was found to be highly cost-effective over a lifetime ($18,100/quality-adjusted life-year).
6. Medically tailored meals (MTMs) target patients with multiple complex comorbidities and limited activities of daily living by providing tailored, fully prepared meals delivered to the home along with nutrition and culinary education. A meta-analysis of five studies showed lower annual health care expenditures (19.7%; 95% confidence interval, 6.9%-62.3%) and 47% fewer annual hospitalizations. In a national simulation model, MTMs were estimated to result in a net cost savings of $13.6 billion after an 8-month intervention period consisting of 10 weekly MTMs.
7. The benefit of FIM programs on food security, diet quality, health outcomes such as decreased glycated hemoglobin and weight loss, and health care utilization, costs, and cost-effectiveness have been reported. However, further research regarding factors such as patient eligibility, intervention dose, foods covered, cultural inclusiveness, impact on vulnerable populations, and health equity are needed to support uptake and expansion.
8. Integrated health systems and private payers have been early adopters of FIM interventions and have provided evidence for scalability across different health delivery systems. Government-sponsored programs have lagged with limited coverage options such as Section 1115 waivers in select states (Medicaid) and coverage of meals or coverage of food and produce (Medicare Advantage plans).
9. Medical nutrition education (MNE) and culinary education are critical and an increased emphasis on training of all health professionals is needed. Few US medical schools meet the recommended minimum of 25 hours of MNE. The Accreditation Council for Graduate Medical Education plans to make MNE a mandatory requirement for residency and fellowship accreditation in the 2026 update.
10. The 2022 White House National Strategy on Hunger, Nutrition, and Health set a goal to end hunger, increase healthy eating, and increase physical activity to reduce diet-related diseases and related health disparities. Multiple pillars support the efforts of various FIM initiatives, including improving food access and affordability, integrating nutrition and health, and enhancing nutrition and food security research.

Clinical Topics: Prevention

Keywords: Cardiometabolic Diseases, Health Equity, Nutrition Therapy

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