Food Is Medicine research hits home, helps patients improve long-term health
April 9, 2024
More than 1 in 8 Dallas County residents and nearly 1 in 5 children don’t have access to enough affordable, nutritious food. The deep-rooted, multifaceted issue of food insecurity elevates the risk of chronic diseases, such as high blood pressure, diabetes, obesity, and other cardiovascular conditions.
Many families – and even some doctors – have a limited understanding of the medicinal nature of food and how poor nutrition can impact long-term health. While society often blames individuals for making unhealthy food choices, the truth is that for many people it’s not a choice but a survival tactic.
A growing body of research points to four primary barriers to healthier eating:
- Food access: Many people live in communities with no local grocery store nearby and no transportation to a place to purchase nutritious foods that are linked to better health, such as whole grains, beans, and fresh, frozen, and even canned produce.
- Nutrition education: There is limited understanding of which foods promote long-term health. U.S. schoolchildren get less than eight hours of nutritional education a year; 40-50 hours would be needed to make an impact, according to the Centers for Disease Control and Prevention (CDC).
- Access to kitchen equipment: People with unstable housing or limited income may not have the necessary pots, pans, and cooking equipment to prepare healthy meals.
- Culinary literacy: Data from 2021 show that just 28% of U.S. adults cook at home daily, and 5% say they “hate” to cook. Even more people may not know how to combine ingredients in a healthy, delicious, and nutritious way.
Health care providers have the chance to fight food insecurity at the point of care. The primary care and Culinary Medicine teams at UT Southwestern at RedBird are launching two Food Is Medicine initiatives to improve access to nutritious food and health care in our community. Our goal is to establish a sustainable model to meet patients where they are as a long-term partner in their nutrition and overall health.
What is Food Is Medicine?
Food Is Medicine (FIM) is a movement to provide people and communities with education, counseling, and access to affordable, nutritious food as part of their health care to prevent, manage, or treat specific conditions and food insecurity and typically includes medically tailored meals and groceries and produce prescriptions prepared with the guidance of a registered dietitian.
FIM programs take a holistic view of a patient’s relationship with food – cultural, emotional, and physical. They also advance health equity and provide connections to food and financial assistance. For long-term success, these programs must ensure patients have sustainable access to food resources as well as the tools and skills to make healthy food part of their lives.
FIM programs have been successful. A recent study found that patients’ food insecurity improved in three out of five produce prescription programs and the odds of remaining food insecure decreased by 24%-48% after an average of six months.
UTSW is adding to the body of FIM research. Cardiologists Ambarish Pandey, M.D., M.S.C.S., and Eric Peterson, M.D., M.P.H., were awarded a $400,000 grant from the American Heart Association for PRODUCE-HF, an 18-month study exploring how produce delivery paired with food and medication counseling could improve diet, medication adherence, and hospital readmission rates among patients with heart failure.
Our teams at RedBird have seen patients reverse high blood pressure without medication by gaining access to healthy foods and nutrition education. The two initiatives we are launching address the physical, emotional, and financial barriers associated with food insecurity – all within the comfort of the patients’ community.
Study: Personal coaching and medically tailored groceries
In January 2024, we launched the Medically Tailored Groceries and Food Resource Coaching study to understand which FIM interventions are most effective at improving patient health and satisfaction. The study is funded by a grant from the AHA, one of just 19 to be awarded in 2024 – and one of two earned by UT Southwestern.
Our team includes Kelseanna Hollis-Hansen, Ph.D., M.P.H. and Tammy Leonard, Ph.D., faculty members in UT Southwestern’s Peter O’Donnell Jr. School of Public Health, and culinary dietitian Milette Siler, RDN, one of the most experienced culinary medicine specialists in the U.S. serving patients at Moncrief Cancer Institute and UTSW RedBird.
Medically tailored groceries (MTG) are nutritious food items selected to support health conditions. This initiative focuses on patients with lower income receiving care at Parkland Health’s CV Roman Clinic with at least one chronic health problem such as diabetes, high cholesterol, or high blood pressure.
Patients who want to participate will have access to a food pantry co-located with their clinic and managed by our partner, Crossroads Community Services. Participants will be randomized into three groups for four months:
- Routine pantry access.
- MTGs from the pantry.
- One-on-one food resource coaching and MTGs from the pantry.
Patients can choose whether to continue getting food from the pantry at the end of the study, and they will have the option to swap foods from their MTG list if they wish. The goal is not to tell people what to do or eat but to make healthy choices easier to access.
Those who get coaching throughout the study will learn basics about why certain foods are recommended – for example, how eating foods such as whole grains, oats, nuts, and seeds can help manage blood sugar levels. They’ll also get guidance on how to access local, state, and federal food resources such as SNAP and WIC benefits, and how continuing to use food resources can impact their health. Participants get coaching when they come to Crossroads to pick up their food, reducing the need for extra trips.
We will analyze the data to determine whether MTG and coaching helped participants improve their nutrition and health. Using what we learn, we hope to create larger, longer-range programs that can be offered to more people in safety-net clinics throughout Dallas-Fort Worth.
Medically tailored grocery list
High-fiber, low-sodium, and low-sugar foods are key to managing blood sugar, blood pressure, and healthy cholesterol. MTGs can be customized to fit food pantry inventory, patient preferences, and specific nutritional needs. Here is an example of foods you might see in an MTG grocery list that could be great options for someone with type 2 diabetes and high blood pressure:
Oatmeal
Whole-wheat pasta
Brown rice
Dry or canned beans
Bagged nuts, unsalted
Canned light tuna
Frozen chicken
MTG list (continued)
Eggs
Canned vegetables, low- or no-salt-added varieties
Canned diced tomatoes, low-sodium
Fresh and frozen fruit, such as berries, oranges, and apples
Fresh and frozen vegetables, such as onions, carrots, and broccoli
Some programs are very granular. UTSW's takes a novel approach that is intentionally NOT overly specific for several reasons. Food pantries see a lot of fluctuation in available products, and we don’t want participants to feel boxed in with their choices. In general, the same dietary pattern is appropriate for most health conditions – it doesn’t have to be complicated to be effective!
Group cooking classes: Exploring Culinary Medicine
Starting in April 2024, we launched a series of group medical visits in culinary medicine in the communities surrounding the UTSW Medical Center at RedBird in Southwest Dallas County. This program builds on our existing Culinary Medicine Clinic and serves people who have any health condition that could be improved with FIM. Roughly 20% of participants experience food insecurity.
In six sessions, patients get their vitals checked and attend a cooking class where they will learn how to use basic kitchen equipment to make nutritious meals at home. Participants take home key kitchen tools after each class, along with recipes, handouts, and personal goals in a binder.
Our first sessions, which are covered by many private and public health insurers, are in partnership with Oak Cliff Bible Fellowship, where we are leasing a kitchen and building community co-leadership into the model of care.
The goal is to bring neighbors together and help people in our communities reshape their relationships with food through positive social experiences and building culinary skills. People may be worried about cost, or they may not trust hospitals with their health, so partnering with local, established organizations provides a comfortable environment and may help us reach people who otherwise might not have been interested.
We plan to expand sessions into more locations in the future, including a planned launch at Concord Church in fall 2024.
The future of FIM
Texas has the second-worst rate of food insecurity in the nation, according to the U.S. Department of Agriculture. From 2022-2023, food insecurity rates across the nation increased by 31%.
Ultimately, policy changes will be necessary to reduce the number of food deserts in Texas and improve availability of healthy foods for everyone. But academic medical centers like UT Southwestern are poised to help communities now, starting with increased awareness among providers about FIM.
In 1985, the National Academy of Sciences recommended medical schools include at least 25 hours of nutrition education, a goal very few medical schools reach even today. By 2010, survey responses indicated that just 27% of medical schools were meeting that criteria, down from 38% in 2004.
Recently, there has been a renewed movement to emphasize nutrition education in medical training:
- In 2018, a bipartisan group in Congress called the Food Is Medicine Working Group met with leaders from medical accreditation organizations to focus on nutrition education.
- In 2023, the Accreditation Council for Graduate Medical Education (ACGME) gathered medical accrediting organizations for a Summit on Medical Education in Nutrition and published the proceedings to promote national collaboration in the advancement of nutrition education.
Culinary medicine programs are one strategy for hands-on nutrition education in a teaching kitchen, and we pioneered this at UTSW with our medical students, expanding to other learners including residents and fellows. UTSW students also have practical integration of nutrition education into existing courses, including virtual modules followed by application to patient dietary change counseling. Advancing nutrition education across the entire continuum of health professional education is essential to equip physicians to collaborate on FIM strategies.
FIM is a logical and essential step in empowering patients with sustainable food sources, nutritional knowledge, and culinary literacy. It is a strategy that can help us break the cycle of chronic, preventable diseases – particularly among marginalized populations that bear the greatest burden of these conditions.
Starting with the basics, such as access to fresh and nutritious food, we can support the people in our communities and help them take steps toward a healthier future.
For more information, call 214-645-8300 or request an appointment online.
