Prescribing food as medicine

May 11th, 2018 / By Steve Delaronde

As the U.S. healthcare system tries to manage the 60 percent of persons with at least one chronic disease that consume 90 percent of healthcare costs, it is an opportune time to consider the advice offered by Hippocrates, the father of medicine, to “let food be thy medicine, and medicine be thy food.” Not only can proper nutrition prevent such chronic conditions as diabetes and heart disease, but the right diet can reverse conditions that are primarily being treated with expensive drugs and medical procedures.

Healthy eating is one of the five healthy habits that researchers found can increase a person’s lifespan by at least 12 years, along with not smoking, limiting alcohol, increasing physical activity and maintaining a normal weight, according to a study published in Circulation in April 2018. A high body mass index (BMI), smoking and high fasting plasma glucose have been identified as the three most important risk factors for adverse health outcomes according to a study published in JAMA in April 2018.

Unfortunately, promoting the positive impact of food has not been part of the U.S. medical establishment, which has focused on drugs, tests, and medical procedures. Primary care physicians (PCPs) are trained as diagnosticians, not nutritionists. Pharmaceutical drugs, diagnostic tests, medical procedures and the option to refer a patient to a specialist are within the PCP’s armamentarium of treatment options. Only 25 hours of nutrition education is recommended for medical students, and only 29 percent of U.S. medical schools provide that according to a 2015 report in the Journal of Biomedical Education.

Medical nutrition therapy (MNT) and home-delivered meal services are beginning to change the relationship between medicine and nutrition. A 2013 study assessing the impact of intensive nutritional services delivered to a Medicaid population with chronic conditions demonstrated decreased healthcare costs in the first three months compared to a group of patients with similar medical conditions that did not receive services. A similar study published in Health Affairs in April 2018 measured the impact of a meal delivery program on the healthcare costs of a dually eligible Medicaid and Medicare population. The result was an average monthly net savings of $220 for those that received medically tailored meals and $10 for those that received a non-tailored food program compared to a control group.

MNT and home-delivered meal services are resource intensive, but inexpensive compared to the costs of most other medical interventions used to treat chronic disease. Smart phone applications are another low cost, but increasingly effective, option for managing chronic disease and promoting good nutrition. These devices can allow healthcare providers to track patient activities, nutrition and symptoms, as well as push information and recommendations to patients.

A Harvard Business Review article published in April 2018 highlights the challenge of not only getting providers and patients to try an app that helps manage appropriate medication, exercise, dietary recommendations and routine patient monitoring of symptoms, but getting them to use it regularly. Tracking calories and nutritional intake has always been a manual effort. There are now applications available that allow the user to take pictures of their food to get estimated calorie counts and nutritional information, thereby increasing the possibility of adoption by users.

Changing the healthcare system to encourage physicians to consider and prescribe food as medicine will only work when incentives are aligned. Payers must not only be open to reimbursing virtual physician visits, MNT and medically tailored food programs in the fee-for-service model, but value-based care programs need to prioritize and measure the role of proper nutrition in maintaining health and managing chronic disease.

Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems.