Prescribing Food as Medicine Lowers Weight, Blood Pressure, and Blood Sugar

Kenny Lin, MD, MPH
Posted on September 18, 2023

At the health system where I work, I can refer patients with food insecurity and chronic health conditions that are sensitive to diet quality to a “Food Farmacy” to meet with dietitians and to receive free produce from local food pantries. Similar “food as medicine” programs have been piloted throughout the United States, including several led by family medicine residencies. As Dr. Jen Middleton wrote on the AFP Community Blog, the 2022 White House Conference on Hunger, Nutrition and Health made a number of policy recommendations to improve the accessibility of nutritious foods, including “accelerat[ing] access to ‘Food Is Medicine’ services to prevent and treat diet-related illness.” However, research on the health outcomes of such programs has been limited.

In a recent study published in Circulation: Cardiovascular Quality and Outcomes, researchers evaluated the effect of produce prescriptions on food insecurity and health status in nearly 4,000 adults and children at 22 sites located in 12 states; 63% of households were enrolled in the Supplemental Nutrition Assistance Program (SNAP), and 83% were enrolled in the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC). Clinicians referred patients for enrollment in nutrition classes, and individuals or households received paper vouchers or electronic cards averaging $63 per person per month to purchase fruits and vegetables from participating grocery stores and farmer’s markets. Program durations varied from four to 10 months.

Compared to preprogram enrollment, the daily fruit and vegetable intake of adults and children increased by 0.85 and 0.26 cups, respectively. Produce prescriptions were associated with decreased food insecurity (odds ratio, 0.63) and improvements in self-reported health status in 85% of patients. Adults with diabetes saw their absolute A1C levels drop by 0.29%, and adults with overweight or obesity had average decreases in body mass index of 0.36 kg per m². Adults with hypertension had lower systolic and diastolic blood pressures of 8.4 mm Hg and 4.9 mm Hg, respectively, at the end of the program.

Although health insurers have not historically paid for patients to fill healthy food prescriptions, a few Medicare Advantage and Medicaid programs now cover produce purchases and other nutrition-focused interventions in high-risk patients. In addition to health gains, the economic case for expanding and sustaining these programs in the long term is strong. A microsimulation modeling study projected that over a lifetime,

implementing produce prescriptions in 6.5 million US adults with both diabetes and food insecurity would prevent 292 000 (95% uncertainty interval, 143 000–440 000) cardiovascular disease events, generate 260 000 (110 000–411 000) quality‐adjusted life‐years, cost $44.3 billion in implementation costs, and save $39.6 billion ($20.5–58.6 billion) in health care costs and $4.8 billion ($1.84–$7.70 billion) in productivity costs. The program was highly cost effective from a health care perspective (incremental cost‐effectiveness ratio: $18 100/quality‐adjusted life‐years) and cost saving from a societal perspective (net savings: $−0.05 billion).

A 2018 AFP editorial provided other practical information for clinicians to help patients with food insecurity, including a list of food assistance programs for children and adults.