Healthy Health Care

produce prescription program

There is a global epidemic of diet-related chronic disease. One of every five deaths globally is due to suboptimal diets, accounting for more than any other risk factor, including tobacco. Emerging evidence suggests that food and nutrition interventions in coordination with health care settings may be associated with improved health outcomes and decreased health care costs.

Food is Medicine

“Food is Medicine” interventions are being explored to prevent, manage, and treat illness through improved diet and lifestyle, such as medically tailored meals, medically tailored groceries (for example, food ‘farmacies’ or healthy food prescriptions), and produce prescriptions. [1] These interventions are usually implemented by clinicians; funded by health care, government or philanthropy; and are provided to patients at no or very low cost. [1]

Medically tailored meals

Medically tailored meals are fully prepared home-delivered meals designed by a dietitian based on individual needs determined through nutrition counseling. The target population of these meals are patients with complex medical conditions who are physically unable to shop or prepare meals. Patients participating in medically tailored meals have demonstrated a range of positive outcomes, including decreased in-patient hospital admissions, decreased overall health care costs, and increased diet quality among food-insecure individuals. [1-4]

Medically tailored groceries

Medically tailored groceries reach a broader range of patients than medically tailored meals, because the patient cooks and prepares food at home. For medically tailored groceries, a nutrition professional selects grocery items as part of a treatment plan for food insecure patients with diet related chronic and acute conditions (e.g., diabetes, cardiovascular disease). The patient collects non-prepared grocery items from a clinic or other community location, and cooks or prepares the food at home. Measured impact of this intervention is not as robust as medically tailored meals, but nevertheless the co-location of food pantries and hospitals/health centers are becoming more common, as well as the ability to participate in this program through food banks. [1]

Produce prescription programs

Produce prescription programs have the broadest impact among “food is medicine” interventions. These prescriptions are vouchers or debit cards for free or discounted produce for food insecure patients who are at risk for diet related disease (e.g, obesity, prediabetes). There have been positive outcomes related to participation in this program, including improved biomarkers among people with diabetes, decreased fast food consumption, decreased body mass index, and increased fruit and vegetable consumption. Cost-effectiveness studies have shown that a 30% subsidy incentive on fruit and vegetables would prevent nearly 2 million cardiovascular disease events and save $40 billion in health care costs. [1,5-7]

Healthy Hospital Environments

Hospitals are important settings for public health efforts because they reach a large population each year, including employees, patients, and visitors. Hospitals have a significant opportunity to support healthy weight by providing healthier food and drink choices in cafeterias and vending machines and provide opportunities for physical activity.

Best practices for supporting healthy eating and physical activity in hospitals

  • Utilize pricing and point-of-purchase strategies to promote healthier choices in cafeterias and vending machines [8-15]
  • Development of healthy food and beverage procurement policies for cafeterias, vending machines, concessions stands, and/or for food provided at meetings, conferences and other organizational events [8-10,16]
  • Improve nutritional quality of hospital food and support a more environmentally sustainable food system by purchasing local foods, sustainable foods, serving less meat, and participating in community benefit programs [17,18]
  • Create incentive-based physical activity programs for employees [8,9]
  • Initiate employee wellness programs that includes promoting use of stairs and walking trails, and targeting healthy eating [8,9]

Health Care

Health care and health service providers are uniquely positioned to help identify patients at-risk for obesity and related chronic diseases, and implement effective clinical interventions to help patients achieve a healthy weight. Health insurers and health care systems can utilize incentives and provide support for clinicians and patients to adopt evidence-based standards of practice for prevention, screening, diagnosis, and treatment of overweight and obesity for children, adolescents, and adults. [9,17] Furthermore, working with the health care system is important to reduce disparities among the populations they serve. [17] Below are some best practices for health care, hospitals, and service providers.

Health care providers

  • Health care providers use clinical guidelines to identify patients at-risk for obesity, and recommend effective healthy eating and physical activity strategies to help patients lose weight and/or maintain weight loss [9,17,19]
  • Health care providers utilize clinical preventive-service recommendations to refer patients with obesity to comprehensive, multicomponent behavioral interventions [17,20–22]
  • Require that health care clinician education includes comprehensive nutrition training as well as prevention, screening, diagnosis, and treatment of obesity [1,9,17,23,24]
  • Health care providers screen patients for food insecurity and connect at-risk patients with nutrition assistance programs such as SNAP, WIC, and school meals [17,25]

Incorporating nutrition education in medical training

Nutrition plays a critical role in the prevention and treatment of obesity and other chronic disease, yet nutrition receives little attention in medical school and other health care provider education. [1,24,26,27] Furthermore, requiring nutrition education as a component of health care provider training is important to ensure equitable patient access to nutrition expertise. [1] Nevertheless, in the U.S., medical schools dedicate fewer than 1% of lecture hours to nutrition education. [27] Globally, an assessment of medical schools in the U.S., Europe, Middle East, Africa and Australasia found that nutrition education is insufficiently incorporated into medical education regardless of country, setting, or year of medical education. Lack of nutrition education affects medical student’s knowledge, skills and confidence to include high-quality, effective, nutrition care into their practice. [26] Ways to ensure that nutrition education in incorporated into clinician curriculums include: legislative mandates; make government funding for schools contingent upon requiring nutrition education; integrating nutrition topics into accreditation standards; and including nutrition questions on the medical board and other qualifying exams. [1,24] 

Hospitals

  • Hospitals provide benefits to their local communities to assess, implement and evaluation strategies to address local community needs [17,28]
  • Hospitals use electronic health records to adopt standards of practice that include BMI screening, assessment, and treatment of obesity [9]

Case Study: The Study of Technology to Accelerate Research (STAR)

Primary care settings provide structure and opportunities to reduce the prevalence of obesity among children. Regular primary care visits can help track and identify trends in increasing body mass index (BMI) levels and offer opportunities for prevention, screening, and treatment. [29]

The use of Electronic Health Records (EHRs) by clinicians during primary care visits may facilitate childhood obesity management by prompting diagnosis and providing decision support tools and electronic resources and tools for evaluation, management, and follow-up care. One such intervention is The Study of Technology to Accelerate Research (STAR) program, which utilizes a point-of-care clinical decision support alert to pediatric clinicians when a child between the ages of 6-12 years measures a BMI ≥95th percentile during a well care visit. The alert included links to growth charts, childhood obesity screening and management guidelines, and standard clinician note templates specifically for obesity. Furthermore, clinicians were trained in motivational interviewing to negotiate follow-up weight management plans, and provided educational materials to families. Some families were assigned a health coach for individualized support. [29]

A trial of this intervention demonstrated that children ages 6-12 years old with obesity had smaller increases in BMI after one year compared with usual care. Overall, this type of approach in the clinical primary care setting demonstrated improved quality of care, and effective support of patients and families in improving obesity-related behaviors. [29,30] Furthermore, childhood obesity interventions with electronic decision support for clinicians and self-guided behavior-change support for parents may be a more cost-effective approach than other clinical interventions targeting children with obesity. [31]

Insurance and Medicaid

  • Obesity-related screening and preventive health care services covered by insurance [9,17]
  • Covering evidence-based comprehensive pediatric weight-management programs and services in Medicaid benefits [17]

Related

Last reviewed January 2022


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