As USA Today reports, the White House Conference on Hunger, Nutrition and Health, scheduled to take place this week, will recommend a pilot program to cover medically tailored meals as part of Medicare Advantage plans. It is one of a laundry list of new plans proposed Tuesday by the Biden administration to “end hunger and reduce diet-related diseases and disparities.”
The last such conference, held more than a half-century ago during the Nixon administration, led to the expansion of food stamps and other food supports that dramatically reduced starvation in one of the richest countries on earth.
Congressional approval will be required for some of the Biden administration’s priorities, including the medically tailored meals pilot, investing in parks, and expanding food stamps with a focus on access to fruits and vegetables. Other programs, such as voluntarily reducing salt and sugar and placing nutrition labels on the front of packages, may call for private sector support.
Revised food programs are urgently needed, experts said, at a time of rampant inflation and growing chronic health issues. At least 10% of the American public is “food insecure,” meaning they’re not sure where their next meal is coming from. And more than 40% of Americans have obesity, in part because the most inexpensive, readily available foods contribute to weight gain and poor metabolic health.
Medically tailored meals can help address both problems in the short run, with other programs needed to address hunger for the longer term, said Dr. Dariush Mozaffarian, dean for policy at the Tufts Friedman School of Nutrition. Mozaffarian, one of the co-chairs of the task force which made recommendations to the White House conference, said he expects medically tailored meals and similar programs will be a centerpiece of any new national strategy to come out of the conference. “I would be shocked and disappointed if ‘food as medicine’ weren’t a prominent part of it. It’s so promising,” he said.
According to USA Today, currently, a small percentage of Americans with the most serious health problems use up almost half of the country’s health care resources. They are admitted to a hospital, discharged to a nursing home, sent home, and then end up back in the hospital or nursing home several times a year. “Medically tailored meals have been shown to break that negative, vicious cycle,” Mozaffarian said. “They use the emergency room less, they get admitted to the hospital less, they go to nursing homes less, they feel better.”
Plus, he said, although Medicaid and Medicare haven’t been allowed to fund medically tailored meals programs, such approaches could save the government money. “Even accounting for the cost of the food, the cost of a hospitalization or nursing home or emergency room visit is so much – is so wildly expensive that just paying for the food is much more effective.”
Research shows that bringing nutritionally tailored healthy meals to people with critical and chronic illnesses can also save money. In one 2018 study, people on medically tailored meals cost the healthcare system 16% less than those who didn’t receive the meals. The cost for six months of meals roughly equals one night’s stay in a hospital, Waters said. “Medically tailored meals are a very effective food insecurity intervention,” said Dr. Seth Berkowitz, who helped lead that study and is now at the University of North Carolina School of medicine.
But there are still unanswered questions about how best to use medically tailored meals to improve health outcomes, he said via email. “I think there is still more we can learn about what combination of medical and social conditions medically tailored meals work best for, along with questions about the ‘dose,’ ‘duration’ .”
Originally funded through federal HIV spending via the Ryan White Act, philanthropy has helped Community Servings thrive and expand, and now the nonprofit also holds contracts with the state and 18 insurance companies. A typical medical meal recipient lives below 200% of the poverty level and needs anywhere from 2 weeks’ worth of meals at the end of life or a decade of food for someone living with HIV or severe diabetes. The aim is to get the recipient stable and healthy, so they can return to independent living.
A handful of nutrition and hunger experts said they’re not really sure what to expect from the White House Conference, but they hope the outcome will include more support for food as medicine. “The role of nutrition in disease is poorly understood and not widely recognized,” said Dr. William Dietz, who directs the Sumner M. Redstone Global Center for Prevention and Wellness at the Milken Institute School of Public Health at George Washington University.
“If that is an important emphasis that emerges from the conference, that could really open the door for a broader application of food as health and disease in the U.S.,” he said, including, he hopes, an expansion of food stamps and free school meals for every child. “Medically tailored meals and its use in patients is really a microcosm of the broader need for a more balanced diet with an emphasis on fruits and vegetables for the general population,” Dietz said.
Nicole Heckman, vice president of benefits access for the AARP Foundation, said she sees medically tailored meals as an essential stop-gap for people in crisis. But they generally last just six months. Follow-on programs like food stamps are also needed, she said, to enable people to “continue purchasing the food they were introduced to” when on medically tailored meals, she said. The food stamp program, now known as the Supplemental Nutrition Assistance Program “is absolutely critical for folks with low income to be able to consistently afford the food they need to live a healthy and active life.”
According to USA Today, more than 16 million older adults don’t know that they’re eligible for food stamps, she said and 3 million of them missed out on more than $200 a month in benefits in 2018. And more than 37 million Americans over 50 live in poverty or “one life event away from slipping into it,” Heckman said. Older adults on fixed incomes are particularly vulnerable to inflation, she said, and in today’s economic climate, “many older adults are being forced to choose between the medicines they need and essentials like food and rent.”
Managed healthcare giant Kaiser Permanente has seen the benefits of medically tailored meals, said Pamela Schwartz, Kaiser’s executive director for Community Health. “We, like others in healthcare, know that being healthy isn’t just the result of high-quality medical care,” Schwartz said. “When people are hungry or they lack proper nutrition or can’t get the food they need for a particular medical need, they’re less likely to get or stay healthy.”
During the pandemic, Kaiser led a study of 2,000 high-risk adults recently discharged from five of its hospitals. After 90 days, patients diagnosed with heart failure were less likely to return to the hospital if they had been receiving medically tailored meals. “It was a rigorous study with a very compelling finding,” Schwartz said.
There was no change seen in patients’ conditions like kidney disease or diabetes, which Schwartz said might have been a result of the short time frame of the study. “Future trials are needed to really understand what works best here and under what conditions,” she said. The national dialogue that’s happening now about food as medicine is unprecedented, with momentum and openness at the national level to talking about the role “food plays in improving health outcomes and costs,” Schwartz said. “I’ve never seen a moment like now.”
The next big push has to be increasing the scale of food as medicine, said Dr. Jason Langheier, founder and CEO of Foodsmart, a digital network of registered dietitians and food retailers. “There’s actually ample resources available to change a family’s life forever, but you have to do the right steps in the right order,” Langheier said. He predicts that by 2030, many people will leave their doctor’s office with not just a prescription for medication, but one for food, as well.
Medicare and Medicaid have not formally made a decision that food is a medical treatment, he said, but all it would take is the signature of the Health and Human Services Secretary to say it’s appropriate for them to pay for evidence-based food treatments.
Making someone 10 customized meals a week costs about $93, Mozaffarian said, or $4,500 a year, compared to a single hospital stay, which can easily run $20,000. About 6.3 million Americans would be eligible for medically tailored meals, he said, based on having a “nutrition-sensitive disease” and some limitation of their daily activity, such as not being able to shop or cook for themselves.
Mozaffarian said he expects the conference will lead to changes in the government’s position on “food as medicine.” Estimates show these programs could provide a net savings of about $185 billion over 10 years, Mozaffarian said. “It’s a no-brainer.”
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