Food is many things.
It nourishes our bodies, delights our senses and gives us something to gather around. Food is also a powerful cultural symbol, reflecting traditions, values and histories of communities around the world.
But for a researcher in the Virginia Tech College of Agriculture & Life Sciences, food is also medicine.
Bailey Houghtaling, Ph.D., a registered dietitian, is working to promote overall wellness among low-income individuals experiencing food insecurity, aiming to prevent or treat diet-related diseases.
“Access to enough nutritious food is essential for individual well-being,” said Houghtaling, also an affiliate faculty member in the Department of Human Nutrition, Foods & Exercise. “Food is Medicine can encompass a variety of interventions.”
The White House Conference on Hunger, Nutrition & Health, held in September 2022, renewed national attention and issued a call to action to end hunger and reduce the prevalence of chronic diseases in the U.S. by 2030. Food is Medicine programs could help reach this goal.
“These programs are promising, and there is a lot of emphasis at the moment on understanding effectiveness for promoting food and nutrition security, although it is important to recognize that Food is Medicine programs are implemented in diverse communities and healthcare organizations with varying levels of support or capacity,” said Houghtaling, who is also a research scientist with Center for Nutrition & Health Impact, a national nonprofit research and evaluation center. “It is critical to understand factors about these contexts that influence program adoption, implementation, sustainment and scalability for public health impact.”
Houghtaling authored two papers that focus on barriers and opportunities to the integration of food as medicine. Her first paper covers organizational factors in healthcare settings that affect the success of Food is Medicine programs.
The second paper outlines how to leverage nationally representative data among U.S. households to identify individual, household and community factors that likely influence participant engagement and utilization of these programs. This is particularly important for programs that limit redeemable products to only fresh fruits and vegetables. Not all Food is Medicine programs do this, but some do.
Both papers were funded by a National Institutes of Food & Agriculture grant. It established the Nutrition Incentive Program Training, Technical Assistance, Evaluation & Information Center through the Gus Schumacher Nutrition Incentive Program. The second paper also was supported by the Robert Wood Johnson Foundation.
Food is Medicine in Healthcare
Food is Medicine programs are relatively new, and there isn’t standard guidance for implementation in healthcare settings. Houghtaling and her collaborators conducted a review to explore the barriers to integrating the programs into U.S. healthcare settings.
“In our research, we focused on situations where healthcare partners, such as physicians or other allied healthcare professionals, were carrying out programs to screen patients with, or at risk for, diet-related chronic diseases for food insecurity,” Houghtaling said. “For those screening positive, we focused on programs where healthcare partners then provided a low- or no-cost healthy food incentive [such as a produce prescription], such as for fruits and vegetables.”
It was found that electronic medical record functionality to identify and track patients and increase the sharing of data between partner organizations was important to support implementation and evaluation. Strategies to help healthcare staff implement these programs were also important, such as providing reminders and problem-solving and technical assistance support.
The study found that it was also important to involve physicians, allied health and students for implementation success and to identify and address capacity barriers early and often. Support from leadership and alignment of the Food is Medicine program with the healthcare organization’s mission or values were also key for success.
“Many healthcare professionals implementing these programs considered them beneficial and noted improvements in job satisfaction,” Houghtaling said.
Based on the findings of this study, the research team developed an implementation checklist that can be a reference for healthcare, partner organizations and technical assistance personnel to support Food is Medicine programs in these settings.
Houghtaling and co-authors noted several opportunities to improve the implementation of Food is Medicine in healthcare contexts moving forward.
Food is Medicine in the Community
In the second study, the research team led by Houghtaling outlined a plan to examine how “prescriptions” for produce through a Food as Medicine incentive program could impact participation through the team’s paper.
Through the Gus Schumacher Nutrition Incentive Program, participants receive produce prescriptions they can redeem for only fresh fruits and vegetables versus frozen, canned or dried options.
According to the researchers, this policy limitation could hurt participation and benefits for households living in communities with limited accessibility to fresh produce.
“Households experience heightened barriers to fresh fruit and vegetable access in the United States, depending on several factors,” Houghtaling said. “It is important to understand the implications of this policy limitation to inform future Food is Medicine policy that maximizes impact and equity.”
In the paper, the researchers plan to use the USDA Economic Research Service National Household Food Acquisition & Purchase Survey, a large nationally representative data set, to examine this policy limitation in support of sensitive policy decisions.
Achieving nutrition security, which means enabling all Americans to access a sufficient quantity and variety of foods and beverages recommended by the Dietary Guidelines for Americans, including fruits and vegetables, is a national priority.
by Max Esterhuizen, Virginia Tech
Featured photo: Food is Medicine programs promote overall wellness among those who experience food insecurity by aiming to prevent or treat diet-related diseases. Photo by Max Esterhuizen/Virginia Tech
