Eating well, on purpose

They can be medically tailored meals and groceries or produce-prescription programs that allow providers to prescribe fruits and vegetables to patients who are at risk for or have a condition like diabetes or heart disease. Programs also address food insecurity, which puts people at risk for chronic diseases.

Patients can redeem these prescriptions — funds for fresh fruits and vegetables — at the grocery store, farmers market, or health care clinic. Our studies show that a huge barrier to eating fruits and vegetables is the high cost of groceries. Programs also provide nutrition programming for patients.

Research, including our own, consistently shows that these initiatives help patients eat more fruits and vegetables and improve health outcomes, including self-reported health and biometrics such as patients’ average blood sugar levels. We’re also seeing decreases in blood pressure and improvements in food security.

Investing in Food as Medicine can yield a strong return — both in patient health and in health care spending. In a 2022 simulation study by researchers at the Friedman School of Nutrition Science and Policy published in JAMA Network Open, providing medically tailored meals (10 meals per week for 8 months) to eligible patients with diet-sensitive conditions and functional limitations was projected to be associated with net health care savings of more than $13.6 billion per year.

These interventions are, by their nature, community connected and must center on the patients, their community, and culture. We co-design programs with this patient-centric approach to ensure we include patients’ perspectives and preferences.

Partners include staff at the clinics we work with, physicians, dieticians, and clinic administrators. We also partner with organizations for nutrition programming including SNAP ED. Here in New Haven, we have strong partnerships through Fair Haven Community Health Care, Yale New Haven Health, and CitySeed. We are interested in better understanding the role and impact of teaching kitchens that provide people with hands-on experience and the confidence and skills to cook, consume, and enjoy eating fruits and vegetables. Finally, we partner with food systems with the long-term goal of clinics and individuals having access to locally produced fruits and vegetables through these programs, which builds the local and state economies.

Our projects are currently funded through grants, but our eventual goal is for Medicaid, Medicare, and other insurance providers to cover these programs. We are looking for Connecticut to seek an 1115 demonstration waiver to allow use of funds to scale Food as Medicine programs, as Massachusetts, New York, and Rhode Island have done. Through ongoing studies, we aim to address key challenges, positioning the state to implement and scale programs in a way that is equitable, respectful, and impactful.

Food4Moms, led by Dr. Rafael Pérez-Escamilla, partners with the Hispanic Health Council to provide pregnant women $100 each month on a Fresh Connect card for 10 months to purchase fruits and vegetables at two food retailers. The women also receive nutrition programming. We have seen outcomes that have the potential to impact mother and child health long term.

The Griffin Hospital PRx, led by Beth Comerford, is a rigorous, randomized control trial to provide evidence on health outcomes. Patients at risk for diabetes or who have diabetes received $40 a month on a Fresh Connect card for 6 months, with additional funds for larger households. Patients receiving the produce prescription program showed significant improvements in consumption patterns and health outcomes.

In Produce4Life, in partnership with Hartford Hospital and Hispanic Health Council, we’re looking to identify strategies to increase use of the card and to increase consumption. The project is a randomized controlled trial in which one group has support from a community health worker trained in Food as Medicine behavior change, while other groups don’t have this support. And in partnership with Fair Haven Community Health Care in New Haven, we recently completed a PRx feasibility study to assess integration of a produce prescription program and to better understand and pilot options for engaging with the local food system.

Across our studies, we see high patient engagement and meaningful outcomes, including changes in food security. Our next steps include finding opportunities to continue these programs and integrating strategies that lead to even stronger outcomes for the patient and their families. In local communities and statewide, we seek to drive systems-level integration of food as medicine programming across health care centers and with the local food system.

We typically engage at least two students each year, but we only have one student currently due to a cut in funding. Students typically stay with us through their master’s program and sometimes longer. The students integrate as part of our staff, engaging in program development, data collection, analysis, and reporting. A few of our students have gone on to work full-time in this field.

Successful Food as Medicine initiatives require so many different interconnected disciplines— medicine, nutrition, community engagement, food systems, economics, health policy, and climate change — and offer an opportunity to break down the silos we often see in academia.

In addition to our partners at Yale and the local community, we have many partners across Connecticut and nationally, including implementers, policymakers, and researchers at institutions including Southern Connecticut State University and Emory University in Atlanta. The food as medicine community is very collaborative and inclusive — we work together to ensure we move this field forward with a health equity focus, addressing health outcomes and food security.