Food Is Medicine: A Presidential Advisory From the American Heart Association

Abstract

Unhealthy diets are a major impediment to achieving a healthier population in the United States. Although there is a relatively clear sense of what constitutes a healthy diet, most of the US population does not eat healthy food at rates consistent with the recommended clinical guidelines. An abundance of barriers, including food and nutrition insecurity, how food is marketed and advertised, access to and affordability of healthy foods, and behavioral challenges such as a focus on immediate versus delayed gratification, stand in the way of healthier dietary patterns for many Americans. Food Is Medicine may be defined as the provision of healthy food resources to prevent, manage, or treat specific clinical conditions in coordination with the health care sector. Although the field has promise, relatively few studies have been conducted with designs that provide strong evidence of associations between Food Is Medicine interventions and health outcomes or health costs. Much work needs to be done to create a stronger body of evidence that convincingly demonstrates the effectiveness and cost-effectiveness of different types of Food Is Medicine interventions. An estimated 90% of the $4.3 trillion annual cost of health care in the United States is spent on medical care for chronic disease. For many of these diseases, diet is a major risk factor, so even modest improvements in diet could have a significant impact. This presidential advisory offers an overview of the state of the field of Food Is Medicine and a road map for a new research initiative that strategically approaches the outstanding questions in the field while prioritizing a human-centered design approach to achieve high rates of patient engagement and sustained behavior change. This will ideally happen in the context of broader efforts to use a health equity-centered approach to enhance the ways in which our food system and related policies support improvements in health.

Keywords: AHA Scientific Statements; chronic disease; diet, healthy; food; food supply; health care costs; risk factors.

Figure 1.

Food Is Medicine sits between the health care sector and food and health.

Figure 2.. Evidence-based dietary guidance to promote cardiovascular health.

Reprinted with permission from Lichtenstein et al. Copyright © 2021 American Heart Association, Inc.

Figure 3.. Path to health care system implementation of a medically tailored grocery intervention.

Outlined components may vary according to the individual health care system, partnering organizations, and individual patient.

Figure 4.. Path to health care system implementation of a medically tailored meal intervention.

Outlined components may vary according to the individual health care system, partnering organizations, and individual patient.

Figure 5.. Timeline of American Heart Association Food Is Medicine Research Initiative, launched with support from the Rockefeller Foundation and other stakeholders.

This represents a general overview of the timeline and should be considered a rough guideline to the planned progression.

Figure 6.. Human-centered design for participant research.

This represents a storyboard to help communicate how a new program or intervention might play out to meet the needs of each individual. This figure was developed in consultation with Kelly Dumke, DrPH, MS, from Kaiser Permanente’s National Social Health Practice.