Q&A: Physicians should explore integrating a ‘food as medicine’ approach in practice

There is overwhelming evidence demonstrating the impact that food has on health, according to a report from the Center for Food as Medicine and the Hunter College NYC Food Policy Center.

In the report, Charles Platkin, PhD, JD, MPH, the executive director of the Hunter College NYC Food Policy Center and the founder and director of the Center for Food as Medicine, and colleagues outlined the history of using food to treat disease, challenges to the food as medicine movement, current evidence and recommendations for stakeholders.

Among their findings, the researchers stated that many medical schools in the U.S. do not require students to take basic nutrition courses.

Fatima Cody Stanford

“Several chronic diseases are linked to poor nutritional status, but there is no standard education about nutrition in medical schools throughout the U.S.,” Fatima Cody Stanford, MD, MPH, MPA, MBA, FAAP, FACP, FAHA, FAMWA, FTOS, an obesity medicine physician and director of equity for the endocrine division at Massachusetts General Hospital, told Healio in response to the report. “This is disconcerting because prevention and treatment of chronic diseases often start with a healthy diet. If physicians are inadequately trained on how to guide patients with regard to nutrition, we will continue to see a proliferation of diseases that could be minimized with proper nutrition.”

Healio spoke with Platkin to learn more about the groundbreaking report and how food as medicine should alter clinical practice.

Healio: What are the key takeaways of the report for physicians?

Platkin: Many physicians lack the education and experience needed to talk confidently with patients about nutrition. Despite the evidence connecting food and diet to health, nutrition counseling is not frequently provided by clinicians, including primary care physicians, to their patients. Requiring comprehensive nutrition training as a component of health care clinician education will ensure equitable patient access to nutrition expertise no matter their geographic location or the type of doctor they are seeing. Ways to ensure the incorporation of nutrition into medical education curricula include legislative mandates; making government funding for schools contingent upon inclusion of nutrition courses; integration of nutrition coursework into accreditation standards; and the inclusion of nutrition questions on board and other qualifying examinations.

Healio: How will inadequate nutrition training in medical school impact the care given to patients?

Platkin: One reason that PCPs may be unwilling to provide nutrition and diet counseling to their patients might be a lack of knowledge about how to provide these nutrition interventions. Many doctors are therefore left to figure out the symptoms and treatments of diet-related issues without the appropriate training. Many physicians have reported providing nutrition counseling, even without any formal education in their medical school curriculum on the topic.

Healio: How can food be used to treat disease?

Platkin: Various food as medicine programs have shown to be effective as a co-treatment for chronic disease. Whether or not a poor diet can cause damage to the body should no longer be debated, as evidence supports the potential causal relationships between dietary factors and diet-related diseases such as ischemic heart disease, diabetes and certain cancers. While diet has the potential to cause disease, it is also capable of building, maintaining and restoring health. Health care systems are increasingly being encouraged to use food as medicine interventions, such as medically tailored meals and food (eg, fruit and vegetables) prescriptions, as methods of achieving improved health outcomes in patients with diet-related chronic diseases.

Despite the long history of food as medicine across history and cultures, as well as its rise in popularity in our modern culture, there remain critical challenges throughout the food ecosystem that may limit the ability for food as medicine to be actualized in practice. Some of these challenges include food insecurity, food justice and health equity; insufficient nutrition counseling from clinicians; food marketing; and the lack of evidence-based food as medicine research to keep up with its modern popularity on the internet and social media. Furthermore, food-industry funded research might contribute to bias in the results of nutrition studies, which then can skew dietary guidelines and the foods that consumers choose based on perceived healthfulness.

Healio: Why are PCPs particularly important to furthering food as medicine efforts?

Platkin: It has been shown that patients who receive advice from their doctors regarding weight loss are more likely to improve their diet, increase activity and lose weight. Therefore, physician-delivered counseling on diet and nutrition may be particularly effective at changing patient behavior and improving their understanding of recommended dietary patterns. Diet counseling from physicians will also help patients interpret all of the nutritional information they are likely to find online and on social media, improving their overall nutrition literacy.

Healio: How should supplements play a part in a physician’s treatment plan given the lack of regulation on its ingredients?

Platkin: Individuals take dietary supplements for a variety of reasons, including as a way to take control of their own treatment or to improve overall health. However, many supplement users are not knowledgeable about the active ingredients, possible side effects or recommended dosages of what they were taking. Patients’ lack of knowledge seems partially attributable to their lack of communication with medical professionals regarding the potential benefits and risks of supplement use. Supplement users reported that they avoided discussing the use of supplements with their physicians because they felt that their doctors lacked knowledge or were biased against the practice, according to the 2007 to 2010 National Health and Nutrition Examination Surveys.

Healio: What impact does food insecurity have on health and how can physicians/practices help patients who are food insecure?

Platkin: Food as medicine programs and interventions, such as nutrition incentive programs and medically tailored meals, can help ensure that vulnerable populations have access to fresh, nutritious foods. Increasing evidence has demonstrated that individuals living in low-income and underserved communities are disproportionately impacted by diet-related disease and chronic health conditions. Federal food assistance programs such as SNAP have been shown to significantly reduce food insecurity. However, solely improving access to nutritious foods may not be enough; programs need to combine and incorporate other interventions, including nutrition and food education, transportation, cooking materials and additional resources like financial support.

Healio: Do you have anything else to add?

Platkin: Incorporating food as medicine practices into traditional health care is a strategy that medical professionals, insurance companies, policymakers, community organizations and other key stakeholders must explore to effectively prevent and treat chronic disease, lower health care costs and improve patient quality of life. The goal of our report is to bridge the gap between traditional medicine and the use of food as medicine in the prevention and treatment of disease. It is our hope that the report will serve as a foundation for understanding the potential uses of food and diet as a therapeutic mechanism.

Reference:

Food as medicine: overview and report: how food and diet impact the treatment of disease and disease management. https://www.nycfoodpolicy.org/wp-content/uploads/2022/03/foodasmedicine.pdf. Published March 30, 2022. Accessed March 30, 2022.