Valuing lives of children, families key to food as medicine from the start
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DENVER — Incorporating food as medicine “from the start” into health care practice empowers providers with a key tool for impacting overall health of their patients, Kofi D. Essel, MD, MPH, FAAP, said at Lifestyle Medicine 2023.
“Some say food ‘is’ medicine or food ‘as’ medicine ... it doesn’t matter, it’s the same concept: strategies or interventions working alongside health care, giving access to high-quality foods focused on the prevention, management or treatment of disease,” Essel, inaugural Food as Medicine program director at Elevance Health, said in a keynote session.
Essel explored the data on the impact of food as medicine on diseases such as hypertension, type 2 diabetes and coronary heart disease, and outlined programs to help provide patients and families with healthy food choices.
Three options that have been covered by the media recently include medically tailored meals, medically tailored groceries and produce prescriptions, Essel said. Essel is also a board-certified community pediatrician at Children’s National Hospital in Washington, D.C.
Medically tailored meals are designed by a dietitian and a chef together, and are delivered to a patient’s home ready to heat and eat. A convenient but expensive option, the medically tailored meals account for 50% or more of the individual’s daily calories and are important because they can be used to replace meals typically consumed by individuals with chronic disease, Essel said.
Medically tailored groceries are healthy foods, such as nuts, seeds and legumes, among others, that are provided as meal kits or as separate items for incorporation into the individual’s diet. They are a cheaper option than medically tailored meals because they are less convenient and require preparation.
Produce prescriptions provide purchasing power for individuals to obtain fresh, canned or frozen fruits and vegetables.
“One in 10 adults consume enough fruits and vegetables,” Essel said. In this context, he added, “A small intervention can make a huge impact on overall health.”
As a pediatrician, Essel has had an opportunity to examine and address how food and nutrition affect the health and future wellbeing of children.
Like adults, only one in 10 children consume enough fruits and vegetables, and their diets are composed of heavily processed foods, Essel said.
However, providing children with healthy food choices is not always easy for families for various reasons, including food and nutrition insecurity. Food insecurity, Essel said, can be a toxic stressor to the body.
“We need to understand where food insecurity exists,” Essel said. “What we need to understand is that food insecurity is what we would call ubiquitous; there’s not one county free of food insecurity in this country. The question is: Are we willing to look for it, or not? Food insecurity is invisible, so unless we’re screening for it, we’re not going to identify it because families will present their best selves for us in our clinical spaces.” This is particularly true in Black and brown households where rates of food insecurity are two to three times higher than those in white households within the U.S., he said.
Essel and colleagues reach individuals where they are by partnering with community-based groups such as the YMCA to prioritize health equity and share information to improve food and nutrition insecurity. By tapping into federal programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP), as well as school meal and summer meal programs, Essel and colleagues provide families with resources they may not have been aware of. They also implemented a prescription produce program and offer culinary education through virtual and online cooking classes.
“Real health care transformation cannot occur if we forget about the next generation,” Essel said. “It’s critical that we think about addressing poverty, addressing social determinants, improving purchasing patterns and purchasing behaviors, but it’s also critical to transform postures — moving toward a posture of recognizing, elevating, advancing, valuing the lives of children and families because then, and only then, can all children have access to food as medicine from the start.”