Food for thought — and health
The Heart Association’s Health Care by Food Initiative serves up some early results.
Amid efforts to combat nutrition-related chronic diseases, the American Heart Association’s Health Care by Food™ initiative is yielding informative early findings.
In January 2024, the association partnered with the Center for Nutrition & Health Impact (CNHI) to coordinate scientific research, public policy advocacy and stakeholder education to advance “food is medicine” interventions. These interventions incorporate healthy food into health care to treat, manage and prevent diet-related diseases such as diabetes, heart disease and hypertension.
During a session this afternoon, “The AHA Health Care by Food Initiative is Bearing Fruits: Early Results From the AHA Food Is Medicine Pilot Projects,” Christopher Long, PhD, a principal research scientist for the center, will share early findings from the initiative, based on a national survey and interview study conducted with people implementing produce prescription programs across the U.S.. The center, a grantee of the Health Care by Food initiative, is the only independent nonprofit research center of its kind with a focus on measuring and evaluating nutrition-related programs.
The center used study responses to understand the relationship between the choices program implementers make when designing their programs and how much program participants stay engaged in the intervention.
“One of the big questions right now in the field of ‘food is medicine’ is how we keep people engaged. One of the things we’ve seen in initial research across the field of food as medicine is that these interventions only work well for the people who stay with the programs and complete the intended participation duration,” Long said.
Implementers in the study were running produce prescription projects funded by the U.S. Department of Agriculture’s (USDA) Gus Schumacher Nutrition Incentive Program (GUSNIP), a USDA initiative to demonstrate and evaluate the impact of fresh produce prescriptions to increase procurement and consumption of fruits and vegetables, reduce individual and household food insecurity and reduce health care usage and associated costs.
The need is great. According to a 2023 American Heart Association presidential advisory, an estimated 90% of the $4.3 trillion annual cost of health care in the U.S. is spent on medical care for chronic diseases. For many of these diseases, diet is a major risk factor.
Millions of people in the U.S. have low diet quality — a major driver of chronic disease and health inequities, especially among under-resourced communities. Health Care by Food is keenly focused on removing barriers to nutritious
food through research and community solutions.
In the Center for Nutrition & Health Impact Study, the research team surveyed 80 program implementers and conducted in-depth interviews with 15, analyzing how program design affects participant engagement. Findings revealed that programs with strong engagement often include:
• Transportation support to food pickup locations
• Flexible hours for food distribution
• Tailored food options based on participant preferences and medical needs
• Staff training to improve participant retention
“None of the findings are particularly shocking,” Long said, “but the programs that are intentional about engagement — those that ask participants what they need — are the ones seeing better results.”
One survey respondent noted the value of the GusNIP produce prescription initiative’s nutritional educational component in building skills, encouraging engagement, fostering relationships between staff and participants, and creating opportunities for social connections among participants.
“The education piece is what’s going to ensure that they’re actually using the prescription and produce and that they’re going to be able to make longer-term changes,” the respondent wrote.
Although the food involved is limited to fruits and vegetables, selection can be customized, Long said.
“It’s not a one-size-fits-all,” he said. “For example, some programs involve registered dietitians to ensure participants receive foods that align with their health conditions.”
The GusNIP produce prescription initiative primarily serves people with a diet-related health condition who are eligible for the Supplemental Nutrition Assistance Program (SNAP) or Medicaid, although eligibility criteria vary by program. Participants are typically referred by health care professionals and may receive free produce through partnerships between clinics and community-based
food organizations.
The research is ongoing, and future phases will analyze electronic health records and claims data to assess long-term health outcomes and quality of life improvements, Long said.
“We want people not just to have better HbA1c values or blood pressure,” he said, “but to feel better — whether that’s going for a walk or playing with their grandkids.”
The Heart Association pledged more than $8 million in funding for food is medicine research, with innovative studies across a range of populations, clinical conditions and interventions, all with a focus on improving engagement and initiating short-term behavior change.
The Health Care by Food initiative has awarded research grants to fund 22 other small-scale clinical trials focused on rapid cycle innovation, adaptive designs and attention to personal experiences. Results of these studies will enable testing of the scalability and sustainability of large comparative effectiveness trials.
