Food consists of many things.
It nourishes our bodies, indulges our senses and gives us something to gather around. Food is also a powerful cultural symbol that reflects traditions, values and histories of communities around the world.
But for a researcher at the College of Agriculture and Life Sciences, food is also medicine.
Bailey Houghtaling Ph.D. '19, a registered dietitian, works to promote the overall well-being of low-income people experiencing food insecurity, with the goal of preventing or treating diet-related diseases.
"Access to sufficient nutritious food is essential for individual well-being," says Houghtaling Ph.D. '19, also a registered dietitian and an affiliated faculty member in the Department of Human Nutrition, Nutrition and Exercise. "Food is Medicine can include different interventions."
The White House Conference on Hunger, Nutrition, and Health, held in September 2022, renewed national attention and called for action to end hunger and reduce the prevalence of chronic diseases in the United States by 2030. Food is Medicine programs could help the cause.
"These programs are promising, and much emphasis is currently being placed on understanding the effectiveness of promoting food and nutrition security, although it is important to recognize that Food is Medicine programs are being implemented in diverse communities and health care organizations at different levels of healthcare. support or capacity," says Houghtaling, who is also a research scientist at Center for Nutrition and Health Impact, a national nonprofit research and evaluation center. "It is critical to understand factors across these contexts that influence the adoption, implementation, sustainability, and scalability of public health impact programs."
Houghtaling wrote two articles that focus on barriers and opportunities for integrating food as medicine. Her first paper addresses organizational factors in healthcare that influence the success of Food is Medicine programs.
The second article outlines how nationally representative data from U.S. households can be used to identify individual, household, and community factors that likely influence participant engagement and use of these programs. This is especially important for programs that limit redeemables to only fresh fruits and vegetables. Not all Food is Medicine programs do this, but some do.
The first article was recently published in the Journal of General Internal Medicine. The second was recently published in BMJ Journals.
Both articles were funded by a grant from the National Institutes of Food and Agriculture awarded to the Center for Nutrition and Health Impact. It established the Nutrition Incentive Program Training, Technical Assistance, Evaluation and Information Center through the Gus Schumacher Nutrition Incentive Program. The second article was also supported by the Robert Wood Johnson Foundation.
Food is medicine in healthcare
Food is Medicine programs are relatively new and there are no standard guidelines for implementation in healthcare. Houghtaling and her collaborators conducted a study to examine barriers to integrating the programs into the U.S. health care system.
"In our research, we focused on situations in which health care partners, such as physicians or other health care allied health professionals, implemented programs to screen patients with, or at risk for, diet-related chronic diseases for food insecurity," Houghtaling said. "For those who screened positive, we focused on programs where health care partners then offered a low- or no-cost healthy eating incentive [such as a produce prescription]such as for fruits and vegetables."
Electronic health record functionality to identify and track patients and increase data sharing between partner organizations was identified as important to support implementation and evaluation. Strategies to help healthcare workers implement these programs were also important, such as providing reminders and troubleshooting support and technical assistance.
The research found that it was also important to involve doctors, paramedics and students for successful implementation and to identify and address capacity barriers early and often. Leadership support and alignment of the Food is Medicine program with the healthcare organization's mission or values were also key to success.
"Many healthcare professionals who implemented these programs considered them helpful and noted improvements in job satisfaction," Houghtaling said.
Based on the findings of this study, the research team developed an implementation checklist that can serve as a reference for healthcare, partner organizations, and technical assistance personnel supporting Food is Medicine programs in these settings.
Houghtaling and co-authors noted several opportunities to improve the implementation of Food is Medicine in healthcare in the future.
Food is medicine in the community
In the second study, the research team, also led by Houghtaling, outlined a plan to investigate how "prescriptions" for products through a Food as Medicine incentive program could influence participation through the team's protocol paper.
Through the Gus Schumacher Nutrition Incentive Program, participants receive recipes for produce that they can exchange for fresh fruits and vegetables only, instead of frozen, canned or dried options.
According to the researchers, this policy restriction could harm participation and benefits for households living in communities with limited access to fresh produce.
"Households experience increased barriers to accessing fresh fruits and vegetables in the United States depending on several factors," Houghtaling said. "It is important to understand the implications of this policy limitation to inform future Food is Medicine policies that maximize impact and equity."
In the paper, the researchers plan to use the U.S. Department of Agriculture's National Household Food Acquisition and Purchase Survey, a large nationally representative dataset, to examine this policy constraint to inform sensitive policy decisions.
Achieving nutritional security, which means ensuring all Americans have access to an adequate amount and variety of foods and beverages recommended by the Dietary Guidelines for Americans, including fruits and vegetables, is a national priority and researchers at Virginia Tech are helping to achieve that goal reaches.
