Nutrition expert Stacey Zawacki says medically tailored meals can help reduce care costs for chronic conditions.

The use of food as medicine isn’t new. General nutrition and specific foods have been used to manage health for centuries. Diet can prevent, or help to manage, chronic conditions. So why aren’t doctors prescribing vegetables? Stacey Zawacki, a clinical assistant professor of nutrition and director of the BU Sargent Choice Nutrition Center, spoke with Inside Sargent about the necessity of applying this old concept to modern society—and the barriers preventing us from doing so.

The idea of food as medicine dates back centuries—what makes it relevant in 2021?

Healthcare costs continue to rise and a lot of very expensive conditions like heart disease, type 2 diabetes, some cancers, and stroke have a nutrition relationship. We also have a strong culture of personal responsibility in the United States. People are expected to know what’s best for themselves and their families. But when they go into a store, the foods that are most affordable, designed to be very palatable, and highly marketed are the opposite of what is recommended, which are fruits and vegetables, whole grains, nuts and seeds, heart healthy oils, and omega-3 rich seafood. It’s really hard for people to overcome those forces.

Where have food-as-medicine approaches been shown to work?

With people who have the highest healthcare expenditures. Pilot data shows that medically tailored meals for people with HIV/AIDS, type 2 diabetes, and other high cost conditions can reduce expenditures. There are also studies that look at incentivizing people for fruits and vegetables or giving fruit and vegetable prescriptions.

How do you address this issue at Sargent?

In my class, Nutrition and Chronic Disease, we look at where policies, institutions, and industry either support or undermine health, and at programs and their role in supporting health and preventing chronic disease. And we have the Sargent Choice Healthy Food and Education Program, a collaboration between the Sargent Choice Nutrition Center and BU Dining Services that’s designed to make healthy eating easier. We don’t want to dictate what people’s choices are, but we work hard to make the healthy choice an appealing choice. That program operates in BU’s dining halls and through the catering program. We also have an education- and skill-based component where we teach healthy cooking classes so students have the skills to implement the principles of healthy eating for themselves.

What has the COVID pandemic revealed about nutrition issues?

We see people with conditions that have a nutrition driver, like heart disease, type 2 diabetes, and obesity at higher risk for severe COVID. We also see disparities in income, education, housing, job training, healthcare, and safe neighborhoods making that diet–disease relationship more severe.

How does food as medicine fit into the US medical model of healthcare?

The approach with medicine is to treat a health condition while the public health approach says, “Let’s keep people from getting sick in the first place.” But we’re investing so much money to handle the medical costs that there isn’t much left over to prevent them. And most medical practitioners don’t have training and preparation in food and nutrition interventions. We have to prepare them better to collaborate with nutrition professionals and utilize nutrition as medicine.

What is the solution?

We’ve been focusing on educating and motivating individuals to eat the foods that are recommended—that isn’t enough in today’s food environment. There are proposals like taxing foods that most of us should eat less of or subsidizing the foods that most of us should eat more of. But there’s not widespread adoption of these—and there’s lots of pushback and lobbying to prevent that from happening. We can’t afford to keep going at the rate that we’re going—and we’re starting to see that it is cheaper to give people the foods they need to manage their health conditions than it is to treat them in a hospital.

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