UB Team Receives Funding to Demonstrate Effectiveness of ‘Food-is-Medicine’ Programs

The AHA has awarded UB $400,000 for the 18-month project as part of the organization’s Health Care by Food initiative, which is leveraging research to build the evidence needed to show the clinical and cost-effectiveness of so-called “food-is-medicine” programs.

The AHA funding comes at a key time. The Centers for Medicare & Medicaid Services (CMS) earlier this year approved an amendment to New York State’s Medicaid 1115 waiver that enables the state to modify its Medicaid program to address the health disparities exacerbated by the COVID-19 pandemic. The waiver paves the way for, among other things, investments in supporting strategies for improved access to food and nutrition, such as food-is-medicine programs.

The field of food-is-medicine is going to develop rapidly as other states, not just New York, have submitted Medicaid 1115 waivers, says Lucia A. Leone, PhD, associate professor in the Department of Community Health and Health Behavior, School of Public Health and Health Professions.

Leone is co-principal investigator on the AHA project with Jill N. Tirabassi, MD, clinical assistant professor of family medicine in the Jacobs School of Medicine and Biomedical Sciences at UB.

“With the state’s Medicaid waiver approval, we know these programs are going to be coming down the pipeline in the next few years. Our aim is to look at three different types of food programs for adults over 65 in Western New York and develop ways to make them as user-friendly as possible,” Leone says.

“It is essential that we are able to quickly develop best practices for ensuring food prescription programs are successful at reaching the people who need them,” she adds. “This research will help practitioners who are looking to design food-prescription programs for their communities understand what works and what doesn’t.”

Food-is-medicine may be defined as providing healthy food resources to treat, manage and prevent specific chronic conditions in coordination with the health care sector.

Food-is-medicine programs often feature:

• Medically tailored meals, which are often delivered to patients with diet-related health conditions or among those at high risk.
• Produce prescription programs that integrate healthy food into a patient’s health care plan, enabling patients to better follow their health care team’s dietary advice.
• And medically tailored groceries, which may include a selection of grocery items prescribed by a registered dietitian or nutritionist for patients with diet-related acute and chronic health conditions who can prepare food at home.

A total of 75 participants will be recruited for the study from primary care clinics at Erie County Medical Center (ECMC). Participants will be split into three groups of 25, each of which will receive a different food-related program over 12 weeks.

One group will receive a weekly credit redeemable at Massachusetts Avenue Project’s mobile produce market. Another group will have fresh produce boxes delivered to their homes via FreshFix, a local food-delivery company co-founded by Leone. And the third group will have medically tailored meal kits, with recipes to make several meals, delivered to their homes each week. The food-delivery partners will curate the items that are sent in each box, tailoring the contents to meet dietary restrictions, such as diabetes or food allergies.

The researchers will focus particularly on the successes and challenges of the implementation of the food-is-medicine programs. Toward that end, participants will receive surveys each week, which will help Leone and Tirabassi gauge whether people used the voucher or food they received. A community advisory board will also be set up to help oversee the project and provide insight into participants’ lived experiences and how those affect their ability to participate in these programs. For example, do they struggle with using smart phone apps and websites to customize the food they receive.

“Older adults face unique barriers with food and nutrition access,” Tirabassi says, explaining the focus on adults over 65. “They often have multiple chronic health conditions, have experienced life course changes — becoming a widower, for example — and are on a fixed income. Many people in this age also have mobility and transportation challenges.”

The AHA project is focused on food-prescription program usage and not health outcomes for a very simple reason, Tirabassi says. “We already know that diet-related changes can affect health outcomes.” But, she adds, “Food-prescription programs have not had very high utilization rates, and that is what we need to change.”  

The Primary Care Research Institute in the Department of Family Medicine at the Jacobs School, which has expertise in healthy aging research, is also a partner on the project.