Food As Medicine: A Self Examination Study Spotlight Take-Away with Chef Dr. Mike

by Michael S. Fenster, MD

“The unexamined life is not worth living.”
― attributed to Socrates

Food as Medicine programs are becoming as ubiquitous as kudzu in the South.

With the recent Food as Medicine initiative announced by the US Department of Health and Human Services in conjunction with The Rockefeller Foundation and interest in food as medicine conferences by such “Big Food” players as Unilever, Danone, PepsiCo[1]  and Kellanova (formerly Kellogg’s),[2] there is the danger of untoward influence by groups that, historically, have not been supporters of diets based on whole, natural foods.

At such a time, it becomes incumbent on those of us involved in such endeavors to engage in a bit of critical self-reflection. An unexamined and unsubstantiated perspective and practice is one that is easily co-opted.

This week’s study provides an honest (and as a negative trial result, a bit of a stinging) result. But that is what real science does. It must be, as Karl Popper observed, “[i]n so far as a scientific statement speaks about reality, it must be falsifiable; and in so far as it is not falsifiable, it does not speak about reality.”

The Study:

  • The study examined the impact of a typical food as medicine program in a group of participants with type 2 diabetes.
  • The study involved two recruitment centers, one urban and one rural.
  • The program as evaluated was remarkable for its duration (average one year), amount of healthful food provided (10 dietitian-curated meals for the entire household per week), and the intensity of preventive healthcare counseling delivered (dietitian counseling and education visits, nurse directed preventive care (e.g., foot examinations), and the support of community health care workers (via telephone calls and in person consultations at the clinic).
  • The control group received usual care but had the option of joining the program after approximately six months.
  • The additional average participant cost was $2,000 per year, or roughly $350,000 for the treatment group.

The Take-Away:

  • Unlike many previous studies that were of an observational nature, this study was a randomized controlled trial (RCT), thus providing a stronger level of evidence.
  • Those in the treatment arm exhibited greater engagement with the program, as reflected in an increase in the number of visits to the clinic (which included food pickup and interaction with the dietitian, nurse, and/or community health worker).
  • At study completion there was no statistically significant difference between the groups in terms of vegetable consumption, fast food consumption, and consumption of sweetened beverages.
  • Between the treatment group and the control group there was no detectable change in healthy attitudes, diabetes self-efficacy, exercise, or smoking.
  • Compared to the control group, there was a nonsignificant difference (p=0.60) in the primary endpoint of hemoglobin A1c (HbA1c) levels at six months and one year, with a decrease in HbA1c of 1.3 percent in the control group and 1.5 percent in the treatment group.
  • At the study’s conclusion, there was no significant difference in weight or blood pressure nor other laboratory variables including cholesterol, triglycerides, and fasting glucose levels.
  • There was no difference in the groups in terms of hospitalization or emergency department visits based on data from electronic health records and claims information.
  • The study authors concluded that, “[i]n this randomized clinical trial, an intensive food-as-medicine program increased engagement with preventive health care but did not improve glycemic control compared with usual care among adult participants.”

The Caveat:
The actual study enrolled less than 10 percent of the 3,712 patients initially assessed. Although the study quotes a total of 465 participants, only 349 (75 percent) had laboratory test results at six months, and these tests form the basis of the analysis. The study groups consisted of the treatment group (170 participants) and the control group (179 participants), making this a relatively small study limited to type 2 diabetics.

Does this study suggest that food as medicine efforts to improve health through diet are wasted efforts at best? Absolutely not.

What we can draw from the study, which is not surprising given the effects (or more accurately the lack of effects) of guidelines, recommendations, and well-meaning initiatives over the last half-century, is that we need to innovate. Giving people more fruits and vegetables with the same old dietary advice doesn’t work. The mantra, which I repeatedly hear, is that we need more education, and we need to do a better job of communicating that message. This study refutes that. The intervention arm was more attentive and engaged, and in the end that made no difference in meaningful outcomes of health measures despite spending well over a quarter of a million dollars. The basic premise hasn’t worked for 50 years, and it doesn’t work now, no matter how smartly we repackage and rebrand it.

Our diet impacts our health in powerful ways. That data remains unchanged. What needs transforming is our perspective on how we go about addressing our individual and societal food relationship.

“Now, bring me that horizon.”

The Study:
Doyle, J.; Alsan, M.; Skelley, N.; Yutong, L.; Cawley, J. (2024). Effect of an Intensive Food-as-Medicine Program on Health and Health Care Use: A Randomized Clinical Trial. JAMA, 184 (2), 154-163.doi:10.1001/jamainternmed.2023.6670

Additional Resources:
Food As Medicine. (2024). Food as Medicine Summit. Retrieved from Food as Medicine Summit: https://www.foodmedicinesummit.com/
Teicholz, N. (2022, April 1). Opinion: Solve nutrition insecurity – but not with donuts. Retrieved from Agripulse: https://www.agri-pulse.com/articles/17470-opinion-solve-nutrition-insecurity-but-not-with-donuts


[1] (Teicholz, 2022)
[2] (Food As Medicine, 2024)

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