Nutrition

Food is Medicine

Why Healthier Eating Should Be a Priority for the Government, the Health Care System, and Private Business

By Dariush Mozaffarian, MD DrPH, Dean and Jean Mayer Professor, Friedman School of Nutrition Science & Policy, Tufts University; and Professor Medicine, Division of Cardiology, Tufts Medical Center and Tufts School of Medicine

Introduction

 “Let food by thy medicine, and medicine by thy food” – Hippocrates, 431 B.C.

We spend mind-boggling sums on health care in the U.S.:  $3.5 trillion per year, or nearly 1 in 5 dollars in the entire economy.  This is more than $10,000 spent each year for every man, woman, and child in the nation – more than $40,000 per year for every family of four. These costs exceed most households’ budgets for food, gas, housing, and other common necessities. And much of this is diet-related.

Suboptimal diet is the leading cause of poor health in the U.S., especially due to chronic diseases.  For example, just ten dietary factors are estimated to cause nearly half of all U.S. deaths from heart disease, stroke, and type 2 diabetes – nearly 1,000 deaths each day.  One in three children born after 2000 will develop type 2 diabetes in their lifetime, while 2 in 3 will become overweight or obese.

Annual direct and indirect healthcare expenditures are estimated to be about $300 billion for cardiovascular diseases, $300 billion for type 2 diabetes, and $1.42 trillion for all obesity-related conditions.  These diet-related burdens also disproportionately harm lower-income Americans, contributing to major disparities.

Given its core role in healthcare costs, leveraging food for better health – a Food is Medicine strategy – should be a priority for our national and state government, the healthcare system, and private businesses.

 

Dietary Priorities

Dietary targets should focus on the latest scientific priorities (Box 1). For example, there should be less focus on dietary fat, isolated vitamins, or overall macronutrients like total protein or carbohydrates.  Instead, we must focus on the health effects of food processing, refined starch, and added sugars; the role of flavanols and other bioactive compounds; the benefits of whole foods such as fruits, nuts, beans, vegetables, and whole grains; the harms of additives like salt and trans-fat; and the role of the gut microbiome.

Box 1.  Examples of Important Advances and New Lessons in Nutrition Science

  • Dietary guidance should emphasize specific food groups and overall dietary patterns, rather than reductionist approaches focused on isolated single nutrients.
  • For weight gain and obesity, not all calories are created equal. Different foods have varying effects on long-term modulators of energy balance. This includes hunger, satiety, brain reward, glycemic responses, hepatic fat synthesis, adipocyte function, metabolic expenditure and the microbiome.
  • Knowledge alone is often insufficient for behavior change. Systems changes must incentivize and normalize healthier foods and disincentive unhealthy options.

Despite advances in our understanding of nutrition, many controversies remain. These include, for example, (1) the relevance of saturated fat, (2) the role of very low-carbohydrate diets, (3) the optimal lowest target for dietary salt; (4) the utility of dietary supplements; (5) the impact of noncaloric sweeteners; (6) the effectiveness of emphasizing total calories vs. diet quality for long-term weight control; and (7) the importance of topics of popular interest such as gluten, organic foods, genetically modified foods, or popular diets (such as Atkins, paleo, keto, vegan, and more).  Yet, while further research is needed, these questions should not distract us as a society from implementing sensible policies to translate our current knowledge.

Policy “Best Buys”

Particularly promising government strategies for consideration include:

  • Strengthening of nutrition standards in schools, afterschool, and early childhood education programs; in child feeding programs such as WIC; and in federal cafeterias at worksites and other federal facilities (e.g., prisons, veterans affairs hospitals, the military).
  • Federal incentives to incorporate nutrition into corporate worksite wellness programs, such as personalized, interactive technology platforms and economic incentives already available in private insurance and corporate programs.
  • A federal excise tax on soda and other sugar-sweetened beverages, as well as potentially junk food, especially if combined with subsidies for healthier foods.
  • Integration of nutrition into healthcare, including in the electronic health record, through medical education, fruit and vegetable prescriptions, medically tailored meals, quality and reimbursement guidelines, and risk-sharing benchmarks that incentivize providers to emphasize prevention over disease treatment.
  • Leveraging the $70 billion per year SNAP program for better nutrition for low-income families, for example through strengthening SNAP-Education, increased subsidies for fruits and vegetables, and a [combined food incentive/disincentive platform to nudge people toward healthier choices.
  • U.S. Food and Drug Administration labeling standards and limits for additives such as salt, trans fat, and added sugar; marketing standards to protect children; and evidence-based health claims for products that help achieve better health.
  • Increased federal research funding, including a new National Institute of Nutrition at the National Institutes of Health; as well as economic incentives for transparent public-private partnerships in health-focused food innovation and entrepreneurship.

 

The Path Forward

A healthier, equitable, and sustainable food system is crucial for better well-being and lower health care costs.  This is crucial to improve the economic competitiveness of all U.S. businesses.  Complementary advances in nutrition science, policy evidence, and technology have identified relevant solutions for practical and impactful actions.  These policy strategies must now be implemented to help realize the power of Food as Medicine.

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