Harnessing the Healing Power of Food: A Look Inside the American Heart Association’s Food is Medicine Research Initiative

The connection between food and health is undeniable. Unhealthy eating habits can seriously impact our health, leading to chronic diseases. On the flip side, healthy eating can prevent and even reverse the progression of some diseases. Unfortunately, in many corners of the world—including in the richest countries, many people lack access to healthy food and a quality diet to support their health. This has contributed to an increase in chronic diseases like cardiovascular disease, diabetes, and obesity. To address this issue, the American Heart Association (AHA) has launched its Food is Medicine (FIM) Initiative. This initiative aims to tackle the inefficiencies and inequities in attaining full, healthy lives through a healthy diet. The initiative hopes to provide evidence of the effectiveness and cost-effectiveness of Food Is Medicine interventions. This will help guide financial coverage decisions for these interventions in medical settings. It's an exciting step forward in promoting better health through nutrition.

The Need for Food as Medicine

The Food is medicine concept dates far back in history. For example, Hippocrates once said, "Let food be thy medicine and medicine be thy food." Likewise, food and medicine have remained interwoven in many cultures. For instance, the Okinawan people believe that the food they eat is ‘nuchi gusui,’ or ‘medicine for life.’

These words still hold true today and take on renewed significance, especially with rising healthcare costs. Chronic conditions such as diabetes, heart disease, and obesity are prevalent and costly to manage, accounting for a large portion of healthcare expenditure. In the United States, about 90% of the $4.3 trillion spent annually on healthcare goes toward medical care for chronic diseases.

Taking a food-focused approach to healthcare not only helps treat existing conditions but also prevents them. Lifestyle factors, including diet, play a crucial role in the development and progression of chronic diseases. By highlighting the significance of nutrition and empowering individuals to make healthier food choices, we can work towards reducing the burden of chronic illness on the healthcare system.

Dr. Kevin Volpp, MD, PhD, FAHA, the initiative’s Scientific Lead and director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, brings a personal passion to the cause, having survived a heart attack himself. He emphasizes, “Healthy foods can help treat and prevent serious chronic diseases that affect millions nationwide and account for a significant and disproportionate share of healthcare spending.” He further explains, “We are implementing an inclusive and coordinated research strategy to explore how Food Is Medicine can support the treatment and prevention of diet-related diseases, with the ultimate aim of making it a regular and reimbursable component of healthcare.”

Indeed, by harnessing the healing power of food, we can improve health outcomes, reduce healthcare costs, enhance quality of life, and promote health equity.

The Food is Medicine Roadmap and the Healthcare x Food Initiative

The Food is Medicine initiative is one of several important strategies for improving population health through food and nutrition policies and programs. This approach shows great potential, but we need more evidence to validate its effectiveness and cost-effectiveness.

In the past, local groups established FIM programs tailored to the specific needs of their communities. Now, there is an increasing effort to evaluate the real-world effectiveness, sustainability and cost-efficiency of these programs, especially with regards to improving the health of patients and those at risk of diet-related medical conditions. However, establishing a strong and rigorous evidence base for these programs can be challenging. The attributes of existing FIM studies vary in terms of sample sizes and target population, randomization approaches, intervention components, duration, and outcome measures making it difficult to determine their effectiveness. Moreover, there is a lack of comparative studies and analysis of long-term cost-effectiveness.

To tackle these challenges, the American Heart Association (AHA) and Rockefeller Foundation, supported by other stakeholders, launched the Healthcare x Food ™initiative to gather evidence on the effectiveness and cost-effectiveness of specific FIM interventions for improving health in clinical settings. The AHA Healthcare x Food initiative is focused on finding clear evidence of the best dose, duration, and intensity for FIM programs for a variety of health conditions and populations.

Following an initial in-depth literature review and gap analysis, AHA aims to support further analysis of existing data and small trials, which will lay the groundwork for the initiative.

However, given the low rates of patient engagement, adherence, and behavior change identified in existing literature, the initiative will initially focus on conducting rapid-cycle short-term studies to test methods for identifying these gaps before moving on to longer-term studies. These pilot studies will be based on human-centered design principles and will seek to incorporate the experiences of patients and healthcare providers to develop and test strategies for increasing program enrollment and engagement across different populations. The next phase of studies will be intermediate-length studies, which will build on the pilot studies to focus on promoting both short-term and long-term behavior change.

Challenges with Diversity and Equity

The AHA Healthcare x Food initiative also aims to tackle the issue of inequality in food security, particularly among underinvested populations and communities. Food security means that everyone has access to safe, affordable, nutritious, and sufficient food at all times. It's not just about having enough to eat; it's also about having access to nutritious food. Significant disparities in food access exist, influenced by factors like health, socio-economics, geography, and cultural relevance. Communities of color, for example, often face a higher prevalence of chronic illnesses such as obesity, diabetes, and hypertension, partly due to limited access to healthy food. Without proper nutrition, these health issues worsen, creating a harmful cycle.

Households with lower incomes, often including many minoritized families, struggle more with food insecurity. Low-paying or unstable jobs in marginalized communities mean less money for groceries and fewer nutritious options. Cultural relevance in food availability is also important. Traditional and culturally relevant foods are not easily accessible or affordable in many communities. Nutrition programs often overlook these cultural preferences, leading to lower participation rates among diverse populations.

Historical marginalization and factors like structural and institutional racism, which fosters poverty, also mean that historically excluded people are often overrepresented among those impacted by poor-quality diets. Discrimination in the education sector and labor markets, along with shortcomings in income support policies and limited investment support, result in many people experiencing worse social determinants of health, all of which create significant barriers to maintaining a healthy diet. While broader structural interventions to change policy environments are important, FIM interventions focused on underserved individuals and communities have the potential to transform the health of those affected by diet-related conditions positively.

Overcoming Challenges, The THRIVE Study

One of the pilot studies aimed at addressing food equity challenges and improving diet quality and cardiovascular outcomes in underserved minority communities is the THRIVE program. THRIVE stands for the AdapTive personalized dietitian coacHing, messaging, and pRoduce prescrIption to improVE healthy dietary behaviors program. Led by Bunmi Ogungbe, Ph.D., M.P.H., R.N., assistant professor, Johns Hopkins School of Nursing and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, THRIVE represents a pioneering approach to tackling food equity and cardiovascular disparities in Black and Hispanic communities. Through a comprehensive strategy that was co-designed and co-created with community members, THRIVE comprises personalized dietary coaching with produce prescription, access to healthy foods through free fruits and vegetables home-delivered or obtained from “FARMacy,” linkage to healthcare and social resources, adaptive messaging and leveraging technology for remote trials management, efficient data capture, and participant engagement, this 18-month study aims to make a significant impact on the cardiovascular health of Black and Hispanic adults with uncontrolled blood pressure in high food priority areas (also known as “food deserts”).

The study is dear to Dr. Ogungbe, who previously experienced having a physician repeatedly recommend culturally unfamiliar foods. THRIVE focuses on individuals with uncontrolled blood pressure, particularly those of Black, Caribbean, and Hispanic descent who have a higher burden of cardiovascular disease. The study will be conducted in Montgomery County, Maryland, and will focus on engaging people with limited access to high-quality food.

The recruitment strategy involves partnering with community service hubs, health systems, and faith-based organizations to reach prospective participants. Prospective participants will complete a pre-screen survey on the Studypages platform. Those who meet the inclusion criteria are eligible after an in-person screening, and consent will be obtained for enrollment in the study. Once enrolled, they will have access to intervention components, including dietician coaching with produce prescription based on the Dietary-Approaches-to-Stop-Hypertension (DASH) diet. Also, participants will receive $30/week worth of fruits and vegetables from the “FARMacy” mobile market through the study’s produce partner-Community FarmShare.

Furthermore, the study aims to tackle cultural disparities affecting food security by ensuring that the study dieticians share a cultural background with the participants and will prescribe produce choices that align with the participants’ cultural background. The THRIVE program will also screen participants for additional healthcare and social needs, such as housing instability, unemployment, etc, and connect them with existing programs available through the study’s collaborating partners (The Medi). THRIVE connects participants to needed healthcare by partnering with health systems, such as Care for Your Health and Mobile Medical Care Inc., which provide culturally sensitive care.

Studypages is the study’s technological partner and will support e-recruitment, automated sending and retrieval of e-consent, two-way messaging at scale, administration of diet and health surveys, and secure transfer of data for analysis. Additionally, SPData will be used to capture patient-generated diet, activity, biometric, and contextual data via participants' mobile devices.

The THRIVE program, with its emphasis on compatible healthy dietary choices and strategic partnerships, promises to improve diet quality and health outcomes (blood pressure control) among Black and Hispanic populations in Montgomery County, Maryland. This innovative study not only seeks to address immediate food security and health concerns but also hopes to set the stage for larger comparative effectiveness trials for long-term improvements in sustained dietary, behavioral changes, and clinical outcomes. The THRIVE program is being set up to become a covered benefit through public and private health insurance.

By refocusing on the foundational role of nutrition in maintaining and restoring health, the American Heart Association's Healthcare by Food initiative is designed to promote effective approaches to treat, manage, and prevent chronic diseases through the prescription of healthy food in the healthcare setting. The goal is to develop evidence on the cost-effectiveness of different food is medicine programs for patients with health conditions. The goal is to develop evidence on the cost-effectiveness of Food is Medicine programs for diet-related conditions and advocate for their inclusion as a covered benefit in public or private health insurance.

The initiative's emphasis on human-centered, evidence-based interventions offers hope for a future where food is not just sustenance but a key ingredient in our collective well-being. The road to fully realizing the potential of Food in Medicine may be long and require rigorous research, collaboration, and innovation, but its promise to transform healthcare is compelling.

We at Studypages are thrilled to be a part of this groundbreaking effort. Our partnership with the THRIVE program reflects our unwavering commitment to implementing health equity-focused interventions, leveraging technology to better understand and address the needs of diverse populations. Stay connected with us to learn more about the latest clinical research updates and be part of the advancement of healthcare research.  

Want to connect with the THRIVE team? Reach out via email at thrive-fim@jh.edu or call (240) 540-4934. Don’t forget to visit the THRIVE study page and follow them on Instagram, Linktree, and Facebook for the latest updates and insights.