As an internist in the public primary care clinic at Zuckerberg San Francisco General Hospital, Dr. Hilary Seligman often asked her patients about their diets. One conversation that stands out involved a man in his 50s, a longtime patient she had just diagnosed with prediabetes. Asked to describe his meals, he revealed that his daily lunch was a sandwich of Spam between two cinnamon rolls.
[time-brightcove not-tgx=”true”]“It really shocked me,” says Seligman. She couldn’t fathom why someone would even put those two foods together until she realized he did it because it was affordable and kept him full until he had enough money to eat again. “Healthier food just costs more,” she adds.
That pivotal conversation shed light on the harsh realities of food insecurity, fueling Seligman’s passion for health equity and the growing movement known as Food Is Medicine (FIM). The philosophy of FIM is simple: Nutritious food is as critical to health as other medical treatments like prescription drugs and should be included in health care coverage.
As the director of UC San Francisco’s Food Policy, Health, and Hunger Research Program and the Nutrition and Obesity Policy, Research and Evaluation Network of the U.S. Centers for Disease Control and Prevention, Seligman has played a key role in spearheading policy changes aimed at treating and preventing diet-related chronic illness by improving what people eat. Her initiatives, EatSF and Vouchers 4 Veggies, provide low-income residents who can’t afford nutritious food with “produce prescriptions” to redeem for fruits and vegetables at various outlets in California and outside the state.
“From the perspective of the patient, it makes a difference when your doctor prescribes something,” says Seligman, a professor of medicine, and of epidemiology and biostatistics at UCSF. People take it more seriously. In this case, instead of “take this antibiotic for your ear infection,” it’s “take this healthy food to prevent your diabetes.”
The statistics clearly illustrate the need for this approach. One in eight U.S. households lacks access to affordable and nutritious food, while half of all American adults suffer from chronic diseases linked to their diets such as cardiovascular disease, high blood pressure, or Type 2 diabetes. Each year, these diet-related conditions lead to more than a million deaths in the U.S., exceeding those caused by smoking. These illnesses are also among the country’s largest health care costs, with a price tag of $1.1 trillion annually, which matches what the entire country spends on food itself.
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Given the profound health and economic impact of poor nutrition, it’s no surprise that the FIM concept is gaining traction. That’s due to a few key turning points, says Dr. Dariush Mozaffarian, a cardiologist and director of the Food Is Medicine Institute at Tufts University.
First, the COVID-19 pandemic drove home the crucial link between diet-related diseases and severe health outcomes, as people with obesity and other nutritional issues often had much tougher battles with the virus. Second, heightened national attention to health disparities, particularly influenced by movements like Black Lives Matter and economic pressures like rising food prices, has further pushed the issue to the forefront. The conversation has also been propelled by the high costs of popular injectable weight loss medications like Ozempic and Wegovy, driving the search for more sustainable health solutions. This collective awareness culminated in the Biden Administration’s 2022 White House Conference on Hunger, Nutrition, and Health, which pledged $8 billion in public and private funds to these causes. In government funding alone, 2023 data from the U.S. Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP), administered by the U.S. Department of Agriculture, shows a near seven-fold increase in the number of FIM sites and a near twelve-fold increase in participation of these programs.
One of the movement’s biggest wins came in recent years when FIM programs, including produce prescriptions, were integrated into Medicaid through Section 1115 waivers in 11 states. Additionally, Medicare Advantage has broadly adopted similar coverage, while the departments of Veterans Affairs and the U.S. Indian Health Service are exploring these initiatives through pilot programs.
To improve patient health, many organizations are addressing the lack of access and affordability of nutritious foods through innovative collaborations. For example, Brighter Bites, a national nonprofit based in Houston, serves thousands of children and their families across the country through school systems and health care organizations, delivering each of them 20 pounds of fresh fruits and vegetables per week, along with nutrition education. It’s funded by government agencies and partnerships with produce companies, other nonprofits, and philanthropic organizations.
Among providers, a big player is Kaiser Permanente, which recently committed $50 million to further integrate FIM into its care model. Part of this work includes launching its Food Is Medicine Center of Excellence. The center combines clinical services—from produce prescriptions and medically tailored meals to culinary medicine and nutrition counseling—with new research and partnerships. In one trial in collaboration with Instacart, Kaiser is studying the outcomes of giving Medi-Cal members in Northern and Southern California more choices with grocery stipends that can be used to purchase fresh and frozen produce, legumes, plant-based oils, spices, and other foods from a curated virtual storefront.
“By building the evidence for how to not only treat but also to prevent these very common conditions, our hope is to improve health—including for our most vulnerable populations—and to lower the cost of care,” says Pamela Schwartz, Kaiser Permanente’s executive director of community health.
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These initiatives align with findings from a 2022 survey that revealed a high level of food and nutrition insecurity among Kaiser Permanente members: A quarter of all members, and nearly half of those on Medicaid, reported struggling to have enough to eat or access to nutritious food. As a result, Kaiser has also been helping members access food assistance through federal programs like SNAP (Supplemental Nutrition Assistance Program), and WIC (Women, Infants and Children).
Trinadad Cuevas Garcia, a 53-year-old nursery worker in Forest Grove, Ore., knows this firsthand. She faced an ironic twist of fate when she moved to the U.S. from Oaxaca, Mexico, where she once grew her own tomatoes, corn, potatoes, and green beans on her family farm. Despite her farming skills and work in the agriculture industry, she could no longer afford fresh produce and had to subsist on a diet of mostly tortillas, rice, and beans.
However, a diagnosis of diabetes in 2021 and a doctor’s referral led Garcia to a produce prescription program at Adelante Mujeres, an Oregon-based nonprofit that supports marginalized Latina women and their families. The program provided her with a monthly budget of $300 to buy fresh produce for her family and to gain access to cooking workshops to learn how to prepare unfamiliar vegetables. Since joining the program, Garcia has embraced a healthier lifestyle, incorporating vegetables like kale, broccoli, and cauliflower into her diet. “I’m so grateful for this program,” says Garcia through a translator, “and I no longer need to restrict myself when buying fresh produce at the market.” Her health has significantly improved as a result; her A1C levels dropped from 7.6 to 6.4, moving her out of the high-risk diabetic category.
While access to these life-changing programs is still limited, it is possible thanks to partnerships with organizations like the Rockefeller Foundation, which supports the produce prescription programs at Adelante Mujeres, Brighter Bites, and others as part of the $100 million it earmarked to FIM programs nationally since 2019. “It’s a little bit crazy when you realize that what we eat is the number one driver of poor health in the country, and yet the health care system has so few tools to actually help patients eat better,” says Devon Klatell, vice president of Rockefeller’s food initiatives.
The research on FIM programs is also starting to build. In a 2024 review of dozens of studies published in the Journal of the American College of Cardiology, Mozzafarian at Tufts and his co-authors found that these interventions have shown the ability to significantly improve diet, manage chronic diseases like Type 2 diabetes and hypertension, and enhance overall physical and mental health, while also being cost-effective. However, larger, more rigorous studies are still needed, and several such robust experiments are currently underway, including a trial involving high-risk pregnancies in Georgia.
If food is truly medicine, say experts, interventions like produce prescriptions should become as routine as taking a pill—and become fully integrated into the health care system. That includes better screening for food and nutrition insecurity, expanded public and private coverage, and more providers. It will also require more nutrition education for patients, and training in the field. Currently, U.S. medical schools offer less than 20 hours of nutrition education across four years, which is less than 1% of the total estimated lecture hours.
It will also require better screening for food insecurity and more innovation to bridge the gap between health care professionals and grocers, some of which is already happening—such as patients getting produce benefits deposited straight onto debit cards to swipe at the grocery store. “We have a system that connects the health care system to the pharmacy in the back of the grocery store, but we don’t have a system to connect the health care system to the healthy foods at the front of the grocery store,” says Seligman.
In order for healthy eating to be the norm, there also has to be a shift beyond underserved communities, says Shreela Sharma, a professor of epidemiology at UTHealth Houston School of Public Health and co-founder of Brighter Bites. “Historically—with smoking, seatbelts—when you shift the social norms, that’s where the sweet spot is.”
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In Congress, there’s a significant push to expand federal support for these initiatives, says UCSF’s Seligman. This expansion isn’t just about encouraging healthier eating; it’s also about bolstering farmers and local food systems. “One of the challenges of these programs is that there isn’t a long term, sustainable funding stream outside of health insurance,” she says. “That’s really the cutting edge. Will health insurance pay for this? Because when people don’t eat healthy food, it’s the health system that’s bearing the downstream costs.”
Food not only underpins our health, but also plays a vital role in our social fabric. Seligman shares a story about a group of socially isolated older adults from the same housing site in San Francisco who decided to spend their EatSF produce vouchers together at a farmers market. They pooled their resources to buy ingredients for a communal meal, which they then cooked and shared. “That’s really important,” says Seligman. “It starts with food, but hopefully food is also an avenue towards better physical and mental health and more connection with one another.”
