Not Just An Apple A Day: California Doctors Start Prescribing Medically Tailored Meals

In California, doctors are prescribing food as medicine to treat low-income patients with congestive heart failure. The program delivers medically tailored meals to 1,000 patients in eight counties across the state.

Here & Now's Robin Young speaks with Sheri Weiser, associate professor of medicine at UC San Francisco, about California's three-year pilot program, which is the first of its kind in the country.

“Anyone discharged with congestive heart failure has to adhere to a very strict diet. They have to eat very low sodium, which is a tall order for people even with resources,” Weiser says. “And on top of that, these are Medi-Cal patients, many who are quite poor and can't really afford to eat healthfully in general.”

On the pilot studies that informed the California program

“So the [Metropolitan Area Neighborhood Nutrition Alliance study in Philadelphia] … was one of those. And what they found is that people who received medically tailored meals, their hospitalizations were reduced by about a half and inpatient stays were also 37 percent shorter. And they also found that monthly health care costs were about 50 percent lower among MANNA clients receiving the meal intervention compared to those not receiving the meal. I helped spearhead along with Project Open Hand and my colleague Dr. Kartika Palar another one of the pilots that formed some of the evidence behind this California pilot. And this was a study in San Francisco where we provided people who had either diabetes or HIV with again similar 100 percent of their dietary requirements over a six-month period along with nutritional counseling. And in that study, we estimated that it costs about half as much to feed people 100 percent of the nutritional requirements for six months as spending one day in the hospital. So one could have significant cost savings on top of improvements in their health and quality of life.”

"When you provide people with healthful food, not only are you helping people with a specific condition like congestive heart failure or diabetes stay healthier, but it's actually helping them address many other comorbidities."

Sheri Weiser

On the high costs of the program

“The other way to look at it is the actual health care savings that could be incurred. You know, even thinking just about readmissions rates. So the unplanned readmission rate to a hospital after 30 days of discharge can be as high as 15 percent, so that ends up costing the state millions of dollars for preventable inpatient stays. It's estimated, even across the country, that as much as $25 billion is spent on preventable readmissions, and that's money that we can save. So one could view that as costly, but the returns on the investment are enormous. When you provide people with healthful food, not only are you helping people with a specific condition like congestive heart failure or diabetes stay healthier, but it's actually helping them address many other comorbidities. It's helping improve their mental health. It's helping prevent them from engaging in risky behaviors like risky sex to procure food as an example.”

On people with food insecurity trading sex for food

“What's interesting is that this isn't a phenomenon limited to women because we are finding actually in the patients that we interviewed with Project Open Hand and in other populations that this also is occurring among men. We had a study, you know, a national study across the U.S. that found that food insecure men had three times the odds of acquiring HIV infection, for instance, because they were engaging in more risky sex. But the phenomenon among women is very key. And I would say internationally, you know, women being disempowered from food insecurity and being forced to engage in risky sexual [behavior] — either having forced sex or having to make choices like engaging in sex exchange in order to meet their most basic food requirements — is a huge issue.

"I have a specific story about that actually. When I got into this whole research area in the first place, I was doing a study with Physicians for Human Rights, and we were trying to understand what was driving the HIV epidemics in Botswana and Swaziland. And so I started interviewing people and like literally the first woman I interviewed says to me, 'Well, we're having sex because we're hungry. If you gave us food, we wouldn’t need to have sex to eat.' And then I think it was literally my third interview that a woman was like, 'Well, what would you do? Here are my choices: I have sex with someone today, get HIV and will then live five to 10 more years, or my children and I starve tomorrow. You know, what would you do?' And no one should be in the position to have to make those kinds of impossible choices.”

"Long before the cost savings are first of all, that it's a basic human right to have freedom from hunger. So it's the right thing to do no matter what."

Sheri Weiser

On the program’s preventative approach to health

“Some of the impetus behind the food-as-medicine movement is the fact that it's thought that this will lead to cost savings. But long before the cost savings are first of all, that it's a basic human right to have freedom from hunger. So it's the right thing to do no matter what. So the cost savings certainly could help convince people who are not already convinced that this is not going to be costly for the health care system because it will lead to cost saving.”

On the likelihood of pushback from Big Pharma

“Well, what's interesting is that one of the most important consequences of food insecurity across many diseases — you know, I've studied this extensively in HIV — is that people who are food insecure don't take their medications. So in some ways it could be helpful to pharma because really these interventions go hand-in-hand. If people have access to food, they'll be more likely to take their medications as prescribed.”

On if California’s program will become part of the national Medicaid program

“We very much hope so. Based on all of the data showing that addressing food insecurity can improve health and that it can be cost effective, we strongly anticipate that we'll see health benefits and cost savings. And I think if it is successful, it's very possible that the federal government could determine that medically appropriate food should be a benefit incorporated as part of Medicaid nationally.”