Rethinking food
Food insecure diabetics especially benefit
There’s a movement afoot to think of food as medicine. A mountain of research supports the advice to Eat Better. If more of us were to regard food as medicine, maybe we’d make better food choices. We’d want to eat good medicine rather than bad medicine.
The idea of food as medicine can manifest as healthy or medically tailored meals targeted at people with food insecurity and who may be diabetic. Food insecurity refers to limited or uncertain availability of nutritionally adequate foods. People with food insecurity may lack the money to buy nutritious food or have limited mobility. Or they may live in a “food desert”, far from a full-service grocery store. The negative effects of food insecurity fall heavily on diabetics. Healthy foods, such as fruits and vegetables, cost more than junk food, which exacerbates blood sugar problems. Happily, recent evidence shows that medically tailored meals can reduce medical care expenses and improve health of food-insecure persons, including diabetics.
To test the effectiveness of medically tailored and non-medically tailored meals, researchers studied selected members of the Massachusetts Commonwealth Community Alliance. All participants were eligible for both Medicare and Medicaid. Both meal programs delivered three meals per day for five days each week for six months. Over average follow-up periods of 19 to 24 months, participants in the medically tailored meal program had significantly lower rates of emergency department visits and inpatient admissions, compared to a control group. Participants in the non-tailored meal program had significantly lower rates of emergency department visits and emergency transportation events, compared to a control group. Both meal programs led to lower average net monthly medical spending compared to the control groups ($220 and $10 for the medically tailored and non-tailored programs, respectively). Delivered meal programs can improve the health of disadvantaged persons in a cost-effective manner.
A follow-up study provided medically tailored meals to 44 food insecure adults with type 2 diabetes in the Boston area. The study design included 1) 10 home-delivered meals per week for 12 weeks, followed or preceded by 2) 12 weeks of self-prepared meals. Home delivered medically tailored meals predicted significantly higher meal quality, as measured by the Healthy Eating Index (71.3 out of a possible 100 compared to 39.9 for self-prepared meals. Participants reported lower food insecurity, fewer episodes of low blood sugar, and fewer days when their mental health interfered with quality of life when provided with medially tailored meals.
A similar study used data from the Massachusetts All Claims Payer data base and from Community Servings, a non-profit group that delivers medically tailored meals in the south Boston metro area. Over a three-year period, the 499 recipients of medically tailored meals had 49 percent fewer inpatient admissions and 72 percent fewer skilled nursing facility admissions than matched non-recipients. Furthermore, if everyone in the study (both recipients and matched non-recipients) had received the medically tailored meals, total monthly per person medical care costs would have dropped by 17 percent ($753 in absolute terms). Nutritious meals can help food insecure persons with nutrition-related medical conditions boost their health and reduce their health care costs.
