MedPage Today: “Whole-of-Government” Approach Needed for Diet-Related Illnesses, Senator Says

From MedPage Today: WASHINGTON — The U.S. needs a “whole-of-government” approach to addressing diet-related diseases, Sen. Cory Booker (D-N.J.) said Wednesday at a Senate hearing on food as medicine. “Currently in the United States, half our population is pre-diabetic [or] has type 2 diabetes,” said Booker, who is chairman of the Senate Agriculture, Nutrition, and Forestry Subcommittee on Food and Nutrition, Specialty Crops, Organics, and Research. “That is something that isn’t exclusively affecting older people … one-quarter of our teenagers today are pre-diabetic or have type 2 diabetes. Much of that can be attributed to the alarming fact that ultra-processed foods now compose two-thirds of the calories in the diets of our children and teens.” A System Based on Wellness Booker, a vegan who stopped eating added sugar for 2 months last summer, noted that in September, “the White House released a bold blueprint to end hunger, improve nutrition, and reduce the epidemic of diet-related diseases. A key component of the national strategy is a call to continue researching and scaling up ‘food as medicine’ programs, such as funding pilot programs to integrate medically tailored meals and nutrition counseling into our Medicare and Medicaid programs.” Booker added that incentivizing farmers to grow fruits and vegetables at the same level as the federal government supports commodity crop production “is a top priority for me in the Farm Bill.” Sen. Mike Braun (R-Ind.), the subcommittee’s ranking member, recalled that when he was running his family’s truck parts distribution company, “we built a system based upon wellness and avoiding the healthcare system and making my employees engage in their own well-being.” For example, employees were offered a free biometric screening, “and if you didn’t get it, you’re going to get penalized because you weren’t doing the right thing.” The wellness program is still going strong today, he added. “Employees have not had a [health insurance] premium increase in 15 years and they go into their deductible less now than they did then, because they’ve become healthcare consumers. In a nutshell, that’s what we need to do more broadly across the country.” But many people — especially lower-income people or those living in “food deserts” with no access to healthy foods — have trouble accessing healthy meals and fresh fruits and vegetables, witnesses said. “For 20 years I served as a part-time primary care doctor and hospitalist at the Philadelphia Veterans Affairs Medical Center,” said Kevin Volpp, MD, PhD, founding director of the University of Pennsylvania’s Center for Health Incentives and Behavioral Economics. “Many of my patients struggled with chronic diseases, such as congestive heart failure and diabetes, which were exacerbated by their challenges finding affordable, healthy foods.” Clinical Trial Shortcomings “Evidence indicates that incorporating food as medicine programs into healthcare can be associated with improvements in outcomes,” said Volpp, who is also a member of the advocacy coordinating committee at the American Heart Association (AHA). “For example, medically tailored meals are associated with fewer hospital and skilled nursing facility admissions, fewer emergency room visits, and healthcare cost reductions.” However, he said, when it comes to proving the value of food as medicine, “only a small number of randomized controlled trials have been done, and they’ve typically been small and thus unable to provide definitive answers. Food as medicine interventions have not generally incorporated freedom of choice and input from patients, reducing potential rates of engagement.” Read more at MedPage Today.