Eight in 10 U.S. adults have a chronic disease, and half of U.S. adults have two or more of these conditions. The leading causes of death and disability—including heart disease, cancer, stroke, Alzheimer's disease, diabetes and chronic kidney disease—are also primary drivers of the nearly $4 trillion in annual healthcare costs. Poor nutrition is a common thread among these conditions.
“Evidence consistently shows that healthy dietary choices can reduce the risk of chronic diseases, improve quality of life and promote longevity. By focusing on balanced nutrition, we can empower patients to take better control of their health and in many cases, reverse or mitigate the course of disease,” said Bobby Mukkamala, MD, immediate past president of AMA, a board-certified otolaryngologist who is also board-certified in lifestyle medicine.
Experts who joined Dr. Mukkamala for an AMA webinar underscored this point, emphasizing that a variety of dietary strategies and food access programs are available to help prevent and manage chronic disease.
Unfortunately, most Americans are eating what some experts call the "SAD plate," or the Standard American Diet, said Kelseanna Hollis‑Hansen, PhD, MPH. She is a research assistant professor at Tufts University’s Friedman School of Nutrition, Science and Policy, and also the faculty director of the New England Regional Collaborative for Food Is Medicine Program.
About 58% of the typical American diet comes from ultraprocessed foods such as chips, doughnuts and pastries. By contrast, only about 30% comes from minimally processed foods such as fruits, vegetables, lean proteins and dairy products, she said.
Treatment should go beyond simply telling patients to "eat better and exercise," said Michelle Hauser, MD, MS, MPA, whose presentation focused on dietary strategies for obesity management. Dr. Hauser is the obesity medicine director of the medical weight loss program in the Stanford University Lifestyle and Weight Management Center and is also president-elect of the American College of Lifestyle Medicine.
Many people have healthy habits but still struggle with weight because of underlying medical conditions, medications, sleep disorders and other factors. “Regardless of any sort of treatment we would recommend, we want to develop a comprehensive lifestyle intervention,” said Dr. Hauser.
The webinar, “Reducing Risk of Chronic Disease Through Diet,” is available to watch on demand at the AMA Ed Hub™. The AMA has designated this blended live and enduring material for a maximum of 1 AMA PRA Category 1 Credit™.
It was the last of a four-part AMA Ed Hub “Healthy Diet and Dietary Patterns” webinar series, all of which was hosted by Dr. Mukkamala. Learn more and watch on demand.
Access programs are improving health metrics
The webinar addressed a promising development in nutrition and healthcare: the “food Is medicine” movement. The goal, Hollis-Hansen said, is to move people from the "SAD plate" to what she called the "happy plate."
Food-is-medicine programs encompass several strategies. Produce-prescription programs provide patients with vouchers, food boxes or debit cards to obtain fruits and vegetables. They can pick up their produce at a farmer's market, in the medical clinic itself or delivered directly to their home with that voucher or card, Hollis-Hansen explained.
Medically tailored groceries offer patients boxes of healthy and nutritious foods, while medically tailored meals provide fully prepared meals for patients with specific chronic conditions or recent hospitalizations.
The evidence supporting these interventions continues to grow. Studies consistently show that food is medicine programs improve food security and dietary quality. Research has also demonstrated improvements in cardiometabolic health, including reductions in blood pressure and A1c levels among patients with hypertension and type 2 diabetes.
Perhaps most striking are findings from real world implementations of medically tailored meal programs. An evaluation of six months of participation found "31% fewer hospitalizations, 20% fewer emergency department visits" and an average cut of about $3,400 in healthcare costs per patient. Moreover, "about 98% of the program costs were offset," suggesting these interventions may be nearly cost-neutral while significantly improving patient outcomes, said Hollis-Hansen. However, more research is still needed to understand the long-term effectiveness of these types of interventions.
A variety of diet strategies to choose from
What should people be eating? Various evidence-based dietary patterns—including the Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) diet, the Harvard Healthy Eating Plate and the Engage, Act, Transform (EAT)-Lancet Planetary Health Diet—all have different approaches but share common principles. At least half of the plate is fresh vegetables and fruits along with whole grains, healthy fats, modest amounts of animal protein and more plant-based proteins, said Hollis-Hansen.
Plant-predominant diets are consistently associated with weight loss and improvements in cardiovascular health, diabetes risk and some cancers, said Dr. Hauser. A good rule of thumb is bestselling author Michael Pollan's simple advice: "Eat food. Not too much. Mostly plants." That is an effective framework for healthy eating, she said.
Other popular dietary approaches such as intermittent fasting and ketogenic diets can also have benefits but should be considered carefully. Time-restricted eating, Dr. Hauser noted, is effective only insofar as it helps people reduce calories, with "nothing else magical about it." While ketogenic diets can improve blood-sugar control and promote rapid weight loss, she cautioned that they may increase cardiovascular risk and often produce less favorable health outcomes than Mediterranean or plant-based diets.
Reducing specific food choices such as sodium and alcohol consumption reduces the risk of chronic disease, said Hollis-Hansen, who encouraged boosting potassium intake through foods such as fruits, vegetables, nuts, seeds and legumes, as well as reducing sodium.
She also highlighted new research on alcohol, noting that there is "no safe threshold" for cancer risk. Even low levels of drinking have been linked to several cancers, while heavy alcohol consumption is consistently associated with increased risks of diabetes, Alzheimer's disease, heart attack and stroke, Hollis-Hansen said.
Advice for physicians
Dr. Hauser stressed the importance of comprehensive, patient-centered care that considers an individual patient's goals, cultural practices, food preferences and access to healthy foods. Regardless of whether treatment includes lifestyle interventions, anti-obesity medications or surgery, "we want to effectively partner with our patients to maximize their health and wellness,” she said.
Although GLP-1 drugs are growing in popularity and have shown remarkable effectiveness, Hollis-Hansen stressed that they are approved "as an adjunct to nutrition and lifestyle." In other words, medications and healthy eating practices should work together rather than be viewed as competing approaches.
Physicians interested in incorporating the food-is-medicine philosophy into their practices should carefully tailor their conversations with patients about their health, said Dr. Hauser.
“No one should ever be shamed or guilted for what they have,” she said. “It’s important to screen for these things ... to assess what patients like, what they have access to, and then make recommendations or tweaks based on that. I think people find it a lot more sustainable to do small stepwise changes.”
Physicians should check in with patients to see if a certain strategy worked and then build on that success, she added.
For many physician practices, incorporating nutrition screening and referrals into already packed schedules is a struggle, noted Hollis-Hansen. The good news is that food-is-medicine interventions can be integrated into clinical practice through a variety of approaches, including EHR prompts and workflows involving medical assistants, dietitians, social workers and community health workers.
Physicians can access the “Food is Medicine Toolkit,” a collaboration between the Tufts’ Food is Medicine Institute and Kaiser Permanente, to learn more about designing and implementing these programs, she said.
How culinary medicine reduces burnout
There’s also the growing field of culinary medicine, which combines nutrition science and cooking skills to help people adopt healthier eating patterns. The ultimate goal is to make healthy eating sustainable by ensuring that nutritious foods are also "delicious and tasty,” said Dr. Hauser, who is also a Le Cordon Bleu-trained chef.
An unexpected benefit has come out of these programs: physician well-being. "The physicians I talk to who implement culinary medicine or food as medicine are so happy to be doing it," said Hollis-Hansen. Early evidence suggests that these approaches may help reduce physician burnout while increasing provider satisfaction.
