Why Is Everyone Talking About Food Is Medicine?
An explainer, with some opinions.
For the past year, there has been a lot of chatter about "food is medicine" (FIM). Reading another headline or breathless LinkedIn update about the potential of FIM, I kept telling myself I needed to sit down and untangle the threads of this collection of nutrition approaches, figure out why everyone was suddenly so excited about them, and form an opinion for myself. (And is it food is medicine or food as medicine?)
If you're finding yourself in the same situation, come along with me to learn more about what food is medicine is, what it looks like in practice, and why everybody seems to be talking about it.
What Is Food is Medicine?
One reason why FIM was unclear in my mind for so long is that the term encompasses a wide range of approaches, and doesn't have one accepted definition. What connects them all is the idea that food is an essential component of health and well-being, and the health care system should help pay for the food people need to thrive — seems obvious, but the US medical system in particular is not structured to prioritize food, or ensure that people are getting enough of the food they need to support their health conditions, lifestyles, and cultural preferences.
The Aspen Institute and Harvard Law School’s Center for Health Law and Policy Innovation released a comprehensive Food is Medicine Research Action Plan, which identifies three categories of FIM interventions: medically tailored meals, medically tailored groceries, and produce prescriptions. Within those three categories, you can find a huge variety of approaches.
Take medically tailored meals and groceries. Some health conditions — such as type 2 diabetes or end-stage renal disease —are better managed with specific diets, or affect a person's ability to cook for and feed themselves (such as people receiving treatment for cancer, or postpartum mothers). With a food is medicine approach, a healthcare provider can refer such patients for medically tailored meals, where they receive fully prepared meals and snacks, or medically tailored groceries, which could be a box of unprepared foods, or structured more like a meal kit, with all the components of specific meals included.
Civil Eats describes these types of interventions in action: patients in Massachusetts who are not able to access or prepare the food they need to manage their health conditions may be referred to Project Bread, a local food organization that connects referred patients to one of Project Bread's coordinators.
“We try to understand the range of barriers that are making it difficult for them to purchase, prepare, or store different, healthy foods,” explained Jennifer Obadia, Project Bread’s senior director of health care partnerships. Once the coordinators get a picture of an individual’s situation, they can send grocery store gift-cards and kitchen supplies or sign the patient up for cooking classes or nutrition counseling. They can even refer them to a service that will deliver “medically tailored meals.” Every three months, they check in on the patient.
Produce prescriptions can include free fruits, vegetables and sometimes other items like beans or grains, which participants buy with vouchers or item-restricted debit cards at farmers markets, grocery stores, or even pharmacies. They may or may not be paired with other supports like cooking classes, nutrition education, or grocery store tours.
What differentiates FIM interventions from other food security approaches is the connection to the health care system, and that it is often paid for by insurance.
It should be noted that defining this loose collection of interventions as "food is medicine" comes from just one FIM action plan; there are many other definitions out there.
of the excellent food-is-medicine-focused Substack has written about the lack of clarity around defining FIM, and I definitely recommend her newsletter for a deeper dive into this topic.
What About the Name?
I know the term "food is medicine" is disturbing to those who want to uncouple food from virtue, and who are pushing back against nutritionism — "a reductionist way of thinking about food that assumes the whole point of eating is to maintain and promote bodily health," as the Center for Body Trust puts it.
The phrase has certainly been abused by nutrition influencers, whose hash-tagged #FoodIsMedicine posts cast a halo around green juice and cauliflower-everything, and peddle all manner of harmful diet advice.
But as dietitian and poet Lucy Aphramor points out in an essay called "Designing Dietetics For White Wellbeing Impedes Racial Justice," proclaiming "food isn't medicine" denies the reality of cultural traditions that have always viewed food as a source of healing, for thousands of years before medicine became synonymous with pharmaceuticals.
‘Food isn’t medicine’ implies Indigenous people’s wisdom isn’t worthy of serious consideration and can be sacrificed for non-Indigenous people’s therapeutic gain. It uses the knife of white supremacist (diet) logic to separate out Indigenous and non-Indigenous people and then centres white wellbeing.
‘It is impossible that food can be medicine’ is exactly what the colonial machinery of erasure wants us to believe. Because it is still trying to wipe out peoples and cultures where food is medicine that survived historical genocide.
Of course no-one intended to replicate racism by calling out nutritionism. But that’s what’s happened.
As for the as/is question, Food is Medicine and Food as Medicine mean the same thing and are used interchangeably. I chose "is" for this essay because it feels more direct, but that is purely personal.
So Why Is It Everywhere Right Now?
The practice of food is medicine described above is not new. In fact, medically tailored meals originated as an intervention in the queer community during the AIDS epidemic, to support those with HIV/AIDS who were too ill to feed themselves.
of wrote about why it is important to acknowledge, honor, and learn from that history, especially in the face of so many threats to the health and well-being of queer people in the US right now.So tech bros didn't invent food is medicine, but they sure love talking about it these days. That is mainly because there is now MONEY to be made with FIM interventions, thanks in part to 2022's White House Conference on Hunger, Health, and Nutrition, the first gathering of its kind since 1969. At the conference, the Biden administration discussed using Medicaid to provide FIM interventions to participants, a suggestion that has resulted in more states (including Colorado) seeking federal funding for FIM programs.
The USDA subsequently announced a $59 million expansion of its funding for produce prescription and nutrition incentive programs. And grocery-delivery services are very excited about food is medicine, likely because some interventions involve home delivery of groceries, which are opportunities to expand the market for companies like Instacart and Door Dash. Instacart in particular is seizing the moment, partnering with the American Heart Association and Rockefeller Foundation on a Food is Medicine Research Initiative. Here's what Instacart is envisioning:
If we get this right, it can revolutionize healthcare. Imagine leaving the hospital after an operation and arriving home to find a personalized bag of groceries waiting on your doorstep to support your recovery — one that is curated by your physician, delivered from your preferred local grocery store, and covered by your insurance. Or imagine patients diagnosed with chronic health conditions and screened for food insecurity being able to shop each week from a grocery list designed specifically to help manage their condition, with the cost of the food and delivery covered by their insurer or their employer.
Can't you $ee the po$$ibilitie$??
OK, But What Are the Drawbacks?
Late last year, JAMA published a piece questioning the huge amount of research money being dedicated to food is medicine research, wondering why we were not instead putting money toward initiatives that we already know work to improve nutrition outcomes, but that have not yet been fully funded and implemented in the US, such as universal free school meals, or reformulating foods to be lower in sugar and salt.
The authors are also skeptical about the food industry's enthusiasm for the food is medicine movement:
Throughout the 20th century, the food industry has perpetuated a personal responsibility narrative, reducing the social causes of diet-related diseases to unhealthy “lifestyle” factors such as poor dietary choices and too little exercise. It took decades for researchers and advocates to educate the public and policy makers about the role of our toxic food environment in driving inequity in chronic diseases. The food is medicine movement risks undoing this work by casting a social problem as a medical one and further shifting public discourse away from commercial interests as major drivers of disease. It is no surprise that many large, influential food companies such as Amazon, Instacart, and Kroger have loudly touted their support for food is medicine by joining task forces, supporting pilot programs, and integrating programming into corporate social responsibility campaigns.
This aspect of their argument is particularly compelling to me. Unfortunately, the authors undermine their case by citing interventions like front of package labeling and taxing "unhealthy" food and beverages as better alternatives — but those approaches seem even more focused on personal responsibility narratives, with a greater potential to create stigma and shame around eating.
In their critique of the food industry, they also fail to point out the irony of corporations like Amazon and DoorDash investing money into FIM research and programs to address the health inequities that are a result of poverty, when their structures and employment practices help perpetuate poverty and are "violating the human rights of their workers by failing to pay them a decent wage," according to a UN poverty expert.
As with the US charity food system, it seems like much attention is focused on alleviating the downstream effects, without questioning how the corporations helping to fund that work are accountable for what is happening upstream. (See my piece on food banks for more.)
Is It Time to Defund Food Banks?
There is also the question of how food is medicine interventions are implemented, which is not always as robust and thoughtful as the Project Bread approach described above. In the Washington Post, a family physician in California described the realities of prescribing "medically supportive food (MSF)," which is paid for by insurance. There is no state guidance on what health plans should look for in the MSF services they contract with, and some health care professionals are struggling with how to assess the companies they are referring patients to.
Michelle Kuppich, a registered dietitian and director of the California Food Is Medicine Coalition, is also concerned about the quality of some of the food entering this growing medical marketplace.
“There are many new companies coming into this space because there is money involved and people want the health-care dollars,” Kuppich said. She said she suspects that some of them “started off selling prepared meals for weight loss and then rebranded.”
Not surprisingly, ingredient quality and sourcing are often afterthoughts for these companies, as are taste and pleasure. Small, local, mission-driven nonprofit organizations seem to better serve the needs of patients and their communities, but will need to be able to scale in order to meet the growing demand.
Can food heal us? I think so. We find the source of healing if we go back to the queer roots of medically tailored meals, where a community was feeding each other with care, those who were well providing for those who were ill — because we are human, and that is what human beings have always done for each other. How closely can the food is medicine movement align with those roots? How human can it be? I'll be keeping an eye on the movement — and maybe now you will too.
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