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Published in the New England Journal of Medicine, Seth A. Berkowitz, MD, MPH, associate professor of medicine at the UNC School of Medicine, wrote perspective piece on how medically tailored meals address health consequences of food insecurity.

CHAPEL HILL, N.C. – Eating a diet rich in a variety of healthy foods packed with antioxidants and nutrients is the gateway to living an active, healthy life. But for some, consistently keeping healthful food on the table is difficult, which results in nutritional hardship. Food insecurity can lead to poor health outcomes, increasing risk of diabetes, hypertension, and other chronic health conditions. Individuals living with complex chronic conditions, such as diabetes or cardiovascular disease, may benefit from customized meals to maintain a healthy lifestyle and diet. Seth A. Berkowitz, MD, MPH, associate professor of medicine in the Division of General Medicine and Clinical Epidemiology at the UNC School of Medicine authors a perspective piece on how medically tailored meals address health consequences of food insecurity.

“Our hope is that research regarding medically tailored meals will lead to wider availability for the cases in which they are proven to be helpful,” said Berkowitz.

Published in the New England Journal of Medicine, Berkowitz’s perspective emphasizes how clinicians need tools to help mitigate health harms food insecurity causes. Community Servings, a nonprofit organization that provides medically tailored meals to chronically-ill individuals and their families, helps meet the needs of those who are experiencing adverse outcomes due to not having quality food to eat. It’s a treatment plan that focuses on the patient’s unique needs by using the power and healing of food. Results from one pilot crossover randomized trial conducted in Massachusetts from 2015 to 2017 in collaboration with UNC School of Medicine, Massachusetts General Hospital, and Community Servings showed how individuals receiving meals substantially improved diet quality, reduced food insecurity, and improved mental health–related quality of life.

“Much like your physician and pharmacist partner to provide you the right medications, medically tailored meal providers like Community Servings collaborate with healthcare providers to offer patients living with critical and chronic illnesses scratch-made meals designed to accommodate multiple dietary restrictions brought on by diet-related illnesses,” said David B. Waters, CEO of Community Servings.  “Most of us have no idea how to tailor our meals to address diet-related health conditions, which leads to further health complications and poor outcomes for the most severely ill and isolated patients in America.”

The individuals who are eligible for these medically tailored meals are those with one or more complex chronic conditions who are socioeconomically disadvantaged, and who typically face food insecurity. Many of these individuals experience challenges managing complex diets or difficulty shopping and preparing food because of disability or circumstance. Berkowitz’s perspective explains how food insecurity is one path by which oppression is embodied as poor health. He says women and people racialized as Black, Hispanic, or Native American experience high rates of food insecurity.

“Women and people of color disproportionately experience food insecurity, likely because of systems of social relations in which women and people of color are kept from the resources needed to avoid food insecurity,” Berkowitz said.

The program involves Community Servings partnering with healthcare systems and health insurers to help identify people who may benefit from medically tailored meals. The meals are an evidence-based nutritional intervention that is tailored to an individual’s specific medical condition(s), and delivered to an individual’s home. Once a person is identified, they are referred to Community Servings to receive a consultation with a registered dietitian-nutritionist. The meals are prepared under the supervision of a registered dietitian nutritionist to meet the nutritional needs of individuals living with HIV, diabetes mellitus, end-stage renal disease, cancer, or other chronic conditions. The program provides 10 meals, or about two thirds of each participant’s one weekly food intake, and it’s delivered to the participant’s home once weekly. The meals are fully prepared and need only to be heated up. A qualitative evaluation of the pilot trial revealed high satisfaction and the participants noted that the food seemed culturally appropriate and helped them manage their diabetes.

Participants did recommend improvements to the program, including integration with lifestyle intervention. Because of this, Berkowitz said researchers are conducting two trials of medically tailored meals for diabetes management, funded by the National Institute of Diabetes and Digestive and Kidney Diseases. These studies are examining the effect of the meals combined with telephone-based lifestyle interventions focusing on glycemic control and weight change.

Berkowitz also said there have been observational studies of medically tailored meals that showed receiving these meals is associated with fewer emergency department visits, inpatient hospitalizations, and nursing home stays  — ultimately reducing costly healthcare.

There’s much more that needs to be done to address food insecurity, but Berkowitz said medically tailored meals can be a good place to see a change for those who experience lack of food and severe illness.

“The best thing to do would be to enact policy change that prevents people from becoming food insecure, but in the absence of that, clinicians need tools, like medically tailored meals, to mitigate the consequences of food insecurity when it occurs,” he said.

Media contact: Brittany Phillips, Communications Specialist, UNC Health | UNC School of Medicine