Millions of Americans are affected by food insecurity and suffer from diet-related illnesses, including cardiovascular disease and Type 2 diabetes. While many disease factors are genetic, others are more controllable, especially nutrition—the focus of the growing “food is medicine” field. Dr. Fang Fang Zhang, associate professor and interim chair of the Division of Nutrition Epidemiology and Data Science at Tufts University’s Friedman School of Nutrition Science and Policy, discusses the school’s objectives and what researchers like her are doing to get it done.
Can you share some of the objectives of the Friedman School’s work tied to food, nutrition and health?
One priority is to translate science into action: bringing cutting-edge, actionable policy evidence, strategies, and interventions to policymakers and other relevant stakeholders to help address the nutrition crisis. Recently, some of our faculty led the formation of an independent, bipartisan task force that made recommendations to inform the second White House Conference on Hunger, Nutrition, and Health held in September. The last such conference was in 1969, chaired by Jean Mayer, founder of the Friedman School. It was a landmark event that had significant and lasting impacts on reducing hunger in the United States. The school will continue to support the national strategies released during this year’s conference: improving nutrition, reducing diet-related illnesses, and addressing equity through excellence in research, education and advocacy.
Your research focuses on nutrition's relationship to cancer and outcomes. What are you most optimistic about?
Various factors contribute to the risk of cancer. These include host factors, such as our age and genes; environmental factors, such as environmental pollution, radiation and infection; and diet and lifestyle factors. Some of these risk factors are modifiable and therefore potentially preventable. We have estimated that about 5% of the new cancer cases each year in the U.S. are attributable to poor diet, including a low consumption of whole grains, dairy foods, vegetables and fruits, and a high consumption of processed and red meats and sugar-sweetened beverages. This means that more than 80,000 new cancer cases each year in our country are preventable.
You’re also on a team investigating the benefits of produce prescription programs. Can you discuss how they work?
Produce prescriptions involve clinicians providing guidance and assistance for patients to access healthy produce for disease prevention and management. Supported by the Rockefeller Foundation and Kaiser Permanente, we have just completed an evaluation of nine produce prescription programs involving more than 1,800 children and 2,000 adults who were at risk for poor cardiometabolic health. In these programs, patients were referred by healthcare providers to receive vouchers or cards loaded with monetary incentives. Patients can redeem the vouchers or use the card to purchase fruits and vegetables at local grocery stores or farmers markets. Significant increases in fruit and vegetable intake and reductions in household food insecurity were observed after participation. Additionally, significant improvements in cardiometabolic health were noted among adult participants, such as reductions in hemoglobin A1c and systolic and diastolic blood pressure.
How can healthcare leaders help advance the “food is medicine” movement in their organizations?
Hospitals can integrate screening for food and nutrition insecurity into the electronic health records and include referrals for eligible patients to receive “food is medicine” services as part of the clinical care routine. Leaders can also take advantage of existing opportunities to pay for services such as produce prescriptions and medically tailored meals within federal healthcare programs. For example, state Medicaid agencies can use authorities such as Section 1115 Demonstration Waivers to test the impact of providing coverage for such programs or provide authorization for Medicaid managed care plans to cover “food is medicine” programs.