HARVARD MEDICAL SCHOOL PRIMARY CARE REVIEW

Food Rx: A Prescription for Health Systems and Medical Education

March 10th, 2022

It’s an overcast Tuesday morning in Scranton, Pennsylvania, as Mary walks into the outpatient clinic for her groceries. The warm air in the lobby feels like a pleasant welcome from the blistery snow outside, but it’s the words spaghetti squash and salmon—two of her favorite items the pharmacy provides—written on the whiteboard that make her smile.

The dietician at the front desk greets Mary and slides a grocery order form across the counter. A seasoned patient, Mary quickly works her way down the form, circling the items she wants to bring home to her family.

“Acorn squash?” Mary asks cautiously, yet curiously.

“That one has been popular among patients that came in earlier today. I wouldn’t knock it until you try it!” exclaims the dietician. Mary pauses for a moment before nodding and circling acorn squash, returning the form to the dietician, and heading back to the meeting room.

Over the next hour, she’ll meet with her care team: a registered nurse, a pharmacist, a certified dietician, and a community health associate. While she’s in her appointment, I gather and pack the groceries she’s requested to fill her food prescription.

Our pantry is stocked with a balanced mix of seasonal fruits, vegetables, and lean proteins that fulfill a diabetes-appropriate diet. We provide enough food for two weeks, a quantity that varies across patients depending on the number of individuals living in their home.

By the end of her appointment at the Fresh Food Farmacy, Mary has an updated snapshot of her vitals, a better understanding of diabetes self-management, a recipe for cooking with acorn squash, and enough food for the next two weeks—all at no cost to her or her family.

Type 2 diabetes and food insecurity

Mary is one of the many patients I’ve interacted with while volunteering at the Fresh Food Farmacy as a pantry clerk. Her story represents a reality far too common in our communities—patients desperate to take control of their chronic health conditions, such as obesity, high blood pressure, and type 2 diabetes, but lacking the financial and educational resources necessary to do so.

In 2020 alone, more than 38 million Americans experienced food insecurity. Another study found that for a family of four, a healthy diet costs approximately $2,200 more per year (about $6 more per day) than a diet consisting of refined grains, fatty meats, and other highly processed foods.

These data are especially concerning when considering the growing prevalence of prediabetes (1 in 3 adults) and type 2 diabetes (1 in 10 adults) in the United States. And if this trend continues, the Centers for Disease Control and Prevention (CDC) has projected that the number of adults living with type 2 diabetes in the United States could reach 1 in 3 individuals by 2050.

How can we innovate health care delivery to lessen the burden of food insecurity, lower health care costs, and provide necessary resources to empower our patients to live healthier lives?

Enter, the Fresh Food Farmacy.

What is the Fresh Food Farmacy?

The Fresh Food Farmacy is an innovative primary care program championed by Geisinger Health System, a fully integrated system that serves over three million patients across 45 counties in Pennsylvania.

Each week, the program provides evidence-based diabetes self-management classes, interactive nutrition workshops, and enough food for patients to prepare 10 nutrient-dense meals for their whole family.

Since 2016, the Fresh Food Farmacy has expanded from one to three locations across Pennsylvania and debuted several satellite models. Today, the Fresh Food Farmacy serves more than 1,000 patients each month.

How does the Fresh Food Farmacy work?

Geisinger physicians refer to the Fresh Food Farmacy when patients have elevated blood sugar levels (Hemoglobin A1c more than 8.0%) and have also expressed difficulty paying for food.

Before patients formally enroll, they must commit to full participation in the program. This means committing to regularly scheduled food pick-ups, as well as attending no-cost diabetes self-management classes, dietary consultations, and other workshops with their care team. The Fresh Food Farmacy is committed to improving the medical, social, and financial well-being of its patients, but in return, requires the full engagement of its patients to work.

Much of the program’s success can be attributed to its community-focused nature. By providing food and educational resources to an entire family, rather than just an individual patient, the Fresh Food Farmacy creates intergenerational, lasting change in the social determinants of health.

Data collected from 2016 – 2019 demonstrates that patients enrolled in the program experienced an average two-point decrease in Hemoglobin A1c, which is marked by $1.5 million in total health care cost savings for those patients. In tandem, blood pressure, cholesterol, and body weight also decreased, and patients cited improvements in mood as well as confidence in their ability to control their diabetes.

Addressing educational gaps

Each week after my shift at the Fresh Food Farmacy, I find myself thinking about my future patients. Despite food’s profound impact on health, today’s medical school curricula fail to provide students with a comprehensive, modern understanding of how different foods affect our metabolism, alter our mental health, and attenuate chronic disease.

Medical students and residents alike report their schools’ curriculum consists of outdated and poorly integrated nutrition education, leaving them unprepared to offer nutritional consults to patients. And further, patients are less likely to receive comprehensive nutrition interventions from primary care physicians who self-report low confidence in understanding nutrition.

Medical school curricula must evolve to include modern nutrition education… and emphasize it! Failing to do so ultimately neglects myriads of patients—patients just like Mary—who aren’t as fortunate to live near to a Fresh Food Farmacy.

**Feature photo obtained with standard license on Shutterstock.

 

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Tyler Schubert

Tyler J. Schubert, BA, is a first-year medical student and Abigail Geisinger Scholar at Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. He earned his bachelor’s degree in public health at Franklin & Marshall College. His professional interests include chronic illness prevention, value-based care, and leadership in primary care.

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