WASHINGTON — The U.S. wants a “whole-of-government” strategy to addressing diet-related illnesses, Sen. Cory Booker (D-N.J.) stated Wednesday at a Senate hearing on meals as medication.
“Currently in the United States, half our population is pre-diabetic [or] has type 2 diabetes,” stated Booker, who’s chairman of the Senate Agriculture, Nutrition, and Forestry Subcommittee on Food and Nutrition, Specialty Crops, Organics, and Research. “That is something that isn’t exclusively affecting older people … one-quarter of our teenagers today are pre-diabetic or have type 2 diabetes. Much of that can be attributed to the alarming fact that ultra-processed foods now compose two-thirds of the calories in the diets of our children and teens.”
A System Based on Wellness
Booker, a vegan who stopped eating added sugar for 2 months final summer time, famous that in September, “the White House released a bold blueprint to end hunger, improve nutrition, and reduce the epidemic of diet-related diseases. A key component of the national strategy is a call to continue researching and scaling up ‘food as medicine’ programs, such as funding pilot programs to integrate medically tailored meals and nutrition counseling into our Medicare and Medicaid programs.”
Booker added that incentivizing farmers to develop vegatables and fruits on the identical degree because the federal authorities helps commodity crop manufacturing “is a top priority for me in the Farm Bill.”
Sen. Mike Braun (R-Ind.), the subcommittee’s rating member, recalled that when he was operating his household’s truck elements distribution firm, “we built a system based upon wellness and avoiding the healthcare system and making my employees engage in their own well-being.” For instance, staff have been supplied a free biometric screening, “and if you didn’t get it, you’re going to get penalized because you weren’t doing the right thing.”
The wellness program continues to be going sturdy as we speak, he added. “Employees have not had a [health insurance] premium increase in 15 years and they go into their deductible less now than they did then, because they’ve become healthcare consumers. In a nutshell, that’s what we need to do more broadly across the country.”
But many individuals — particularly lower-income individuals or these residing in “food deserts” with no entry to wholesome meals — have hassle accessing wholesome meals and contemporary vegatables and fruits, witnesses stated. “For 20 years I served as a part-time primary care doctor and hospitalist at the Philadelphia Veterans Affairs Medical Center,” stated Kevin Volpp, MD, PhD, founding director of the University of Pennsylvania’s Center for Health Incentives and Behavioral Economics. “Many of my patients struggled with chronic diseases, such as congestive heart failure and diabetes, which were exacerbated by their challenges finding affordable, healthy foods.”
Clinical Trial Shortcomings
“Evidence indicates that incorporating food as medicine programs into healthcare can be associated with improvements in outcomes,” stated Volpp, who can be a member of the advocacy coordinating committee on the American Heart Association (AHA). “For example, medically tailored meals are associated with fewer hospital and skilled nursing facility admissions, fewer emergency room visits, and healthcare cost reductions.”
However, he stated, with regards to proving the worth of meals as medication, “only a small number of randomized controlled trials have been done, and they’ve typically been small and thus unable to provide definitive answers. Food as medicine interventions have not generally incorporated freedom of choice and input from patients, reducing potential rates of engagement.”
“To unlock the full potential of food as medicine, we must systematically answer important questions regarding intensity, duration, and delivery of food as medicine interventions; the role of patient preferences and choices; the incorporation of educational behavioral strategies or coaching; the comparative effectiveness of ways to change behaviors and habits; and cost-effectiveness,” Volpp added, noting that the AHA and the Rockefeller Foundation have dedicated a complete of $250 million to construct a National Food as Medicine Research Initiative. The organizations plan to launch the initiative subsequent spring.
John Bulger, DO, MBA, chief medical officer of insurance coverage operations and strategic partnerships at Geisinger Health Plan in Danville, Pennsylvania, mentioned the success of the well being plan’s Fresh Food Farmacy challenge, which offers every of this system’s 1,600 individuals with sufficient wholesome meals for 10 meals for themselves and their households every week; individuals additionally obtain medical interventions from care managers, dietitians, and diabetic schooling consultants. The end result? Participants’ common HbA1c degree dropped by half, and hospital emergency division visits dropped by 30%, he stated.
Bulger cited an instance of a 55-year-old, 181-lb. widowed grandmother named Rita who was this system’s first affected person. “Her [blood] sugar was about three times what it should be … and her cholesterol was twice what it should be. After going through the program, she actually had normal blood sugar — she dropped her blood sugar by two-thirds. She lost 50 lb. to [reach] 135 lb. and dropped her bad cholesterol from being twice what it should be, to being about half the high end of normal.”
Geisinger is now increasing this system to incorporate extra illnesses like kidney illness and coronary heart failure, he stated.
Role of Meat and Dairy Products
Sen. Roger Marshall, MD (R-Kansas), famous that he was working with Sen. Kirsten Gillibrand (D-N.Y.) “on getting milk back into the [school] lunch focus — specifically whole milk. We’re going to have a generation of women that have osteoporosis and osteopenia in their 40s rather than their 50s because they’re not drinking milk at school.”
He additionally expressed concern that the Agriculture Department’s Food and Nutrition Service “recently provided recommendations for WIC [the Women, Infants, and Children program] that included additional non-dairy substitutes for moms and children … I think this is contrary to the recommendations of increased options of dairy products in the Dietary Guidelines for Americans. And then I’m concerned about ‘Meatless Mondays’ and the impact of less protein in people’s diets as well.” He requested the witnesses whether or not they thought meat and dairy have been vital sources of protein and calcium.
“It’s a complicated question to answer,” stated Volpp, including that, for instance, some meats are more healthy than others. “Saturated fat is obviously a problem for people with heart disease. And the same thing with dairy — I think there are healthier alternatives in some cases, but it is very important to have enough protein in the diet. So we need to figure out holistically how do you accomplish that, given the full range of food options.”