How to Prescribe Food as Medicine

Cate Collings, MD

More Americans are beginning to recognize that the food they eat can have a profound effect on their health, longevity, and well-being.

While hardly new, the food-as-medicine concept — in which clinicians prescribe diet changes as part of formal treatment plans — has risen in the public consciousness as COVID-19 exposed risks including chronic disease, hunger, and food and nutrition insecurity. A whole-food, mostly plant-based diet has been shown to prevent, treat, and even reverse some chronic diseases.

As more people grow receptive to the idea of ​​so-called “farmacy” prescriptions, clinicians must fully grasp the evidence that overwhelmingly supports the efficacy of prescribing whole-food, plant-predominant diets. They have a responsibility to equip themselves with the resources and knowledge to prescribe food appropriately and effectively.

What a food prescription might look like.

Any of us can suggest that a patient eat more vegetables. But can we apply the concept of the dietary spectrum when making recommendations, help patients avoid common pitfalls when using calorie density to lose weight, or identify which macronutrient sources may contribute to disease progression?

Probably not. The average 4-year medical school curriculum spends less than 1% of all lecture time on nutrition, and one study found that only 14% of internal medicine resident physicians reported feeling qualified to offer nutritional advice to patients. Yet we know that it is what people are and are not eating that is the number-one cause of mortality globally.

Resources are available from the American College of Lifestyle Medicine (ACLM), the nation’s medical professional society representing clinicians dedicated to a lifestyle medicine and food-as-medicine–first approach to healthcare. ACLM, which represents 7000 physicians and allied health professionals, is the only organization that educates, equips, and supports certification of physicians and other clinicians in lifestyle medicine.

Just recently, ACLM released a 10-part series of research white papers on the benefits of a whole-food, plant-predominant dietary lifestyle for treatment of multiple chronic conditions. The unique food-as-medicine collection is an evidence-based compilation resource for medical professionals treating patients with chronic diseases.

Each paper in the series provides a comprehensive evidence guide on the state of research in the field to support further learning, discussions with colleagues, and provider-to-patient education. Focus areas include plant-based diets and reproductive cancers, weight management, enteral nutrition, and autoimmune disease.

As acceptance of food as medicine grows, it is vital that our healthcare system not exclude historically underserved communities, where lifestyle-related chronic diseases often thrive. People in these communities deserve the resources to help them shop for and prepare healthy food on fixed or low incomes. Clinicians can help patients navigate the barriers that are food deserts and dispel myths that plant-based diets don’t supply proper protein.

There are examples of health systems working to achieve this health equity. Geisinger Health System in Pennsylvania has established a Fresh Food Farmacy to prescribe food to people suffering from diabetes and food insecurity. Patients receive more than 20 hours of diabetes education, welcome kits containing measuring cups and spoons, recipes, and enough food to prepare 10 healthy meals for their family every week.

Massachusetts General Hospital Revere Healthcare Center partnered with a local food bank to develop a plant-based food pantry to serve food-insecure patients with chronic diseases, providing food to an average of 384 recipients a month. The hospital will next evaluate the project’s health outcomes and pursue sustainable funding, which could ultimately help establish a successful model for other health systems to replicate.

The rising interest in food as medicine is an exciting opportunity. Clinicians can embrace this change through education, certification, and by investigating the evidence-based resources to provide patients with information that they are beginning to demand not just to prevent, but to manage and reverse, their chronic health conditions. That’s something very few pharmaceuticals can promise to achieve.


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