by Dr Daniel Dawley

The American Heart Association (AHA) recently issued a scientific statement regarding Food Is Medicine programs and how they offset the cost of caring for cardio-metabolic diseases. They reviewed over 1600 articles to narrow down their analysis to the 14 best articles for complete data extraction.

This was published in the American Heart Association Journal Circulation in June 2025: A Systematic Review of “Food Is Medicine” Randomized Controlled Trials for Noncommunicable Disease in the United States: A Scientific Statement from the American Heart Association   

The meta-analysis of trials involved many design types.  These included produce prescriptions designed to increase access to fruits and vegetables either through vouchers or by providing specific produce items, medically tailored groceries designed to increase access to fruits and vegetables either through vouchers or by providing specific produce items, and medically tailored meals similar to medically tailored groceries, but consisting of fully prepared, ready-to-eat meals.

Multiple impacts

The data they extracted from these randomised control trials suggested that food as medicine interventions had impacts across multiple populations with multiple outcomes. The evidence was strong enough to state that implementation and dissemination of the food is medicine program should continue and progress. The problems questioned were gaps in the identification of populations that would most likely benefit, and what the dose, duration and frequency of the interventions should be.

About the author

Dr Daniel Dawley has been whole food plant-based for 20 years. He lives with his wife in a small rural community in Northwest Ohio where they grow a wide variety of greens and vegetables. A Board Certified medical physician, Daniel has a keen interest in genetics and evolutionary biology and is a strong advocate for the power of WFPB eating.

These studies and initiatives are occurring against a background revealing rates of cardiometabolic illnesses that are greater than 50% in American adults at a cost to the US of over $1 trillion per year, which is equivalent to what the US spends on food itself. 

For the diseases of diabetes, cardiovascular disease and inflammatory conditions, the root cause often boils down to a poor diet. About 45% of all deaths from cardiometabolic diseases can be attributed to unhealthy eating.  

Medical providers realize that giving diet advice is important but health care providers are now initiating Food Is Medicine initiatives realizing that it is more effective to provide patients with food itself and training.

I would like to note that the validity and effectiveness of food is medicine initiatives and programs occur in the context of showing that they are cost-effective and can save money.

The cost question

When a medicine goes to the FDA for approval, it is evaluated for its safety and effectiveness in improving health. The cost-effectiveness of a medication is not taken into consideration in approving the medicine.

Although food used as medicine certainly has no significant side effects, it is known to improve the health of the patient and their health outcomes. These programs are held to the higher standard of having to additionally show that a program is also cost-effective. The medicines that are approved, medical procedures, and devices are not held to that standard. It is one factor and the reason why food is medicine initiatives are not routinely backed by the medical community and insurance. 

It has been shown in well-designed studies that food is medicine programs effectively manage risks to health, bring down costs, and reduce the need for expensive healthcare services.

A recent study (January 2025, Cleveland Clinic) showed that medically tailored meals could enhance patient satisfaction, reduce hospital visits, and lower healthcare costs, particularly for vulnerable populations. The study’s recommendation was to prioritise this approach in primary prevention within the US healthcare system. 

Another study, in Massachusetts in April 2025, found that nutrition support led to 23 per cent fewer hospitalisations and 13 per cent fewer ED visits. Among adults enrolled in the government-funded program for over 90 days between 2020 and 2023, average healthcare costs dropped by an average of more than $2500 per person.

The AHA’s Health Care by Food initiative’s scientific director said that referring patients to these programs “really should be no different than placing a referral to a registered dietitian or nutritionist, or similar collaboration that clinicians engage in regularly.”

Popular support for FIM

New polling data on 6-12-2025 from The Rockefeller Foundation shows greater than four in five adults in the United States (80 per cent) — across demographics, income levels, party affiliations, and geographies — support integrating Food is Medicine (FIM) programs into U.S. healthcare. Seventy-nine per cent of respondents reported that Food is Medicine programs would personally help them eat better, and 90 per cent stated they would prefer to rely more on healthy eating than on medications.  

Nearly 4 in 5 Americans think that Food is Medicine programs should be covered by both public and private insurance, including 85 per cent of self-identified Democrats and 78 per cent of Republicans. Eighty-four per cent of respondents believed Food is Medicine could help improve the overall quality of health in the United States.

An important note, however, is that 49 per of the American public and 67 per cent of healthcare workers view high costs of nutritious food as the single largest barrier to eating well. Rockefeller Foundation Releases New Polling Data: Majority of Americans Want Food Is Medicine Programs | RF.  This survey involved over 2000 people including four hundred health care workers and was weighted by gender and education and actual proportions within the population to represent the US demographics equally. 

In February 2025, The Rockefeller Foundation announced $3.5 million in grant funding to support small and mid-scale U.S. farmers to improve health outcomes for people with chronic disease.  The Foundation has announced its $100 million investment to expand access to Food is Medicine, including supporting vital research like the American Heart Association’s Health Care by Food Initiative. The Foundation also initiated partnerships with the U.S. Department of Veterans Affairs and the U.S. Department of Health and Human Services to speed the integration of Food Is Medicine into health systems. 

All of the above are major announcements with significant amounts of monetary support to advance food is medicine initiatives, recognising that they have a substantial and vital role to play in improving health outcomes and reducing costs in the United States. This is money spent outside the US budget process and is not affected by the current political atmosphere. It certainly appears that the American public recognises the importance of these programs, with a major desire to integrate them into their lives.

Nutritious diet improves outcomes

Notes by an author from the above studies reiterate the statements above; “A nutritious diet improves health outcomes; we know that clearly,” said Hilary Seligman, MD, MAS, a professor of medicine and epidemiology at the University of California, San Francisco, and lead author of the AHA statement.

“For some reason, programs in healthcare that are prevention-oriented or address social needs are often held to a cost standard,” she said. “This is a double standard because we approve new medications for use based on whether they work, not whether they save money. Healthy food can be more effective than medication in preventing and treating chronic disease, at least over the long term. This should be all we need to know to justify their cost.”

I would like to relate one further take with some examples. I have been involved with some nationally accredited obesity and bariatric surgery programs in past years. I rechecked some of the program’s requirements for this topic.

Patients undergoing bariatric surgery are required to see a dietitian monthly and comply with the recommendations for a minimum of three but usually 6 months to up to a year. Some people are required to lose a certain amount of weight if it will improve their surgical procedure. They’re also required to see a social worker to help them integrate diet changes into their life. They are also required to have a psychiatric consult to be sure that diet outcomes will be used appropriately by then.

The insurance companies that pay for the surgical procedure usually require 6 to 9 months of diet counselling, and some require 12 months. If the patient misses a monthly scheduled dietary visit, they have to start over and not just continue on. The reason for this is that the providers of this surgery and the insurance companies realise that just suggesting some diet changes will not be effective. Specific, ongoing teaching is required.

It would certainly be appropriate if we could recognise that other chronic diseases, which are affected and influenced by diet and nutrition, could also receive the same aggressive care. The effectiveness of a handout or recommending certain types of food is insufficient; it requires extensive education and perhaps even actual teaching of food preparation to be truly effective.

Advisory consensus on GLP-1s

I would also like to note a new advisory consensus in prescribing GLP-1s. The recommendations were that patients should receive counselling on diet and lifestyle before starting these medicines to make them more effective and improve health outcomes. It was felt that while the medications can reduce hunger in patients who take them, they work best in conjunction with lifestyle changes, the most important of which is proper nutrition.

An emphasis on diet with good nutritional intake, proper food preparation, and avoidance of processed foods would be important.  The advisory also names other lifestyle factors like sleep, mental stress, substance use, and social connections as important priorities that can help patients maximise long-term success on these medications. 

Although I don’t have data from a study to determine how well counselling is conducted, it appears from what I have read and observed that the counselling described above is similar to what we often do for chronic disease management now. This has often been just a handout or, at best, a one-time recommendation from a dietitian, when, in reality, the requirement for effective improvement should involve detailed counselling and assistance with food selection and preparation, depending on the patient’s circumstances.

The long-term effectiveness of this medicine will involve that input.  It is not clear to me that we have learned the importance of ongoing and detailed counselling for changes that are difficult for everyone to make.

One thing to also note is that the diets above improve nutrition, but most have likely not involved whole-food, plant-based type diets. Initiation of such a diet, if advocated and accepted by the patient, would yield far better and more far-reaching results than even the positive outcomes observed in the above studies. Numerous studies on populations following a WFPB diet have certainly reflected this.