Originally published on LinkedIn
As the founder of a “Food as Medicine” startup, NourishedRx, it was interesting to click on a Pitchbook 3Q Analyst’s Note and see that our sector may be either “overhyped” or the “next frontier.” I was happy to see that the Pitchbook analyst ended on a highly bullish note on the long-term prospects of new “nutrition-based treatment modalities:”
“Proper nutrition is a crucial yet often underappreciated aspect of the prevention and management of chronic health conditions, and the concept of food as medicine has been gaining momentum due to a confluence of factors: the success of pilot food prescription programs, explicit government support, early adoption by payviders, and the rise of personalized nutrition.”
All biases aside, I couldn’t agree more and I applaud Aaron DeGagne, CFA for spotlighting a sector that’s still not getting the resources its impact should warrant – even if some of the vulnerabilities described in the note don’t fully resonate with me.
As someone who is hands-on in the sector, here’s some perspective that may add some color.
(1) The Proof Point Question
Pitchbook says the evidence is clear that “proper diet and nutrition can prevent and reverse health conditions.” But it also says that food-as-medicine programs need more scientific and clinical proof before becoming a standard part of care.
This kind of skepticism drives me a little nuts. Not only is the efficacy of good nutrition well-established, but the fact that poor diet is the most highly correlated risk factor to morbidity and mortality in our country is also very clear. It is laid out nicely in this JAMA article. Healthy diet or lack thereof truly are the proverbial “blessing or curse.” The Pitchbook report cites one robust study that says Medicare and Medicaid subsidies for fresh fruit and vegetables could prevent 300,000 cardiovascular-deaths alone, and $40 billion in lifetime healthcare costs. Copious foundational studies, as delineated in this Food and Society at Aspen Institute Food-is-Medicine action plan have shown impact on diabetes clinical markers, kidney disease progression, hospital readmission rates, productivity, and so on. It’s not that we shouldn’t continue to collect and analyze data to learn and improve, but we shouldn’t wait for more research when the “house is on fire.”
U.S. healthcare is frustratingly slow to embrace cost-effective, long-term, systemic solutions and always eager for silver bullets. If there was a pill or vaccine that could save 300,000 lives and $40 billion in care costs without side-effects, it would get fast-tracked post-haste. Compare that with the new Alzheimer’s drug, Leqembi, which was approved by CMS in 2021 despite modest efficacy, 20% of patients reporting adverse reactions, and a massive price tag that could swallow almost half of all Part B drug spend within three years.
Another concern from Pitchbook is that the real impact of food-as-medicine can’t be proven because it can’t be isolated from other factors like lifestyle change. But that’s also true for any drug or therapy. Even more to the point, lifestyle change is an integral part of a comprehensive food-as-medicine program – because that’s what makes the impact sustainable.
(2) The Scalability Question
The Pitchbook report also references a scalability question. The concern is that food-as-medicine programs would benefit us all, especially the 60% of Americans with chronic illness or the 17 million Americans living in food deserts, but it would be impossible and prohibitively expensive to expand programs so broadly.
This is an important and valid point. Food-as-medicine programs do bear a cost and therefore should be targeted to people who are high-utilizers of healthcare services with health-related social needs and who would benefit significantly from dietary and lifestyle interventions. At NourishedRx, we direct our services to those with the most diet-sensitive circumstances and disease, who are also at risk of nutrition insecurity. And even then, scalability is a challenge – but it’s one that we are successfully addressing with technology. Our dietitians boost their impact many times over by leveraging our platform to identify individual needs and circumstances, match those needs and preferences to culturally concordant food and community resources, and provide ongoing personalized education and coaching. And, our payer partners have full visibility to the entire patient or health plan member journey. Collaboration and transactions amongst key stakeholders is efficient, enabling scale that would otherwise be unattainable.
(3) The Consumer Resistance Question
The Pitchbook report offers a lot of skepticism about consumer resistance to dietary restrictions, food quality, compliance, and engagement.
These doubts do not match our first-hand experience. We start by tailoring high quality, nutritious meals and food to personal and cultural preferences. We work on the premise that categorical change is not always practical, and improvements in diet that move the needle, even slowly, can be the start of a longer, more sustainable journey.
Our engagement levels are off the charts because we work with the people in our programs closely, as human beings, who are learning new information about their diets and whom readily embrace coaching and encouragement for the big changes they’re undergoing. Their appreciation for this support, and their pride and enthusiasm for their own personal transformation is incredibly fulfilling. And it’s part of the deeper purpose underlying our programs. Supplying nutritious food is not the end goal but the gateway to a sustainable way of living and a healthier, more productive life that can even impact our clients’ family, friends, and social circles.
An Integrated Approach to Better Health
I’ll add one more thing. Food-as-medicine interventions should not be viewed as tangential or secondary to clinical care, but as an integrated component of the overall healthcare model. A lot of people who write about food as medicine miss that point.
We know that 85% of health is due to conditions outside clinical interventions. Nutrition is a huge, key component of that 85%. If we want to really improve population health cost-effectively while also decreasing our overall healthcare spend, food-as-medicine programs should be one of the primary tools that lead the way, not an afterthought.
Nutrition is foundational to health. It’s time we recognize that in healthcare.
