Originally published on LinkedIn
Written in collaboration with our partners at the University of CT, Derek Aguiar PhD in Computer Science, Amy Gorin, PhD in Clinical Psychology, Director of the Institute for Collaboration on Health, Intervention, and Policy (InCHIP), and Loneke Blackman Carr, PhD, RD, Assistant Professor of Community and Public Health Nutrition in the Department of Nutritional Sciences.
In the 1980s, government officials in the Reagan administration were struggling to come up with low-cost ways to comply with the federal school lunch program mandate of giving every student two vegetables per meal. The solution they proposed was, if nothing else, creative: classifying ketchup as a vegetable. The proposal was never adopted, but the idea of ketchup as a vegetable had entered into the public consciousness. This myth became widely accepted, likely because Americans have long recognized that our institutions don’t take proper nutrition as seriously as they should.
Our nation was at the height of America’s war on hunger when the ketchup-as-a-vegetable controversy erupted. By the 1990s, the war was largely won if measured solely by caloric intake. But this victory was achieved primarily through calorically dense processed foods, added sugars, and unhealthy fats, which has incurred significant costs to public health.
Calories are not all equal, of course, and diet is now the leading cause of chronic illnesses, including stroke, heart disease, and diabetes. Americans who are food insecure are the most likely to be afflicted with these illnesses, and they often can’t access nutrient-rich foods. Even when they can get wholesome foods, they have difficulty finding the money or the time to buy and make nutritious meals.
Currently, 90 percent of healthcare costs are driven by expenses related to treating chronic illnesses. A nutrition-based approach to food insecurity will reduce suffering and, at the same time, reduce healthcare costs. Strictly speaking, by making nourishing foods a priority, we can both prevent the onset of diet-related illnesses and reduce the symptoms of those who are currently living with diet-related diseases. This shift will have added public policy benefits of bending the overall healthcare cost curve by investing in preventative nutrition instead of reactive sick care.
We need to refocus our efforts and work to make sure that vulnerable families, children, and older adults have access to quality, nutrient-dense meals that incorporate fruits, vegetables, beans, whole grains, and nuts. That is why healthcare leaders have been emphasizing nutrition insecurity rather than simply food insecurity. As Dariush Mozaffarian, Sheila Fleischhacker, and José R. Andrés wrote in JAMA in April, “the new concept of nutrition security should be embraced and normalized.”
So how do we get more Americans, particularly those who are at risk and those who live in food deserts and swamps, to have nutrient-rich foods as the foundation of their diets? The answer, beyond access, is personalization. There are many factors involved in food decisions—from structural access barriers, cultural traditions, and family history to personal taste preferences and preparation style. What’s more, achieving life-long change is challenging and complex.
What we’ve found at NourishedRx, formerly Project Well, is that when provided culturally relevant food options, people are eager to learn the dietary rules of the road, and in many cases, they become more open to SNAP, WIC, and other community-based support programs. In addition, we know that making the shift to a healthy diet is a process of moving along a continuum, not a one-and-done deal. Harm reduction theory applies.
Our approach works. As an example, we’ve teamed up with Blue Cross Blue Shield of Minnesota to provide a first-of-its-kind dietary support program for high-risk Black Indigenous People of Color (BIPOC) pregnant women and their families. Our food offerings are culturally specific and individualized by Registered Dietitians (RD), and we have seen an 80 percent retention rate in the program. In addition, there have, so far, been no pre-term or low birth weight pregnancies among the women participating in the program.
The notion that nutrient-rich diets can reduce suffering and solve many of our healthcare problems is gaining traction. In its latest nutrition guidance, published today, the American Heart Association pivoted away from its usual good-and-bad food lists. Cardiovascular disease is the number one cause of death in the United States, and the association decided that telling Americans to add certain foods to their meals and abandon others wasn’t working. Instead, it is recommending that Americans embrace wholesome, nutritious diets.
On top of that, the association recognized that to get people to stick to a nutritious dietary lifestyle, it needed to be sensitive to individual tastes, ethnic differences, and life situations. So, if a family is accustomed to preparing macaroni and cheese for dinner, the association now suggests they use whole grain or lentil pasta rather than preparing a different dinner altogether.
We are now working on an important next step: providing personalized and healthy food at scale. To support larger populations, an increasing number of RDs must be employed to keep our RD-to-participant ratio low and, therefore, the quality of service high. An AI solution that leverages multifaceted user and meal data facilitates individualized food personalization while benefiting from shared dietary patterns and preferences across individuals and populations. Moreover, this can be done at scale, not by completely automating an RD’s job, but rather supporting each RD in a human-in-the-loop paradigm to more accurately and efficiently recommend personalized food offerings.
As we’ve found, the American Heart Association’s advice is sound. If we want more Americans to adopt nutrient-dense meals, we have to start by respecting their desire to eat food they enjoy and can access - ideally at scale.
