FOOD IS MEDICINE PROGRAMS - FOOD FARMACY

Food Farmacy at Health Brigade

Location: Richmond, Virginia
Coverage Area:
within an hour of Richmond, Virginia
Founded in: 2017
Director: Wendy S. Klein, MD, MACP

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A 12 week program that provides 25-35 servings of health-promoting foods weekly to patients with type 2 diabetes or other diet related conditions. These servings are vegetables from organic farms, supplemented with healthy fats and proteins. During the 12 week program, participants meet six times as a group for cooking demonstrations, health education lessons including nutrition and mindfulness. When they began, they had a curriculum taught by a graduate program from a local university, but stopped doing this because the program used Myplate guidelines which were not reflective of the nutritional needs of patients experiencing type 2 diabetes or up-to-date research.

Mission

We provide exceptional health services to those least served in a caring and nonjudgmental environment. We offer our patients services that are compassionate, evidence-based and person centered. The Food Farmacy is about removing barriers to the practice of health promoting behaviors and to serve patients from a social determinants of health lens.

Number of patients served

6-15 patients/per class and they are on their seventh class. 70 served total. 15,000 servings provided. 

Successes

Attendance of participants. Have had success in patients reducing their A1C by more than 1% over the 12 weeks. People love the program and want to come back. Also had some patients come off of insulin. 

“If you’re receiving those foods, the idea is that they’re probably going to replace other foods in your diet that aren’t as health promoting.”

“A1C is a really effective risk indicator for everything else that is a downstream effect that you get when you experience a metabolic health condition. It’s not perfect, but whenever you look at heavy studies about saving money, if people reduce their A1C just by a couple of percentage points, you have really amazing changes in their healthcare utilization rates and in the rates of microvascular and macrovascular complications. High blood sugar is not good. It’s really unhealthy for everyone. And so if you’ve got to have one indicator, I think that’s the best one.”

Argument in favor of food farmacies

Healthy food is cheap compared to medical care and it has shown great results. Why treat food related disease with medicine and not food?

 

“I think the biggest argument is the high rates of type two diabetes and obesity, the levels that have risen in America along with other conditions that are linked to metabolic health. I don’t think it’s really comprehensible. We don’t understand how insane it is, but if you click through the maps on the CDC website and see the progression of type two diabetes across the country, it’s absolutely mind blowing. And if nothing else tells us that the regular management of chronic disease has not worked at all, you can barely make the case that it’s even stemmed the tide. So in the context of one person’s individual food choices, healthy food, whatever we decide it is, can be expensive. But in the context of medical care, healthy food is really, really, really cheap, so I think that’s the first argument to be made, is that you have something that is showing really amazing results in some sectors and it’s cheap and it’s subtractive medicine, that is, we’re working to take something away, which is unhealthy food or non health promoting food, like sugar. And if you have the opportunity to practice that kind of medicine in an individual or public health perspective, I think it speaks for itself. The data’s coming in little by little that it can work. If you want to help people change a food related disease, hopefully agnostically or apolitically people can agree that type two diabetes and other metabolic health conditions are food related diseases. So why are we treating a food related diseases with medicine? We try and treat it with food.”

Cost of service

Free for patients. Funded by grants and individual donations. $15/person in food costs for each visit. Teaching kitchen was donated by Supervalue.

Screening and eligibility

Patients must have a Hemoglobin A1C above 7%, but program does also make space for people experiencing high blood pressure and obesity. Physicians will refer patients they think might benefit to Julian Levine through the hospital EMR, and Julian will meet with those patients to determine interest and eligibility. No screening for food insecurity as they serve an uninsured population and many are food insecure. Patients must have a Hemoglobin A1C above 7%, but program does also make space for people experiencing high blood pressure and obesity. Physicians will refer patients they think might benefit to Julian Levine through the hospital EMR, and Julian will meet with those patients to determine interest and eligibility. No screening for food insecurity as they serve an uninsured population and many are food insecure.

Greatest challenges overcome

Figuring out what optimal healthy nutrition is for people with diabetes. 

Greatest challenges yet to overcome

Transportation for patients. Logistics around providing patients correct information and making sure they are checking in with their medical provider. 

Perceptions as to what will be needed for food pantries to be paid for by third parties

Data on cost savings and health improvements associated with food farmacies. 

 

Health systems putting more resources into programs that address social determinants of health.

 

“I think what’s needed is for health systems to see the savings. Number one I think it’s going to come down to the money. And then also the health improvements. (…) I think some big systems are going to have to commit to building out programs with the same energy that they put into other state of the art programs. Dealing with social determinants of health, like transportation or food or housing, traditionally gets relegated to less flashy departments, and I don’t see that changing necessarily, but I think that putting more resources into traditionally under utilized programs like that, if someone sees the cost savings, then my hope is that it will explode

Data on patient outcomes

Blood pressure, A1C, Weight, patient satisfaction, patient knowledge change