Food as Medicine

Row upon row of plants reach for the summer sun: peas, cabbage, tomatoes and a dozen other vegetables. A bee lands on a squash’s saffron flower, gathers nectar and departs. Four stories below, a siren wails to life as an ambulance noses its way into rush hour traffic. This garden on the top of a hospital in Roxbury is one piece of a puzzle Boston Medical Center and others want to solve: not just how to heal patients, but how to stop them from getting sick in the first place.

Boston Medical’s solution trades medicine in favor of food. Their rooftop garden supplies the Preventive Food Pantry, a program they hope will improve patients’ health, prevent chronic conditions like diabetes and lower healthcare costs, all by giving their patients the ingredients and skills they need to make meals that are nutritious. Compared to what many other nonprofits are able to offer, the food Boston Medical dispenses is healthier. Most food pantries can not afford to be picky about donations. What they are given is what they give away. At Boston Medical though, “We don’t accept junk food, we don’t give out junk food,” said Latchman Hiralall, manager of the food pantry since it opened in 2001.

Patients come to the pantry after a physician gives them a referral, a step that removes some of the stigma associated with taking charity.

“It takes a lot of courage to go to a food pantry,” said Hiralall. “It’s like begging for food.”

The pantry determines what food to give each patient based on that patient’s preferences and medical conditions. The patient receives not only enough for himself, but enough to feed his entire family. The amount of food is meant to last a week, though Hiralall said patients often tell him they can stretch it to two weeks.

Boston Medical also employs a dietitian to teach cooking classes in the hospital’s kitchen. The classes show patients how to use ingredients from the pantry to cook healthy meals.

“Until I started participating in the kitchen, I didn’t know how to cook the food,” said Sarah Zene of Dorchester, a patient who receives food for her diabetes. The classes had a big impact on Zene. She lost 80 pounds in six months, a change she attributed to the pantry’s ingredients and recipes.

Between patients and their families, the pantry gives more than 7000 people at least a quarter of the food they need each month. Since insurance companies won’t pay for the program’s annual cost of $300,000, the pantry’s survival depends entirely on philanthropy.

Several other hospitals who want to create similar programs have asked Boston Medical for advice. One of the biggest challenges they will face is how to prove preventive medicine works. Boston Medical does not currently study the effects of using food as medicine, but Connecticut-based nonprofit Wholesome Wave does.

Wholesome Wave launched its Fruit and Vegetable Prescription Program in 2010 and has since expanded it to seven states and the District of Columbia. Their program gives food from farmers’ markets to overweight and obese children who are at risk of developing diet-related diseases. Catherine Luu, Program Manager for Wholesome Wave, said before her organization can expand the program further they will have to demonstrate its effectiveness. The current key measures of success they use are weight, body mass index (BMI), blood pressure and fruit and vegetable consumption. In 2012, more than half of the program’s participants reported an increase in how many fruits and vegetables they ate. More than a third of the children improved their BMI. While these results show promise, Wholesome Wave is refining their program to consider other criteria.

“We’re trying to understand how to bridge our current measurement of impact with what would be needed to fund the program,” said Luu.

Kerri Hawkins, a dietitian who works in private practice in Arlington, Massachusetts, said the best physiological measurements to show the affect of food on health are cholesterol levels and blood pressure, but that waist circumference, body fat percentage, weight and BMI are also influenced by diet.

The use of food as medicine is relatively new in institutional healthcare and standards are not well-established to measure its benefits. Boston Medical, Wholesome Wave and other pioneers will need to define the best practices for their novel approaches if they want them to grow and succeed.

“It’s a lot of work,” said Hiralall, “but at the end of the day you know you’re helping all these people.”

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