This is the moment: advancing Food is Medicine through research

Everyone deserves access to enough safe, affordable, and nutritious food to be healthy for life. However, both food insecurity and nutrition insecurity far too frequently stand in the way of this vision as a common, persistent, and potent driver of diet-related chronic diseases. These health conditions—including but not limited to obesity, diabetes, cardiovascular disease, and cancer—are the most common, costly, consequential, and preventable causes of death in the United States [1].

Food is Medicine (FIM) is a paradigm that strives to fully integrate nutrition and health care through services such as medically tailored meals and groceries, produce prescriptions, and teaching kitchens tethered to nutrition or lifestyle medicine programs and services within communities [2]. More broadly, FIM and FIM-related interventions range from prevention to treatment and reflect the critical links between food security, nutrition security, health, and health equity, integrated into health care delivery [3]. FIM has gained considerable traction across the public and private sectors as a viable solution for addressing diet-related chronic diseases, especially after the concept was codified within the Biden-Harris Administration’s National Strategy on Hunger, Nutrition, and Health in 2022 [4] and again in 2024 at the US Department of Health and Human Services (HHS) Food is Medicine Summit [5]. Moreover, in 2023, a national summit with leaders, practitioners, and individuals with diverse lived experiences in health care, research, government, advocacy, philanthropy, and the private sector identified challenges and opportunities to sustainably incorporate FIM services into the health care system and at scale [3]. Our office at the NIH, the Office of Nutrition Research, is also very engaged in FIM activities [6]; furthermore, we were closely involved with HHS’ development of a new FIM virtual toolkit [7].

In a prior Perspective piece in this journal [8], our office (in addition to other offices and institutes at the NIH) suggested that nutrition research should incorporate the entire continuum of providing healthy food to human populations—ranging from food production to the behavioral and economic determinants of food selection to nutrient physiology. We now further suggest that the FIM movement is one expression by which research on the continuum of nutrition can be implemented.

Although few disagree with the concept that nutrition is a core element of whole-person health, structural and cultural barriers have complicated the successful implementation of FIM programs and policies in diverse communities across the nation [2]. To overcome these challenges, a comprehensive, cross-agency federal strategy is both necessary and under way. Furthermore, the HHS Office of Disease Prevention and Health Promotion, with which many federal agencies interact and coordinate on FIM-related projects, specifically highlights the need to ensure equity and access in FIM activities [9].

Although pockets of evidence support the value of FIM, more research is needed, especially regarding efficacy for improving health outcomes in large and diverse populations. These data are also necessary to provide a rigorous scientific evidence base to inform future programs, practices, and policies. Furthermore, although FIM research efforts are, by necessity, multidisciplinary and cross-sectoral, NIH has a key role to play as the nexus for biomedical and behavioral research.

FIM Research Across NIH

Recently, our office released the NIH Nutrition Research Report 2022–2023, which summarizes nutrition research and training activities supported and conducted by NIH in Fiscal Years 2022 (FY22) and 2023 (FY23) [10]. NIH’s total investment in nutrition-related research and training was ∼$2.1 billion in FY22 and ∼$2.2 billion in FY23. Although research activity in the FIM space is limited compared with other areas of NIH-funded nutrition-related research, it is growing. Currently, NIH is supporting rigorous FIM research in a variety of areas relevant to the agency’s mission. NIH aims to continue to support this vital work toward promoting health, preventing disease, and achieving health equity. To exemplify its support of FIM efforts, NIH –in FY23 alone—supported several research projects conducted across the United States to evaluate FIM interventions and their effectiveness on a variety of different health outcomes and diseases (Table 1). Importantly, through NIH-funded research, we are learning how FIM strategies that are influenced by a wide range of factors affect health outcomes, and we are identifying optimal ways to implement such programs in communities in a sustainable way.

TABLE 1.

NIH-Supported Food is Medicine Research Activities, FY23.

NIH Institute or Center	Research Project (NIH Grant Number)
National Institute on Minority Health and Health Disparities	Delivering Food Resources & Kitchen Skills to Adults with Food Insecurity and Hypertension (R01MD017961)
	Lowering the Impact of Food Insecurity in African-American Adults with Type 2 Diabetes Mellitus (R01MD013826)
	Multilevel Community-Engaged Intervention to Build a Sustainable and Equitable Food Economy in the Mississippi Delta (R01MD018208)
	Produce Prescriptions and Group Medical Visits: Addressing Food Insecurity and Social Isolation in Primary Care (K01MD015766)
	The Mid-Atlantic Center for Cardiometabolic Health Equity (P50MD017348)
National Institute of Diabetes and Digestive and Kidney Diseases	Food as Medicine for HIV: A Randomized Trial of Medically Tailored Meals and Lifestyle Intervention (R01DK127365)
	Food is Medicine: Randomized Trial of Medically Tailored Food Support for Diabetes Health (R01DK124630)
	Food is Medicine: Randomized Clinical Trial of Medically Tailored Meals for Individuals with Type 2 Diabetes Mellitus and Food Insecurity (R01DK125831)
	Impact of Medically Tailored Meals on Obesity, Other Health Outcomes, and Healthcare Utilization under Medicaid Flexible Services (R01DK134452)
	Pragmatic Randomized Controlled Trial Assessing the Impact of Medically Tailored Meals and Medical Nutrition Therapy via Telehealth Among Patients with Poorly Controlled Diabetes (R18DK118590)
National Cancer Institute	Carcinogenesis and Chemoprevention (P30CA077598)
	Food to Overcome Outcomes Disparities (R01CA230446)
National Institute on Aging	Optimizing Telehealth Delivery of a Weight Loss Intervention in Older Adults with Multiple Chronic Conditions: A Sequential, Multiple Assignment, Randomized Trial (R01AG077163)
Eunice Kennedy Shriver National Institute of Child Health and Human Development	Food for Life Course Equity in Maternal Security and Health (U54HD113173)
National Institute of General Medical Sciences	Indigenous Trauma & Resilience Research Center (P20GM139759)
National Institute of Nursing Research	Food Supplementation Interventions to Improve Weight Loss for Adults with Food Insecurity and Obesity (R56NR020466)
National Heart, Lung, and Blood Institute	Cost-Effectiveness of Food is Medicine Interventions to Improve Diet and Reduce Cardiometabolic Diseases (R01HL115189)

Abbreviation: FY, fiscal year.

Because health conditions affected by nutrition are broad, diverse, and influenced by many external factors beyond human biology, an interdisciplinary research lens is important for FIM strategies. For example, one currently NIH-funded research project is investigating the influence of healthy food delivery and community health worker support to socially disadvantaged populations in Baltimore, MD, including those at high risk of cardiovascular health disparities [11]. Other NIH-funded projects include person-centric studies testing novel delivery platforms that use health coaching [12], telehealth visits [13], as well as videoconference-based teaching kitchen classes in which participants learn and cook together in a socially supportive environment in their own home kitchens [14]. More ongoing NIH-funded research projects are evaluating multilevel interventions that involve a range of components such as medically tailored food pantries for patients with cancer [15] or medically tailored meals for individuals with HIV [16], food vouchers for farmers markets [17], and medically tailored meals and/or medically tailored groceries in different US regions [18,19]. Other NIH-funded projects are evaluating combinations of produce prescriptions and group medical visits [20], testing the value of food supplementation and food vouchers or medically tailored meals on food insecurity and obesity [21], and investigating whether certain food products can reduce cancer risk [22]. NIH-funded scientists are also exploring the relationship between medically tailored meals and health care use/costs for high-risk patients within a Medicaid pilot program involving multiple hospitals [23].

Furthermore, several ongoing NIH-funded research projects are working directly with communities toward developing relevant and sustainable FIM strategies. One example is a community-engaged project to develop a sustainable food economy in the Mississippi Delta – a region with a high poverty rate compared with the national average and limited access to fresh produce and other nutritious foods [24,25]. Researchers are also partnering with Tribal communities to assess metabolic and epigenetic effects of Indigenous foods and culture [26] and evaluating the role of trauma on food insecurity in Indigenous pregnant people [27]. Moreover, many of these projects are assessing program cost-effectiveness, and most are randomized clinical trials, two important elements toward enhancing the practicality and rigor of FIM-related research and expanding the existing evidence base built from mostly small pilot studies of FIM programs.

NIH is also supporting the Nutrition for Precision Health, powered by the All of Us Research Program [28], currently the single largest national investment in nutrition research. Importantly, our hope is that once available, the publicly accessible data from this program can be leveraged and integrated with FIM approaches to make individual- or population-level tailored nutrition accessible and affordable for prevention and treatment, help reduce the risk of metabolic diseases, optimize health, and improve quality of life [29].

Addressing Existing Gaps

In 2023, in collaboration with other federal Departments and Agencies (including but not limited to the Centers for Disease Control and Prevention, the Food and Drug Administration, USDA, and the US Department of Veterans Affairs), NIH issued a request for information (RFI) on FIM Research Opportunities [30]. A summary of the public response to this RFI was recently released and highlighted several research directions to advance the evidence base for FIM, with an underlying theme of prioritizing equity for both individuals and communities [31]. Another important underlying theme was expansion of study endpoints to include patient-centric measures of quality of life and behavioral/mental health. The need to study the economic implications of FIM programs was also noted, especially because there are limited data to quantify cost-effectiveness or cost-neutrality of these approaches. This lack of knowledge is a major hurdle to FIM implementation within communities, especially those that are underserved. Another scientific gap noted in response to the RFI is research addressing the needs of at-risk populations – such as pregnant people, children, and older adults – and how they may benefit from FIM interventions.

Moreover, because robust integration of food and nutrition resources into health care systems and communities remains difficult, implementation research is necessary to identify sustainable business models and solve reimbursement-related challenges. As such, building acceptance for FIM interventions and programs will benefit from prevalence and preference analyses of community farms and small growers, food system values, and operational challenges related to the food supply.

Another key FIM research opportunity is the need to compare data and results across FIM studies. Standard terminology for equity, mental and behavioral health, health care use and cost, food insecurity, nutrition insecurity, core program components, and outcomes are needed – along with the development and routine use of common data elements. Research designs that are integrated within the health care continuum, such as pragmatic clinical trials, will likely speed adoption of evidence as it is being gathered. To maximize the return on investment to the scientific community and relevance to potential public health interventions, new studies addressing FIM interventions should also include an assessment of the intersection of social determinants of health and food accessibility/availability.

In conclusion, realizing the vision of FIM has great potential to address diet-related chronic diseases, widespread hunger, and food and nutrition insecurity. Now is the time to build on the substantial momentum across the government and private sectors to accelerate progress through rigorous research, and we welcome investigators to submit FIM-related proposals to NIH through existing funding mechanisms [32]. We here at the Office of Nutrition Research are looking forward to an ongoing dialog with our nutrition research community in the FIM space; this is the moment.

Author contributions

The authors’ responsibilities were as follows – NJJ, AAB: designed the manuscript; NJJ, EGG: conducted the portfolio analysis of NIH-supported Food is Medicine research activities in Fiscal Year 2023; all authors: contributed to the writing of the manuscript; and all authors: read and approved the final manuscript.

Funding

The authors report no funding received for this study.

Conflict of interest

The authors report no conflicts of interest.