Impact of a multicomponent food-as-medicine intervention on behavioral and mental health outcomes for patients with and without food insecurity.
Marcela D Radtke, June M Tester, Lan Xiao, Wei-Ting Chen, Benjamin O Emmert-Aronson, Elizabeth A Markle, Steven Chen, Lisa G Rosas
Author Information
Marcela D Radtke: Propel Postdoctoral Research Fellow, Stanford University School of Medicine, Stanford, California, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.
June M Tester: Osher Center for Integrative Medicine and Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA; Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.
Lan Xiao: Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.
Wei-Ting Chen: Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA; Office of Community Engagement, Stanford University School of Medicine, Stanford, California, USA.
Benjamin O Emmert-Aronson: Open Source Wellness, Oakland, California, USA.
Elizabeth A Markle: Open Source Wellness, Oakland, California, USA.
Steven Chen: Alameda County Health, San Leandro, California, USA.
Lisa G Rosas: Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA; Office of Community Engagement, Stanford University School of Medicine, Stanford, California, USA; Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA. Electronic address: lgrosas@stanford.edu.
BACKGROUND: Increasingly, food-as-medicine (FAM) programs are being implemented as a strategy for improving the health of patients. However, current policies limit nutrition resources to patients with specific chronic condition diagnoses and do not include food insecurity as a qualifying condition. OBJECTIVE: Explore the impact of Recipe4Health (R4H), a multicomponent FAM intervention, on behavioral and mental health outcomes in patients with and without food insecurity. METHODS: Patients (n = 336) with diet-related chronic conditions and/or food insecurity were referred to R4H, which included 16-weekly produce deliveries and behavioral intervention sessions. Food security status was assessed using the U.S. Department of Agriculture 6-item survey. Outcomes included vegetable/fruit intake, physical activity (PA) and mental health. Within- and between-group pre-post changes were assessed using repeated-measures linear mixed-effects models, adjusting for baseline. RESULTS: The majority of patients had one or more chronic conditions (96%) and identified as food insecure (62%). Patients with food insecurity experienced significant increases in daily servings of vegetables/fruit (+0.38 ± 0.15; P = 0.01) and minutes of moderate-to-vigorous PA per week (+28.94 ± 9.84; P < 0.01). Patients with food security did not experience significant increases in vegetables/fruit (P = 0.09) or PA (P = 0.06). Food-insecure and food-secure patients both experienced significant improvements in loneliness, anxiety, and depressive symptoms from baseline (P < 0.01 for all). Between-group differences were observed only for anxiety, where patients with food security experienced significant improvements in anxious symptoms compared to food-insecure patients (-1.24 [-2.33, -0.14]; P = 0.03). CONCLUSION: Policymakers may consider expanding eligibility criteria to include food insecurity as an independent qualifying condition for FAM.
