WASHINGTON — The United States needs a “whole-of-government” approach to fighting diet-related disease, Sen. Cory Booker (DN.J.) said Wednesday during a Senate hearing on food in as drugs.
“Currently in the United States, half of our population is pre-diabetic. [or] has type 2 diabetes,” said Booker, who serves as chair of the Senate Agriculture, Nutrition and Forestry Subcommittee on Food and Nutrition, Specialty Crops, Organics and Research. “It’s something that doesn’t exclusively affect older people…a quarter of our teens today are pre-diabetic or have type 2 diabetes. Much of that can be attributed to the fact alarming that ultra-processed foods now constitute two-thirds of the calories in the diets of our children and adolescents.”
A system based on well-being
Booker, a vegan who quit eating added sugar for 2 months last summer, noted that in September, “The White House released a bold plan to end hunger, improve nutrition and reduce the epidemic of diet-related diseases A key part of the National Strategy is a call for continued research and scaling up of “food as medicine” programs, such as funding pilot programs to incorporate medically appropriate meals and counseling nutritional benefits in our Medicare and Medicaid programs.
Booker added that incentivizing farmers to grow fruits and vegetables at the same level that the federal government supports staple crop production “is a top priority for me in the Farm Bill.”
Sen. Mike Braun (R-Ind.), a ranking member of the subcommittee, recalled that when he ran the family truck parts distribution business, “we built a system based on well-being and bypassing the healthcare system and forcing my employees to engage in their own well-being.” For example, employees were offered free biometric screening, “and if you didn’t get it, you’re going to be penalized for not doing the right thing.”
The wellness program is still going strong today, he added. “The employees did not have [health insurance] increase in premiums in 15 years and they pay less in their deductible now than they did then, because they have become consumers of health care. In a nutshell, this is what we need to do more broadly across the country.”
But many people – especially those on low incomes or those living in “food deserts” without access to healthy foods – struggle to access healthy meals and fresh fruits and vegetables, witnesses said. . “For 20 years I was a primary care physician and part-time hospitalist at the Philadelphia Veterans Affairs Medical Center,” said Kevin Volpp, MD, PhD, founding director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania. “Many of my patients struggled with chronic conditions, such as congestive heart failure and diabetes, which were exacerbated by their difficulty finding healthy, affordable foods.”
Gaps in clinical trials
“Evidence indicates that integrating diet programs as medicine into health care may be associated with improved outcomes,” said Volpp, who is also a member of the American Advocacy Coordinating Committee. Heart Association (AHA). “For example, medically appropriate meals are associated with fewer hospitalizations and admissions to skilled nursing facilities, fewer emergency room visits, and reductions in healthcare costs.”
However, he said, when it comes to proving the value of diet as medicine, “only a small number of randomized controlled trials have been done, and they have generally been small. and therefore unable to provide definitive answers. Food-as-medicine interventions have generally failed to incorporate freedom of choice and patient input, reducing potential rates of engagement.”
“To unlock the full potential of food as medicine, we must systematically answer important questions about the intensity, duration and distribution of food as medical interventions; the role of preferences and patients; the incorporation of educational or coaching behavioral strategies; the comparative effectiveness of ways to change behaviors and habits; and cost-effectiveness,” Volpp added, noting that the AHA and the Rockefeller Foundation have committed a total of $250 million to build a national food-as-medicine research initiative. The organizations plan to launch the initiative next spring.
John Bulger, DO, MBA, chief medical officer of insurance operations and strategic partnerships at Geisinger Health Plan in Danville, Pennsylvania, discussed the success of the health plan’s Fresh Food Farmacy project, which provides each of the 1,600 program participants enough healthy food for 10 meals for themselves and their families each week; participants also receive clinical interventions from care managers, dietitians and diabetes education consultants. The result? Participants’ average HbA1c level dropped by half and hospital emergency room visits dropped by 30%, he said.
Bulger cited the example of a 55-year-old man weighing 181 pounds. widowed grandmother named Rita who was the program’s first patient. “His [blood] the sugar was about three times what it should be…and his cholesterol was twice what it should be. After going through the program, she actually had normal blood sugar – she dropped her blood sugar by two-thirds. She lost 50 lbs. [reach] 135 pounds and dropped his bad cholesterol from double what it should be to about half normal.”
Geisinger is now expanding the program to include additional diseases like kidney disease and heart failure, he said.
Role of meat and dairy products
Sen. Roger Marshall, MD (R-Kansas), noted that he was working with Sen. Kirsten Gillibrand (DN.Y.) “to put the milk back in the [school] focus on breakfast – especially whole milk. We’re going to have a generation of women with osteoporosis and osteopenia in their 40s rather than 50s because they don’t drink milk in school.”
He also expressed concern that the Department of Agriculture’s Food and Nutrition Department “recently provided recommendations to the WIC [the Women, Infants, and Children program] this included additional non-dairy alternatives for moms and kids…I think this is contrary to the recommendations for increased dairy options in the Dietary Guidelines for Americans. And then I’m concerned about ‘Meatless Mondays’ and the impact of less protein in people’s diets.” He asked witnesses if they thought meat and dairy products were important sources of protein. and calcium.
“That’s a complicated question to answer,” Volpp said, adding that, for example, some meats are healthier than others. “Saturated fat is obviously a problem for people with heart disease. And the same with dairy – I think there are healthier alternatives in some cases, but getting enough protein is very important. in food, so we need to understand holistically how to do that, given the full range of food options.”
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