Opportunities and Challenges for Promoting Sustainable Diets within “Food is Medicine” Programs in the United States: A Qualitative Research Study

Abstract

Background

The United States population is experiencing concurrent, interrelated challenges of diet-related chronic diseases, food and nutrition insecurity, and climate change. Food is Medicine (FIM) has been described as a range of food-based programs that aim to prevent, manage, and treat diet-related chronic diseases in partnership with health care systems. Research is lacking in how these programs could promote plant-rich dietary patterns and other sustainability practices to support both human and planetary health.

The United States population is experiencing concurrent, interrelated challenges of diet-related chronic diseases, food and nutrition insecurity, and climate change. Food is Medicine (FIM) has been described as a range of food-based programs that aim to prevent, manage, and treat diet-related chronic diseases in partnership with health care systems. Research is lacking in how these programs could promote plant-rich dietary patterns and other sustainability practices to support both human and planetary health.

Objectives

This study explored how FIM experts in the United States define FIM and plant-rich dietary patterns and their views on the opportunities and challenges to incorporating sustainable diet practices into FIM programs.

This study explored how FIM experts in the United States define FIM and plant-rich dietary patterns and their views on the opportunities and challenges to incorporating sustainable diet practices into FIM programs.

Methods

We conducted semistructured Zoom interviews with 20 national FIM experts between July and October 2024. Participants were recruited through purposive and snowball sampling. Data were analyzed using inductive and deductive thematic analysis guided by the socioecological model.

We conducted semistructured Zoom interviews with 20 national FIM experts between July and October 2024. Participants were recruited through purposive and snowball sampling. Data were analyzed using inductive and deductive thematic analysis guided by the socioecological model.

Results

Expert perspectives differed on the definition and scope of FIM but largely agreed on the components of a plant-rich dietary pattern. Participants viewed produce prescriptions and medically tailored meal and grocery programs as aligned with plant-rich dietary patterns but described challenges with the lack of standardization across programs. Experts described pilot FIM programs that have incorporated sustainability practices but lacked explicit messaging on the human and planetary health cobenefits. Supporting local or regenerative producers and reducing food waste were identified as sustainability practices that could be systematically incorporated into FIM programs. Challenges included misalignment with the political environment and policy and systems barriers that restrict enabling environments for supporting sustainable diets.

Expert perspectives differed on the definition and scope of FIM but largely agreed on the components of a plant-rich dietary pattern. Participants viewed produce prescriptions and medically tailored meal and grocery programs as aligned with plant-rich dietary patterns but described challenges with the lack of standardization across programs. Experts described pilot FIM programs that have incorporated sustainability practices but lacked explicit messaging on the human and planetary health cobenefits. Supporting local or regenerative producers and reducing food waste were identified as sustainability practices that could be systematically incorporated into FIM programs. Challenges included misalignment with the political environment and policy and systems barriers that restrict enabling environments for supporting sustainable diets.

Conclusions

The FIM movement offers promising opportunities to promote collaboration among food and health system actors, but challenges require coordinated actions within and across sectors. Future FIM programs could identify potential areas of human and planetary health cobenefit and incorporate sustainable diet principles into program design and evaluation.

The FIM movement offers promising opportunities to promote collaboration among food and health system actors, but challenges require coordinated actions within and across sectors. Future FIM programs could identify potential areas of human and planetary health cobenefit and incorporate sustainable diet principles into program design and evaluation.