Diabetes patients who’ve experienced the evolution of blood sugar care — from finger pricks to glucose monitors — may soon receive a different kind of prescription from John Peter Smith Hospital: a meal plan.

Although a local program that allows for these kinds of food prescriptions is still seedling, conversations about food pharmacies have been quietly growing at the county hospital since Dr. Bryan Becker, a physician and president of Acclaim Physician Group, arrived last year. 

Food as pharmacy is not merely the pursuit of expanded food access, Becker said. Instead, it’s access and nutritional support from health providers, customized for a patient’s specific health needs. 

The concept is simpler than the execution. Becker, his colleagues and possible partners across the country, are contemplating how to connect culturally sensitive, easy-to-access, easy-t0-prepare, inexpensive meals with the people who need them, while measuring health outcomes along the way.

“How do we cultivate the right approach for individuals who are getting food such that we can use it as either an adjunct or maybe, in some instances, a formal approach to helping them treat their clinical conditions?” he said. 

DASH, deliveries and produce prescriptions

The idea that food could be medicine stretches back centuries. In 400 B.C., the physician Hippocrates reportedly recommended people prevent diseases by eating nutrient-dense foods.

From a research perspective, though, studies like the Dietary Approaches to Stop Hypertension, or DASH, trial in the 1990s spurred thinking that diet truly affects health, Becker said. 

Now, food as medicine models vary from medically tailored meal delivery, the home delivery of meals prepared by registered dieticians to address a patient’s specific needs, to fully fledged grocery stores, or “farmacies,” within a hospital system.

The ever-expanding movement has gained traction not only because it works — enabling patients to eat and be healthier — but it saves money. A 2020 review of studies evaluating food pharmacy interventions found that medically tailored meals and produce prescriptions can be cost-saving to the health care system. 

For example, the review notes that a person in the U.S. can receive seven months of medically tailored meals, nutrition counseling and case management for the same price as an average hospital stay. Furthermore, a 30% subsidy incentive on fruits and vegetables over the course of a lifetime could save approximately $40 billion in health care costs.

A ‘double opportunity’

Amid promising possibilities, startup isn’t easy. Becker hopes to actualize a small-scale version of a food as medicine program during the 2023 fiscal year, which begins in October. Ideally, he said, that would mean implementing the same program in multiple locations in Tarrant County and determining what works before scaling up.

Right now, he’s thinking food prescriptions — which patients could redeem in local stores — or medically tailored meal delivery. Programs like these could help patients with diabetes, hypertension and possibly heart failure, Becker said. The next challenge will be creating sustainable change, even after the prescription runs out.

“But that takes time,” he said. “It takes time to change patients’ behaviors, and we want to work with them through that transition.”

Before connecting patients with food, however, the county hospital must determine which organizations to partner with and how to pay for the program. Becker noted that several Medicare Advantage plans cover nutrition counseling and medically tailored meal delivery. Capitalizing on both partnerships within and beyond the community and utilizing publicly funded nutrition benefits is a “double opportunity,” Becker said. 

Creating healthy opportunities ‘without diluting culture’ 

When Becker explained the possibility to the JPS Board of Managers in April, board member Amanda Arizola cautioned Becker to consider cultural competency as a guiding principle in the development of the program. 

Cultural competency is the “the ability to understand, appreciate and interact with people from cultures or belief systems different from one’s own,” according to the American Psychological Association. 

In the meeting, Arizola listed several organizations — Healthy Tarrant County Collaboration, Grow Southeast, CoAct, Opal’s Farm, Greater Mount Tabor — as culturally competent models already coexisting in Tarrant County’s food ecosystem. 

Arizola doesn’t speak for the board, she told the Report. Still, she hopes the hospital thinks creatively and collaboratively in their approach to the program. 

“We can’t impose (an) American style of health without recognizing the colonization of food throughout,” she said. “There are ways to create healthy opportunities without diluting culture.”

In the meeting, Becker acknowledged her concerns. His wife’s family, he said, is Chinese. They have different food preferences. He also told the Report that, when looking for co-pilot organizations, Acclaim Physician Group and the hospital will consider cultural competency a criterion for partnering.

‘Food is so personal’

For example, Becker has been eyeing RxDiet as a model, he told the Report. RxDiet, a “virtual food farmacy” in New York City, provides an artificial-intelligence-based meal ordering and delivery system for health care organizations and their patients. 

The platform can customize culturally specific meals on a micronutrient level, said Dr. Mike Cantor, a physician in Boston who serves as an adviser for RxDiet. 

“Food is so personal,” he said. “What we’re doing here is we’re using technology to deliver very personalized dietary information in the context of coaching and behavioral change support to help people eat healthy and get healthy and stay healthy.”

The approach intrigued Cantor, in part, because of its possibility to help people long term. As a clinician, he’s been frustrated by the lack of progress his patients make on medication alone.

“There’s an old saying, ‘You are what you eat,’ and it’s kind of true,” he said.

Endless walls of kale grow with Eden Green’s vertical farming method. (Courtesy | Eden Green Technology)

RxDiet works with health plans that then cover the cost of the program, he said. So, for a county hospital system like JPS Health Network, the costs would be minimal. “If the food is paid for, RxDiet is paid for as well,” he said. 

When it comes to gathering the food to then offer or deliver, Becker said he plans to source locally. He’s been in contact with Eden Green Technology, an agricultural technology company in Cleburne. 

Eden Green has pioneered a novel — and vertical — approach to greenhouse farming. The company’s pilot facility, across the street from a Walmart distribution center in northwest Cleburne, is 1.5 acres, but produces the equivalent of 40-50 acres of open-field farming in terms of leafy green volume.

“Depending on the varietal, we can do up to 17 harvests in one year,” CEO Eddy Badrina said. 

The model cuts down waste that happens in the harvest and delivery of produce from other parts of the country, he said. They can’t grow everything — “we’re not a silver bullet,” he said. Larger plants like corn and potatoes don’t make sense within a vertical system. But, their first greenhouse has grown 200 varietals of leafy greens and other vegetables like tomatoes and peppers.

Last year, Badrina invited a group from Fort Worth, including a representative from JPS Health Network, to tour the greenhouse. He’s supportive of the county hospital pursuing this program, and hopes Eden Green could be a collaborative partner. 

To do so, they’ll need to go through the procurement process like any other vendor, he said. And if Eden Green were successful, the plan would be to build another greenhouse in Fort Worth. 

When he spoke with the Report, Jesse Herrera seemed cautiously optimistic about the food as medicine enterprise. Herrera is the executive director of CoAct, a nonprofit design studio in Fort Worth, and a colleague of Arizola. 

One of CoAct’s projects, in partnership with Healthy Tarrant County Collaboration and the Office of Commissioner Brooks, is Grow Southeast, an incubator for community-owned urban farms in Southeast Fort Worth.

He calls JPS Health Network an “influencer.” As both a taxpayer-funded institution and a county hospital, the system can model more creative fundraising strategies — like incentivizing community partners to collaborate in exploring solutions rather than “forcing an organization to assume a solution upfront.”

Amid JPS Health Network’s power, he hopes the system remains open to solutions and takes its time getting to know the issue. He calls this strategy “challenge-aligned.”

“Challenge-aligned is about learning the intimate details of a challenge, who it affects, and how it affects them,” he said. “It is about understanding how the challenge is experienced day-to-day by community members.”

For example, he’s hopeful JPS Health Network will work to understand why community members buy the food that they already buy. The process will take time, but it allows for more effective execution, he said. 

“It’s going to take time to build trust (in these communities),” he said. “There’s no ifs, ands or buts to it. So if you want them, if you want to be intentional, you’re going to have to make the time.”

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....