Healthy Food Resources, Better Health
By Rita Colorito
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Jennifer Maxwell, MD, a family medicine doctor at Yakima Valley Farm Workers Clinic, often sees patients struggling with both food insecurity and making dietary changes to manage their diabetes. To address both, Dr. Maxwell doesn’t just prescribe medication and tell them to “eat better.” She provides these patients the means to do so through the clinic’s partnership with the Washington State Department of Health’s Fruit and Vegetable Prescription Program, or FVRx. It’s one of 24 such health care partners participating statewide since the program started in 2016. FVRx serves people who have or are at risk for a diet-related illness and have food insecurity.
Produce prescription programs like FVRx fall under “food is medicine,” a growing movement of science- and evidence-based initiatives that recognize the critical role of nutrition in preventing, managing, and even treating chronic disease. The Food Is Medicine Institute at Tufts University defines the movement as interventions that “reflect the critical link between nutrition and health, integrated into health care delivery.”
Medically tailored meals and medically tailored groceries are the other disease treatment and management interventions. Prevention interventions include population-level health food policies and programs and nutrition security programs, such as the Supplemental Nutrition Assistance Program; Women, Infants, and Children Nutrition Program; and school meals.
Washington’s FVRx program
In Washington state, depending on partner parameters, patients can receive between $250 to $500 in FVRx vouchers (and soon prefunded ecards) over six months. They are redeemable at certain grocers, food cooperatives, and farmer’s markets statewide for fresh, frozen, or canned produce without added salt, sugar, or fat. At Yakima Valley Farm Workers Clinic, food insecure patients with an A1C blood test of 8% or higher receive $40-$80 in monthly vouchers for six months. The program is so popular, there’s a waiting list.
“In this last cohort, patients on average had a decrease of a half of a percentage point for their A1C. Some patients had as significant a decrease of 8.3 percentage points, which is huge in terms of health improvement,” says Gabrielle Frank, RDN, primary care nutrition services manager at Yakima Valley Farm Workers Clinic.
While robust research is scarce, one study published in the August 2023 Journal of the American Heart found produce prescription programs associated with significant improvements in fruit and vegetable intake, food security, and health status for adults and children. Adults with poor cardiometabolic health also had clinically relevant improvements in A1C, blood pressure, and body mass index.
Many of Dr. Maxwell’s patients work long hours, without paid time off, making it hard to convince them to schedule medical visits when they don’t see immediate benefits. The FVRx program has incentivized patients to make and keep follow-up appointments, says Dr. Maxwell. “With this program, they see a direct benefit today, and then it translates into long-term benefits.”
Medically tailored meals and groceries
Medically tailored meals, or MTMs, began in the 1980s in response to the HIV/AIDS pandemic. MTMs and medically tailored groceries support patients with severe, complex, or chronic conditions. They are typically provided by nonprofits and other community organizations and delivered to patients’ homes. Upon referral from a physician or practitioner, registered dietitians assess each patient to develop meals and groceries tailored to their nutritional needs and condition.
Not all MTM programs are created equal. As food is medicine has gained traction, some traditional food and meal delivery companies have tried to rebrand themselves. “Most don’t appear to meet voluntary accreditation standards crafted by medically tailored meal providers,” found a STAT News investigation: Some provided patients with fried food or meals that were high in fat or sodium.
To develop quality standards, in 2023, the Food is Medicine Coalition, a leading national coalition of nonprofit organizations that provide medically tailored meals, created an accreditation program for medically tailored meal providers. Lifelong, a Seattle-based nonprofit, is the first in Washington state to receive FIMC accreditation. (FISH Community Food Bank in Ellensburg is a FIMC member, a precursor to accreditation, providing MTMs to clients in Kittitas County.)
Each year, Lifelong provides MTMs and MTGs to some 2,000 low-income clients in King, Island, and Snohomish counties. A significant portion are homebound and have challenges either accessing food or preparing their own food. “One of the things medically tailored meals, or even groceries, can do is reduce the stress around food access,” says Emily Hanning, Lifelong’s vice president of food and nutrition. The home delivery model can even help address the loneliness epidemic, she says.
“Bringing meals to clients fosters a sense of connection and community. Oftentimes we’re one of the only people interacting with a client that week,” says Hanning. “We’re also able to do an informal mini wellness check. Then if there’s any follow up needed, we’ll reach out and make sure that we’re getting clients the other support they need.”
Along with providing condition-specific nutrition, MTMs also address dental or swallowing issues, barriers for many patients, says Hanning. “We’re able to mechanically soften food to provide adequate nutrition.”
Poor diets not only impact a patient’s health, they also impact their wallet: 85% of all health care spending is related to the management of diet-related chronic diseases, according to Tufts’ Food Is Medicine Institute.
In Lifelong’s annual survey, 88% of responding clients reported improvements in their health. A recent Health Affairs analysis estimated the one-year impact of MTMs (based on 10 weekly meals for eight months) would result in more than $3,000 net annual cost savings per person in Washington state and nationally $23.7 billion overall, after accounting for intervention costs. Nationally, this level would also avert over 2.6 million hospitalizations.
In recent years, the need has increased so much that Lifelong now has a waitlist. Hanning is hopeful that Apple Health will soon cover MTMs via Washington’s Section 1115 Medicaid waiver, the federal mechanism that provides flexibilities for states to try new approaches with their Medicaid programs.
In February, the state Health Care Authority submitted a rate methodology under its Medicaid Transformation Project (its name for the Medicaid waiver) for reimbursable nutrition support services aimed at removing barriers to healthy nutrition. They include nutrition counseling and education, MTMs, meals or pantry stocking, fruit and vegetable prescriptions, and short-term grocery provisions. These nutrition support services are expected to increase the annual aggregate expenditures for nutrition service providers by approximately $50 million.
“We know that there are going to be reductions to food assistance and SNAP that people depend on coming up. So, the waiver, we hope, will provide an opportunity to help support our community members with healthy food,” says Hanning.
In 2023, the Centers for Medicare and Medicaid approved an additional five years of payment for health-related social needs services under Washington state’s Medicaid Transformation Project. The Trump administration has since rescinded CMS guidance that promoted these Section 1115 waivers for health-related social needs services addressing social determinants of health. While the new policy does not nullify existing approvals granted under the Biden administration, new requests will now be considered on a case-by-case basis.
Food insecurity and social determinants of health
Many food is medicine interventions are tied to food insecurity, a social determinant of health; not surprising, as poor diets and food insecurity are strongly linked, with both increasing the risk of early death, disability, and poor health. The U.S. Department of Agriculture defines food insecurity as “a household-level economic and social condition of limited or uncertain access to adequate food.” The USDA’s 2023 Household Food Report found 9.5% of Washingtonians are food insecure.
“We can’t discuss food as medicine without addressing food insecurity. If people don’t have reliable access to nutritious food, the idea of using food to prevent or manage disease isn’t realistic. Things like affordability, transportation, food deserts, and lack of nutrition education all play a role in whether someone can consistently access healthy, culturally appropriate meals,” says Chelsey Lindahl, RDN, CD, manager for health promotion and wellness at MultiCare Center for Health Equity and Wellness in Tacoma. The center and MultiCare Yakima Memorial Hospital are also FVRx health partners.
In recent months, patients have also told Dr. Maxwell they don’t want to go out as frequently into the community out of fear. “Less frequent shopping trips means you can’t buy as many fresh fruits and vegetables because they will expire,” she says.
Food insecurity is often hidden in plain sight. Screening for insecurity is often something many physicians miss, says Dr. Maxwell. Yakima Valley Farm Workers Clinic uses the Hunger Vital Signs screening tool for all patients at intake and once yearly. Food cost is a big reason most don’t eat healthier.
“Our patients are living in the margins, and sometimes food is not the most high priority for them in terms of what their needs are, or what they see as the vehicle to support health improvement three or six months from now,” says Frank.
Over 22% of Yakima households receive benefits through SNAP, double the state average. Nearly 1 million Washingtonians use SNAP benefits each month. Statewide, nearly half of all babies, one third of pregnant women, and one quarter of children under age 5 rely on the WIC Program.
The Trump administration’s budget bill cut SNAP by $186 billion over the next decade. In Washington state, the average household under the Thrifty Food Plan is expected to receive $56 less per month. The maximum allotment for a family of four would drop from $975 to $848. The cuts come at a time when food costs continue to outpace wage growth for many Americans.
Community health workers at Yakima Valley Farm Workers Clinics also help connect patients to local food banks and apply for SNAP benefits. The majority of their clinic locations in Washington and Oregon also contain embedded offices for WIC, the federal Special Supplemental Nutrition Program for Women, Infants and Children.
“As health care providers we really need to reserve judgment about eating choices, or what is behind why families feed their kids the way they do,” says Frank. She recommends “How the Other Half Eats,” by Priya Fielding-Singh, PhD, to better understand food insecurity and what informs food choices. “Most people do want to feel healthy and know when foods are healthy, but there are just so many complex barriers that get in the way of that being their day-to-day reality,” she says.
Culinary medicine and whole-person care
Food is medicine interventions often include nutritional counseling, the educational, and sometimes emotional, support patients need to make lasting dietary changes. “Registered dietitians are trained in motivational interviewing and are able to take a broad concept like ‘eat more vegetables,’ and make it applicable to the context of their life,” says Frank.
One FVRx client recently shared that after six months, she has regular meal patterns, stopped drinking soda, and takes her medication as prescribed. Her A1C dropped from 13.7 to 6.3. “She was struggling with depression and her dietitian connected her with a mental health counselor. The dietitian she worked with provided this older adult with whole-person care,” says Frank.
Patients often share that changing their diet feels daunting and confusing, says Emma Dotson, DNP, ARNP, who specializes in cognitive neurology at the Swedish Center for Healthy Aging in Seattle. That’s where culinary medicine comes in: a growing evidence-based field that blends the art of food and cooking with the science of medicine. The center includes culinary medicine in its shared medical appointments, an innovative program where a patient cohort meets for eight months to learn lifestyle interventions for disease prevention and management.
Once a month on Zoom, Dina Piatt, RDN, provides a virtual cooking demonstration of brain-healthy recipes and education around nutrition. “A lot of patients don’t know the effect food has particularly on brain health,” says Piatt. The center’s plant-based recipes, such as blender banana bread, are intentionally simple and affordable, with easy prep and cleanup, so patients are more likely to make them.
In the past, generous funding allowed the center to deliver the ingredients to patients so they could follow along. Patients report feeling better and having lower A1C and blood pressure, from changing their diet, says Dotson. “Even those with early stages of dementia can participate with their care partner.” The feeling of self-efficacy, she says, creates a domino effect to keep up with other needed lifestyle changes.
Yakima Valley Farm Workers Clinic’s Toppenish Medical-Dental Clinic also offers all patients both in-person and virtual cooking classes around specific topics, such as heart health, diabetes management, and pediatric nutrition.
While the federal government’s nascent Make America Healthy Again movement focuses on ultra-processed foods, Dr. Maxwell says cooking meals from scratch isn’t an issue for her patients. “Most of my patients actually prepare their own food. It’s the cost-and taking a risk in buying something that they don’t know whether their family will actually eat it when they have a limited budget,” she says.
“It’s really not controversial that good nutrition is important. But how to actually make that work for our patients is key. And a lot of it is the health equity perspective,” says Dr. Maxwell. “It’s a reasonable question when patients are not eating fruits and vegetables to ask if they are afraid that they will run out of food before they have money to buy more. These are good questions before we continue to write more prescriptions and think that the patients just can’t or won’t.”
Rita Colorito is a freelance writer specializing in health care.
This article was featured in the November/December 2025 issue of WSMA Reports, WSMA’s print magazine.