The Food is Medicine movement originators are trying to standardize medically tailored meals

WASHINGTON — Food corporations, grocery stores, and even tech companies are claiming they are a part of the growing effort to use food to treat medical conditions. Now, the nonprofits that pioneered the work want to standardize it.

The Food is Medicine Coalition, an association of community-based nonprofit food providers, released a 32-page accreditation standard, which was shared first with STAT Wednesday. It focuses on one of the most-well established “food is medicine” interventions, known as medically tailored meals, which are prepared meals cooked for specific conditions, like HIV and heart failure.

The requirements are stringent. Organizations must have one accredited full-time dietitian on staff for every 1,000 clients they serve. Accredited organizations also can’t serve any foods with artificial sweeteners, preservatives, or anything “ultra-processed.” They also are directed to cook foods in a way that “preserves the nutrient value of the food,” such as by “baking, braising, and sautéing rather than frying.”

The effort underscores the fear among advocates that the amorphous nature of the “food is medicine” efforts currently being launched — ranging from cooking classes and AI-driven meal planning apps to produce delivery boxes and premade meal delivery services — will muddy the conversation around food’s impact on health, and ultimately make it harder to integrate food into health care in the same systematic way that pharmaceuticals or medical devices are integrated today.

“My biggest fear … is that we don’t have the rigor of defining these interventions,” said Alissa Wassung, the executive director of the Food is Medicine Coalition. “So we implement interventions that actually are not the thing we’re talking about. Then we see subpar outcomes … and then we abandon the whole project … that’s a very real risk at this moment.”

The new standard was crafted over the course of more than a year by a committee of agencies across the country alongside SCS Standards, a nonprofit that has helped develop rules for everything from sustainability-grown produce to lab-grown diamonds. The ultimate standard was approved by the Food is Medicine Coalition’s advisory board after pilot testing. The coalition anticipates the accreditation process will take six months and will include an on-site audit. Access to accreditation is tied to membership in the coalition, which costs between $2,500 and $6,250, depending on the size of the organization applying.

Nonetheless, certain elements of the standard are likely to promote controversy, even among people who believe that food can be medicine. The prohibition on ultra-processed foods is likely to generate debate among nutritionists and dietitians, some of whom have argued that the term is largely meaningless, and unfairly maligns otherwise healthy foods, like certain breads, solely because of their extensive ingredient lists. The standard does, however, make exceptions for certain foods that could be considered ultra-processed under the leading classification system, which is known as NOVA. It allows, for example, for bread to still be served, despite the ban.

“Since we have no accepted standards for ‘ultra-processed foods’ in the U.S., they need to remove that reference,” said Joanne Slavin, a professor at the University of Minnesota, who also questioned why artificial sweeteners, dyes, and preservatives were banned as well. (Slavin, who served on the 2010 committee that determines the national dietary guidelines, has received research funding from companies that produce ultra-processed products and those with artificial sweeteners and preservatives, including Pepsico and Coca Cola.)

The standards also require accredited service providers to be nonprofits. That would prevent the slew of for-profit meal providers that have launched in recent years from getting the group’s seal of approval.

Wassung defended the move, arguing that nonprofit organizations are key to the mission of the food is medicine movement.

“Our vision is a future where anyone who needs the medically tailored meal or grocery intervention has access to it, that it is of the highest quality, and that access is not dependent on where they live or their ability to pay, and that is only possible with the nonprofit model,” Wassung said, adding that “we really endeavor to define ourselves from the inside out, not in opposition.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.