Healthy Food Choices Need More Than New Recipes

For low-income Californians learning healthier eating habits, smoothies can be a way to start. That’s what doctors, researchers and patients found in Alameda County. There, as I wrote in a column earlier this month, doctors are prescribing healthy foods to people with chronic diseases. Through a pilot program called Recipe4Health, one of the lessons for patients was that blending leafy greens into a drink helps manage blood sugar. 

Blending smoothies got them to appreciate the taste of vegetables, in a form that was easy to prepare. Those who had not been making salads or cooking vegetables became more interested in plant-based eating, and the program provided online cooking lessons and recipes.
 

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Most of the attention on programs like Recipe4Health has been on making fresh produce available to low-income residents with chronic conditions. But just as important as providing the fresh foods is teaching patients how to prepare them. Exercise instruction is also key. As Sacramento legislators consider the future of the state’s food-as-medicine pilot program, it is vital to recognize that losing the program’s classes will take away the chance to give people life-changing knowledge and skills. 

“Behavior change is underdiscussed,” said Wei-ting Chen, a Stanford researcher who studied the impact of Recipe4Health over a span of one year. Chen’s colleagues presented those findings at a spring conference of the American Heart Association.

Doctors typically instruct patients with those conditions to eat better and exercise. Sound familiar? They can prescribe changes in behavior. But there is no “behavior pharmacy” to fill that prescription. Patients are left to figure it out. 

To help patients figure out how to adopt better health behaviors, doctors and health officials need to ask patients what they want and what they are willing to do, said Zalak Trivedi, a Alameda County Recipe4Health dietician. Trivedi said patients often know what they want and need to do, but need help learning how to do it. That could mean learning how to start exercising or how to cook healthy foods that they had never learned to make. 

“It’s not just the food alone; it’s the group support,” said Chen about the Alameda program. “It’s the behavior.”

To teach that behavior, the Oakland-based organization Open Source Wellness provided weekly Zoom meetings for exercise and cooking instruction for Recipe4Health. Those meetings were the behavioral pharmacy for doctors’ orders. Open Source Wellness co-founder Elizabeth Markle, Ph.D., said patients find support and encouragement from supportive doctors, dieticians and classmates.

Patients in the program exercised more, ate more fresh vegetables and lowered food insecurity, Chen and her colleagues found. Doing so led to a lowering of cholesterol levels and more effectively managed blood sugar, the research found. 

“People are moved to change behavior when they are accepted, supported and feel a sense of belonging,” said Markle, a licensed psychologist. 

More than 3 million adult Californians went hungry in 2021. Food insecurity impacts nearly half of all Black adult Californians and of undocumented people in the state. While 3 million Californians have been diagnosed with diabetes, 10 million — one-third of the adult population — are prediabetic. People of color are twice as likely to be diabetic and 1.5 times more likely to be prediabetic. 

Nearly every county in California has some kind of state-supported food-as-medicine program for MediCal recipients. Sacramento legislators are working to pass a law to continue food-as-medicine programs once federal funding ends in 2027. 

Beyond MediCal, Open Source Wellness is working with YMCA associations around the country, including one in San Diego. Next year, YMCAs in Los Angeles and San Francisco may join the network.

Healthy food and social support is the way back to health for some; whether through public systems, like MediCal, or through private organizations like the YMCA. For patients in Alameda County, Chen and Trivedi said, that can begin with a smoothie and support.

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