Abstract
The momentum is real, and it is welcome. Food is Medicine has moved from the margins to the mainstream of health policy. Nutrition is finally working its way into medical education. There is growing recognition of the toll ultra-processed foods take on human health.
I see this work up close: I serve on the Texas Nutrition Advisory Committee (TNAC), the governor-appointed body created by Texas Senate Bill 25 to examine how nutrition shapes human health and how ultra-processed foods drive chronic disease, to review the science independently, and to help develop the state’s dietary and nutritional guidelines.
And yet, amid all of it, one voice is missing: the average lifestyle medicine clinician. For more than two decades, these clinicians have been prescribing nutrition as a therapeutic intervention—not studying it, not piloting it, doing it. Their experience belongs at the center of this conversation. Instead, it is largely absent from it.
So let me say plainly what that experience has taught us.
Food is Medicine is not a metaphor. But it is being misread, and that misreading is costing us clinical results. When we say food has the power to prevent, treat, and often reverse lifestyle-related chronic disease, we are not saying: hand someone a produce box and call it a prescription. We are not saying that medically tailored meals or medically tailored groceries, on their own, will move HbA1c or systolic blood pressure. Access, without context, is not therapy.
Food is Medicine, when done right, is a comprehensive therapeutic intervention. It requires nutrition education. Culinary skill building. Ongoing clinical support. Behavior change infrastructure. And, critically, it must be prescribed and guided by lifestyle medicine-trained clinicians who understand how to use food as medicine, not merely alongside it.
Hollis-Hansen and colleagues make the case clearly: behavioral strategies, nutrition education, and culinary training are not add-ons to Food is Medicine programs; they are the intervention. Strip them out, and we are no longer measuring treatment. 1 We are measuring access. When a study provides the food but omits the education, the skills, and the clinical relationship that turn food into therapy, the result is null because the finding is not whether food works. It is a finding about an incomplete intervention.
Those of us who have practiced lifestyle medicine know this firsthand. We have watched patients reverse type 2 diabetes, normalize blood pressure, and reduce their medication burden—not because we handed them a grocery voucher, but because we built a therapeutic relationship around food, taught them what to do with it, and walked with them through the change. The food mattered. So did everything we wrapped around it.
This is not an argument against produce prescriptions, medically tailored meals, or the policy and payment work now underway. It is an argument for designing them and studying them as they are meant to be. If we want Food is Medicine to earn its place in coverage decisions and clinical guidelines, the trials that test it have to reflect how it actually works at the bedside: nutrition education, culinary skills, behavior change support, and clinician guidance built into the intervention itself, and the whole of it measured.
The good news is that the proof is not waiting to be discovered. It already exists, quietly, consistently, in the clinics of practitioners who have spent their careers turning food into treatment and watching it work. The question is no longer whether food is medicine. The question is whether we are finally willing to prescribe it as we mean it, and to listen to the clinicians who have known how all along.
Food is Medicine works. The people who have spent two decades proving it deserve, at last, to be heard.