April 11, 2023
Office of Nutrition Research (ONR)
Office of AIDS Research (OAR)
National Heart, Lung, and Blood Institute (NHLBI)
National Institute on Aging (NIA)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
National Institute of Dental and Craniofacial Research (NIDCR)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
National Institute of Mental Health (NIMH)
National Institute on Minority Health and Health Disparities (NIMHD)
National Center for Complementary and Integrative Health (NCCIH)
National Cancer Institute (NCI)
Tribal Health Research Office (THRO)
Office of The Director, National Institutes of Health (OD)
Division of Program Coordination, Planning and Strategic Initiatives, Office of Disease Prevention (ODP)
Office of Dietary Supplements (ODS)
Office of Research on Women's Health (ORWH)
Administration for Community Living (ACL)
Centers for Disease Control and Prevention (CDC), Division of Nutrition, Physical Activity and Obesity (DNPAO)
Centers for Medicare & Medicaid Services, (CMS)
Office of the Assistant Secretary of Health (OASH)
Office of Disease Prevention and Health Promotion (ODPHP)
Health Resources and Services Administration (HRSA)
Indian Health Service (IHS)
U.S. Department of Veterans Affairs (VA)
United States Department of Agriculture (USDA)
Food and Drug Administration (FDA)
Agency for Healthcare Research and Quality (AHRQ)
This Request for Information (RFI) invites input on research opportunities and best practices for Food is Medicine research programs. These programs are part of a whole-of-government approach to end hunger, improve nutrition and physical activity, and reduce diet-related diseases and disparities. Review of this entire RFI notice is encouraged to ensure a comprehensive response is prepared and to have a full understanding of how your response will be used.
Poor nutrition is one of the leading contributing factors of death and disability in the U.S. Indeed, millions of Americans are affected by food insecurity and diet-related diseases, including heart disease, obesity, and type 2 diabetes. Besides the economic burden, the toll of hunger and these diseases disproportionately impact underserved communities, including NIH-designated populations that experience health disparities, people with disabilities, older adults, certain military families, and veterans. Better integrating nutrition into health using Food is Medicine initiatives is a key component of the Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health.
Food is Medicine is an umbrella term for a variety of activities and services that respond to the critical link between nutrition and health. It does not have a technical, widely agreed upon definition.[i] It has been referred to as having the following two components – (1) the provision of food that supports health and (2) a nexus to the health care system.1 The nexus to health care systems recognizes health care providers as a trusted source of information. Of people who report receiving dietary guidance from their health care provider, 78 percent of those that do receive such advice initiate dietary change. [ii] Food is Medicine is not intended to replace the use of medications or other treatments but may be able to reduce the doses needed or allow medications to work more effectively.
Food is Medicine services and activities include but are not limited to: (1) medically tailored meals (MTMs), (2) medically tailored and healthy food packages or groceries (3) nutritious food referrals or vouchers, (4) prescriptions for nutritious groceries or produce, and (5) culinary medicine and teaching kitchen programs.
Sustainable clinical-community partnerships may reinforce and act as an effective bridge between healthcare systems and patients to improve an individual’s dietary and lifestyle behaviors. Indeed, evidence is mounting that Food is Medicine approaches are associated with meaningful improvements in food security, health biomarkers (e.g., body mass index, cardiometabolic parameters, hemoglobin A1C), insurance costs, and health quality indicators (e.g., hospital readmissions for the same diagnosis).1,[iii],[iv],[v]
Community-based food and meal programs are an innovation that enhances successful Food is Medicine models that support wider social determinants of health and hold much promise for positive nutritional health impacts. Several of these programs have linked with long-standing Federal nutrition education programs like the USDA administered Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program – Education (SNAP-Ed) and are using Federally supported materials such as MyPlate and WIC Nutrition Education resources.
Recognizing that connecting eligible people to sustainable community-based Food is Medicine activities is a viable solution to address the social determinants of health, the US Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) is permitting substantial flexibility in programmatic design and authorized states to undertake transformative initiatives through Section 1115 of the Social Security Act. These demonstration waivers now allow states an avenue to develop and test “whole-person care” approaches in Medicaid. More than four states have obtained Medicaid waivers to provide services, including those that also address Food is Medicine, other nutrition services, and housing security.[vi] In addition, CMS finalized a rule that allows certain accountable care organizations to qualify for advanced payments that could be used to address food security through Food is Medicine programs for Medicare recipients in 2024.[vii]
As part of a whole-of-government approach to better integrating nutrition into health, there are considerable investments and interest in the intersection between food and health care systems exemplified through programs supported by the Centers for Disease Control and Prevention (CDC), Indian Health Service (IHS), the National Institutes of Health, the United States Department of Veteran’s Affairs (VA), and the United States Department of Agriculture (USDA). For example, between 2019 to 2022, the USDA administered Gus Schumacher Nutrition Incentive Program (GusNIP) provided $267 million in funding to 172 projects throughout the United States and its territories. In addition, the second year of GusNIP, participants redeemed more than $20 million in nutrition incentives and GusNIP participants reported increased fruit and vegetable intake and improvements in food security. More work is needed to understand how existing incentive programs, among other Food is Medicine activities can better improve nutrition and advance health equity. In addition, various healthcare organizations have been entering the Food is Medicine space, some in collaboration with the Cooperative Extension System via the USDA and CDC. As one example, Dining with Diabetes has been implemented in a variety of states and has included developing, implementing, and evaluating a referral process between healthcare systems and Cooperative Extension.
Through this RFI, the National Institutes of Health (NIH) and other federal departments and agencies are seeking input on research opportunities that will optimize, implement, and disseminate information on regionally and culturally appropriate as well as linguistically sensitive Food is Medicine activities. This information will be used by the federal government for research planning and strategies for implementing Food is Medicine activities to reduce food and nutrition insecurity, diet-related diseases and disparities, and disease related malnutrition.
This RFI invites participation from a broad range of interested parties, including but not limited to:
PROVISION OF SERVICES AND ACTIVITIES
COMMUNITY OUTREACH AND ENGAGEMENT
EDUCATION AND TRAINING
COVERAGE FOR SERVICES
Are there any additional comments that you would like to share about Food is Medicine services and activities?
How to submit a response
Responses to this RFI must be uploaded using the online form at this URL: https://rfi.grants.nih.gov/?s=6418bcd5d23bfe80540f6582
Answer fields are available for each question. Text can either be directly typed into these fields, or “cut and pasted” from another electronic document. It is not necessary to address each question/item. Do not include any proprietary, classified, confidential, trade secrets, or sensitive information in your response.
Responses must be received by 11:59 pm (ET) on June 30, 2023
Providing a response to this RFI is voluntary. Responses will be reviewed and analyzed by federal government staff. No individual feedback will be provided to any responder. The Government will use the information submitted in response to this RFI at its discretion. The Government reserves the right to use any anonymized submitted information on public NIH websites, in reports, in summaries of the state of the science, in any possible resultant solicitation(s), grant(s), or cooperative agreement(s), or in the development of future funding opportunities.
This RFI is for information and planning purposes only and shall not be construed as a solicitation, intent to publish a grant, or cooperative agreement, or as an obligation on the part of the Federal Government, the NIH, or individual NIH institutes and centers to provide support for any ideas identified in response to it. The Government will not pay for the preparation of any information submitted for this RFI or for the Government’s use of such information. No basis for claims against the U.S. Government shall arise because of a response to this request for information or from the Government’s use of such information.
Christopher J. Lynch, Ph.D.
Office of Nutrition Research (ONR)
Division of Program Coordination, Planning and Strategic Initiatives (DPCPSI)
Email: firstname.lastname@example.org (Please do not send RFI responses to this e-mail address)
For technical issues with this online form contact:
Michael Dorsey, Ph.D.
NIH, Office of Extramural Research
(Please do not send RFI responses to this e-mail address)