This month, President Trump nominated Dr. Casey Means, a former ear, nose, and throat surgeon who dropped out of residency and reinvented herself as a wellness influencer and New York Times bestselling author, for Surgeon General. I read Means's book, "Good Energy: The Surprising Connection Between Metabolism and Limitless Health," a few months ago. It discourages intake of processed foods, eschews fad diets, aligns with mainstream nutrition guidance (e.g., Michael Pollan's pithy "eat [real] food, not too much, mostly plants"), and has received positive reviews in publications ranging from NPR to Family Medicine.
My main concern about the book is that it seems aimed mostly at well-off households with the health literacy and leisure time to read self-help books and the disposable income to do most of their shopping at farmer's markets and Whole Foods stores. If Dr. Means ends up being confirmed by the Senate, she should consider writing a sequel ("Great Energy"? "Good Energy for the Budget-Conscious"?) for the 11 million families headed by single parents who often work two or more jobs to get by and have fewer options for buying groceries. For these families, the healthiness of food may not be their top priority. A Pew Research Center survey found that overall, Americans ranked taste as the most important factor in choosing food, followed by cost, then healthiness and convenience. So it isn't enough to tell people what foods are best for their health (or make labels on packaged foods simpler to understand); we also need to make the healthy option the default option.
There is good evidence that federal nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP, previously known as "food stamps") and Special Supplemental Nutritional Program for Women, Infants, and Children (WIC) improve health. A Research Letter in JAMA documented increases in food insecurity and days with poor physical health after the end of a temporary pandemic increase to SNAP benefits in March 2023. An Agency for Healthcare Research and Quality evidence synthesis that I previously discussed showed that WIC improves important maternal and child health outcomes. Conversely, a longer-term study suggests that food insecurity in childhood increases cardiovascular risk and obesity in young adulthood, since one is more likely to eat excess food of poor nutritional value if they don't know where their next meal is coming from.
Although I support banning soda purchases from SNAP, eliminating food insecurity by making the program more generous could have an equally beneficial an effect on health. Currently, a four-person household in Pennsylvania must earn less than $62,000 per year to be eligible for SNAP, and the average benefit is $6 per day, or $42 per week. A national program that provided low-income adults with additional vouchers averaging $63 per month for produce purchases (the majority of households were already enrolled in SNAP and/or WIC) led to improvements in food security, diabetes control, weight loss, and blood pressure.
In a recent statement, the U.S. Preventive Services Task Force found insufficient evidence to assess the benefits and harms of screening for food insecurity in health care settings. That doesn't mean that targeted "food as medicine" programs, which should be "understood as complementing and not supplanting existing food and nutrition assistance programs," can't be effective. Ten states have piloted Medicaid managed care projects to address poor nutrition as a health-related social need and use health care dollars to pay for food pharmacies, healthy food vouchers, and medically tailored meals.
It's worth noting, though, that these promising programs are likely to be defunded if the nearly $1 trillion in Medicaid and SNAP cuts in the recent federal budget bill passed on a party-line vote by the House of Representatives eventually becomes law. Either way, I will continue giving to our local food bank, as the prescription for food insecurity is food, and hungry patients do not make healthy patients.