Food as medicine: in a world obsessed with pharma and weight loss

What is food-as-medicine?

“Let food be thy medicine and medicine be thy food” allegedly said Hippocrates, founder of western medicine. Over 2000 years later, ‘food as medicine’ still refers to eating a nutritious diet to prevent diseases, reverse conditions and avoid health escalations - but it is now scientifically verified. But if the concept is simple and proven, why don’t more people change what they eat for better health? Can we now replace the need for a healthy diet with GLP-1s like Ozempic? How can applying technology to this ancient idea help prevent diseases and decrease the burden on health services? 

Firstly, why is diet so important? 

Put simply, a poor diet kills us earlier. In a recent Lancet study, poor diet emerged as the biggest contributor to premature death, accounting for over 20% of global deaths. In the US alone, poor diet leads to 500,000 deaths per year. Diet-related illnesses don’t just kill us earlier, they also reduce quality of life, cause financial stress and put pressure on social systems. High medical bills and the increased likelihood of unemployment can also create financial difficulties. Chronic conditions, like cardiovascular disease, diabetes and obesity, affect over half of Americans, and these are all largely preventable conditions through healthy diets. They also end up costing the US health system $700 billion per year. 

The power of food as medicine

Seeing ‘food as medicine’ doesn’t mean replacing life-saving care with food, it means using food as a positive health intervention to prevent or manage conditions. The early results of thoughtful food-as-medicine interventions have been promising - growing evidence shows a triple win of improving population health, increasing care experience, and reducing per capita healthcare cost. One study showed that over 18 million hospitalisations and $180 billion in net medical cost could be avoided, just by offering insurance-covered tailored meals to patients with chronic diseases. For those with Type 2 Diabetes, one study found that after six months of a food delivery programme, there was a 15% decrease in obesity, with similar results in the UK.

What are the barriers to more people using food as medicine? 

If the link between good food and good health is so clear, then why is diet still the leading cause of disease? We believe it comes down to accessibility, affordability and the overlooked cultural significance of food when designing interventions.

In the US, 23.5 million people live in ‘food deserts’ so accessing healthy food can be a convenience challenge. Proximity, for example in the case of having unhealthy snacks nearby, is also a factor that has been shown to override cognitive resources like willpower. Healthy food is also expensive, and in Northern America and Europe, 8 and 1 million people respectively cannot afford a healthy diet. A diverse, healthy diet costs on average 4x that of a calorie-sufficient diet, so it’s unsurprising that many opt for the latter in tougher financial times. When the affordability barrier is removed, however, there are huge positives for both individuals and healthcare systems. One study found that a 30% subsidy on healthy foods corresponded with 3.3M cardiovascular disease cases prevented, and $100 billion in formal healthcare costs avoided. 

What’s more, many food-as-medicine initiatives assume humans make food decisions on a rational cost-benefit assessment. This overlooks the deep cultural, emotional and social significance of food in people’s lives. Food is social, we often eat with others and our tastes are defined by those around us, and it is emotional - as children we were often rewarded with unhealthy food, and foods like sugar can temporarily reduce stress by suppressing the hypothalamic pituitary adrenal (HPA) axis in your brain. Forgoing sociable eating experiences - for example switching for shakes or frozen meals - we risk non-compliance and increasing loneliness. Plus, if interventions are purely designed around health credentials - not taking into account taste, or personal taste preferences - there is a higher risk of disengagement. 

Isn’t it easier to just prescribe GLP-1s? 

Glucagon-like peptide 1 (GLP-1), including drugs like Ozempic, are deemed the wonder drug to deliver noticeable results within weeks - compared to the months it takes to deliver results from a change in diet. The drug has been so successful that it has moved markets, for example Weight Watchers shares dropped 70% when Novo Nordisk’s first obesity drug gained FDA approval, and leading dialysis provider Fresenius' shares fell by 19%.

Yet when it comes to health, there is no silver bullet. A healthy and diverse diet is not only designed for weight loss, it is also needed for the essential nutrients to maintain our immune system, reduce disease and maintain the gut microbiome, which is critical to mental health. We have made this reductionist mistake before: in 1977, research showed a link between saturated fat, cholesterol, and sodium to chronic diseases, and the dietary guidelines shifted away from encouraging the right foods, and towards avoiding harmful amounts creating a fear of all fats - including essential fatty acids. 

It is also unsustainable to keep people on drugs forever - positive behaviours need to be integrated. Only about a third of those who started taking the drugs for obesity were still doing so a year later, according to one analysis, and those who stop taking it are likely to return to their original body weight within 5 years. The current cost (more than $1,000 per patient per month) is prohibitive for long term use at scale.

How can technology improve diets? 

Technology has removed some of the barriers to healthy food. In the UK, people can now buy good quality food at discounted prices before it goes to waste via Olio and Too Good To Go, and Oddbox. Plus, for higher price points people can use meal kits like Green Chef or Fresh Fitness Food. In the US, insurers are providing members with medically tailored groceries such as RxDiet - a Giant portfolio company. Technology has also made precision nutrition possible: we can now evaluate our DNA, microbiome, and metabolic response to specific foods or dietary patterns to determine the most effective eating plan to prevent or treat disease. Tim Spector’s pioneering microbiome research has led to Zoe, and companies like Jona aim to combine AI microbiome profiling with personalised nutrition to improve digestive health. AI has also started to democratise education and motivation - with personal AI assistants like Inflection AI’s Pi helping with ‘motivational advice’ and ChatGPT available for generic health inquiries.

A new era of Food as Medicine

A healthy diet is essential to keep lives long and to save healthcare costs. However, when it comes to clinically-provided solutions, the personalisation and convenience of consumer experience is often ignored. Imagine a world where healthcare solutions can be just as delightful as your favourite food delivery app - where we use machine learning models to optimise the healthiest, most affordable groceries for meals and have them delivered in less than 24 hours by partnering with local grocers. Whether it's a suburban father planning food for his family, a low-income worker in the Bronx getting healthy food paid by their insurance to manage their diabetes, or a San Francisco tech executive with no time to cook receiving personalised ingredients to minimise future health risks, we can provide better ways to eat to make it delightful and convenient to be healthy. We believe the future of healthcare is seeing a human as an individual, focusing on prevention and good customer experience, and we believe this approach will help reduce costs to the healthcare system long term.

If you’re building something exciting in the healthcare space  - reach out to Jia Lin at jialin@giant.vc