March 27, 2023
While the role of diet in health and well-being has long been acknowledged, a confluence of factors has led to a recent “renaissance of nutrition” – one where food is receiving renewed attention in the prevention and treatment of disease.1 Burgeoning interest in the link between food and health among the scientific and medical communities, as well as the general public, collided with the COVID-19 pandemic, putting a spotlight on issues related to food insecurity and illuminating the impact of nutrition on health outcomes Americans with diet-sensitive chronic conditions like diabetes, obesity and heart disease were more likely to have adverse impacts from COVID-19, including increased hospitalization and mortality rates.2,3 And in 2022, amid a growing body of research linking food and health – particularly ultra-processed foods as a key contributor to poor health outcomes –the Biden Administration raised the visibility of food and nutrition policies impacting health, and health equity by hosting the White House Conference on Food, Nutrition and Health, an event that had been on hiatus for more than half a century.3
Employers are well-positioned to take part in this nutrition renaissance by crafting benefits, programs, policies and workspaces that promote healthful eating. This resource makes the case for doing so by exploring how nutrition intersects with employee health and how it can support broader organizational health and well-being initiatives. It also offers recommendations for employers on creating a healthy food environment and culture and provides ways employers can promote affordable and easily accessible nutritious food.
What is ‘Food as Medicine?’
As a part of the nutrition renaissance, “food as medicine” has become a commonly used term, but its meaning can vary by context. The food as medicine movement has roots in the AIDS pandemic, when medically tailored meals were provided to patients to manage side effects and improve their quality of life when other treatment was not yet available. Over time, the movement has evolved in recognition of the impact that a nutritious diet can have on other conditions like cancer, cardiovascular disease and renal failure.4 Today, some would define food as medicine specifically as the use of medically tailored meals, groceries and produce prescription programs to treat disease, while others describe it as a “spectrum of services and health interventions that recognize and respond to the critical link between nutrition and chronic illness.”4,5 More broadly, “food as medicine is a reaffirmation that food and nutrition play a role in sustaining health [and] preventing disease.”6
Why Should Employers Prioritize Nutrition as Part of Their Health and Well-being Strategy?
Good nutrition touches on almost every aspect of employee health. It can lead to better health outcomes, lower health care costs and improved mental well-being. And yet, according to the U.S. Department of Agriculture (USDA), almost half of American adults suffer from at least one preventable chronic disease, many of which are affected by poor diets.7 Most American adults don’t consume the recommended amounts of fruit and vegetables daily.8 This pattern is echoed globally, with one study indicating that vegetable intake was below recommendations in 88% of countries studied.9 The mean global score on the Alternative Healthy Eating Index, a tool “based on foods and nutrients predictive of chronic disease risk,” is 40.3 (0 being the least healthy and 100 being the most healthy), indicating that typical food consumption is far from the ideal dietary recommendations.10
This dearth of fundamental nutrition has a significant impact on overall population health. Dietary habits are not just a matter of personal concern – they have much broader implications for employers and the health care system. Consider the following:
- We are facing a global epidemic of diet-related diseases: Globally, one in five deaths can be attributed to poor diet.11 But research has shown that diets loaded with fruits and vegetables can decrease an individual’s overall risk for diseases like cancer and diabetes12 Studies have shown that people who consumed three to five servings of fruits and vegetables per day had a 28% reduction in cardiovascular disease risk, compared to those who consumed less than two servings per day. Even one serving of leafy green vegetables per day can lead to an 11% reduction in cardiovascular disease risk.13 Research has also indicated an association between increased vegetable intake and a reduced risk of weight gain and obesity.14
- Beyond physical health, nutrition also influences mental health: A field called nutritional psychology aims to illuminate the intersection of a healthy diet and positive mental health. Research has shown that a poor diet can be detrimental to mental health, while a healthy diet can play a role in preventing and treating mental health conditions. One study found that heightened sugar intake was associated with an increased risk of being diagnosed with a mental disorder after 5 years.15 Conversely, studies have shown that those who consume traditionally healthier diets, like the Mediterranean or Japanese diet, are 25% to 35% less likely to suffer from depression than those who consume a Western diet.16
- Nutrition plays a key role in cognitive functioning: Many foods found in a nutrient-dense diet have been shown to have a significant impact on cognitive functioning. For example, leafy greens have been shown to help slow cognitive decline, while the omega-3 fatty acids found in fish, avocados and walnuts can help break down damaging proteins that build up in the brains of Alzheimer’s patients.17 Conversely, a study from 2022 found that higher consumption of ultra-processed foods (“industrial formulations” that contain “added flavors, colors, emulsifiers and other cosmetic additives and little or no whole foods”) was linked to a higher rate of cognitive decline over an 8-year period.18,19 These findings indicate that an improved diet may lead to increased employee functioning on the job.
Provider Nutrition Education Is Lagging
Nutrition education is lacking for many medical professionals. A study done in 2010 found that most medical students spent fewer than 20 hours on nutrition during their 4 years of medical school – an amount of time that is “completely disproportionate to its health benefits for patients.”20 Some have aimed to change this. For the past 15 years, the Harvard T.H. Chan School of Public Health and the Culinary Institute of America have put on a joint Health Kitchens conference to educate doctors and health care professionals on diet and research so they can in turn educate their patients.21
- Diet-related diseases create a significant economic burden: The health care spend for individuals diagnosed with diabetes is 2.3 times higher than those without diabetes, not including the indirect costs from absenteeism, reduced productivity at work and the inability to work due to disease-related disability.22 As of 2017, the estimated economic cost of diagnosed diabetes was $327 billion dollars – and 31% of that cost is shouldered by private insurance.22
If Nutrition Is So Important, Why Isn’t it More Broadly Embraced?
Despite the wide-ranging benefits of a healthy diet, there are numerous barriers that employees and their families face when it comes to purchasing and consuming nutritious food. These barriers are important to consider as employers contemplate potential initiatives aimed at improving nutrition. They include but are not limited to the following:
- Healthy food is more expensive: Per serving, healthier foods cost nearly twice as much as food that is less nutritious.23 Thus, it’s not surprising that 61% of Supplemental Nutrition Assistance Program (SNAP) participants cite food costs as the top hurdle to a healthy diet and that lower-income individuals in the U.S. have the lowest intake of vegetables.13, 24 Inflation is only exacerbating diet inequities; U.S. consumers experienced a 9.4% overall increase in year-over-year food price increases between April 2021 and April 2022, while over the past decade, food inflation has generally hovered around 2%.25 With the higher cost of food , employees may increasingly feel limited to buying less expensive, less nutritious options for themselves and their families. However, research has shown that individuals are inclined to choose the healthier option if it is financially feasible. A pilot program of thousands of SNAP participants showed that when individuals were offered a $0.33 rebate for every $1 spent on fruit and vegetables, fruit and vegetable intake increased by 26% over the course of a year.13
Food Insecurity Across the Globe
Food insecurity is a global issue. Those facing food insecurity lack consistent access to enough quality, nutritious foods to live an active, healthy life. According to The State of Food Security and Nutrition in the World 2021 report, between 720 and 811 million people in the world faced hunger in 2020. 26 Within the United States, 10.2% of households had low or very low food security. Black and Hispanic Americans are more likely to be impacted by food insecurity than White Americans; 19.8% of Black Americans are food insecure, compared to 7.0% of White Americans.27 Employees working jobs with variable hours may be especially vulnerable to food insecurity since fluctuating work hours can present a barrier to enrollment in government assistance programs.
- Social determinants of health can make it difficult for employees to maintain a healthy diet: The ability to eat nutritiously is often constrained by one’s environment.28 In addition to cost, geography and access to safe and reliable transportation play a significant role in securing healthy food. Neighborhoods with limited physical access to nutritious and affordable food (i.e., food deserts) and residential areas with a high density of high-calorie fast food and junk food (i.e., food swamps) influence food choices and subsequently employee health. Research shows that living in a food desert is linked to a poor diet, as well as a greater risk of obesity.29,30,31 On the other hand, in studies of both adults and adolescents, increased access to supermarkets is related to improvements in diet quality, fat intake and fruit and vegetable consumption, although this relationship is not consistent across all studies.32 Importantly, research also shows that food swamps - where unhealthy food options inundate healthy ones - have a statistically significant effect on adult obesity rates, even more so than the absence of full-service grocery stores.33 Both food swamps and food deserts are more common in low-income neighborhoods and those with higher concentrations of racial and ethnic minorities.
Access to safe, affordable and reliable housing is another key factor in the larger food environment. Individuals without reliable shelter may not have access to a clean place to prepare and store food, which often limits them to purchasing non-perishable, shelf-stable items that may contain higher amounts of sodium and preservatives. Those without stable housing may also be unable to receive and store medically tailored meals from community programs.
- Low nutritional literacy can lead to a less than optimal diet: Nutritional literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand nutrition information and skills needed in order to make appropriate nutrition decisions.”34 A 2022 study from the USDA indicated that most Americans think their diet is healthier than it is, indicating a ripe opportunity for a nutritional literacy intervention.35 Social determinants of health also play a role in nutritional literacy. In one study, individuals who had less education and reported lower household incomes had poorer nutrition literacy scores.34 Individuals with lower nutritional literacy are less likely to read and correctly interpret food labels and are also less likely to correctly estimate food healthy portion sizes.34 Lower nutritional literacy scores have been linked to the increased consumption of a Western diet (including fried food, red meat and processed foods), while higher nutrition literacy scores have been linked to healthier dietary choices that align with the Mediterranean diet.34
- A lack of time is one of the more commonly cited barriers to eating a healthy meal or diet: In a 2018 study conducted by the USDA, 30% of participants noted a lack of time to prepare meals from scratch as a barrier to eating nutritiously.36 Another study that evaluated the impact of lack of time on healthy eating noted that schedule constraints not only limit the time available to prepare food, but a perceived lack of time can also drain mental resources and decrease the energy available to prepare a meal.37
What Strategies Are Employers Using to Elevate Nutrition as an Integral Part of Health and Well-being?
Employers are well poised to address diet-related diseases through strategies that bring nutrition to the forefront of the employee experience. While other well-being initiatives may require an investment of time and energy from employees, strategies to promote better nutrition may not, as meals, food planning and preparation, and grocery shopping are likely already built into employees’ routines. Employers can prioritize nutrition and shape the food environment both at work and home through a combination of benefits, programs, policies and structural changes. The recommendations below fall into the following categories:
- 1 | Positioning On-site Dining Facilities as a Conduit to Healthy Choices
- 2 | Beyond the Café: Options to Promote Food Access and Healthful Eating
- 3 | Creating a Positive Food Culture
- 4 | Extending Nutrition Strategies to a Dispersed Workforce
What Is a Food Environment?
The European Public Health Alliance defines food environments as “a combination of the ‘spaces’ in which people make decisions about food, and the foods and drinks that are made available, accessible, affordable and desirable in those spaces.”38 According to the Centers for Disease Control and Prevention (CDC), food environments also include a person’s proximity to food store locations; the distribution of food stores, food service and other entities by which food is obtained; and a connected system that allows access to food.39
1 | Positioning On-site Dining Facilities as a Conduit to Healthy Choices
There are numerous opportunities for employers to prioritize nutrition within the workplace. Included below are a range of evidenced-based considerations to influence the availability, presentation and pricing of on-site nutrition and food culture.
Placement and presentation are key: Employers can leverage choice architecture – the way options are presented - to subtly encourage more nutritious food choices.40 For employers looking to implement choice architecture, here are a few strategies:41,42
- Product availability: Expand the number of healthy food and beverage options available while minimizing unhealthy options; offer seasonal produce; prewash, peel and cut produce for more convenient consumption
- Food presentation: Place healthy options in highly visible locations (at the front of serving lines, eye level in display cases); display appropriate portion sizes; remove “impulse purchases” like desserts and other snack foods from the checkout area.
- Serving mechanisms: Increase perceived variety by differentiating serving dishes; use smaller serving dishes and utensils to decrease the intake of less healthy items.
Make it easy for employees to make healthy choices in the moment: Color-coding food items is a quick and effective way to communicate nutritional value to employees. Consumer-friendly, color-coded food labels summarize a variety of information and distill it into simple categories, removing the need for employees to evaluate a nutrition label in detail.42 There are a number of methods available to employers interested in implementing a nutritional color-coding system:
- Traffic lights: The traditional traffic light structure groups food into three health categories: green, yellow and red. A 2-year study of the traffic light method, in tandem with choice architecture strategies, showed a 6.2% decrease in calories per transaction, as well as a notable 23% decrease in calories from “red” foods deemed least healthy.43
- Positive nudges: Positive nudges, otherwise known as green labeling, simplify food choices even more. With this strategy, healthy food choices are nudged via a green label, and there are no “yellow” and “red foods” to avoid stigmatizing these items.42 A study on the effects of a green-label strategy (where green labels were assigned to meat, fish, eggs, fruits and vegetables, among other nutritious foods) showed an 8% increase in the sale of these foods after a year.42
- Nutri-Score five- color scale: Another strategy that has been embraced by several European countries is the Nutri-Score, which utilizes a five-color nutritional scale that ranges from dark green to red.44 The five-color scale acknowledges a more nuanced understanding of food and nutrition by evaluating an item’s poor content, including sugar, calories, saturated fatty acids, and sodium content against favorable contents, such as fruits, vegetables, nuts, fiber and proteins, to assign an overall score that fits into the color scale, with dark green being the most nutritious and red the least. When evaluated against other nutrition labeling methods, the Nutri-Score system was found to be consumers’ preferred type of nutrition label, as well as the easiest to understand.45
Consider how food is priced: Employers can leverage a variety of pricing strategies to encourage healthy choices, including pricing nutritious foods equally or less than unhealthy foods (employers can offer a discount on one to two healthy meals per week for a less costly investment) and creating a rewards program that offers employees a free healthy meal after a certain number of nutritious purchases. A recent study found that “incentivizing purchases of healthy foods, particularly fruits and vegetables, is an effective strategy to elicit positive behavior change.” The study also revealed that this outcome was true regardless of socioeconomic status.13 In addition to considering how food is priced, employers can also consider the methods employees use to purchase food on-site. Some employers have automated on-site food payments that connect employee IDs to payroll, which enables employees to pay with a simple swipe of their ID card.46
Unum’s BeWell Program
Unum’s BeWell program extends freshly prepared nutritious and healthy meals to employees at a discounted price to encourage a healthy lifestyle. BeWell recipes, which are available in Home Office cafés, are 500 calories or less, and have less than 500 mg of sodium and less than 5 grams of saturated fat. The meals must also meet at least three of five requirements: be plant-based, and include healthy fats, lean or plant-based protein, limited added sugar and high fiber or a probiotic diet. BeWell items are discounted by 60%, meaning employees can get a healthy lunch for just over $3. Unum notes that BeWell items regularly outsell other items. Employees can also save 30% at the salad bar and 60% on fruit cups, yogurt cups, oatmeal, and eggs at Grab & Go Markets.
As employees return to the office, Unum is offering the “BeWell Kitchen” program, which teaches employees how to prepare delicious BeWell meals. A Registered Dietitian Nutritionist and an Executive Chef host a lively, interactive class, where participants have a hands-on experience, learning how to make a BeWell dish and how it supports well-being.
>Leverage small-scale solutions to support on-site workers: Employers who don’t have the option to offer large on-site dining facilities can still encourage employees to eat better at the workplace. Mini-markets and refrigerated vending machines can provide healthy, prepared foods for employees to consume at work or take home. Additionally, studies have noted that the lack of on-site equipment, including microwaves, refrigerators and food preparation areas can be limiting to employees who wish to prepare their own food at work.47 Office kitchens, such as those with a fridge, sink, dishwasher and reusable plates and cutlery, enable employees to bring healthier and less expensive lunch options from home.48 Employers can also provide employees with company-branded lunchboxes for a convenient way to transport food from home.
2 | Beyond the Café: Options to Promote Food Access and Healthful Eating
In addition to on-site dining spaces, worksites can facilitate broader community engagement through farmer’s markets, mobile markets, community-supported agriculture and on-site food pantries for employees in need.
Farmer’s markets: Famer’s markets can provide access to fresh food while building community. Farmer’s markets are a convenient option for employees who may not have access to one in their neighborhood, live in food deserts and/or have limited time to grocery shop.49 Farmer’s markets tap into the concept of produce prescription programs, also known as “food pharmacies,” which are programs that aim to increase access to fruits, vegetables and other healthy foods.13
Community Farmer’s Market at Cleveland Clinic
Summer 2022 marked the 14th season of Cleveland Clinic’s community Farmer’s Market program. The program offers patients, visitors, employees and community members access to healthy, local foods as well as cooking demonstrations, prepared foods, seasonal recipes and health education opportunities. The market partners with over 30 local vendors and matches up to $25 SNAP dollars for fruits and vegetables purchased.
Mobile markets: For employers who don’t have the resources to support an on-site farmer’s market, mobile farmer’s markets are a great substitute. Mobile farmer’s markets are stocked with fresh produce and foods from local farms that can reach more locations than a traditional farmer’s market. One study showed that individuals who had access to a mobile market consumed 1.5 more servings of fruit and vegetables per day compared to a control group.50,13
Community supported agriculture (CSA): In a CSA model, community members connect with local farmers and provide advanced funding for the harvest season in exchange for a share of fresh produce once it’s grown. This model can be translated to the workplace by offering employees the opportunity to sign on with a CSA as a group. To encourage participation in a workplace CSA, employers can facilitate payment for the CSA through payroll deductions or by offering a stipend for the program.51 Other ways to encourage employees in a workplace CSA include healthy cooking demonstrations, team-building lunches using the CSA produce, or even a trip to the farm.52
Workplace food pantries: In 2021, 53 million people in the U.S. turned to food banks and community programs to help feed their families.27 Employers can support employees facing food insecurity by connecting them with existing programs and vendors, such as Employee Assistance Programs, as well as community programs like food pantries. Some employers also stock shelf-stable food packages, ready to take home same-day for employees who may find themselves in an urgent time of need.
Atrium Health’s Help NOW Program
Atrium Health is committed to connecting team members with critical community resources. As part of its Help NOW program, Atrium Health offers free food kits to food insecure teammates in need of immediate food supplies. These kits offer enough food to feed a family of four for 2-3 days. In addition to meeting immediate team member needs, an Atrium Health Community Health Worker follows up with teammates to refer them to local food pantries to ensure longer-term food supplies. The program has expanded to cover all teammates within the Atrium Health enterprise, and future improvements could include delivering these food kits directly to teammates’ homes.
3 | Creating a Positive Food Culture
“Cake culture” – the overwhelming availability of snacks and treats in the workplace – has been named as one of the barriers to a healthy workplace foodscape. A study done in 2019 found that on average, working adults obtained an additional 1,292 calories each week through food at work, often from nutrient-poor foods like pizza, soft drinks and baked goods.53 Food is often used to celebrate and reward colleagues, and one study noted that employees’ healthy eating strategies are “strained and frequently sabotaged” by catered meals and food altars (snack stashes) at work. Shifting a company’s approach to food may also be exactly what employees want. One survey found that 64% of workers in the U.S. think their workplace negatively contributes to their health, while another study uncovered that 73% of employees desire healthy cafeteria and snack options at work.54,55 Employers can pivot away from cake culture through the following tactics:56
- Combine celebrations for birthdays, anniversaries and other life events into once-monthly gatherings to limit their frequency.
- Offer a fruit and veggie tray alongside sweet treats.
- Instead of offering sweets as a reward or celebratory item, consider offering a healthy catered lunch, flowers, vouchers for a concert or event and/or a donation in honor of the employee.
- Request that employees limit or refrain from buying vacation treats for the office or filling breakrooms with leftover holiday candy.
Healthy food can also be used as a tool to facilitate social connectedness. Employers can bring colleagues together through on-site or virtual cooking demonstrations (e.g., cooking with seasonal produce or plant-based recipes), nutrition-related communication channels or intranet forums, instructional classes on topics such as reading a nutrition label and cooking with pantry staples, and even creating a company-wide cookbook that compiles healthy employee recipes.
4 | Extending Nutrition Strategies to a Dispersed Workforce
In addition to the spectrum of on-site food and dining programs, employers have opportunities to extend equivalent programs to a hybrid workforce. These strategies have the added benefit of expanding nutrition efforts to family members, especially children.
Strategies to promote healthy eating within a dispersed population include:
Meal delivery programs: Meal kit delivery services give employers the ability to provide nutritious meals directly to their workforce. Meal kits address many of the barriers employees face when trying to eat healthy, from the time spent grocery shopping and preparing food to cost and ease of access, and can be tailored to support a variety of dietary needs. Employers offering meal delivery services can structure the benefit a few different ways:
- Determine how much the company wants to subsidize, whether it’s some or all the cost. Subsidies can be determined as a percentage of overall spend (e.g., the employer covers 50% of the monthly meal kit costs, up to a cap or unlimited amount) or as a flat dollar amount (e.g., the employer contributes $100 per employee per month towards the meal kit subscription service). Anecdotally, employers have seen significant benefit uptake when they subsidize 100% of the first box and a lesser amount for subsequent boxes.
- Meal kits can also be offered as a targeted benefit for employees during a specific time frame vs.as an ongoing benefit. Employers looking to support employees can provide meal kits to those on leave for hospitalizations and parental or caregiver leave, for example.
- Employers can also offer benefits like lifestyle spending accounts that give employees funds that can be spent on meal kits and groceries or access to discount platforms that offer savings on groceries and meal kits.
Grocery savings: Grocery discount programs are another avenue to encourage healthy food purchases. These programs typically work like a store discount card, allowing employees to access a capped weekly discount on fresh, healthy food. The weekly benefit can encourage increased utilization, since employees are encouraged to return to the grocery store each week to take full advantage of the benefit. Employers can structure a grocery savings benefit in numerous ways:
- Choose a predetermined discount (e.g., 25% to 50%) on fresh produce, up to a weekly maximum savings amount (e.g., $5 to $10). Alternatively, determine a prepaid healthy food allowance each month that only allows employees to redeem items from an approved product list.
- Offer the discount program as a reward to “unlock” for employees who engage with a dietician; the benefit is an added supplement to support the dietician’s recommendations.
- A grocery savings benefit can also be tiered to provide a more robust benefit for lower-paid employees.
Digital nutrition coaching and food planning platforms: Platforms combining digital nutrition coaching with food purchasing have emerged as a newer nutrition solution. These platforms give employees an opportunity to engage with registered dieticians (RDs) and create customized meal plans that meet their dietary needs. The sessions can be either preventive in nature or targeted to help manage conditions like diabetes, cardiovascular disease, high cholesterol and more. Some of these platforms integrate with online grocery apps that make it easier for employees to translate follow-ups from their RD sessions into action. A peer-reviewed study of one platform indicated that a third of participants who used the program for at least 2 years experienced 5% weight loss.57
Platforms that include digital educational content have the added benefit of supporting employers’ nutritional literacy efforts. Studies have shown that online nutrition and cooking courses can lead to improved eating behaviors and meal composition.58 Other solutions to increase nutritional literacy include using visual representation, like the shape of a fist, to convey portion size.59
What’s on the Horizon for Nutrition?
Large employers are leaders in helping to ensure that employees and their families are supported in both their professional and personal lives. Many are already actively involved in helping employees and their families access healthy meals and nutritional and dietary counseling to help educate and promote healthy lifestyles. With the growing demand for a reformed approach to nutrition, Business Group on Health anticipates more employers will consider additional food-related programs for their populations.
Above and beyond the strategies included in this article, there is also a public call to action resulting from the Administration’s National Strategy on Nutrition that calls on business and health care leaders to:
- Improve food security, nutrition and health through food and nutrition-focused offerings in company offices, events, benefit packages and insurance plan designs.
- Accelerate access to “Food is Medicine” services to prevent and treat diet-related illness.
- Increase access to and insurance coverage for behavioral interventions and nutritional counseling to improve diet and health.
This call to action raises questions about potential requirements, recommendations or other implications for employer-sponsored health plans to cover or pay for food beyond what is typically covered today. Because payments or reimbursements made by a health plan are generally tax free when they cover qualified medical expenses, health plan coverage for meals is limited to certain situations, such as when someone is receiving in-patient medical care. It’s unclear whether the legal and regulatory standards applicable to health plans are expected to be updated to reflect a broader allowance for food.
In addition to permitted but optional food-related coverage, there is uncertainty regarding potential mandates for plans to cover food “as medicine” or under preventive services that must be covered with $0 cost-sharing. For example, under the Affordable Care Act “A” or “B” recommendations of the U.S. Preventive Services Task Force (USPSTF) are required to be covered by health plans with no cost-sharing. The USPSTF has recently undertaken a review of “Food Insecurity: Preventive Services” and adopted a final research plan that potentially could lead to food-related recommendations which then would be required of plans to provide to covered individuals for free.
While food access and appropriate nutrition is important and would generally be expected to correspond to certain health outcomes, the scope of requirements, recommendations and/or permitted coverages that is appropriate and viable for health plans to cover and administer remains vague. Given the stated scale of the issues presented by the White House Conference’s report, it is possible that potential plan costs may be meaningfully increased by any required programs – especially those with $0 cost-sharing. Additionally, the administrative effort and cost to implement and monitor such a program in accordance with plan and legal requirements may be complicated and burdensome for plans to undertake efficiently and/or with current resources.
As employers expand access to healthy foods and nutrition programs across a varied and expansive workforce, they need to consider the barriers employees may face as they acquire and consume a nutritious diet. Opportunities exist for employers to integrate nutrition strategies with on-site venues and digital programs to positively shape the food environment within their organizations.
Business Group Resources
- Social Determinants: Food Access and Insecurity
- Is the Future of Medicine Functional Medicine? A Conversation with Dr. Mark Hyman
- Bringing Holistic Medicine into the Fold
- An Employer's Practical Playbook for Treating Obesity
More TopicsArticles & Guides Culture and Strategy Physical Health
- 1 | Witkamp R, van Norren K. Let thy food be thy medicine….when possible. European Journal of Pharmacology. 2018;836:102-114.
- 2 | Centers for Disease Control and Prevention. Obesity, Race/ Ethnicity, and COVID-19. https://www.cdc.gov/obesity/data/ obesity-and-covid-19.html. Accessed August 2, 2022.
- 3 | Centers for Disease Control and Prevention. Diabetes and COVID-19. https://www.cdc.gov/diabetes/library/reports/reportcard/diabetes-and-covid19.html. Accessed October 28, 2022.
- 4 | Food is Medicine Coalition. The Medically Tailored Meal Intervention. http://www.fimcoalition.org/our-model. Accessed September 1, 2022.
- 5 | Graber E. Food as Medicine. Accessed August 23, 2022, 2022. https://nutrition.org/food-as-medicine/
- 6 | Academy of Nutrition and Dietetics Foundation. Food as Medicine. https://www.eatrightfoundation.org/resources/food-as-medicine. Accessed September 1, 2022.
- 7 | Schap T. The Healthy Eating Index: How Is America Doing?U.S. Department of Agriculture. 2022. https://www.fns.usda.gov/healthy-eating-index-hei. Accessed November 1, 2022.
- 8 | Searing L. Most adults don’t consume the recommended amount of fruits and vegetables. The Washington Post. January 23, 2022. https://www.washingtonpost.com/health/how-many-servings-fruits-vegetables/2022/01/20/a16b85e8-7a03-11ec-9102-d65488c31bb1_story.html. Accessed October 15, 2022.
- 9 | Kalmpourtzidou A, Eilander A, Talsma EF. Global Vegetable Intake and Supply Compared to Recommendations: A Systematic Review. Nutrients. May 27 2020;12(6)doi:10.3390/nu12061558
- 10 | USDA Food and Nutrition Service. HEI Scores for Americans. April 28, 2022. https://www.fns.usda.gov/hei-scores-americans. Accessed October 5, 2022.
- 11 | Downer S, Berkowitz SA, Harlan TS, Olstad DL, Mozaffarian D. Food is medicine: actions to integrate food and nutrition into healthcare. BMJ. 2020;369:m2482. doi:10.1136/bmj.m2482
- 12 | Lederer A, Huber R. The relation of diet and health: You are what you eat. International Journal of Environmental Research and Public Health. 2022;19(13)
- 13 | Donohue JA, Severson T, Martin LP. The food pharmacy: Theory, implementation, and opportunities. Am J Prev Cardiol. Mar 2021;5:100145. doi:10.1016/j.ajpc.2020.100145
- 14 | Nour M, Lutze SA, Grech A, Allman-Farinelli M. The Relationship between Vegetable Intake and Weight Outcomes: A Systematic Review of Cohort Studies. Nutrients. Nov 2 2018;10(11)doi:10.3390/nu10111626
- 15 | Knüppel A, Shipley M, Llewellyn C, et al. Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Scientific Reports. 2017;7:6287.
- 16 | Selhub E. Nutritional psychiatry: Your brain on food. Harvard Health Publishing. 2022. https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626. Accessed September 30, 2022.
- 17 | Foods linked to better brainpower. Harvard Health Publishing. 2021. https://www.health.harvard.edu/healthbeat/foods-linked-to-better-brainpower. Accessed September 12, 2022.
- 18 | Gomes Goncalves N, Vidal Ferreira N, Khandpur N, et al. Association between consumption of ultraprocessed Foods and Cognitive Decline. JAMA Neurology. 2022.
- 19 | Bonaccio M, Di Castelnuovo A, Ruggiero E, et al. Joint association of food nutritional profile by Nutri-Score front-of-pack label and ultra-processed food intake with mortality: Moli-sani prospective cohort study. BMJ. 2022;378:e070688. doi:10.1136/bmj-2022-070688
- 20 | Minor L. The Wall Street Journal. Why medical dchools need to focus more on nutrition. 2019. https://www.wsj.com/articles/why-medical-schools-need-to-focus-more-on-nutrition-01570736240?tesla=y. Accessed November 17, 2022.
- 21 | Feldscher K. Crash course in healthy cooking aims to help docs better help their patients. Harvard T.H. Chan School of Public Health March 1, 2013. https://www.hsph.harvard.edu/news/features/eisenberg-healthy-cooking-course-helps-docs-help-patients/. Accessed November 17, 2022.
- 22 | Yang W, Dall T, Beronjia K, et al. Economic costs of diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5)
- 23 | Kern D, Auchnicloss A, Stehr M, et al. Neighborhood prices of healthier and unhealthier foods and associations with diet quality: Evidence from the multi-ethnic study of atherosclerosis. International Journal of Environmental Research and Public Health. 2017;
- 24 | USDA. USDA Releases Study on Hurdles to Healthy Eating on SNAP. June 23, 2021. https://www.usda.gov/media/press-releases/2021/06/23/usda-releases-study-hurdles-healthy-eating-snap. Accessed August 15, 2022.
- 25 | Congressional Research Sevice. U.S. Food Price Inflation and Agriculture Policy. 2022. https://crsreports.congress.gov/product/pdf/IN/IN11945. Accessed August 23, June 3, 2022.
- 26 | United Nations. The State of Food Security and Nutrition in the World 2021. 2021. https://www.fao.org/state-of-food-security-nutrition/2021/en/. Accessed January 20, 2023.
- 27 | NIHCM Foundation. Hunger in America. October 19,2022. https://nihcm.org/publications/hunger-in-america. Accessed November 1, 2022.
- 28 | Pancrazi R, Van Rens T, Vukotić M. How distorted food prices discourage a healthy diet. Science Advances. 2022;8(13)
- 29 | Larson N, Story M. A review of environmental influences on food choices. Ann Behav Med. 2009; 38:56–73.
- 30 | Neckerman KM, Bader M, Purciel M, Yousefzadeh P. Measuring Food Access in Urban Areas. New York, NY: Columbia University Built Environment and Health; 2009.
- 31 | Wilde PE, Llobrera J, Valpiani N. Household food expenditures and obesity risk. Curr Obes Rep. 2012; 1:123–33.
- 32 | A Steeves E, Martins PA, Gittelsohn J. Changing the food environment for obesity prevention: Key gaps and future directions. Curr Obes Rep. 2014:451–8.
- 33 | Cooksey-Stowers K, Schwartz MB, Brownell KD. Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States. Int J Environ Res Public Health. Nov 14 2017;14(11)doi:10.3390/ijerph14111366.
- 34 | Taylor M, Sullivan D, Ellerbeck E, et al. Nutrition literacy predicts adherence to healthy/unhealthy diet patterns in adults with a nutrition-related chronic condition. Public Health Nutrition. 2019:2157-2169.
- 35 | American Society for Nutrition. Most people think their diet is healthier than it is. June 14,2022. https://nutrition.org/most-people-think-their-diet-is-healthier-than-it-is/. Accessed November 2, 2022.
- 36 | USDA. USDA Releases Study on Hurdles to Healthy Eating on SNAP. 2021. https://www.usda.gov/media/press-releases/2021/06/23/usda-releases-study-hurdles-healthy-eating-snap. Accessed August 15, 2022.
- 37 | Escoto KH, Laska MN, Larson N, Neumark-Sztainer D, Hannan PJ. Work hours and perceived time barriers to healthful eating among young adults. Am J Health Behav. Nov 2012;36(6):786-96. doi:10.5993/ajhb.36.6.6
- 38 | European Public Health Alliance. "What Are 'food environments'?" Decembr 20, 2019. https://epha.org/what-are-food-environments/. Accessed December 15, 2022.
- 39 | Centers for Disease Control and Prevention. General Food Environment Resources. June 3, 2022. https://www.cdc.gov/healthyplaces/healthtopics/healthyfood/general.htm. Accessed December 15, 2022.
- 40 | Rantala E, Vanhatalo S, Tilles-Tirkkonen T, et al. Choice architecture cueing to healthier dietary choices and physical activity at the workplace: Implementation and feasibility evaluation. Nutrients. 2021;13(10)
- 41 | Marcano-Olivier M, Pearson R, Ruparell A, Horne PJ, Viktor S, Erjavec M. A low-cost Behavioural Nudge and choice architecture intervention targeting school lunches increases children's consumption of fruit: a cluster randomised trial. Int J Behav Nutr Phys Act. Feb 13 2019;16(1):20. doi:10.1186/s12966-019-0773-x
- 42 | Montagni I, Prevot F, Castro Z, et al. Using positive nudge to promote healthy eating at worksite: A food labeling intervention. JOEM. 2020;62(6):260-266.
- 43 | Thorndike AN, Gelsomin ED, McCurley JL, Levy DE. Calories Purchased by Hospital Employees After Implementation of a Cafeteria Traffic Light-Labeling and Choice Architecture Program. JAMA Netw Open. Jul 3 2019;2(7):e196789. doi:10.1001/jamanetworkopen.2019.6789
- 44 | Santé Publique France. Nutri-Score. January 25, 2023. https://www.santepubliquefrance.fr/en/nutri-score. Accessed February 1, 2023.
- 45 | Chantal J, Hercberg S. Nutri-Score: Evidence of the effectiveness of the French front-of-pack nutrition label. Science & Research. 2017:181-187.
- 46 | Thorndike A, Gelsomin E, McCurley L, et al. Calories Purchased by Hospital Employees After Implementation of a Cafeteria Traffic Light–Labeling and Choice Architecture Program. JAMA Network Open. 2019;
- 47 | Lake AA, Smith SA, Bryant CE, et al. Exploring the dynamics of a free fruit at work intervention. BMC Public Health. Aug 19 2016;16(1):839. doi:10.1186/s12889-016-3500-4
- 48 | Gotter A. How to set up an office kitchen your team will love. 2022. Hoppier. https://www.hoppier.com/blog/office-kitchen. July 20, 2022. Accessed September 15, 2022.
- 49 | Pesce NL. The in-office farmers market is the hottest workplace perk right now. MarketWatch. November 29, 2018. https://www.marketwatch.com/story/the-in-office-farmers-market-is-the-hottest-workplace-perk-right-now-2018-11-29. Accessed August 23, 2022.
- 50 | Wills K. Will a mobile farmers market work for your community? Michigan State University Extension. March 5, 2014. https://www.canr.msu.edu/news/will_a_mobile_farmers_market_work_for_your_community.
- 51 | Goth G. SHRM. Farm-to-Worksite Programs Promote Healthier Eating. 2018. https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/farm-to-worksite-programs-healthier-eating.aspx. Accessed September 26, 2022.
- 52 | Appalachian Sustainable Agriculture Project. Workplace CSAs. 2021. https://asapconnections.org/find-local-food/csa/workplace-csas/. Accessed August 23, 2022.
- 53 | Onufrak S, Zaganjor H, Pan L, et al. Foods and beverages obtained at worksites in the United States. Journal of the Academy of Nutrition and Dietetics. 2019;119(6):999-1008.
- 54 | Bolden-Barrett V.. Office food is the biggest obstacle to wellness, employees say. HR Dive. January 16, 2018. https://www.hrdive.com/news/office-food-is-the-biggest-obstacle-to-wellness-employees-say/514744/. Accessed August 23, 2022.
- 55 | Place A. Meal program provides healthy lunches to remote workers. EBN. May 12, 2020. https://www.benefitnews.com/news/meal-program-provides-healthy-lunches-to-remote-workers. Accessed August 25, 2022.
- 56 | Walker L. Research suggests it’s time to rethink office cake culture. University of Chester. January 17, 2020. https://www1.chester.ac.uk/news/research-suggests-it%E2%80%99s-time-rethink-office-cake-culture. Accessed November 11, 2022.
- 57 | Hu EA, Nguyen V, Langheier J, Shurney D. Weight Reduction Through a Digital Nutrition and Food Purchasing Platform Among Users With Obesity: Longitudinal Study. J Med Internet Res. Sep 2 2020;22(9):e19634. doi:10.2196/19634
- 58 | Adam M, Young-Wolff KC, Konar E, Winkleby M. Massive open online nutrition and cooking course for improved eating behaviors and meal composition. Int J Behav Nutr Phys Act. 2015;12:143. Published 2015 Dec 3. doi:10.1186/s12966-015-0305-2.
- 59 | CDC. Food Literacy. https://www.cdc.gov/healthliteracy/researchevaluate/food-literacy.html. Accessed September 9, 2022.
This content is for members only. Already a member? Login