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New Research Addresses Food Insecurity Through Medically Tailored Meals
By Monica Yepes-Rios, MD, and Wendy Phillips, MS, RD, LD, FAND, FASPEN
Food insecurity remains a major issue across the country. According to the USDA, 12.8% of US households—about 17 million—experienced food insecurity in 2022, up from 10.2% in 2021.1 Children are especially vulnerable, with 8.8 million living in food-insecure households. Low-income communities, communities of color, and rural areas are disproportionately affected due to limited access to affordable and nutritious food, known as "food deserts."
To address this issue, Cleveland Clinic and Morrison Healthcare collaborated on a study assessing impact and feasibility of medically tailored meals (MTMs). The study provided personalized meals to meet the therapeutic needs of patients with obesity, diabetes, and other conditions. MTMs not only treat disease but also reduce health care costs and utilization. The research was recently published in Nutrition and Health.2
While MTMs have become more common over the past decade, most programs rely on philanthropic support, and the optimal parameters for these programs are not well-defined. The aim of this study was to assess the feasibility of an MTM program developed by a major health care institution using internal investments and an online platform for meal ordering.
By demonstrating their benefits, we can encourage broader adoption, leading to decreased health care utilization, cost savings, and improved patient satisfaction.
Program Methods
Between August 2021 and June 2022, 60 patients were enrolled in the study. To qualify, individuals had to be at least 50 years of age, have a minimum of two hospital or emergency department visits in the prior six months, and a diagnosis of congestive heart failure, uncontrolled diabetes mellitus, or uncontrolled hypertension. Additional criteria included screening positive for food insecurity and living in a food desert zip code.
The median age of participants was 63.5 years old, with ages ranging between 51 to 81. Most of them were insured through Medicare (41.7%) or a combination of Medicare and Medicaid (35%). Nearly three-quarters of participants reported an annual income under $29,999. The group also included individuals from a variety of backgrounds including Black (70%), white (25%), American Indian (3.3%), Asian (1.7%), and Middle Eastern (1.7%).
Each person participated in the program for three months and received 14 frozen meals per week from a courier. Meal boxes also included seven milk or milk substitutes, fruit, and bread to achieve two-thirds of the daily recommended calories. All meals were designed to include less than 2 g of sodium with 60 to 75 g of carbohydrates.
Participants could choose from 38 meal options, including broiled salmon, mushroom enchilada, quinoa bowl, Latin breakfast bowl, and vegetarian stuffed cabbage.
The menu was developed in-house by chefs and RDs through conducting focus groups and taste tests with health care providers and community members to assess palatability and nutrition.
Patient Feedback
In the study’s second week, patients were interviewed by telephone to assess process improvement in terms of food quality, delivery, packaging, and heating. At three months, they were asked to complete an electronic health and satisfaction survey that included a five-point Likert scale to assess satisfaction with the program, interactions with the team, delivery process, meal quality, and portion sizes.
Participants also responded to questions regarding meal sharing, preferred meal frequency/quantity, cultural improvements, behavioral changes, changes in beliefs/perceptions of healthy meals, disease self-assessment, economic benefits, and weight management.
After the program was completed, patients were asked how the meals changed the way they prepared food. Many stated they were more open to new foods they had not cooked with previously, such as couscous, sweet potatoes, or apples. Others noted the program introduced them to the concept of searching for darker colors in vegetables to determine nutrition content and that they are now more conscious of what comprises a healthy portion and balanced meal.
Decreased Health Care Utilization
MTMs are designed by RDs to meet the dietary needs of patients managing conditions such as diabetes, heart disease, kidney disease, and cancer. By providing balanced, nutrient-dense meals, MTMs help prevent complications, stabilize conditions, and support overall health.
Research shows that MTMs reduce health care utilization. Our study found that participants using MTMs had a 30% decrease in emergency department visits and a 37% decrease in inpatient length of stay. Reducing hospitalizations is critical as chronic disease complications often result in costly inpatient care and frequent emergency visits.
Increased Cost Savings
MTMs help prevent complications, improve disease management, and enhance overall health, leading to fewer hospital admissions, shorter stays, and fewer emergency visits, all of which contribute to lower health care costs.
Studies show that MTMs result in significant savings. On average, participants in our study saved $12,046 in health care costs while enrolled in the program. For insurers and government programs like Medicaid and Medicare, investing in MTMs can improve patient outcomes while cutting long-term costs. By integrating MTMs into care models, health care systems can shift from reactive treatments to proactive disease prevention, fostering a more efficient and sustainable system.
Improved Patient Satisfaction
MTMs help patients follow prescribed diets without the stress of meal planning, shopping, or cooking. This may ease the burden of managing complex dietary restrictions, especially for food-insecure or mobility-challenged individuals.
MTMs also contribute to better health outcomes, leading to fewer hospital visits. Patients often report feeling more supported and confident in managing their conditions. They learn what meals are healthy and compatible with their medical conditions, learn new skills, and adopt healthier eating patterns.
Feasibility of MTMs
MTMs are one of the most intensive food as medicine interventions. Due to high upfront costs, many for-profit organizations hesitate to implement them. However, investing in nutrition has long-term benefits. According to the American Hospital Association, the average cost of a single hospital stay in 2019 was $14,101—an amount that could fund nearly two years of MTM services for a patient, covering food, packaging, labor, and delivery.
Health care organizations running MTM programs can promote financial sustainability while improving patient satisfaction, reducing hospital visits, and lowering costs, particularly for vulnerable populations.
— Monica Yepes-Rios, MD, is medical director of community health and food as medicine at Cleveland Clinic.
— Wendy Phillips, MS, RD, LD, FAND, FASPEN, is regional vice president for Morrison Healthcare.
References
1. Rabbit MP, Hales LJ, Burke MP, Coleman-Jensen A. House Food Security in the United States in 2022. USDA Economic Research Service; October 25, 2023. https://www.ers.usda.gov/publications/pub-details?pubid=107702.
2. Haddad EN, Miles R, Alejandro-Rodriguez M, et al. Feasibility of self-investment in a medically tailored meals program by a large health enterprise: Cleveland Clinic experience [published online January 24, 2025]. Nutr Health. doi: 10.1177/02601060241307980.