Healthcare Costs Start With What We Eat

Using nutrition to improve the prevention, treatment, and palliative care of disease could be the most cost-effective cure for America's rising healthcare costs and health insurers are getting into the act.

Americans have created a self-destructive relationship with food that is fueling chronic disease epidemics and driving up healthcare costs.

"Other cultures do not behave the way we do with our food," Rebecca Katz, a California-based chef and author of three books based on her philosophy of "sustainable nourishment," told me recently. "We want it cheap and we want it fast, and there's a price to be paid for that. We have to get back to the basics."

The Baltimore native is a longtime chef who earned a master's degree in nutrition and health education from Hawthorn University. In 1999, she experienced the powerful connection between health and food first-hand when her father was diagnosed with cancer. Katz had no idea how to cook for someone fighting laryngeal cancer, and neither did anyone else.

"At that time, food and cancer was like inviting ants to a picnic. Nobody wanted to talk about it," she told me. "There was so much more science to look at."

Since then, Katz has taken a careful look at the scientific data linking food to clinical outcomes.

Her second book, The Cancer-Fighting Kitchen, notes some powerful data points, including the astounding figure that as many as 80 percent of cancer patients are malnourished, "in some cases leaving them too weakened to withstand ongoing treatment."

Helping her father survive his cancer ordeal was the first step in an epic quest for Katz, who believes the concept of sustainable nourishment is an essential ingredient in any recipe designed to help Americans lead healthier lives.

Health Objective: Sustainable Nourishment
While insurers, employers, healthcare providers and government regulators are seeking to craft carefully calibrated rewards and penalties to incentivize people to embrace better nutrition, Katz says more fundamental changes will be necessary to achieve changes in the American diet that are more than passing fads or resolutions that last a few weeks, if you are lucky.

"This isn't rocket science," she assured me.

Sustainable nourishment is "nutrient-dense, health-supportive food that tastes great," she says, noting that systems of rewards and punishments have limited effectiveness in changing a human behavior as engrained as someone's eating habits. "If it doesn't taste good, you won't eat. It's not enough to put someone on a really strict diet."

Katz says changing people's dietary habits is a hands-on process. "It's not just enough to say it. Demonstrating it and having people taste it is what works," she told me. She has led classes and appeared on videos, but prefers workshops with patients and healthcare providers "where they actually taste the food."

Working with "point-of-care providers" to teach them how to cook for someone undergoing cancer treatment helps healthcare providers teach patients sustainable cooking habits, says Katz, who has led a series of workshops for oncology caregivers at Stanford University. "It's not just the doctors, it's anybody who is touching the patient," she told me. "Oncologists are incredibly interested in this."

And so are insurers and employers.

How Health Plans Promote Good Nutrition
"We offer Highmark customers flexible incentive programs to facilitate behavior change and reward positive lifestyle practices, such as good nutrition," Anna Silberman, the Pittsburgh-based Blue Cross Blue Shield affiliate's VP of clinical client relations, told me this week. "We work with customers to develop customized reward programs that address their unique population's condition prevalence, culture, and lifestyle risks."

Highmark health plans include several wellness programs that promote good nutrition, Silberman says. As part of rewards programs, employers can offer through Highmark insurance policies, members can complete online "wellness profiles" that assess lifestyle risks and help establish a plan to change dietary habits.

"This interactive tool covers nutrition and addresses readiness, motivation, and confidence to change eating habits. After completing the questionnaire, members better understand their health status and a personalized action plan is provided to improve or maintain healthy eating habits," Silberman told me.

Highmark and its employer clients reward members for working with coaches who help them make dietary changes, she told me: "Coaches provide onsite and telephonic personal wellness consultations and personal nutrition coaching. Inbound and outbound calls are made based on chronic conditions, lifestyle risk, and customized programs."

Beginning in January, Highmark is set to offer grocery store loyalty cards that will be "used to track and reward healthy food purchases," Silberman says.

Minneapolis-based United Healthcare also has several programs to encourage health plan members to make positive dietary changes. In Tennessee, United offers health plan members Care4Life, an education and support program for people living with Type 2 diabetes.

The program uses online tools, including a mobile app, to deliver personalized diabetes management information. Care4life provides access to healthy recipes, nutrition tips, and behavior modification information provided in collaboration with the American Diabetes Association.

Employers are watching their workers waistlines closely, LuAnn Heinen, vice president at the National Business Group on Health, told me this week: "Large employers have deployed a range of strategies to promote healthy eating at work, at home, and when dining out."

Those strategies include plates and cafeteria trays that guide appropriate portion size, third-party programs such as Weight Watchers, and individual coaching for weight management, she says.

Employers and their health plan partners definitely have a role to play in encouraging healthy eating habits. "It makes sense to consider incentives at the workplace… pricing that favors healthier options, rewards card programs for on-site dining and so on," Heinen told me.

Beyond Waistlines
I hope the efforts to transform the American waistline do not stop at the border line. Our high-sugar, high-fat, high-salt cuisine has become one of the top U.S. exports. Do you really need a hint to know what American restaurant chain has a presence in nearly every country on Earth?

Hint: hamburger.

"It was not always this way," Katz told me. "Unfortunately, our way is infiltrating into other countries, and you're seeing diabetes in places where it never existed before. We should be incorporating more of other countries' foods into our diet, not the other way around."

The California chef's fourth book on the connection between food and health, "The Healthy Mind Cookbook: Big flavor recipes to enhance brain function, mood, memory and mental clarity," is slated for publication in February. She told me the book will break new ground: "The gut is the second brain. What we put in the gut affects how we feel."