High on the roof of the Sandra Eskenazi Outpatient Center in Indianapolis, a 5,000-square-foot farm yields thousands of pounds of produce each year for outpatient nutrition and cooking classes.

Sky Farm, which also grows flowers for patient rooms and hosts a honeybee hive to promote pollination, is part of a food-as-medicine movement that is gaining ground as physicians prescribe specific foods and meal plans to treat diseases like cancer, diabetes and hypertension.

The approach has proven popular with Indianapolis residents as well as medical professionals. Betty Brewer, for instance, had never thought of food as medicine, but taking a nutrition class at Eskenazi changed her perceptions.

“Medicine can help to heal you and make you feel better. And I had never thought about (food) like that,” she said.

Learning to love their veggies

The food-as-medicine movement began in England in the 1970s and took root in the U.S. in the early 1980s as a way to help treat the HIV/AIDS epidemic. The movement is based on research showing that dietary habits can influence disease risk and offer medicinal and protective qualities.

In Indiana, Eskenazi Hospital has been offering outpatient classes on nutrition, as well as many other health-related topics, for more than 20 years. The Sky Farm project was incorporated into the construction of the outpatient center, which opened in 2013.

Registered dietitians lead the popular nutrition classes and discuss the nutritional value of produce, while also demonstrating how to cook it. Each member of the class leaves with vegetables and that week’s recipe.

“We definitely know that it is much easier for someone to take the concept or knowledge and turn it into behavior change when they have the resources to make that change — and so telling someone to eat a vegetable like a carrot, versus teaching them how to prepare a carrot, giving it to them to take home,” Amy Carter, director of clinical nutrition and lifestyle health with Eskenazi Health said . “We know the people that we put in these programs consume more fruits and vegetables. They also report feeling a little bit more confident about cooking healthy foods and also learning how to shop and buy produce.”

Brewer said she wasn’t always cooking in the healthiest way before, using peanut oil and Crisco. But since she attended the class and watched the cooking demonstrations, her cooking style has changed.

“I realized you didn’t need all the grease. I'm not a young person, and I've been cooking like that forever,” she said. “But I'm learning, which you never get too old to learn. I'm glad I took this class. I really am. I've learned how to cook a lot of food that I didn't know how to cook before.”

Brewer said she is also starting to notice changes in her health.

“I used to feel kind of weighed down and tired. But now I feel a lot better,” she said.

The hospital staff also benefits from the garden. Carter said Friday drop-in recipe sampling and produce distribution before the pandemic was wildly successful.

“Since the pandemic, we've actually been giving the produce department by department during the summer, so that we can celebrate our staff a little bit,” she said. “They're always overjoyed to receive the produce. It is super fresh and usually harvested the same day. It's such good quality of food, it really does help our staff.”

Medically prescribed Meals on Wheels

Another group using food to help treat diseases is Meals on Wheels of Indiana. Six years ago, the organization joined the Food is Medicine Coalition, a group of direct providers that offer medically tailored meals for people struggling with a chronic illness.

To participate in this program, a client must have a medical prescription. Dietitians from the Meals on Wheels staff then work with the doctor to create a meal plan according to the client’s medical needs. For example, a client needing a heart-healthy diet would receive low-sodium options, and a client with diabetes would be given food low in sugars and carbohydrates.

Another large part of Meals on Wheels’ involvement with the Food is Medicine Coalition is creating meals for persons living with HIV and AIDS. Ryan’s Meals for Life is a statewide initiative involving several partners that delivers medically tailored meals to people who are in treatment or post treatment with HIV and AIDS.

The Food is Medicine Coalition has 30 partners across the U.S., but Meals on Wheels of Indiana is the only one in the Midwest, said Meals on Wheels communications manager Brandi Sasore.

The meals have been producing positive results. Clients have become stronger, gained weight, been able to cycle off medicines and many other benefits since starting the medically tailored meals, she said.

“It’s a little harder to quantify, but our clients also mention the emotional and psychological benefit of food security, and not having to worry about their meal planning and if it’s right for them,” Sasore said.

The organization also offers shelf-stable pantry boxes tailored according to the client’s meal plan.

“You won’t find a lot of junk food in our pantry boxes,” she said. “We source organic and low sodium canned foods. We try to be mindful at every touchpoint with our clients.”

The meals are made at local hospitals, where volunteers pick them up and deliver them to clients. Clients are referred to the program through hospitals, social workers and other agencies. Meals usually begin arriving to clients within 48 hours of referral.

Using medically tailored meals to improve health and health outcomes also helps to lower the cost of medical care and hospitalizations, Sasore said.

“There's been a lot of research that the coalition has done in relation to medically tailored meals and hospital admission stays,” she said. “We partnered with Community Health Network a couple years ago to do a 30-day hospital readmission program, and to look at the efficacy of our meals at reducing readmission rates within 30 days of a hospital stay. The rates for readmission were lower.”

A growing movement

Carter said in the future, she would like to have more gardens throughout the city and be able to allow more people access to fresh vegetables.

“It's fantastic for us to have Sky Farm. It is an amazing production facility,” she said. “But it's not necessarily as accessible for a lot of our patients. So I think in my big dreams, we start doing a little more gardening at some of our other locations or with other community partners.”

The nutrition class not only inspired Brewer to look at food a bit differently, but it also inspired her to begin her own garden. Through the class, she learned about container gardens and realized gardening didn’t have to be as difficult as she once thought.

“I always wanted a garden, but I didn’t know you could have a garden in a pot. I now have nine pots, and this helped to really inspire me to that,” she said.

Brewer’s example has also inspired her son to start his own container garden and her daughter to start a traditional yard garden this year. So far, Brewer has grown cherry tomatoes, various herbs and green peppers.

Meals on Wheels is starting to look at building an Indiana-based Food is Medicine Coalition with other partners across the state.

Sasore has been asked to speak at the national HIV/AIDS conference in D.C. in October because Meals on Wheels of Indiana is the only partner in Food as Medicine Coalition that has a statewide program.

Sasore is also working on bringing awareness to the Medically Tailored Home-Delivered Meal Demonstration Pilot Act that was first introduced in 2020, but will now be reintroduced to the U.S. House of Representatives. The bill, co-sponsored by Rep. Jackie Walorski, R-Ind., would establish a pilot program that would allow meals to be covered under Medicare Part B. It would give vulnerable seniors access to medically tailored meals and would also provide data intended to build a more resilient and cost-effective health care system.

“There is a lot of traction that picked back up this year,” Sasore said. “Food security is something I think people are finally paying attention to. So, we have hope.”

For more information on classes with Eskenazi Health please go to eskenazihealth.edu/programs/nutrition-education

For more information on the Meals on Wheels program please go to mealsonwheelsindy.org