Diet contributes to the development of many chronic conditions including obesity, cardiovascular disease, hypertension, stroke, type 2 diabetes, metabolic syndrome and others. With more than 80% of older adults living with at least one chronic condition, and higher disease burden in people who are medically underserved, many could benefit from nutrition counseling or medical nutrition therapy (MNT) from a Registered Dietitian Nutritionist (RDN). Currently, Medicare only covers such services for diabetes or kidney disease, leaving a critical gap in coverage for other chronic conditions linked to diet.
Medical Nutrition Therapy Act
The Medical Nutrition Therapy (MNT) Act of 2023, S.3297/ HR6407 introduced by U.S. Sens. Susan Collins (R-ME) and Gary Peters (D-MI), and U.S. Reps. Robin Kelly (D-IL) and Jen Kiggans (R-VA), holds the promise of expanding access to essential medical nutrition therapy services. This legislation would broaden coverage to encompass prediabetes, obesity, high blood pressure, high cholesterol, malnutrition, eating disorders, cancer, gastrointestinal diseases (including celiac disease), HIV/AIDS, cardiovascular disease and any other disease or condition causing unintentional weight loss.
The bill recognizes the evolving landscape of healthcare needs by authorizing the Secretary of Health to include additional diseases based on medical necessity, instead of requiring Congress to address it.
Moreover, it empowers nurse practitioners, physician’s assistants, clinical nurse specialists, and psychologists to refer their patients for MNT, ensuring a collaborative and comprehensive approach to patient care. Reviews have confirmed that interventions by registered dietitian nutritionists for chronic disease prevention and management are clinically effective.
Diet-Related Disease Costs $50 Billion Annually
The significance of this bill is underscored by the alarming statistics on diet-related diseases, with a 2019 study revealing a staggering $50 billion yearly healthcare cost attributed to heart disease, stroke and type 2 diabetes. Approximately 20% of these costs are directly linked to poor dietary choices. The MNT Act aims to intervene at the root of the problem by providing coverage for outpatient MNT for these conditions. Interventions to prevent and manage these diseases have significant health and economic benefits. Individuals who receive medically tailored meals, nutrition counseling, and case management are associated with fewer hospital admissions and skilled nursing admissions with decreased medical spending overall.
Aligning with the Food as Medicine and Obesity Care Movements
The MNT Act aligns seamlessly with recent policy initiatives, particularly those highlighted in the 2022 White House Conference on Hunger, Nutrition, and Health. The historic event emphasized the need to enhance Medicare and Medicaid coverage for nutrition and obesity counseling, as well as underscoring the importance of empowering consumers to make healthier food choices. Recent food as medicine summits by Tufts and the U.S. Department of Health and Human Services (HHS) have spotlighted the importance of food and nutrition in health. Further, the legislative push for the MNT Act resonates with the broader Food as Medicine movement, which acknowledges the critical role of consistent access to diet and nutrition resources in achieving health goals. Research on medically tailored meals supports this approach, highlighting the importance of pairing meals with individual nutrition assessments and counseling, and providing carefully curated nutritional support that not only helps manage conditions such as diabetes and heart disease, but also mitigates the progression and complications of co-existing chronic conditions such as obesity.
Despite advances in the science of obesity and effective treatment options, 96% of U.S. adults with obesity did not receive the necessary care for their condition.
The recently released Obesity Bill of Rights establishes and promotes “essential rights to drive transformational change and define the core requirements for people with obesity to receive person-centered, quality care.” (Read this article for more on the Obesity Bill of Rights.)
Obesity is a treatable chronic disease, just like diabetes and heart disease, and living with obesity worsens other chronic diseases. Yet despite significant advances in the science of obesity and effective treatment options, 96%, approximately 103 million, U.S. adults with obesity did not receive the necessary care for their condition. With nearly $173 billion spent annually on healthcare for obesity alone, the MNT Act would contribute to reducing the economic burden associated with diet-related illnesses.
MNT Act Addresses Health Equity
Conditions such as hypertension, coronary heart disease, hepatitis, stroke, cancer, asthma, diabetes, arthritis, chronic obstructive pulmonary disease (COPD), and kidney disease are disproportionately prevalent in populations with lower food security (see table below, source). Lower food security is associated with higher probability of chronic disease diagnosis. Communities of color also suffer from chronic disease health disparities driven by reduced access to care, healthy foods, and safe places to be active.
MNT can contribute to health equity by ensuring that individuals from diverse backgrounds have access to personalized and culturally sensitive nutritional advice. This helps in addressing specific health needs and preventing nutrition-related health disparities.
The Academy of Nutrition and Dietetics is a proud champion of the MNT Act, which is supported by more than 50 national organizations; if your organization is interested in joining this effort, complete this form. To give your personal support, visit the Academy’s Action Center and urge your members of Congress to sign on to the Medical Nutrition Therapy Act of 2023.
It is a vital step toward achieving the goals set by the 2022 White House Conference on Hunger, Nutrition, and Health to reduce diet-related diseases by 2030. By enhancing access to the essential service of MNT, we can tackle root causes of preventable chronic diseases, aligning with the Food as Medicine movement for a more holistic and equitable healthcare approach in the United States.
Jeanne Blankenship, MS, RDN, is vice president of Policy Initiatives and Advocacy for the Academy of Nutrition and Dietetics in Washington, D.C.
Photo credit: Shutterstock/Ground Picture
