Dr. Marianna Wetherill, an ACLM member and associate professor at the University of Oklahoma Health Sciences Center, shared insights from her leadership of NOURISH-OK, a five-year NIH-funded study exploring the relationship between food insecurity and metabolic health. Partnering with Tulsa CARES, a nonprofit HIV service organization, the study aimed to understand how food insecurity affects insulin resistance and chronic inflammation among people living with HIV and to test a targeted Food as Medicine (FIM) intervention through a 12-week, home-delivered grocery program.
The study highlighted that healthy eating is not a single behavior but a collection of separate behaviors, and participants showed wide variation in readiness to try new foods. Some were eager to experiment, while others were unfamiliar or hesitant with certain ingredients. This reinforced the lifestyle medicine principle of meeting people where they are, allowing choice to empower participants and increase engagement.
Flexibility in food offerings emerged as a key factor for program success. Participants received curated boxes with multiple options within the same food groups, promoting choice while aligning with an anti-inflammatory eating pattern. However, too much variety could overwhelm participants, and early support through simple check-ins, such as booster texts and phone calls, proved effective in encouraging engagement and reducing anxiety around unfamiliar foods.
The study also revealed logistical challenges, including underestimating the staffing and coordination required for assembling, delivering, and troubleshooting food boxes. Community health workers and dietetic interns were critical to implementation, while relying on already busy staff proved unsustainable. Providing participants with small but meaningful kitchen tools, such as immersion blenders, enhanced accessibility and signaled program support for their success.
Participants’ responses to specific foods highlighted the importance of cultural and emotional connections to eating. While beans were polarizing, dehydrated vegetables were highly appreciated for convenience. The intervention also emphasized the emotional and relational aspects of food, leading to the development of a 12-week workbook, My Food Journey, which focuses on mind-body connections, relationships, and personal values rather than traditional nutrition content.
Community partnerships were central to the design and implementation of the intervention. The program was co-developed with local partners from the outset, and participant input directly informed the workbook and study measures, such as including chronic pain as an outcome. Advisory committees and focus groups ensured the intervention reflected community needs and strengthened participants’ sense of ownership and connectedness.
A key takeaway from NOURISH-OK is that food interventions often affect entire households, not just individuals. Family members engaged in healthier eating and mindfulness practices, demonstrating that the impact of FIM programs can be broader than individual-level outcomes. Future interventions should expand both implementation and evaluation approaches to capture household-level changes and holistic benefits.
Overall, the NOURISH-OK study underscores the importance of choice, cultural relevance, emotional support, and community partnerships in designing effective Food as Medicine interventions for low-income populations. These insights provide practical guidance for clinics, nonprofits, and health systems seeking to improve nutrition equity and metabolic health through targeted, flexible, and participant-centered approaches.
