Abstract 4351043: Designing Medically Tailored Meal Interventions: The Food as Medicine For Families (FAME-F) Randomized Clinical Trial

Abstract

Background: Medically tailored meals (MTM) are a promising Food is Medicine intervention but several implementation questions remain unanswered. Since food is shared, providing food for only a specific individual, rather than the entire household, could ‘underdose’ MTM, but providing MTM for the entire household is more costly. Using a commercial shipper rather than a dedicated driver may broaden accessibility, but possibly at the cost of a personal relationship that improves mental health. Research Questions: 1) Does a ‘feed the family’ strategy improve diet quality relative to ‘feed the individual’? 2) Does a dedicated delivery driver promote reduced loneliness compared with using a commercial shipper? Methods: 2x2 factorial randomized comparative effectiveness trial. All participants received 10 MTM per week for 12 weeks, prepared under the supervision of a registered dietitian nutritionist. Participants were randomly assigned along two dimensions: dose (‘feed the family’ vs. ‘feed the individual’), and delivery (‘dedicated driver’ vs. ‘commercial shipper’). The primary ‘dose’ dimension outcome was daily fruit and vegetable consumption (FV) as measured by the Dietary Screener Questionnaire. The primary ‘delivery’ dimension outcome was loneliness as measured by the de Jong Gierveld scale. Analyses were intention-to-treat, adjusted for baseline outcomes, and allowed for possible interactions between dimensions. Results: 93 participants were randomized (46 to ‘feed the family, 47 to ‘feed the individual’; 43 to ‘dedicated driver’, 50 to ‘commercial shipper’). Mean age was 57.6 years (SD: 12.9), 67% were women, and 48.9% were non-Hispanic white. Mean monthly income was $1983 (SD $1433), 75% had hypertension, 67% had diabetes, and 17% reported CHF. For the ‘dose’ dimension, there was little difference between arms in cups FV consumption per day (‘feed the individual’ 1.52, ‘feed the family’ 1.58, difference 0.06, 95%CI -0.28 to 0.41, p=0.92). For the ‘delivery’ dimension, there was little difference in loneliness scores (dedicated driver’ 7.1, ‘commercial shipper’ 6.8, difference 0.4, 95%CI -1.5 to 2.2, p=0.71). Conclusion: FV consumption was similar whether MTM was provided for the whole household or for a specific individual, and loneliness was similar whether a dedicated driver or a commercial shipper was used. Using a ‘feed the individual’ and ‘commercial shipper’ strategy may allow for more efficient MTM implementation.