Smriti Kirubanandan and Dr. David Katz
Imagine a world in which we knew—as in fact we do—that blood pressure is an essential predictor and determinant of health outcomes, both near term, and long term. Imagine a world in which blood pressure powerfully predicted—as it does—life span, health span, and the risks for diverse chronic diseases and all-cause mortality. Imagine a world where we knew all that—and measured blood pressure in just about no one.
As absurd as this sounds, that was the world before the blood pressure cuff was invented, the world before the routine measurement of blood pressure was possible. It is also the world we live in now if we replace the words “blood pressure” with “diet quality.”
Measured objectively, diet quality is the single leading predictor of the risks of chronic disease and premature death from all causes in the United States today. It is the leading predictor of these same outcomes in dozens of countries worldwide. However, we measure dietary intake very rarely. Our traditional systems which contain tools used to assess diet-systemic interviews, food frequency questionnaires, and diet diaries—are labor-intensive, memory-dependent, tedious, and, most importantly, given our economic climate, very expensive.
Now, the House of Medicine acknowledges the importance of diet as a vital sign. The American Heart Association recommends that diet be measured in every clinical encounter to address diet-related chronic diseases proactively and make healthcare less of disease care. To address this concern and elevate our thinking and issues, we need to wear an innovative lens and use technology to scale us in a rapid and sustainable format. There are efforts to create a fast, simple and validated dietary diagnostic tool that assesses diet quality and generates a standard metric that can is to be used to identify and manage risk across a population.
This critical shift toward patient and provider usability makes it possible to measure diet quality as ubiquitously as we measure other vital signs, such as blood pressure.
The implications of a ubiquitous diet vital sign are enormous. For example, what can happen if we can measure an upstream variable—such as diet quality—across populations at scale? We can prevent disease, curb the onset of disease, save money, and help health systems improve their bottom lines.
By measuring diet quality across a population of people who may or may not yet have diagnosed conditions, we identify risk before the person has developed the disease and thereby becoming a cost center. Imagine the power of identifying risk early in primary care, employee wellness health risk assessments, or annual wellness visits. Doing so can prevent a lifetime of disease and medication, increasing lifespan and reducing cost.
Once risk has been identified, we can drive more patients into already established and funded prevention programming, for which many payers are expanding coverage. For example, Medical Nutrition Therapy and Medically Tailored Meals are now available under many private insurance plans for those who have not yet received a diagnosis of diabetes or chronic kidney disease. Using diet quality as a trigger for these services not only “catches” the problem before it mushrooms but drives more reimbursable revenue into struggling health systems.
How can this standard metric of diet quality be used? Unlike other vital signs, it can be a proxy for current and predictive overall health and well-being. Medication adherence or downstream metrics such as HbA1c or BMI are typically used, which often need to tell a complete story about RISK. Given the shift to more value-based contracts that require careful, standardized management of risk in a population, diet quality as a KPI will facilitate risk mitigation and cost savings.
On the heels of the White House Conference on Hunger and Nutrition, there is broad and serious momentum to “do something” about the diet-related disease epidemic that even President Biden has called out. Making diet a universal vital sign is a critical step in giving diet quality the attention it deserves. Our health, national security, and national budget depend on it.
Knowledge truly is where power begins—it is not just a measure, but by comparing what is to what should be, it is a cue to action respected and honored throughout the house of medicine and society at large. Measuring diet quality routinely would lead all but ineluctably to its elevation—potentially adding years to lives and life to years.