We all know that eating a healthy diet is good for us.
In fact, nutrition is one of the most powerful tools we have to prevent and manage chronic health conditions like heart disease, diabetes, and hypertension. The evidence is strong enough that the American Heart Association identifies eating better as one of Life’s Essential 8, the eight key factors for improving heart health.
So, why is it so hard for Americans to eat well?
Part of the problem is knowing what to eat as part of a healthy diet. Nutrition can feel complicated, especially when health claims can be conflicting or confusing. How much protein does one really need? What are good fats and bad fats?
But the fundamentals of a heart-healthy diet have been remarkably consistent for years: eat plenty of fruits and vegetables, prioritize healthy sources of protein, and choose whole grains while minimizing sodium, processed foods, and added sugar. This was reinforced in the most recent 2026 Dietary Guidance released by the American Heart Association.
Knowing what to eat and being able to eat that way are, however, not the same thing.
Eating a healthy diet is not simply a matter of individual choice; it also depends on whether you can afford healthier foods, which often cost more. Nearly 1 in 7 U.S. households struggled with having enough food to eat at some point in 2024, according to the latest USDA data.
Even foods that seem healthy can contain unhealthy ingredients. A salad may seem like an obviously healthy choice, yet it can contain a surprising amount of sodium and saturated fat if it has processed meat, cheese, and dressing. Since much of the sodium is already baked into our food, it is not surprising that nearly seven in 10 adults exceed the recommended intake of sodium of 2,300 milligrams per day.
As a preventive cardiologist and one of the authors of the 2025 high blood pressure guideline by the American Heart Association and American College of Cardiology, I know how compelling the data are to support a low-sodium diet to manage high blood pressure. Yet every day, I see that simply recommending a low-sodium diet to patients is not enough to get them to adopt it.
What if you could get low-sodium meals delivered to manage your blood pressure just as easily as you can pick up a prescription refill for your blood pressure-lowering medication?
That is the idea behind a growing movement known as Food Is Medicine. The concept is straightforward. In addition to nutritional advice, medically tailored meals can help prevent and treat chronic diseases. In response to a congressional directive, the Department of Health and Human Services developed a Food is Medicine initiative to coordinate federal efforts and provide a roadmap for the integration of nutrition into health care.
Yet evidence gaps remain: which approaches work, for whom, and at what cost? We must answer these questions with the same rigor we expect for drugs. This is exactly what the American Heart Association’s Health Care by Food initiative, launched with support from the Rockefeller Foundation, is aiming to do. This initiative is funding the research needed to determine how to make healthy food programs in health care systems accessible, affordable, and scalable.
Some of the early evidence is encouraging. In a recent randomized clinical trial of 206 adults living with heart failure in the Navajo Nation, a meal program reduced the likelihood that patients would be hospitalized or visit an emergency department within 90 days by about 30%.
We also need to do better at teaching nutrition in medical schools. In 2026, HHS and the Department of Education announced a new initiative for medical schools to deliver at least 40 hours of nutrition education in U.S. medical schools. Because healthy nutrition is important for every patient, every doctor needs to learn and know this information.
In addition to change at the individual patient level, changing the health of our population will require changing the food environment around us.
While this may seem like a daunting task, one of the best examples of success in improving population health comes from Finland. More than 50 years ago, North Karelia, a rural region in eastern Finland, faced a cardiovascular crisis. Heart disease mortality was among the highest in the world. The problem was so severe that local representatives petitioned the government to take action.
The North Karelia project was born. Public campaigns focused on dietary changes, including replacing butter and full-fat dairy with healthier fats as well as increased vegetable and fruit intake. Food manufacturers changed their products, and schools changed what was served. Over the next several decades, coronary heart disease mortality in eastern Finland fell by more than 80% among working-age adults.
We can also learn from U.S. public-health success stories. Take the example of motor vehicle accidents. For much of the 20th century, car crashes were an enormous public-health problem. Simply urging people to drive carefully was not enough: beginning in the 1960s, the U.S. adopted a broader approach that combined safer vehicle and road design—including seatbelts and later air bags—with safety laws and enforcement. Despite a tenfold increase in miles driven, the motor-vehicle death rate fell by 90% per mile traveled between 1925 and 1997, according to the Centers for Disease Control and Prevention.
The need in the U.S. has never been more urgent. According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics report, which my colleagues and I published this year in Circulation, poor-quality diet is one of the most common risk factors for heart disease. Moreover, poor diet contributes to millions of deaths around the world each year.
We can continue to tell people to eat healthier. And we should. But our current approach is like telling people to drive more safely while watching deadly crashes happen in cars without seat belts. Better advice alone will not be enough. To transform the health of the American population, healthy food should be something we can recommend, be able to prescribe, and deliver as part of health care.
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