Dr. Jason Langheier, founder and CEO of Foodsmart, is a leading advocate for the “food as medicine” movement across the United States. Driven by his passion for health equity and sustainable obesity prevention, he’s dedicated to making nutritious food accessible and affordable for all. In this insightful conversation, he shares how his childhood in rural New York shaped his mission and discusses the broader impact of food on health.
Watch the video of this podcast episode on the Nemours YouTube channel.
Guest:
Jason Langheier, MD, MPH, Founder & CEO, Foodsmart
Host/Producer: Carol Vassar
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week we’ll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go.
Music:
Let’s go, oh, oh, Well Beyond Medicine.
Carol Vassar, podcast host/producer:
Dr. Jason Langheier is a physician, entrepreneur and the visionary founder of Foodsmart whose mission is to make healthy eating accessible and affordable for all. He’s a well-respected leader in the Food as Medicine movement and is passionate about his work to prevent obesity, especially in children. That passion is rooted in his own blue-collar upbringing outside of Buffalo, New York, where obesity-related chronic disease was and is high. It was a time when his family received food stamps and he received free school lunches and those experiences continue to guide his focus and leadership on issues of health equity and sustainable prevention.
Dr. Langheier sat down with us at HLTH in Las Vegas to talk about the influence his upbringing has had on the work he does today and how Foodsmart has become the digital platform of note in the fight against obesity across the nation. Here is Dr. Jason Langheier.
Jason Langheier, MD, Foodsmart:
So I grew up in a rural area outside Buffalo and on food stamps and really appreciated how hard my mom and dad worked. My dad was sometimes laid off from his job as a truck driver or a mechanic and it was a little embarrassing to take those little stamps into the grocery store. But in hindsight, Dad, and also free lunches from schools, he realized how impactful that was, combined with the fact that my mom, who struggled with obesity her whole life, even worked at an organization called Diet Workshop, kind of like a Weight Watchers and dragged me in at 10 years old with usually her and a number of women that were in middle age struggling with obesity. And that kind of left a mark too, to hear what they talked about and the challenges that they worked through in life. But my mom tried to apply all those learnings to help us get a little bit of a better shot.
Not that we didn’t eat too many hot dogs and a lot of chicken wings. My mom says that stress eating chicken wings from Fourth Street in Buffalo causes chronic disease in any family. But jokes aside, this was also against a backdrop of a lot of chronic disease. I mean, I had three aunts and uncles with strokes in their fifties. My godmother, aunt and neighbor died really young from diabetes and that just seemed normal. But the part that’s really memorable is I was the first person to go to college in my family and when I went to Williams, which was a wonderful place that I didn’t even realize was that good of a school until later on.
But there’s all these kids with wealthier parents and 85-year-old grandparents would come to visit the visit weekend and you’re like, “Oh, wow. I grew up differently.” But the closing remark I’d make is that when I started the Pediatric Obesity Clinic, Boston Medical Center over 20 years ago, 2002, it really woke me back up to realize that no, you didn’t grow up poor. Growing up poor is when you’re 5 years old and morbidly obese, you’re diabetic and it’s because you have a single mom who was first generation from Haiti and Mattapan or Puerto Rico and Dorchester that don’t even have enough resources to buy healthy food.
And then their own pediatrician who cares about them deeply at a place like Boston Medical Center would send them to the food bank who would in turn give them leftover Pop-Tarts, chips, sodas, Gatorade because that’s what got donated and unintentionally those pediatricians back then 20 years ago, it’s gotten a lot better now, but were unintentionally prescribing these terrible foods and making malnutrition even worse in these kids. That woke me up to realize that’s real poverty. That’s inequity, and that’s a huge part of the inspiration for the work we do today at Foodsmart.
Carol Vassar, podcast host/producer:
You’ve alluded to how your mother in particular was influential on how you learned to eat as a child, as an adolescent. Talk about the role parents today play with regard to shaping their children’s eating habits and ultimately their health.
Jason Langheier, MD, Foodsmart:
Yeah, it’s mission-critical. Carine Lenders was actually the person who took over the Nutrition and Fitness for Life program that I helped start at Boston Medical Center, and she’s still doing it today. And what she’s shown in her research and many others have as well, is that number one, you cannot change outcomes for kids related to obesity, diabetes, et cetera, if you don’t change what the parents buy. And usually that comes with the parents changing how they eat some too. It’s modeling and it’s literally the creation of the environment that a child can’t control, which is far more powerful than trying to get a kid to do a red, yellow, green tracking app or something. It doesn’t work. And in fact, it can create some anomalies in your own psychology if you expose kids to that way of thinking early on.
But the other issue is that kids 0 to 5 have a very fungible, not only metabolism, but their bodies are still growing, so you can grow into being a little overweight still. And then last but not least, it’s like the fabric of your neuroscience is built then. They say your personality is built 0 to 5. Well, that’s because literally your brain and neural tracks are built 0 to 5. And it’s not that they don’t continue to evolve, but they’re a lot more locked down. So it becomes, as the data shows, infinitely harder to change after that time period. So it’s not lost hope after 5, but it’s just so much easier to attack the problem if you get the parents engaged in buying different food and just reshaping the environment. And so parents can be obese or diabetic because whatever they went through in childhood where it’s harder to change, but they still have every shot in the world to give their kids a better start.
Carol Vassar, podcast host/producer:
Tell me about Foodsmart. What is it? How does it fit into the whole Food is Medicine ethos?
Jason Langheier, MD, Foodsmart:
So Foodsmart we founded officially back in 2010, so it’s been a 15-year journey. And we’re now the largest provider of telenutrition in the United States, with the most dieticians, provider group and serve the most patients, although 70% of our patients are on Medicaid, which is really rewarding. And what Foodsmart does is not just telenutrition, but we like to think of it as food care and trying to birth the food care segment of healthcare, which we think is ridiculously as important as pharmacy and pharmacy benefits management. And for a little while that seemed counter-cultural. Doctors like, “Well, I’m a doctor. I prescribe medicines and I do surgeries.” Now I think that’s changed. I think food as medicine is now more legitimized in part because of work that great organizations like Tufts School of Medicine and Dari Mozaffarian have done that we’ve partnered with on a big randomized control trial with Kaiser, and we also just partnered with Instacart and released a new white paper on these outcomes we’ve achieved on full-blown food care, which I’ll describe in a moment at scale.
And my mentor, Walter Willett from Harvard School of Public Health, who’s the second most published person in the world, and he cheats and publishes a paper on every last nutrient. I give him a hard time, but he’s an amazing professor and thinker about this space. And I think what we’ve tried to do is kind of meld together all that nutritional epidemiology research I learned from Walt and Harvard School of Public Health with real fundamental neuroscience, which is my background. And realizing that you have to be patient with people and families because the only thing that really works, back to our earlier conversation, is reshaping your behavioral economics. As human beings and as parents, you can’t change every little decision you make as a person and you can’t change or control every little decision you make for kids. In fact, it’s better to be a lighthouse parent than a helicopter parent.
But what you can do is you can set the environment for yourselves and for your kids, and that’s in your control. You can make these big decisions. I’m going to live in this town, on this street, and go to this school. I’m going to put this food in my house, and even if I have not all the resources in the world depending on my job, I’m going to spend the resources I have in this prioritized way and use these tools and these resources that I can get from different places to give people the best shot. And so what food care is is not just nutrition counseling or just food as medicine, giving people food subsidies. It’s the combination of, “Hey, I heard about this from my doctor. I got a food script from my doctor or from my food bank or my community-based organization that speaks my language, Spanish or Vietnamese or Polish.”
It’s then hearing about it in partnership with your health plan or a friend in your community or a neighbor. Then it’s meeting your primary care dietician and it’s not just the dietician that you meet once and maybe I’ll see you again in few months and I got a meal plan from them. This is part of my care team. It’s like my doctor that I see once a year or multiple times, and this person’s going to work with me on a personalized curriculum, a checklist of things that I can change like get my SNAP EBT card, which I have to apply for. And maybe I was too intimidated to fill out the application before and this person helped me do it. Then I got it in the mail. Then they set me up with the Foodsmart, the food marketplace where we integrate with Instacart and Walmart and Amazon and restaurant ordering like Grubhub and medically-tailored meal companies, including local women in minority-owned businesses like Dion Dream in Chicago.
And then we help you start to go down this journey and instead of saying, “Oh my gosh, you drank so much soda, you’re doing all these terrible things. Stop.” And then instead, buy a bunch of really expensive salmon and your problems are solved, which is not even the right answer. Instead, it’s more of a journey like, “Oh, have you ever tried club soda? What about lime? What about lemon? What about raspberry? What about Spindrift? What about Bubly? Which one do you like? And that’s a journey in its own right. A couple visits and then all of a sudden you realize like, “Oh, I really like Spindrift.” “Great.” And then just stop buying the soda. And basically three in four people don’t even say anything about it because they’re like “This is my new soda.” So it’s a positive psychology approach that looks at the long view, and then all of a sudden you find yourself a year later and it’s like, “Wait, I have SNAP.”
You taught me how to do price comparison so I can afford healthy food and I realized I’m psychologically enabled to buy healthy food. I’m no longer falling for the trick that CPG food advertisers like. Unintentionally the game they’re playing with you is like oh, you can only afford these high-calorie, low-cost things and that also are addictive, but we’re basically weaning you off that. Plus, from a neuroscience perspective, it takes three to seven exposures to actually reacclimate your taste buds. But for kids, it only takes a few. And so if you help people with a systematic approach, all of a sudden you find yourself with a family that has cooking supplies, a heat source, refrigeration, SNAP benefits. They stretch those SNAP benefits with price comparison. Maybe they add in WIC, and then along the journey, the health plan that they had, their Medicaid plan and the state behind that plan that funds it, would’ve supported them with a little bit of medically tailored grocery support that know Foodsmart, for example, partners with Instacart on their Fresh Funds and with Walmart and with others.
And/or maybe you were an older adult on a D-SNP Medicaid-Medicare plan and you got congestive heart failure and we gave you medically tailored meals for a period of time. But then we put in place all these other components so you could eventually just use your SNAP dollars and buy healthy food for the long run. And by the way, it’s not just obesity or diabetes or CHF, it’s things like cancer chemotherapy as you go through that. It’s chronic kidney disease. It’s things like autoimmune conditions. So nutrition plays a fundamental role right alongside drugs. And if you get those things right in combination, you can actually change your life for the long run and you can change your kids’ life for their future.
Carol Vassar, podcast host/producer:
I’m hearing a lot of moving parts here.
Jason Langheier, MD, Foodsmart:
Yeah, definitely.
Carol Vassar, podcast host/producer:
And a lot of community partnerships.
Jason Langheier, MD, Foodsmart:
Yeah.
Carol Vassar, podcast host/producer:
That are vital to making certain that people are eating right for their condition or for whatever it is that they need to address medically. You mentioned in our pre-interview that you do a lot of work with the city of Chicago. How does this look in Chicago? Who are your partners? How is this working and do you have any research that supports all of this?
Jason Langheier, MD, Foodsmart:
Yeah, we work all over the country in all 50 states and even in Puerto Rico and D.C. And yet we have these certain areas of deeper concentrations because of really awesome partnerships with places like County Care, so Cook County Health. Cook County is one of the largest counties in the U.S., second-largest county in U.S. Chicago is the third-largest city. They’re a beacon of how Medicaid and a Medicaid managed care organization should be run. They do really good work. And long before they partnered with us, they’d already been texting their patients and doing different things. It’s only recently the Supreme Court ruled that health plans can use texts, for example, to reach out to their members and let them know about these wonderful programs and benefits they have access to. So in this modern era where we’re all overloaded with social media and content from advertisers, and you cannot make sense of what’s truth and not truth and just overloaded with content, breaking through requires trust.
So working with some plans like Cook County, they’ve done a wonderful job. But we also work with other health plans and other health systems, including Advocate, which is our largest of our health system investors. So a number of health systems like Advocate, MGB, and the Harvard System, Intermountain and Memorial Hermann are just a few around the country that we work with. And so we have this concentration in Chicago with places like Advocate and Cook County Health. And then what happens from there is, you mentioned the community partnerships, then we start to partner with all these federally qualified health centers and local doctors that work with the community. And there’s ones where there is predominantly Spanish speakers and Polish speakers, Arabic speakers, and you have to then have dietitians that speak those different languages. And then you also have to understand the cultural aspects of those foods.
But you also have to realize that if you’ve lived in America for a while, you’ve been also eating a lot of processed food or exposed to these things. So it’s not as simple as it’s this or it’s that. It’s a combination. But being able to get really deep with the community means you can also partner with places like Dion Dreams and Dion Dawson is an awesome entrepreneur and he is solving final mile problems like delivering quality food to parts of the South Side that were traditionally a food desert. And one of the other things that you don’t realize, a place like Chicago was a place that had huge food deserts, but now with the combination of Instacart and Walmart and programs like Dion Dream, there are no food deserts anymore because when you sign somebody up with a dietitian and then you partner with the Foodsmart and our partners like Dion and Instacart, Jewel-Osco or a Walmart or a Kroger, you get foods to anybody. So you’ve overcome an accessibility barrier.
You’re also helping people afford the food with SNAP and elements of price comparison and those subsidies that the health plan helps fund like County. And they’ve done one of the most forward-leaning food benefits management or Food is Medicine programs in the country because they kind of meet the needs of everybody, from pregnant moms to those struggling with refractory diabetes, until the problem is solved.
Carol Vassar, podcast host/producer:
I find it interesting that there are no more food deserts. Talk more about that, that final mile is really important. Are we reaching that across the nation?
Jason Langheier, MD, Foodsmart:
We are, and don’t get me wrong, there are still pockets, so I’ll give some extremes. So obviously South Side Chicago has traditionally had food deserts and there’s still very much a need to build more grocery stores, especially run by local entrepreneurs, and there’s a lot of great work going on in that regard. At that same time, you can get delivery to those cracks, which you wouldn’t be able to do historically. Then and there’s other places in rural areas like the Umpqua Health Plan in rural Oregon where you think, “Oh, well, rural areas must have big food desert gaps.” It’s like, well, even there you can get delivery and you can find the local food providers. But there’s still corners of the U.S., like in the Mississippi Delta where you couldn’t get the delivery that you needed. There weren’t the grocery stores, but I’m on the Board of Partnership Throughout the America, the organization that grew out of Let’s Move! that Mrs. Obama founded. And so we have a project, actually building a grocery store.
And so there’s still going to be those few spots, but the point is that about 97% of U.S. zip codes are now covered. And I don’t think people have woken up to the realization that, “No. We have a solution now and it’s about collaborating together to engage people and breaking through the noise of all the misinformation to help people get their primary care dietician, get their benefits from their health plan, and get into a Foodsmart environment where they’re being less controlled by food manufacturing advertising and more having the free will to kind of slowly change the way they eat and get acclimated to these different tastes and the fact that they can afford healthy food for the long run.
Carol Vassar, podcast host/producer:
Do you think that some of the food companies, the larger manufacturers of processed food in particular, bear a responsibility here and should they be stepping up and saying, “Okay, we want to be part of the solution rather than the problem?”
Jason Langheier, MD, Foodsmart:
I do, but it’s complicated. I mean, having been a business consultant myself in addition to being a doctor and a neuroscientist, and pediatrics, I empathize with people who have leadership roles like Indra Nooyi was a CEO at Pepsi, Doug Daft was the CEO of Coca-Cola, who I knew. These are good people, and oftentimes we get into these firefights of like, “Oh, you’re like the tobacco industry,” and it’s complicated. I think they do bear a responsibility, and I do think as one of my mentors Rob Lustig would say, “Sugar is a poison.” It really is, but it’s not quite the same as tobacco. I think what it really is, they have to build strategies that allow them to get out of these businesses that their stockholders count on. I mean, America is built on a capitalist infrastructure with lots of laws and rules about accounting, and it’s illegal for Coca-Cola and Pepsi and other companies to just flip a switch overnight. They’re not allowed to do that.
So I think the public should have a little grace with realizing people work at those companies. So if they just changed it overnight, which I would love like for kids health and such, they’d also be unemploying a lot of people. So I think it’s really what I look for in the leadership of those organizations and their boards is like, are you taking a deeply proactive approach to diversifying your portfolio and changing food systems that are good for planetary health as Walter Willett with Harvard School of Public Health Guidelines. That’s number one.
Number two is maybe there are other ways that they can support, for example, hydroponic farming, which many of them are. For example, there are a bunch of CPG companies that are now working on these new methods, solar powered hydroponic farms that are serving up local food that doesn’t have to be distributed all around the world. And if you look at the portfolios of any of these companies, they’re doing really good stuff. It’s just a question of how quickly are they getting unaddicted from their own marketing machine. And I don’t think that they on their own can do it. Sometimes they almost want the outside world to force their hand by creating a groundswell of another model that people can use.
I mean, it starts with what can you do to help families take control of these choices instead of being confused by the misinformation and then giving those CPG food manufacturing companies the demand they need to serve people with the kind of healthier products that makes sense, that still helps them grow and run a business. I put it as an opportunity to change.
Carol Vassar, podcast host/producer:
There is no simple solution to the obesity crisis in the U.S., especially in children. I want to get your opinion though, on anti-obesity medications. What are your thoughts?
Jason Langheier, MD, Foodsmart:
Yeah. Another example of awesome innovation first of all. I know some of the people working on these things at Novo Nordisk and Lilly and Pfizer, and they do really good work. And these drugs were outgrowths of work in the laboratory for many years. So I have a huge respect for them because they’re neuroscience drugs in as much as they’re digestive health drugs that suppress appetite. And so they are wonderful innovation on the one hand. On the other hand, while they’re kind of a research masterpiece, our country doesn’t do a very good job of handling how marketing is done with Pharma and it becomes a free-for-all really quickly. So you have social media influencers telling people and starting with adults first, “Hey, eat whatever you want. Take Ozempic, take Wegovy, take Mounjaro, and then you’ll do great.” But that’s a lie. I mean, literally the FDA label says that you’re supposed to do this with nutrition and lifestyle change.
It’s right there on FDA label. And so you’ll see some of these social media ads that will tell you, eat whatever you want, but then underneath it’ll say, but do this with nutrition and physical activity. It’s literally the opposite message. So it’s not regulated and it really should be, number one. Number two, it’s a missed opportunity. These drugs literally suppress your appetite. So if you told people, take this, it will help you get better, but don’t eat whatever you want. Actually just slowly start to acclimate your taste buds when you don’t have an appetite for all the unhealthy food, because then when you’re done taking the drug, you’ll have changed your food environment and then this will last for a long run. And here’s why you don’t want to take a GLP-1 forever because it leads to loss of bone density. And some studies show that half of the weight loss comes from loss of muscle mass. You don’t want that.
I mean, the other studies on 44-year-olds and 60-year-olds are when you have accelerated aging because of loss of muscle mass, you don’t want a drug that accelerates your aging even more. And that’s a little bit what GLP-1s do. They help you lose weight, but they accelerate your aging. So one more thing that they do which is really interesting, is they also reduce the amount of addictions. Like oh, you hear stories of people saying, “I don’t drink anymore after taking a GLP-1,” or “I am not addicted to XYZ.” Because the addiction centers, dopaminergic addiction centers involve food and drugs and other addictions. So yeah, you suppress that a little bit, but then when you come off of it, your addictions come back with a vengeance. Now apply all this to kids. So you’re a kid who can change from 0 to 5 just through lifestyle.
And the study from Carine, metformin showed that even with that generic drug, you were better off just doing lifestyle in that earlier age bracket in particular. So the fact that the American Academy of Pediatrics approved GLP-1s, especially in 0 to 5-year-olds, I think is very short-sighted. I don’t think it was poorly intentioned and certainly in certain circumstances, but instead of bariatric surgery, it might make sense or if a kid’s at risk of heart failure, but only in really narrow settings. It shouldn’t be broad-based. So I think that can get refined a little bit more.
And then further in general, GLP-1s, again, powerful drugs, better than bariatric surgery. So people should really have step up and step down therapies. And I think that’s starting to happen with the healthcare world. You should try to put the right lifestyle changes in place. You should get a food script, you should try to change your food environment, and for some people, you’ll start to change your outcomes without a GLP-1, but then others will still need extra help.
Great, get that extra help, but then keep trying to change your food environment with your food script. So in other words, every time you get a GLP-1 script, you should get a food script. And then people shouldn’t come off those drugs until they’ve actually made progress at changing their food environment and their eating behavior because people are very likely to regain not only the weight they lost, but more weight than they lost. And only 25% of people are on a GLP-1 by the end of one year because of all the challenges. And so if we do this the wrong way, we’re basically investing five to 15K a year in people to make them sicker. If we do this the right way, we’re investing in helping them change their life forever if you pair a food script with a GLP-1. And so I hope that health plans, employers and health systems and the drug makers will continue to work together to get that right, set of step up and step down therapies in place.
Carol Vassar, podcast host/producer:
Again, no simple answers here. Anything you’d like to share with our audience that I haven’t asked you about with regards specifically to obesity, but even more specifically, childhood obesity?
Jason Langheier, MD, Foodsmart:
Yeah, I think with child obesity, obviously again, I’m passionate about it because of that early work at Boston Medical Center. And it’s heartbreaking to see a 5-year-old child who already has the cardiovascular system and body of somebody who’s more like 50. That’s really scary. And one thing that I don’t think people talk about is that a lot of kids also become developmentally delayed from the malnutrition. Again, these are kids that are eating nothing but chips, Gatorade, Pop-Tarts, cereals every day as their core sustenance, and their best meal of the day is maybe the chicken nuggets or pizza that they got, frozen pizza at school for free lunch. That’s not a good way to live. And we’re literally robbing those kids that have no choice, no freedom from even having the opportunity to live a good life. And that flies in the face of anyone’s politics. It doesn’t matter, Democrat or Republican. No one wants that for kids in this country or any country. So I think we all have an obligation to take a look at this.
When I was in med school, there was a lot of implicit pressure like, go be a neurosurgeon, go be a high-paid role. And those are amazing roles, but I loved neurosurgery in particular, but I ended up going down this path instead because these problems are more complex system problems because you have to collaborate with so many different kinds of people to make the system change. But I’m hopeful we’re entering an era where after a lot of good work from Let’s Move! and Mrs. Obama’s White House and a lot of strong academic research in the area, we can flip from a research mode into an action mode and implement food care across the continuum, as well as when we see kids who are 0 to 5 that are on an at-risk path or already obese or with pre-diabetes, we jump on it and we solve the problem. And we work with parents gently and kindly to work through it, realizing that they have a chance to change the future.
Carol Vassar, podcast host/producer:
Dr. Jason Langheier is the founder and CEO of Foodsmart.
Music:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
Thanks to Dr. Langheier for joining us on this episode of the Nemours Well Beyond Medicine podcast. And thanks to you for listening. Learn more about Foodsmart using the link in the show notes for this episode. The Nemours Well Beyond Medicine podcast comes to you each week and you can subscribe to the podcast. That way you can make certain you don’t ever miss it. Just go to nemourswellbeyond.org. There you can catch up on past episodes, you can subscribe and you can leave us a review. That’s nemourswellbeyond.org. You can also catch the podcast on any of your favorite podcast apps and on the Nemours YouTube channel. Have an idea for an episode? Leave us a voicemail on that website or email [email protected], that’s [email protected].
Our production team today includes Cheryl Munn, Susan Masucci, Lauren Teta, and Sebastian Riella. Join us next time as we welcome nurse futurist Dr. Bonnie Clipper. Until then, remember, we can change children’s health for good Well Beyond Medicine.
Music:
Let’s go, oh, oh, Well Beyond Medicine.
