From the Clinic to the Community: A Conversation with Dr. Hilary Seligman on Food Is Medicine

Published: October 8, 2026

Food insecurity is increasingly recognized not simply as a social issue, but as a key factor in shaping health and chronic disease. Yet recognizing the connection between food and health raises a more difficult question: What should healthcare professionals do about it?

In preparation for the upcoming  11^th Annual Philip R. Nader Legacy of Health Lectureship, we spoke with Dr. Hilary Seligman about the experiences that drew her to the intersection of clinical medicine, public health, and food insecurity; the evolution of Food is Medicine; and what it will take to translate growing enthusiasm into sustainable systems and policies.

“Healthcare systems, food banks, public health agencies, and community organizations haven't always worked closely together. None of these sectors can do this alone. Creating sustainable partnerships across those sectors is essential if we're going to move the field forward.”

— Dr. Hilary Seligman

Our conversation began with the experiences that first brought her to this work and the lessons that have shaped her thinking and research along the way.

Your career sits at the intersection of clinical medicine and public health. How did you find your way into work on food insecurity and chronic disease?

I trained as a general internist and worked in primary care in a safety-net setting. I didn't initially set out to bridge clinical medicine and public health. But once I became interested in food insecurity, it became clear that there weren't many people working specifically in the space between food insecurity and clinical care.

One experience that stayed with me was attending a conference where there was a contentious debate between professionals in public health and from the charitable food community. I remember thinking: We all have the same goals. There should be a space where the anti-hunger community, public health, and clinical medicine can work together. That was the space in which I wanted to be.

One of my patient interactions also changed the way I thought about chronic diseases. I was caring for a patient whose blood sugar indicated prediabetes. I went through the usual counseling about diet and asked what he typically ate. He described something like a piece of Spam between two cinnamon rolls.

The important question wasn't simply, "Why are you eating that?" It was, "What is driving you to eat that?" The answer was that it was what he could afford, and it kept him full.

I went looking for guidance on how to help patients with diabetes or prediabetes eat healthier when they couldn't afford healthy food. At the time, there wasn't much. That helped set me on this path.

Where do physicians fit into Food is Medicine?

One of the first challenges was convincing people that food insecurity was relevant in the clinical setting. We did that. And the next instinct is to give clinicians tools to "prescribe" healthy food; this is a good idea! But I think the larger question is how we reduce friction so healthcare can be a more effective partner in addressing chronic disease outside of the clinical setting.

There is an inherent tension here. The healthcare setting isn't necessarily the best place to provide ongoing support for food access. Much of that work belongs in communities and in public health and in prevention.

So, the question isn't how the healthcare system takes over this work. It's how the healthcare system becomes a good partner — and how we build structures that help people get what they need now while also addressing the broader conditions affecting their health.

Food Is Medicine programs are expanding across the country. What are we learning about how to make them work?

We are learning a great deal from states and communities about how to implement these programs more effectively and in ways that work better for patients.

Delivering an intervention sounds simple until you try building the systems around it. There are questions about billing and reimbursement, technology, and how people receive benefits. For example, instead of receiving a predetermined box of produce, could someone receive a benefit on a card that allows them to choose the healthy foods they want?

At the same time, communities are different. Access to grocery stores varies. Rural and urban communities have different challenges. People have different cultural and taste preferences. Food delivery may be valuable in one setting and less useful in another.

We need to determine the core components that make Food Is Medicine interventions effective — how long they should last, how much food support is needed, and what kind of nutrition education should accompany them — while leaving room for local tailoring and household differences.

And when we talk about whether they work, we shouldn't think only about clinical outcomes. These programs affect farmers, grocers, food distributors, employers, schools, families, and local economies. Their impact can extend well beyond the clinic.

What can healthcare systems, food banks, public health agencies, and community organizations do together to move from responding to food insecurity toward preventing it?

We already have systems to address food insecurity. The Supplemental Nutrition Assistance Program (SNAP), a federal program that provides nutrition assistance to eligible households, is a central part of that infrastructure. One opportunity is to make sure that system can function as effectively as possible.

But not everyone is eligible for SNAP, and existing benefits don't necessarily cover all a household's food needs. That's one place where Food Is Medicine interventions may have a role.

The larger point is that none of these sectors can do this alone. Healthcare systems, food banks, public health agencies, and community organizations haven't always worked closely together. Creating sustainable partnerships across those sectors is essential if we're going to move the field forward.

Research evidence alone doesn't always change policy or practice. What have you learned about translating evidence into action?

One thing we've learned is that money can become a common language across partners that don't ordinarily speak the same language — healthcare systems, insurers, farms, community organizations, and policymakers.

That creates tension. We didn't necessarily set out to develop these interventions because they would save money. We developed them because we thought they could improve health. Yet, interventions addressing non-medical drivers of health are frequently asked not only to demonstrate that they work, but also to be cost-effective.

There are significant policy challenges as well. We don't yet have well-codified, sustainable reimbursement mechanisms for many of these interventions. Too often, programs depend on grants or temporary pilots rather than durable infrastructure. Community organizations may also need support building the capacity to work with healthcare reimbursement systems.

There is a great deal of enthusiasm for this work. The challenge is that funding doesn't always follow that enthusiasm — particularly when we're talking about prevention, where the benefits may take years or even decades to become apparent.

What concerns you as Food Is Medicine grows?

There are real tensions in how these strategies are deployed.

Do we work through local community organizations or large vendors? Do we concentrate resources on people with advanced diseases, or invest more in prevention? Do we provide a smaller intervention to many people, or a more intensive intervention to fewer people?

Those choices produce different outcomes.

One concern is when program design is driven primarily by the constraints of a grant rather than by what we know about effectiveness. If an intervention is delivered at too low of a dose to produce an effect, and the results are disappointing, people may conclude that "Food Is Medicine doesn't work" when the intervention itself may simply not have been sufficient.

We need to think about providing the right intervention, at the right intensity, at the right time, to the right person — and then rigorously study the outcomes.

What would the future of Food Is Medicine look like if we got it right?

In an ideal world, our public health and federal nutrition infrastructure would effectively address food insecurity at the population level.

Food is Medicine could then have a more specific role: supporting people during critical periods in their lives when we know dietary intake is particularly important. From a clinician-researcher perspective, I think about it like a medication — something used intentionally, for the right person, at the right time, and at the right intensity.

We've made substantial progress in recognizing the importance of healthy food. But recognition isn't the same as access.

We still have to contend with an environment in which unhealthy foods are heavily marketed, healthier foods may cost more, food prices overall are rising, and many communities lack full-service grocery stores. Even when healthy food is available, identifying the healthier option isn't always straightforward.

The next phase of this work should be about building the systems, policies, and programs that make healthy food genuinely accessible to the people who need it most.

What advice would you give to health science students, early-career clinicians, and public health researchers who want to work at this intersection?

Learn implementation science.

It's important not just to design an intervention that can be studied under ideal conditions, but to study interventions that can be implemented successfully in the real world.

Relationships are equally important. Much of the most meaningful work in my career has happened because of relationships built across sectors. You must be willing to step outside the boundaries of public health, clinical medicine, or whatever your primary discipline may be and build those bridges.

And remember that careers rarely look from the inside the way they look on a CV. Mine wasn't a straight path. There were manuscripts that weren't published, grants that weren't funded, and directions I pursued that weren't viable. There were also things I once believed that I later became convinced were wrong.

I've been someone who says yes to opportunities to participate and contribute. Some of those opportunities initially seemed as though they had little to do with advancing my career — attending community events, having conversations, and showing up when asked. In retrospect, many of the most important things I've learned came from saying yes to exactly those experiences.

Continue the conversation with Dr. Seligman at the 11^th Annual Philip R. Nader Legacy of Health Lectureship, where she will present the keynote lecture “Food is Medicine Interventions to Support Food & Nutrition Security: Where Do We Go From Here?”

Dr. Seligman is a Professor of Medicine and Professor of Epidemiology & Biostatistics at the University of California San Francisco. She is also the Director of the Food Policy, Health, and Hunger Research Program, Co-Director of the UCSF IMPACT Program, Program Director of the National Clinician Scholars Program (NCSP), and Director of the CDC's Nutrition and Obesity Policy, Research and Evaluation Network (NOPREN)

Register today to join us for the 11^th Annual Philip R. Nader Legacy of Health Lectureship: go.uth.edu/Nader-11thAnnualLectureship

Interview conducted and edited by UTHealth Houston School of Public Health NCI Cancer Control Research Training Program Postdoctoral Fellow, Shelby Flores-Thorpe, PhD, MEd, CHES. Dr. Flores-Thorpe is located at the UTHealth Houston School of Public Health location in Austin, TX and her research focuses on health policy, health communication, and bridging the gap between researchers and state legislative offices to increase the use of health research in policymaking. She is a lead team member on the Texas Research-to-Policy Collaboration (TX RPC) Project and helps coordinate health communications for the Austin Location.

---