What happens when medical meals taper off?

Clinical takeaway: After three months of medically tailored meal support, cutting meals by half over five months showed no difference on A1C and BP versus continuing 10 meals a week. 

Medically tailored meals are aimed at patients with complex, advanced, or critical illness. Adults with diabetes and hypertension who haven’t yet developed complications typically fall outside that group and typically don’t qualify. How many meals these patients need is a key question for programs weighing how much to invest per participant.

Preliminary results from a randomized trial extend the evidence to these earlier-stage patients and test a stepped-down meal schedule, with cooking instruction and nutrition education provided alongside the meals.

All participants received 10 meals per week for the first three months, with outcomes measured at baseline and eight months. Across both arms combined, A1C fell 0.5%. Systolic and diastolic blood pressure fell 3.7 mm Hg and 4.1 mm Hg, though the systolic estimate was the least precise, with a confidence interval that approached no change. 

One arm then tapered by one meal per week each month, reaching five meals per week in the final month. At 8 months, outcomes did not differ from those in the arm that continued receiving 10 meals per week, including diet quality, food security, A1C, and blood pressure. The abstract does not provide arm-level data, so the size of the tapered group's improvements cannot be determined.

Diet quality rose 3.15 points on a Mediterranean-style eating score. Participants also had more than twice the odds of a higher food security status than at baseline. 

The randomized trial enrolled 110 adults with type 2 diabetes and hypertension at one New York City site between 2024 and 2026. Participants averaged 63 years old, 68% were women, 47% identified as Hispanic, and 43% as Black. Both arms also received a heart health curriculum with cooking demonstrations and fresh produce, and outcomes were tracked through eight months. 

Every participant received 10 meals per week for the first 3 months and the heart health curriculum throughout the study, so the trial cannot determine how much of the improvement was attributable to the meals themselves. The lack of differences between the tapered-meal arm and the arm that continued receiving 10 meals per week is consistent both with a durable effect of the meals and with the curriculum driving much of the benefit. The abstract notes that the curriculum was designed to support healthy eating beyond the meal program.

“This study is important in highlighting that a gradual taper of medically tailored meals does not necessarily reduce the effectiveness of a medically tailored meal program over time,” said Kevin Volpp, MD, PhD, director of the Penn Center for Health Incentives and Behavioral Economics at the University of Pennsylvania and scientific lead of the American Heart Association initiative that funded the trial. “This is important since medically tailored meals are expensive, and this type of approach could be helpful in providing a more sustainable and scalable way to improve cardiometabolic health for more people.” 

Source: Makarem N, et al. (2026 Nov 2) American Heart Association Scientific Sessions 2026. Abstract MDP2382. Medically tailored meals improved high blood pressure, Type 2 diabetes and diet in adults