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By Laura Hilgers

Cathryn Couch (center) helps two young volunteer chefs prepare medically tailored meals for Ceres Community Project, the nonprofit she founded in 2007. Her work inspired a state-funded pilot study.
Cathryn Couch (center) helps two young volunteer chefs prepare medically tailored meals for Ceres Community Project, the nonprofit she founded in 2007. Her work inspired a state-funded pilot study. | Photo courtesy of Kim Stuffelbeam.

One woman’s mission to cook healthy food for patients is making an impact statewide.

Cathryn Couch was working as a retreat center chef and private caterer in Sebastopol in 2006 when she received an unwanted call that changed her life. Her horseback-riding instructor was on the other end, insisting that Couch hire her teenage daughter for the summer, so the girl could learn to cook. “My first thought was, ‘What the f—?,’” Couch says. “Literally, the kid didn’t know how to hold a knife, and I’m supposed to hire her for a catering job?”

Because the mother wouldn’t back down, Couch suggested that the chef and the girl volunteer to cook for the homeless. That way, the teen could get experience in a kitchen. But then Couch remembered a local mother with metastasized breast cancer who probably needed healthy meals. Couch searched around, found three more people struggling with serious illnesses, and began cooking with the teenager one day a week.

When the husband of the woman with breast cancer picked up his family’s first meals, Couch was so moved by the “utter relief” on his face that she thought this might make a great long-term volunteer project. But three weeks later, she woke at 6:30 in the morning with an idea: “So many more people could benefit from this,” she recalls. “This should be a nonprofit.”

Couch heeded the call. She gave up her two jobs and in 2007 founded Ceres Community Project, which delivers medically tailored meals to patients with serious illnesses. The meals are still cooked by teenage volunteers, under the guidance of adult chefs and mentors — and the young people were essential to Couch’s mission. She had been concerned for a long while that too many young people were growing up in homes where they didn’t learn how to cook, even though homemade meals are vital for health.

From the start, Ceres was different from other meal delivery organizations. Its food is 100 percent organic, locally sourced (often from Ceres’ own gardens) and free of refined sugar. A recent weekly menu included beef meatball stew with chickpeas and cauliflower couscous, as well as a mushroom, onion and cheese frittata alongside a yam and chard stir-fry.

Since its beginnings in a church kitchen more than a decade ago, Ceres has expanded to two commercial kitchens in Sonoma and one in Marin. In 2020, the nonprofit served 184,000 meals to 1,500 mostly low-income Bay Area residents, with clients receiving seven to 21 meals a week, usually at a low cost or for free. (Higher-income folks can pay full cost.) Ceres has been so successful that it’s inspired 10 similar programs nationwide and even one in Denmark.

Along the way, Couch has become a national voice in the movement to transform health care so that nutrient-rich foods are considered as essential as prescription medications. “She is at the cutting edge of this process, building the evidence and the dialogue around the idea that food is medicine,” says Pam Schwartz, executive director of community health at Kaiser Permanente, who has worked with Couch on a research study. “Her voice is elevating the work.”

It seems almost inevitable that this would be Couch’s life work. A native of Michigan, she grew up in a foodloving family. They gathered for dinner every night, and her mother, an early Julia Child devotee, owned a first edition of Mastering the Art of French Cooking. “I learned to cook by osmosis,” Couch says. But her parents were overweight, and in her late teens, Couch started exploring healthier ways to eat. She became a vegetarian for many years and read books like Frances Moore Lappé’s Diet for a Small Planet, which positioned food as a social justice issue back in 1971.

“Imagine what full integration of food into the health care system would look like. … We’re just at the beginning of climbing that mountain.” — Cathryn Couch

Couch graduated from the University of Michigan in 1977 and then pursued an MBA there, meeting her husband, Jeff Black, in business school. They moved to California, landing for a while in Mill Valley. Couch became the national director of communications for the Hunger Project, a nonprofit devoted to ending world hunger.

The couple eventually decamped to a more rural life in Sonoma, where they raised a son and Couch started a vegetarian home-delivery meal service, which she ran for 10 years. But Couch, an energetic and tenacious woman, continued to love the data of business school and the activism of the Hunger Project. The more she got into her work with Ceres, the more concerned she grew that so many Americans had limited access to healthy food. This especially worried her because so many health problems arose from a poor diet. Today, 56 percent of deaths in the U.S. are from diet-related conditions, such as heart disease, cancer, stroke and diabetes, according to the Centers for Disease Control.

Eight or nine years ago, Couch connected with the Food is Medicine Coalition (FIMC), a group of nonprofits that serve medically tailored meals. These are meals — like what Ceres offers — that are individually designed by a registered dietitian nutritionist to address the medical needs of a patient and delivered to people through a referral from a health care provider. One of FIMC’s missions is to share research — available on its website — showing that medically tailored meals can improve patient outcomes and lower health care costs.

Couch was so fired up by these findings that, after returning from the FIMC’s national symposium in 2016, she sat down with her state senator, Mike McGuire, to discuss how medically tailored meals could benefit patients in California.

Their conversation led the state to fund a threeyear, $6 million pilot study, starting in 2018, to look at whether medically tailored meals could reduce hospital readmission rates among Medi-Cal patients with congestive heart failure. According to a 2017 University of Alabama study, the cost of a heart failure–related hospitalization is $14,631 per patient. But Ceres can provide patients 21 meals a week for 12 weeks for about $2,400, and the healthy diet might keep patients out of the hospital.

The California pilot study concluded in December and the results are not out yet. But the preliminary data was so convincing that, starting in January 2022, 18 of California’s 21 Medi-Cal plans will offer medically tailored meals as a covered benefit for certain conditions. In other words, a Medi-Cal patient leaving the hospital after surgery might go home with a prescription for healthy meals — and have it covered by their plan.

The national implications of this are huge. “If we can really demonstrate how integration of medically tailored meals into Medi-Cal in a state like California can work,” Couch says, “it can work anywhere.”

Elisabeth Chicoine, chief quality officer at Santa Rosa Community Health — which refers clients to Ceres — concurs. “This is a big stamp of approval,” Chicoine says. “It’s really thinking about health and wellness and medicine in a new way.”

Meanwhile, Ceres has also conducted largescale, randomized controlled trials with Kaiser Permanente, looking at outcomes among patients with congestive heart failure, diabetes, chronic kidney disease and COVID who receive medically tailored meals. Researchers plan to submit the results of those trials to a major medical journal soon.

With so many exciting developments unfolding, Couch, 66, has put any thoughts of retirement on hold. “It’s an amazing shift that’s happened in five years,” she says. “Imagine what full integration of food into the health care system would look like: veggie prescriptions, grocery boxes, medically tailored meals. We’re just at the beginning of climbing that mountain.”

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