Abstract Body: Introduction: South Asians (SA) have a 2-4-fold increased risk of developing cardiometabolic disease (CMD) compared to non-Hispanic Whites in the US. Certain dietary practices (“fried snacks, sweets, high-fat dairy") that are rooted in cultural values may contribute to the higher risks. Addressing CMD disparities in SA through Food-is-Medicine (FIM) interventions requires culturally adapted approaches and community input.

Methods: This qualitative study aimed to understand cultural influences on SA dietary practices and identify facilitators and barriers to engaging SA in FIM interventions. We conducted in-depth interviews among SA adults aged 18-85 with CMD (e.g., diabetes, HTN, HLD, CAD, CVD) or their caregivers until thematic saturation was reached. Open-ended questions explored food choices, barriers to dietary change, and preferences for intervention designs. Interest in FIM program features and the importance of family involvement for dietary change were measured by 5-point Likert type questions (1: not important/open; 5: extremely important/open). Ratings were analyzed with descriptive statistics. Qualitative template analysis using NVivo identified key themes.

Results: Among 20 SA adults with CMD (60% female, 70% first-generation, mean BMI 27.1), most (70%) favored South Asian (vs. American) foods in their daily diet. Rationale included: familiarity, preference, health, cultural preservation, and cooking knowledge/skill. Participants wished to maintain healthy aspects of the SA diet, like vegetable dishes and spices, but were open to reducing intake of “carb-rich” staples (e.g., white rice, roti) and cooking with too much oil. Social environments were seen as a major barrier to healthy eating due to social pressures to eat more and tempting food at gatherings. Most (80%) were open to participating in dietary interventions and were highly interested in features like written education materials (4.3/5), individual nutritional counseling (4.15/5), and customized meal plans with instructions (4.15/5). The majority (75%) viewed family involvement as extremely important for long-term dietary change. They also preferred interventions that were recommended by healthcare providers (4.23/5) and delivered remotely (65%).

Conclusion: Future designs of culturally tailored FIM interventions for SA should incorporate healthy modifications to traditional cuisine, personalized education, and family involvement. This may enhance program acceptability and participation.