Registered dietitian nutritionists are uniquely positioned to lead systems level change, yet many RDNs are never taught how to build programs that don’t already have a blueprint. This session traces one RDN’s path from a research assistantship to directing a campus wide health and well being department, illustrating how Food as Medicine programming can be built, scaled, and sustained inside real institutional constraints. Attendees will examine the practical building blocks of program development, including community partnership models that hold up under staff turnover and funding cycles, the data points that earn leadership buy in during a program’s first year, and the design principles that separate a one time pilot from a replicable, multi sector system. Drawing on examples from a decade of Food as Medicine work in Buffalo, NY, including farm to hospital sourcing, workplace wellness initiatives, and a coalition spanning more than 180 organizations, this breakout offers RDNs a practical framework for turning community and clinical influence into structural impact.