Black communities in the U.S. are among the most disenfranchised in terms of equal access to healthy food and nutrition education. As a result, Black Americans are more likely to consume low-quality foods with poor nutritional value that are associated with cardiometabolic disease. Medically tailored meals (MTM) are a promising food-is-medicine intervention to address nutrition inequities, but they lack the ability to provide nutrition education and behavior change skills. Shared medical appointments (SMA) can offer the education and training needed to achieve sustainable healthy eating behaviors. This study examined the feasibility, acceptability, and preliminary biopsychosocial effects of MTM and MTM+SMA in a Black community with cardiometabolic disease. We hypothesized that 1) the study is feasible (≥ 40 % recruitment rate, ≥ 70 % retention rate in each arm), 2) the intervention is feasible (≥75 % SMA attendance, ≥ 60 % meals consumed), and 3) the intervention is acceptable (net promoter score (NPS) >9 in the MTM and MTM+SMA arms). We conducted a three-arm pilot randomized controlled trial. Study arms included: (1) MTM (2 meals daily for 10 weeks), (2) MTM+SMA (same MTMs plus 10 weekly 1–2-hour group medical visits), and (3) MTM-Later (waitlist control- same MTMs provided after the intervention period). Participants were adults (≥ 18 years old) who self-identify as Black/African American and have cardiometabolic disease. A total of 67 participants were randomized to the three study arms; MTM (n = 24), MTM+SMA (n = 21) and MTM-Later (n = 22).