Many programs rolling out across the country allow doctors to write patients prescriptions for healthier foods. Here’s how these programs can improve healthcare — and lives — in America.
When a child struggling with hunger shows up at the Nunnelee Pediatric Specialty Clinics in Wilmington, North Carolina, the doctors do what doctors often do — they write a prescription.
But this prescription isn’t for medication, or even for a referral to a specialist.
It’s for healthier food.
Pediatricians at the clinic provide children who are dealing with food insecurity a box of nonperishable food, along with a “food prescription” for 15 to 20 pounds of fresh produce, lean ground turkey, and whole-wheat bread.
This “Food Farmacy” program is a collaboration between Nunnelee and nonprofit Nourish N.C.
The goal of the program is to improve children’s current health by providing them with access to healthier food. And, by introducing children to healthy eating early on, it may also boost their long-term wellness.
Food prescriptions target food insecurity
Food prescription programs like this, also known as fruit and vegetable prescription programs, are cropping up around the country.
Many of them are designed to get fresh fruits and vegetables and other healthier foods into the hands of children and adults who can’t afford to buy them, or who live in areas where healthy foods are hard to find.
“Food prescription programs may be most suited for underserved populations who lack the resources needed to have consistent access to healthy food,” said Heidi Wengreen, RD, PhD, an associate professor of nutrition at Utah State University.
In 2017, 11.8 percent of U.S. households were food insecure at some time during the year, reports the U.S. Department of Agriculture.
While many food prescription programs target people with lower incomes, Wengreen said these approaches can also work as a motivational tool for other groups.
“People may be more likely to make a behavior change if the recommendation comes from their healthcare provider, as part of a treatment plan for conditions such as diabetes, heart disease, high blood pressure, or obesity,” she said.
This kind of encouragement has the potential to improve the health of millions of Americans.
According to the Centers for Disease Control and Prevention (CDC), 6 in 10 Americans have a chronic disease, and 4 in 10 have 2 or more conditions.
These diseases have a strong link to the foods that people eat. A 2017 study estimates that 45 percent of adult deaths due to heart disease, stroke, and type 2 diabetes were due to unhealthy diet.
But just over half of Americans met the dietary guidelines in 2009-10, according to the CDC.
Many barriers to healthy eating
Food prescription programs are just one of many interventions aimed at helping people eat healthier.
They represent a shift in how doctors, hospitals, and insurers think about keeping people healthy, one that acknowledges the important role that food plays in preventing diet-related diseases.
Ronit Ridberg, PhD, a food policy and nutrition researcher at Betty Irene Moore School of Nursing at the University of California, Davis, said when primary care providers talk to patients about food security and access, it “elevates and validates the critical role that food and nutrition play in our overall health and well-being.”
However, there are many factors that keep people from healthy eating.
Food prescription programs address the problem of access, which Ridberg said is one of the biggest barriers to consuming healthier foods.
One way that food prescription programs promote access is to offer coupons or vouchers that people can redeem for healthier foods at farmers markets or retail grocery stores.
Food prescriptions may also be redeemable at local food banks.
Other programs provide patients with a produce box from a community farm or organization. Some hospitals even have their own gardens that provide community access to fresh produce.
“Providing financial incentives or food prescriptions to those who are food insecure is a critical starting point, since food insecurity is linked to risk of chronic disease,” said Ridberg.
Just providing people with access to healthier food, though, may not be enough. Other barriers to healthy eating need to be addressed, as well.
For example, people may not know how to cook fresh vegetables or grains. Or they may not have a kitchen equipped to make meals from scratch.
“The most successful prescription programs include nutrition education, and promote other types of healthy behaviors that help people to make lifelong changes to their lifestyle,” said Wengreen.
Food prescriptions boost health
There is growing interest in food prescription programs throughout the country.
Many are run by nonprofits or health systems. The 2018 U.S. Farm Bill also provides funding for these kinds of approaches to health through its Produce Prescription Program.
The long-term success of prescription food programs depends upon them improving people’s health and food security.
Wholesome Wave, a nonprofit that partners with companies and organizations throughout the country, has seen good results from its food prescription programs.
In its Los Angeles program, which is a partnership with retailer Target, 57 percent of families reported that their child’s health improved due to the program.
Several small studies have also found benefits from food prescription programs — such as improved blood sugar levelsin diabetics, decreased body-mass index (BMI), and increased consumption of fruit and vegetables among participants.
In a larger study published last month in the Journal of Nutrition Education and Behavior, Ridberg and her colleagues found that 72 percent of low-income families increased their food security after participating for several months in a pediatric fruit/vegetable prescription program.
However, more research is needed to know whether these short-term outcomes will translate into better health long-term.
Other research, though, has already shown the power of food to heal and prevent chronic diseases.
In 2002, a study found that a 3-year diet and exercise program lowered people’s risk of developing type 2 diabetes by 58 percent. People in this program ate a diet low in saturated fat, sugar, and salt, that also included lean proteins and fresh fruits and vegetables.
And in 2010, Medicare started covering the lifestyle-based program for treating heart disease, based on the work of heart expert Dr. Dean Ornish. The program consists of following a low-fat diet, exercising regularly, quitting smoking, lowering stress levels with meditation, and strengthening social connections.
Saving money by eating healthy
These are lifestyle programs, though, not food-prescription programs. But a study published this month in PLoS Medicine may provide some additional motivation for the government and health insurers to fund food prescription programs.
Especially since the United States spends $3.3 trillion each year in healthcare costs, according to the CDC.
That amount includes $199 billion per year in healthcare costs for heart disease and stroke. These conditions also cause $131 billion in lost productivity each year.
In the new study, researchers from Tufts University looked at what would happen if all Medicare and Medicaid enrollees — 82 million 35- to 80-year-olds — received subsidies to buy healthier foods.
They estimated that a 30 percent subsidy on purchases of fruits and vegetables would prevent 1.93 million cardiovascular disease events — such as heart attacks and stroke — over the lifetime of the enrollees. It would also save $40 billion in healthcare costs.
A 30 percent subsidy on purchases of fruits, vegetables, whole grains, nuts/seeds, seafood, and plant oils would prevent 3.28 million cardiovascular disease events, and save $100 billion in healthcare costs.
These subsidies haven’t been put into place yet. But it’s the kind of encouragement that many think our country needs right now.
“Diet is implicated in so many chronic diseases, and most Americans fall well below the federal recommendations for daily fruit and vegetable intake,” said Ridberg. “Many of us stand to benefit from a fruit and vegetable prescription.”