Prescription for vegetables

Food as Medicine

by Jessica Ilyse Kurn

“One more piece of broccoli before dessert” is a phrase many of us can recall from childhood. It was the nagging voice of our parents’ pleading, trying to entice us to eat the green stuff. Though it sounds almost simple in that format, getting our daily dose of healthy foods is not always easy to achieve. For many people, access to such food is out of reach either because produce is too expensive, a grocery store is too far away or they’re homebound. Others are stumped about how to cook Brussels sprouts, cabbage or kale, and for some, preference and convenience seem to be the main issues.
Diet-related diseases are on the rise as Americans turn away from produce and whole grains, and towards sugary drinks, processed and fried foods, and larger portion sizes. Coupled with a lack of physical activity, these factors contribute to the leading causes of death and are creating major financial woes. According to the Centers for Disease Control and Prevention (CDC), two-thirds of American adults and more than one-third of children and adolescents are overweight or obese. This leads to a slew of health problems from heart disease, type II diabetes, stroke, and osteoporosis, to cancers of the colon, prostate, mouth, throat, esophagus, lung and stomach. The CDC estimates that people who are obese have medical costs $1,429 higher than normal-weight adults—an annual burden of $147 billion on the U.S. healthcare system.
In a testimony to the U.S. Senate in 2004, then Surgeon General Richard Carmona said, “Because of the increasing rates of obesity, unhealthy eating habits, and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents.” The alarm had been sounded, and a slow and quiet revolution began in the healthcare industry.

HEALTH INSURANCE COMPANIES
With both the well-being of the population and cost-savings in mind, a few health insurance companies have realized it is time to take a more active role in their members’ health. Many insurance companies subsidize gym memberships, but recently a few have started providing rebates for a community supported agriculture share, or CSA. CSAs allow members to get a weekly portion of a local farm’s bounty. The FairShare CSA Coalition out of southern Wisconsin pioneered this model in 2005 and is currently partnering with four health plans and more than 40 farms to reduce the cost of farm-fresh veggies for consumers. Between 2005 and 2011 nearly 28,000 rebates were claimed.
This program not only encourages a healthy Madison-area population, but also keeps local family farmers in business, as they receive fair prices for the foods they grow. Though this program hasn’t spread across the country, other insurance companies are sure to follow suit as the obesity epidemic continues to put a financial strain on the healthcare industry.

HEALTHCARE PROVIDERS
There are many risk factors associated with poverty that can make populations more vulnerable to obesity. For example, low-income neighborhoods often lack grocery stores that sell fruits, vegetables, low-fat dairy and whole-grain products. Healthy food is generally more expensive. With a limited budget, processed foods become a more cost-effective way to make a dollar stretch further.
The non-profit Wholesome Wave noticed both the disparities in access to healthy food and the national childhood obesity epidemic, and shaped a program to address both concerns. Through its Fruit and Vegetable Prescription Program (or, cleverly, FVRx), the organization capitalizes on the advice-giving authority of healthcare providers. Overweight and obese children ages, 2 to 18, in underserved communities meet with a nutritionist and primary care provider to learn about healthy eating, and end up walking away with a special prescription. This is not any run-of-the-mill prescription, but rather a prescription for healthy food, redeemable at a participating farmers’ market. FVRx subsidizes $1 of produce per family member per day—so a family of 4 could get $28 each week to use toward apples, squash, lettuce and spinach. Monthly appointments reinforce goals, track progress and allow participants to refill their prescription for another month of healthy eating.
Last year the program saw significant progress: participating children’s BMI (a measure of body fat based on height and weight) decreased by almost 38 percent, and more than half reported increased consumption of fruit and vegetables. 82 percent of participants were on Medicaid or other public insurance, so this program is really working to foster food security and access to healthy food in a highly disadvantaged population.

INSTITUTIONAL FOOD SERVICE PROGRAMS
With limited income and sometimes restricted mobility, older adults also faceproblems obtaining healthy foods. Martha’s Vineyard Hospital is working to promote a healthy senior population. Chris Porterfield is the hospital’s Director of Food and Nutrition Services and manages the local Meals on Wheels and the senior-center food service programs at the Windemere Nursing and Rehabilitation Center. When he arrived, he looked at what seniors were served. “The quality was bad, it wasn’t healthy—full of sodium, high in sugar—and the seniors didn’t like it,” he says. So he made some wholesome changes.
Now Mr. Porterfield writes up new menus each month and doesn’t put pressure on his staff to use government-subsidized foods, which he says appear cheaper
at first, but when shipping expenses and costs to the health of the population are calculated, wind up costing more. He also initiated dietician-led programs at the senior centers to teach nutrition for older adults. In 2004 the program served almost 16,000 meals, and by 2012 they served more than 29,000. He credits this increase to innovative, varying menus, as well as another simple change: “We now send the meals over cold so that people can [heat and] eat them when they want instead of on a set schedule.” This makes for less food waste and gives seniors more autonomy.
Chris hopes to add more fresh and local produce to his menus. At this point he’s using surplus produce from area farms, but says there’s not “enough volume to make a meaningful use.” The goal is to ramp up partnerships with Martha’s Vineyard farms in the very near future.
Hippocrates once famously said, “Let thy food be thy medicine.” Programs like CSA rebates, fruit and vegetable prescriptions, and nutritious senior meals take this concept to heart. With preventative measures the programs serve the population well and illustrate how the healthcare industry can step up to the plate and start playing a more significant role in promoting healthy eating.