The Fruit & Veggie Prescription Program

November 23, 2012

From the upcoming issue of Food, Nutrition & Science, Wholesome Wave and health advocates are prescribing fruits and vegetables.

Health care providers at Unity Health Care's Upper Cardozo Health Center in Columbia Heights, D.C. are doing something unusual. Instead of focusing on treatment, they are focusing on prevention. The Cardozo Health Center is one clinic partnering with Wholesome Wave to prescribe fruits and vegetables – instead of antibiotics – to their patients.

The Fruit & Veggie Prescription Program (FVRx), developed by Wholesome Wave, a non-profit organization whose mission is to improve access and affordability of fresh, local produce to food deserts, is designed to provide assistance to overweight and obese children, or pregnant women, and their families who are at risk of developing preventable diseases.

Through the FVRx program, fruit and vegetable “prescriptions” are distributed by community healthcare providers and redeemed at participating farmers markets for fresh, locally grown fruits and vegetables. The program is intended to provide direct economic benefits to small and midsize farmers and bring additional resources into the local economies of underserved communities.

Ashley Fitch, Program Manager, Fruit & Vegetable Prescription Program at Wholesome Wave, says that data shows the role of the healthcare provider is important in health behavior change, and that capitalizing on the healthcare provider/patient relationship is really important in improving consumption of fresh fruits and vegetables.

“For the people who always wanted to shop at the farmers market but couldn’t afford it, the money alone will be enough to cause a lifestyle change. But for the families who aren’t sure about the difference between fresh local produce and other foods, the education is really critical. Having that education come from a medical team amplifies that message and motivates families,” says Fitch.

Fitch says that many doctors have been telling them they’ve been recommending healthy eating and fruits and vegetables for years, knowing it was an empty recommendation because their patient could not afford it. But since “prescriptions” translate into redeemable coupons, patients are finally able to act on their doctors’ advice. Providers in the program say it is amazing to now tell someone to eat fruits and vegetables and actually have a way to help them do it.

“Across the country, access to planned obesity visits or health behavior change counseling is minimal. In the Fruit & Vegetable Prescription Program, we facilitate skill building around health behavior change for providers and nutritionists, and combine that with an actual incentive for families to eat better. The result is a monthly conversation about weight, produce consumption, and health,” says Fitch.

Jessica Wallace is a Physician’s Assistant at the Columbia Heights Upper Cardozo Health Center. She thinks the prescription aspect of the program is effective for a number of reasons. One is that people in general inherently trust their health care providers, and they know the value of a prescription to help them to feel better. By using that same familiar format as a tool to access healthy foods, it emphasizes just how important a healthy diet can be. It's also a tangible reminder to eat well week after week. And, additionally, the financial assistance is crucial to taking the motivation and making that health behavior change possible.

“The FVRx program helps to improve health outcomes by allowing our families expanded access to fresh, local, seasonal fruits and vegetables week after week, for a total of 6 months of support. Once you have used the ‘prescription’ to purchase your fresh produce, then people are motivated to cook and serve it to their families. We are increasing the amount of fresh produce consumed daily (guidelines say we all should eat at least 5 fruits and vegetables every day), not just for the overweight or obese child who qualified for the prescription, but also for all of the other family members as well,” says Wallace.

She says that with a comprehensive program of nutrition education and physical activity, as well as group support and individualized goal-setting, we can absolutely see changes in larger health outcomes – stabilizing or decreasing BMIs, normalizing growth charts in kids as they grow. Although the final data is not in yet from the full FVRx season, Wallace anticipates that the additional financial assistance to families to make healthy changes will augment these changes.

“Much has been made of ‘food deserts,’ which are a very real problem for many communities in the U.S. However, in the case of our particular patients, the majority of whom live in a rapidly gentrifying area, there are many grocery stores and farmers markets in a close radius. However, when cost is prohibitive, it is as if these places don't exist. Only one of our 36 families supported by FVRx had ever been to a local farmers market prior to receiving the prescriptions. It can take extra effort to allow the same degree of access to community resources, whether due to poverty, language, or cultural isolation. But it is so important, especially when you consider that poor and minority populations tend to suffer disproportionately from obesity and all of its chronic medical complications,” she says.

Wallace says that the family obesity program at Upper Cardozo Health Center will continue in their Community Health Center (it has been ongoing since 2008), and they hope to receive further funding from Wholesome Wave for next year.  They run a similar program at other clinics throughout the city, and Wallace says it would be great to scale up this program to provide access to even more families. The ultimate goal, she adds, is to support our patients in making sustainable healthy lifestyle changes by whatever means necessary. Fitch agrees.

“We are thrilled that the initial ‘proof of concept’ stage is completed for this program, and that it has shown promising results, including decreased BMI for 38.1% of participants over a 4-month intervention period. Since those pilot results were released in 2011, we have been fielding inquiries from a variety of sectors, which is particularly exciting as we focus on strategic planning for long-term scaling and sustainability. At this point, we are carefully considering paths for expansion that will allow us to bring the positive impact of FVRx to community members who need it most,” says Fitch.

Click here to learn more about Wholesome Wave and check back for our December issue featuring a video diary of Wholesome Wave’s DVCP work at farmers markets through the eyes of Wholesome Wave's Executive Vice President and Co-Founder Gus Schumacher.