A pilot food prescription program promotes produce intake and decreases food insecurity

Aiyer, Jennifer N.; Raber, Margaret; Bello, Rosalind; Brewster, Anna; Caballero, Elizabeth; Chennisi, Catherine; Durand, Casey P.; Galindez, M.; Oestman, Katherine; Saifuddin, Maryiam; Tektiridis, Jennifer; Young, Reginald H.F.; Sharma, Shreela V.

doi:10.1093/tbm/ibz112

Cited by 81 publications

(170 citation statements)

References 22 publications

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“…Participants suggested an exchange of recipes along with a description of each fruit and vegetable provided. Other food prescription programs cited proximity to the food pick-up site as a challenge to client retention [ 12 , 13 ]. However, our program addressed this problem through direct delivery of produce.…”

Section: Discussionmentioning

confidence: 99%

Prompting a Fresh Start for Adults With Food Insecurity and Increased BMI: A Case Series of Four Patients in a Food Prescription Program

Oliveira¹,

To²,

Cruz³

et al. 2021

Cureus

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Estimates place low intake of fruits and vegetables, physical inactivity, and high BMI (overweight-obesity) as all in the top 12 causes of death. Food and dietary education are becoming a focus in how we approach disease prevention and management, and food prescription programs in particular are showing promise, especially in under-resourced, food-insecure communities. This paper describes a pilot food prescription program in a handful of uninsured patients enrolled in an interprofessional clinical and educational program of a medical school in South Florida. This case series of four patients struggling with food insecurity profiles the demographic and clinical characteristics of the participants and provides the results of standardized assessments of their dietary behaviors, physical activity levels, and attitudes toward food before and after the intervention. This four-month pilot food prescription program, Fresh Start Food Rx, involved a prospective case report of four patients seen on a mobile health center (MHC) for uninsured patients in South Miami, Florida. The MHC is part of an interprofessional health professions education, health care, and social service program of the Herbert Wertheim College of Medicine at Florida International University called the Neighborhood Health Education Learning Program (NeighborhoodHELP). A systematic review of South Miami MHC patient electronic medical records identified eligible participants for the program: patients with food insecurity and a BMI >30, with comorbid health conditions. Patients with greater BMI and more comorbidities were prioritized. Once enrolled, we provided biweekly packages of fresh fruits and vegetables along with monthly dietary education to the participants. Key measures included self-reported fruit and vegetable consumption, attitude toward healthy eating, and level of activity. Pre-and post-intervention focus groups assessed barriers the participants faced to eating healthy and pursuing physical activity, satisfaction with the program, feedback on strengths and weaknesses, and anticipated behavioral changes after completion of the program.Prior to the intervention, participants reported eating fruits on an average of 4.5 days out of the week. Postsurvey answers increased to 5.0 days per week. Though the average amount of days per week that participants reported eating vegetables decreased slightly, the average number of vegetable servings that participants reported eating in a week increased. At termination of the program, most participants agreed that a diet rich in fruits and vegetables is good for you, that it is important to eat fruits and vegetables every day, and that a diet rich in fruits and vegetables can protect against cancer. This case study demonstrates that easier access to healthy foods, such as fresh produce delivery, and regular health education have the potential to promote healthier attitudes toward foods like fruits and vegetables. This change in attitude can then influence behavior, such as choosing to try new produce or incre...

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Section: Discussionmentioning

confidence: 99%

Prompting a Fresh Start for Adults With Food Insecurity and Increased BMI: A Case Series of Four Patients in a Food Prescription Program

Oliveira¹,

To²,

Cruz³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…Importantly, this approach could be implemented within existing structures such as the Gus Schumacher Nutrition Incentive Program, 29 and its network of grantees could be leveraged to conduct trials targeting specific nutrients for improvement. 30 Stocking standards for food stores accepting SNAP 31 and Medicaid-based food prescriptions 32 for SNAP recipients may also be viable policy options. Because 66% of Medicaid recipients and 12% of Medicare recipients are also on SNAP, 30 any dietary improvement through SNAP policy may result in less government spending on health care.…”

Section: Discussionmentioning

confidence: 99%

Elevated Dietary Inflammation Among Supplemental Nutrition Assistance Program Recipients Provides Targets for Precision Public Health Intervention

Ciesielski

Ngendahimana

Roche

et al. 2021

American Journal of Preventive Medicine

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Introduction:The Supplemental Nutrition Assistance Program was designed to prevent food insecurity among low-income Americans and has been linked to improvements in pregnancy health, long-term child development, and criminal recidivism. However, the pursuit of food security does not ensure nutritional sufficiency, and the program has not improved diet quality or cardiometabolic mortality (i.e., heart disease, stroke, diabetes). In this study, longitudinal cohort data are used to identify by Supplemental Nutrition Assistance Program status the proinflammatory characteristics that predispose to chronic disease.Methods: Between 2015 and 2018, annual 24-hour dietary recalls were conducted with 409 residents from low-income, urban neighborhoods in Columbus and Cleveland, Ohio (statistical analysis started in 2019). The Dietary Inflammatory Index was calculated. It provides empirically validated estimates of the internal inflammation that each diet should produce; higher Dietary Inflammatory Index scores have been associated with elevated inflammatory biomarkers. Finally, associations between Supplemental Nutrition Assistance Program and Dietary Inflammatory Index were evaluated, and dietary components that differed by Supplemental Nutrition Assistance Program status were identified.Results: Supplemental Nutrition Assistance Program recipients had higher Dietary Inflammatory Index scores (+0.40, 95% CI=0.09, 0.70) and a consistently lower intake of 4 anti-inflammatory nutrients (dietary fiber, b-carotene, magnesium, vitamin E) than nonrecipients. Vitamin D intake did not differ by Supplemental Nutrition Assistance Program status but was well below the Recommended Daily Allowance in this sample.Conclusions: Supplemental Nutrition Assistance Program recipients had elevated Dietary Inflammatory Index scores, implying higher diet-driven inflammation. This was due, in part, to low intake of 4 anti-inflammatory food components, which were higher yet still nutritionally insufficient among nonrecipients. Findings highlight specific nutritional targets for improving public health through dietary change.

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“…Notably, one $40 fruit and vegetable subsidy delivered to 65 low-income patients with persistent hyperglycemia over 13 weeks led to a 0.71% decline in A1C [56]. Qualitative data similarly suggest patients and care providers perceive nancial, dietary and health bene ts from these programs, and support their ongoing delivery [43,50,[58][59][60]. Food prescription programs also appear to be cost-effective, with one recent modelling study indicating that a national subsidized healthy food prescription program in the US could eliminate $100.2 billion in healthcare costs if implemented over the lifetime of bene ciaries [61].…”

Section: Introductionmentioning

confidence: 87%

“…One approach to better address this problem is to assist patients who are experiencing food insecurity to purchase diabetes-appropriate foods through subsidized healthy food prescription programs. Preliminary evidence suggests that these programs may improve diet quality and self-reported health, while reducing food insecurity, hypertension and BMI, including within Indigenous communities [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. Notably, one $40 fruit and vegetable subsidy delivered to 65 low-income patients with persistent hyperglycemia over 13 weeks led to a 0.71% decline in A1C [56].…”

Section: Introductionmentioning

confidence: 99%

A Subsidized Healthy Food Prescription Program for Adults with type 2 Diabetes who are Experiencing Food Insecurity: Protocol for a Randomized Controlled Trial, Modelling and Implementation Studies

Olstad

Beall

Spackman

et al. 2021

Preprint

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Background: The high cost of many healthy foods poses a significant challenge to the maintenance of optimal blood glucose levels for adults with type 2 diabetes (T2DM) who are experiencing food insecurity, leading to diabetes complications and excess acute care usage and costs. Subsidized healthy food prescription programs may help to reduce food insecurity by financially supporting patients to improve their diet quality, prevent diabetes complications and avoid acute care use. This study will use a type 2 hybrid effectiveness-implementation design to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a subsidized healthy food prescription program for adults who are experiencing food insecurity and persistent hyperglycemia. A randomized controlled trial (RCT) will investigate program effectiveness via impact on blood glucose levels (primary outcome), food insecurity, diet quality and other clinical and patient-reported outcomes. A modelling study will estimate longer-term program effectiveness in reducing diabetes-related complications, resource use and costs. An implementation study will examine all RE-AIM domains, including reasons behind program successes and failures, fidelity, mechanisms of impact, contextual determinants of effective implementation and sustainability. Methods: 404 adults who are experiencing food insecurity and persistent hyperglycemia, including adults who identify as Indigenous, will be randomized to a subsidized healthy food prescription intervention (n=202) or a healthy food prescription comparison group (n=202). Both groups will receive a healthy food prescription. The intervention group will additionally receive $1.50/day/household member to purchase healthy foods in supermarkets for 6 months. The implementation process will follow the Quality Implementation Framework. Outcomes will be assessed at baseline and follow-up (6 months) in the RCT and analyzed using mixed-effects linear and multinomial logistic/ordinal regression models. Longer-term outcomes will be modelled using the validated UK Prospective Diabetes Study outcomes simulation model-2. Implementation processes and outcomes will be continuously measured via quantitative and qualitative data and analyzed using descriptive statistics and theory-informed directed content analysis, respectively. Discussion: This research will provide a comprehensive body of data with high internal and external validity to assist policymakers and practitioners to effectively and rapidly translate the evidence generated into programs and policies to support patients with T2DM who are experiencing food insecurity. Trial registration: ClinicalTrials.gov NCT04725630 (January 25, 2021; https://www.clinicaltrials.gov/ct2/show/NCT04725630?term=Subsidized+Healthy+Food+Prescription+Program&cond=Diabetes+Mellitus%2C+Type+2&draw=2&rank=1).

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A pilot food prescription program promotes produce intake and decreases food insecurity

Abstract: Patients participating in a collaborative clinic-based food prescription program had a significant decrease in food insecurity.

Cited by 81 publications

References 22 publications

Prompting a Fresh Start for Adults With Food Insecurity and Increased BMI: A Case Series of Four Patients in a Food Prescription Program

Prompting a Fresh Start for Adults With Food Insecurity and Increased BMI: A Case Series of Four Patients in a Food Prescription Program

Elevated Dietary Inflammation Among Supplemental Nutrition Assistance Program Recipients Provides Targets for Precision Public Health Intervention

A Subsidized Healthy Food Prescription Program for Adults with type 2 Diabetes who are Experiencing Food Insecurity: Protocol for a Randomized Controlled Trial, Modelling and Implementation Studies

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