July 6, 2012 (Updated March 23, 2023)

Discussion Friday: Prescribing Fruits and Vegetables

by Anne Mauney, MPH, RD

63 comments

Morning, friends, and TGIF! I thought today it would be fun to mix things up and share a little reading for you all in hopes of getting a good discussion going.

When I was at my parent’s house last weekend, my mom gave me a few article clippings from the Washington Post that she thought I would find interesting. One of them was an article about an amazing new program in which low income DC area residents have started receiving prescriptions for — get this — fresh fruit and vegetables!

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Example of a food coupon (source)

Unity Health Care Upper Cardozo clinic has been providing the prescriptions through their weekly program “We Can,” in which low income families that struggle with obesity or chronic disease can come for cooking classes, exercise classes, and information on developing a healthier lifestyle. The problem was that just educating the low income families about eating more fruits and vegetables and cooking more at home didn’t really help if they couldn’t afford the fresh produce on their own, so on June 6, the clinic began writing fruit and vegetable prescriptions. The program is starting small with hopes of expanding later — for now, 35 families will receive $1 per family member per day ($112 per month for a family of 4) to spend at their choice of five different DC area farmer’s markets.

The produce prescription program, which was originally created by a nonprofit called Wholesome Wave, has been implemented in other cities previously and has shown success in improving access to and intake of fruit and vegetables among the low income prescribers and their families.

Working in a hospital this summer for my dietetic internship has convinced me even more of the need for preventative (vs. just reactive) programs combatting obesity and chronic diseases. Since I’m getting a Masters of Public Health from UNC, in addition to all the normal RD science coursework, I also took a number of classes on creating prevention programs to combat obesity and chronic disease on the community level, and I love the sound of this new (to DC) program. Not only does it improve health education and fruit and vegetable access, but the hope is that giving fruits and vegetables a literally medical endorsement will encourage the families to make real changes in the way they eat and shop (and think) about health.

So — what do you all think? I’d love to hear your thoughts on this. Do you think a more medical endorsement of healthy eating like this will help to finally drive the point home that medicine can be food instead of just pills? Do you think this could ever be adopted in a hospital setting? I know the hospital where I’m interning this summer could use it, with most of its patients low income!

Here’s a link to the full Washington Post article, if you’re interested!

- anne

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63 comments
  • Michelle@PeachyPalate
    That is such a great idea! In Ireland the hospital food provided is pretty shocking. You've probably heard about Jamie Olivers School Food Movements, but their is another English Chef, Heston Blummenthal, who tried to take on the hospitals in the UK. The food is nutritionally poor, not exactly fresh, lacking in variety and far from tasty! Implementing such a programme here in Ireland would not only involve reeducating general society but also reeducating those that provide foods to hospitals (as generally they are outside agencies) and also changing the whole mindset in terms of making a profit as opposed to providing food that patients need to recover; it would not only help them physically but I believe healthy nutritious and tasty food can do heaps for the mental health of people!
    Reply
    • Anne P
      I completely agree - it's horrible how gross the food in hospitals here in the US is, too. All the patients at my hospital complain about how nasty the "healthy" food options are - which sucks because it reinforces their idea that healthy food = not tasty, bland food. Sigh.
      Reply
  • Renie
    I truly don't know, Anne. It just makes me sick of all the government intervention into our lives these days. It makes you wonder how we older folk lived to adulthood without government aid. I suppose this would be ok for hospitals, but you know how that works, pretty soon they will want to come to your home and make sure your doing it right. I wish the public would use their brains GOD gave them and decide on their own.
    Reply
    • Renie
      P.S. I think it is a wonderful idea if it is contained to the hospital just so they don't make a new government agency out of it.
      Reply
    • Gina @ Running to the Kitchen
      I'm with you on this, Renie. More programs, more tax payer $, more governmental control and the result is that people just end up feeling "entitled" to it (help) then. I've lived in an area that bordered on incredible low income/poverty when I was in Florida and my husband owned a business IN that area. I've never seen such abuse of governmental programs before in my life. It truly made me sick.
      Reply
      • Anne P
        To play devil's advocate - if programs like this are actually successful (and obviously on a larger scale), it could actually mean a LOT less taxpayer money in the long run because of the reduction in health care costs! That's horrible about what you saw in Florida, though - I'm sure there's a lot of that everywhere.
        Reply
        • Gina @ Running to the Kitchen
          True :) And I do agree with that, I'm just admittedly skeptical based on past experiences and knowing what it would take (money & effort wise) to make a program like this so successful that it would actually in turn lower health care costs eventually. I tend to agree with Renie in the thought process of just wishing people would use their own brains to make decisions rather than feeling entitled to it from some sort of "program" whether governmental or not. While I do believe there are some that truly do not understand how to eat healthy (and therefore this program would benefit), I believe there are far more who choose to just not make it a priority for themselves or their kids. Fancy cars, entertainment options and other things rise to the top instead. Personally, I don't feel like it's anyone's job to try and convince people like that either through education or monetary incentives to change. Much like you can't convince someone to workout and lose weight until THEY decide for themselves it's a priority, I feel like food choices are the same and I sure as heck don't want to be spending my money supporting that effort. Basically for me it comes down to personal responsibility and ownership. Whatever your monetary situation is, if you make it a priority, it can be possible. And now that I've revealed my extreme right wing thoughts on this, I'll shut up :)
          Reply
          • Anne P
            Haha no worries - I always welcome thoughtful, respectful debate! I completely agree with you that a lot of it is just that people don't care/don't make health a priority - like you said, spending money on expensive electronics instead of healthy food. I remember friends who did internships last summer where they visited low income people at their homes said they would literally have massive flat screen TVs in their trailers. Crazy. The problem, though, is that I feel like the culture/environment in the US is not geared towards health at all, so maybe by starting some programs that are more geared towards prevention it might convince people they really do need to change, you know? Or at least make it easier/a more welcoming environment for those who DO want to change, but aren't able to because of their financial/living situation. Great comment, though - like you, I wish more people would just suck it up and do what's good for them because then spending a gazillion dollars on healthcare wouldn't be an issue anymore... it's unfair that those of us that do make health a priority end up footing the bill for some of these people via taxes!
            Reply
          • Gena
            Gina, I totally hear your points, and I'm sure that witnessing the abuse of aid is maddening. Thanks for sharing your personal perspective on that score! That said, I don't think it's always true that these decisions boil down to personal responsibility. Yes, if you have some income, even meager income, coupled with a culture that emphasizes health and wellness, plus access to produce, you can make the kind of health choices we're all used to being encouraged toward. When you are living in dire poverty--especially a scenarios like food desserts--you literally do not have access to vegetables, let alone the income and cultural incentive to approach them. Do some people abuse government aid? Absolutely. But are there others--people for whom starvation is an actual possibility--whom that aid is designed to help? Yes, and abuse of the system may not mean that the system is inherently without value. I understand how, from the outside, these scenarios seem to invite our mapping of the free will we've always had onto others' choices. But I also think that few of us know what it's like to be the victim of endemic, oppressive poverty, coupled with a culture in which health is not celebrated at all (that is to say, most of us who have taken it upon ourselves to muster up the motivation to get healthy did so in part because, at the end of the day, our culture celebrates healthy choices, even if we also get some mixed messaging through fast food advertising and so on). This is a luxury many of us take for granted. The program Anne mentions is small, and it may not ultimately do much in the face of endemic poverty, but it at least is the product of a culture in which we're trying to bring a basic value for health into communities in which it's lacking, along with the access that often does not exist. For every instance of abuse, there is also an instance in which we have the opportunity to save lives--or at least show that we care about improving them.
            Reply
          • Brittany (Healthy Slice of Life)
            I definitely see the multiple sides to this argument and would much rather have fruit and vegetable prescriptions that people can use toward getting wholesome foods for their families and preventing health problems down the road rather than a prepaid credit card (EBT) that could be abused. I tend to side with Gina and favor personal responsibility and community aid (which differs from government handouts because community aid is a voluntary personal responsibility rather than a government mandated sanction).
            Reply
    • Anne P
      I don't see something like this as government intervention at all - programs like this would just giving people the option to help themselves if they choose to. No one would be forced to come to the education sessions or to take the fruit & veggie coupons/prescriptions, so what's the harm? It's up to people to take the initiative and take advantage if they want to.
      Reply
      • Renie
        Good point and one I will think about. Thanks Anne
        Reply
  • angel
    Love this idea! So many people deal with an illness which could possibly be cured or improved by eating healthy food. What's shocking is that some folks spend hundreds each month on medicine, yet still don't want to change their eating habits even with the possibility of eliminating their drug prescriptions. Something needs to be done to educate and motivate people to get healthy. I'd love to see more medical institutions implementing a program such as the one above.
    Reply
  • Carol
    I think it is a great idea if people take advantage of it. These coupons are another tool for families to use who might not otherwise have access to the farmer's market or a desire to go. The money they would be spending on produce could be used for other things the family needs more. That being said, the family could also not take advantage of the coupons. All the agencies can do is offer the coupon. It is up to the family to go to the farmer's market and use it. The same would apply to the cooking classes, fitness classes, etc. that would be offered. Great ideas, but not worth it if the targeted audience does not utilize the services.
    Reply
  • Claire @ Live and Love to Eat
    I interned one summer for a program that provided $20 in vouchers to senior citizens to use at Farmers Markets. It's a great concept.
    Reply
  • Lindsey @ Sound Eats
    Wow, that's a fabulous program they've started! Honestly, while I share similar sentiments with you (working in a hospital, seeing the need for preventative medicine/ nutrition), I'm not sure how successful this would be in a hospital setting. I think the single most important thing now we can do in a hospital/ clinical setting is to educate on healthy options, and affordable ways to find them in our local areas.
    Reply
  • Danielle
    Wow!! I love this idea so much! I just recently graduated with an MS in Nutrition and one of the biggest take aways for me was the idea of preventative medicine. I love that this method focuses on encouraging positive behaviors to help change habits and health rather than simply prescribing a "pill" to help with weight loss. I think this should be present in each state and believe it could make a huge difference in the way low income families eat. I was just reading an article the other day about how much cheaper processed foods filled with corn are in comparison to fresh fruits and vegetables. This is a step in the right direction!!!!
    Reply
  • Molly @ Heart, Sole & Cereal
    this idea is AWESOME! i teach in DC at a school composed of mostly low income families, so i have a first hand view of what most of my kids are eating. i talk with them a lot about what they have for breakfast, what they are packing for lunch (or is being packed for them, as the case may be), and what they eat when they get home for dinner. truly, it is alarming. i know that a lot of times the argument from parents is that fresh foods aren't available in their local grocery stores (which does tend to be the case if you look at areas of high poverty in cities across the u.s. - grocery stores in these areas tend to have and sell less produce) and if they are available, they are so expensive. when the choice is feeding your entire family for $20 at mcdonalds or spending $20 and only getting a few vegetables, i hate to say it, but i can understand why the connection between poverty and obesity is so strong. programs like this, even if it takes a while for families to start using them, or even if only some families use them, can only help!
    Reply
    • Anne P
      That's awesome that as a teacher you are taking an active roll in talking to the kids about what they eat - I have a feeling that most teachers are not such great role models. Agree with the rest of your comment - every little bit helps!
      Reply
      • Molly @ Heart, Sole & Cereal
        haha i try my best...maybe i'll start offering extra credit for the kids who eat the fruits and veggies the school provides at lunch ;) i love taking leftovers to school for lunch though because (since i eat with my students) they get a first hand look at what i eat and they tell me all the time "that looks really good" or "what is that, that smells awesome!". i figure just trying to open the dialogue is a good first step. and i always pack extra vegetables to share with them. for some reason they're willing to try things if i'm also eating them as opposed to eating what the school provides. whatever works!
        Reply
        • Anne P
          That's so awesome. Good for you :)
          Reply
  • Jill K
    It's a wonderful idea. I wish this program all the success, because healthy eating AND exercise is the best preventative medicine. -besides you look and feel great! :-)
    Reply
  • Lindsay @ The Lean Green Bean
    omg LOVE IT! here we have coupons for low income seniors to use at the farmer's market and i think it's such a great program. veggie power! :)
    Reply
  • Megan@ The Runninc Doc
    I think this is a fantastic idea in theory. I just wonder how much of a difference it will make in the long run. I love the idea of providing classes and education on how to cook healthy foods and exercise, but do we really need to provide more government payouts? As someone who recently switched from eating almost exclusively processed foods to eating A LOT of fruits and veggies, my grocery bill is actually cheaper these days. So I just wonder exactly what keeps these people from buying healthy foods in the first place. Is it truly because they can't afford them or is it more out of laziness (hey, this was me a few months ago!) and lack of knowledge on how to prepare those foods properly? Just some food for thought. :)
    Reply
    • Anne P
      That's so great to hear that you have found your bill to be cheaper now that you buy more produce! What convinced you to make the change? I'm sure a lot of it is out of laziness (and lack of knowledge), you are right. It sounds like this program already does some cooking classes/education, so hopefully the combination of the two will be good?
      Reply
  • Ida
    The vouchers are a great idea, but I'm not sure they would actually do anything to combat bad eating habits. First people have to get to the markets, which isn't always easy. If people do go to the farmers market and purchase produce there is no telling how they are going to prepare what they buy. I think people also need access to educational tools showing how to prepare veggies in a healthy manner.
    Reply
    • Anne P
      Very true - agree! It sounds like the program does provide education as well, so hopefully that will help...
      Reply
  • Cristina
    Wholesome Wave is the same organization that does the Double Dollars program that you and I discussed awhile back! I’m sending your post to a friend because we did a school project on health and farmers’ market initiatives!
    Reply
    • Anne P
      Yes - love the Double Dollars program idea, too! And thanks for sharing my post with your friend - hope you are doing well!
      Reply
  • Nikki
    On a slightly different note, as an RD in training can you please tell me if the recommendation for 5 fruits and veggies a day means 5 fruits + 5 veggies, or just 5 fruits and veggies total?
    Reply
    • Anne P
      Just total :) But of course the more veggies in particular, the better!
      Reply
  • Charise
    I think the basics of this program are a great idea. Our culture is far too quick to prescribe a pill instead of trying lifestyle changes for some health issues. And, I do understand where there's who are hesitant to provide more "govt handouts" come from - but the orgs providing these are not always govt institutions/using govt funds! I DEFINITELY think access to healthy food needs to be coupled with education. I volunteer for an organization that works on both fronts - one program brings bags of fresh, seasonal, local-when-possible produce into low-income "food deserts" once a week for a very reasonable price (~15 lbs for $15, and we accept EBT). Another program teaches families how to cook real food on a budget, and yet another goes into elementary schools to teach kids basic nutrition.
    Reply
    • Anne P
      Agree - the organizations where you volunteer sound amazing! The last program you spoke about sounds like my dietetic internship last summer at the Cooperative Extension in NC - cooking classes for kids, canning classes for adults, etc.
      Reply
  • Emily
    I love love love this idea! I'm in a MPH program focusing on Health Behavior and Health Education. Last summer we designed a program for practicum in which families (of any income, but we targeted low-income) can come to weekend events (like walking groups, bike safety classes, swimming classes and cooking classes) in exchange for dollars to use at the local Farmer's Market. The program had a surprisingly good turn out last year and it's still going strong this summer. We've definitely got some work to do, but I'm so proud of the project! Prevention and education are definitely the key to a healthier population.
    Reply
    • Anne P
      What a great idea - I love that you made education/exercise the requirement first before getting the coupons. Sounds like the perfect way to pair education with financial help!
      Reply
  • Katie @ Peace Love & Oats
    My first thought was that this is a great idea! But then I started to read the comments and people make a lot of good points. I do think this is a good way to encourage people, but it should be a part of something more, like a complete education program on healthy eating.
    Reply
    • julia
      i like the idea of giving money that is specifically for fruits and veggies and not to be used for refined starches/sugars. while I sympathize with the sentiment that gina and renie mention, I feel like the economics of it can be looked at from both directions. i'm sure there are plenty who would point to the reduction in health costs if we reduced the obesity rates. it's hard to find a non-governmental way to deal with large scale public health probs, like obesity, esp since the high cost of healthcare effects everyone, regardless of the recent supreme court decision.
      Reply
    • Anne P
      I agree - education should always be included with programs like this - and it sounds like it is provided at the clinic where they get the prescriptions!
      Reply
  • julia
    oops, my mistake, I didn't mean to post that as a reply to you, Katie! sorry for the confusion.
    Reply
  • Hunter
    This is fantastic! I love that this program also supports local farmers markets as well as increasing the awareness that fruits and vegetables are crucial to a healthy lifestyle. Nice work DC!
    Reply
  • Stephanie
    I know in the Boston area a lot of farmers markets have started accepting SNAP benefits but also matching each SNAP dollar spent. Certain markets have had more success with this than others. I think it's a great idea as access is always important but I would be curious to see data to show that it's doing any good long term.
    Reply
    • Anne P
      We learned about matching dollar programs like that in my MPH program - it sounds like a pretty great way to convince people to use their dollars for fresher food... I would also be curious to see long term data - I'm sure it's in the works!
      Reply
  • Sloane @ Life Food and Beer
    I have read a few articles on the misconception that package food is cheaper than fresh fruits, vegetables, and meats. Baking your own homemade chicken nuggets are cheaper and much healthier than buying the packed fried ones from the freezer section. I think classes to teach people how to cook for themselves on their budget is a great idea.
    Reply
    • Sloane @ Life Food and Beer
      Also, I live in a state that has a food voucher program currently. And I'm not sure if every state has EBT Cards, but they give lower income families money for foods. They do not include hot foods, but they are able to purchase foods including meats and veggies. My local farmers market excepts these cards as well. I don't know if I believe another government program giving out vouchers will help when you already have programs in place that allow people to purchase food of their choice. I think just educating people will do so much more than giving vouchers.
      Reply
      • Anne P
        I agree, but I think the main point of this program, though, was that it was giving "prescriptions" vs. just vouchers - yes, basically the same thing, but the program hoped that by having a more medical slant to it it might convince the people to think of fruits and veggies in a different light, e.g. food as medicine. Plus, the people getting them were already coming for education at their clinic it sounds like, so it wasn't just vouchers - more of a collaborative approach - they were already teaching these people about being healthier, but wanted to drive that home more by helping them to have the resources to get themselves to the farmers markets, etc.
        Reply
    • Anne P
      I agree - that's why education is such an important thing in interventions like this, because giving people money for fresh foods won't really help unless they know how to prepare it in a healthy (and tasty) manner! And you're right about packaged foods often not being cheaper - I think the main problem is just 1) laziness, and 2) lack of time. Families are busy and want quick meals, so they go for packaged/processed - maybe not necessarily because it's cheaper but because it's easier - especially if they don't know how to or have the resources to whip up really quick fresh and simple meals. Eating more vegetarian meals once in awhile will also greatly reduce costs, but a lot of people don't really know how to make veggie meals that are tasty/filling, I don't think.
      Reply
  • Lexi @ You, Me, & A World to See
    Ahh I just saw this over at Gena's blog, and I must say I was quite intrigued. I love farmers' markets but do recognize that they're considered a luxury for many. That being said, I do think that the idea of "prescribing" fruits and vegetables is a step in the right direction.
    Reply
  • Marta Ferreira
    I think this is an awesome idea. Many low income people live in urban areas where even getting to a grocery store is hard to do. (Think about how many grocery stores with the big names are in the suburbs and how many are in the more depressed areas) If this makes fresh fruits and vegetables more accessible to them it is awesome. I am for helping people help themselves and some of these people don't know how to live any other way (Fast processed foods, etc.)
    Reply
    • Anne P
      Absolutely - areas where people have trouble getting to a grocery store/finding fresh produce are called "food deserts"; they are something we talked about a lot in my grad program. It's a big problem, for sure.
      Reply
  • Adventurer
    I think the DC program and others like it are tremendous initiatives. Clearly, prevention -- including education, incentives to pursue healthy lifestyles, and so on -- are of enormous importance in improving personal health, quality of life, and reducing health care costs that are borne by all of society, not just the individual. The challenge, of course, is one of literally getting folks to change life styles, to change culture. And that's not easy. And what often seem to be attractive ideas and great initiatives don't always translate into the kind of change required. So, it will be very interesting to see how the DC initiative works. Pls see if you can provide an update in a few months! And hope the lake has been fun!
    Reply
    • Anne P
      Great comment - agree, especially in that programs that seem like they will be a success are not always in actuality! I will definitely keep an eye out to see how this program does in the future.
      Reply
  • Gena
    Fantastic discussion, Anne! Thanks for bringing the article to light. As I said, I did a little cheer when I read it, not because I think one little voucher can change endemic problems, but because I think the program signals a cultural shift: it's evidence that we're starting to care more about preventative health. And even if the barriers are still enormous, that culture shift is important in its own right.
    Reply
    • Anne P
      Absolutely agree. Maybe this program won't make much of a change... but at least it exists - that alone is a step in the right direction.
      Reply
  • Sara @ Real Fun Food
    I've loved reading through the comment discussion on this, and I think it's a great idea. I live in London, where there are even more social programs to help people, and it's easy to focus on the people who take advantage of the system. There are a lot! However, I agree with another comment that said for every one who takes advantage there is someone out there who truly needs help. I think it's important to think about what it's actually like to walk in someone else's shoes because it's easy to judge when you've had a comparably privileged life. Sure, we pay a lot of taxes and a lot people take advantage, but at the end of the day we're all living luxurious lives compared to almost everyone in the entire world. Especially Americans!! There will be people in every society who take advantage, so ultimately it's a case of helping them out or seeing people starving on the streets, dealing with higher rates of crime, etc. I'm so glad to see programs like this that focus on education and preventative health - there aren't enough!
    Reply
  • Elizabeth
    They did this in Philly last year in conjunction with Farmer's Markets and FQHC health centers. The funding came from an insurance company. It was great. It's hard though, because in those areas there's so much food insecurity that people are just taking what they can get for free. Also, they don't have the time or patience to devote to long term changes. There was also some grant funded research to show that these farmer's markets in socially troubled area decreased (at least statistically significantly) violence during the summer months. Its hard though for farmers, because you can't just give people vegetables, you have to teach them how to cook 'em. And they have to be able to. And they have to not cook 'em in pork lard. I think this is great, but its really challenging to implement. I think my thoughts are all over the place here, but I'll leave you with this ironic moment from last summer working with this program. After one pt met with the RD she came out and was put on a 1200 calorie diet. She asked me how many calories were in an egg. I said 70. She then started crying because she usually scrambled 6 eggs for breakfast because they were so cheap. And that was roughly 1/3 of her day.
    Reply
    • Anne P
      That's sad about the lady and the eggs... and wow, 1200 calories?! That's really low...
      Reply
      • Elizabeth
        yea, apparently all the women were between 1200 and 1400 which sounded low to me too, but it wasn't really my place to argue...
        Reply
  • Allie
    I think this is a great idea, and just want to offer one more perspective. I currently work in low-income housing and am working on getting my MSW, and while it’s frustrating to see the abuse of government programs by some every day, you have to put yourself in their shoes. Many of my tenants and the people I work with haven’t had much their whole lives, and have had to make decisions based on their needs at that moment, not for the future. This includes food. If you are fighting to just get by everyday, you may not be thinking of meal planning for the week, but what can feed your kids at that moment. Obviously this doesn’t apply for everyone, and is a generalization, but it something I have to remind myself. I never had to worry about starving and my next meal was always guarantied. It is a personal choice for me to buy and prepare healthy meals, but many people don’t even know they have that choice, because their mindset is different.
    Reply
    • Anne P
      Great comment - thanks for sharing!
      Reply