Prescriptions for produce helping to cut obesity

New Haven — Yesika Gonzalez and her boyfriend are loaded with nearly a dozen heavy bags of produce from the farmers’ market in this city’s Fair Haven section.

“Corn, peppers, tomatoes, potatoes, too many fruits, apples, pears,” she ticks off in an accent that is still heavy with traces of her native Puerto Rico. “I think that’s it. For today.” In fact there was more, including broccoli and eggplant.

These are the fruit and vegetables that will feed Gonzalez and her three children for a week. It’s just what the doctor ordered. Literally.

Gonzalez’s family is among more than 30 enrolled in the Fruit and Vegetable Prescription program — FVRX — an innovative strategy to combat obesity. Doctors actually write patients prescriptions for fruit and vegetables from their local farmers’ market. But the key — the patients also get money to pay for them.

“The thought that someone would give money and help people who have a diagnosis of obesity or overweight buy fruit and vegetables,” said Elizabeth Magenheimer, the family nurse practitioner who works with these families at the Fair Haven Community Health Center, “was one of the most brilliant ideas.”

It’s the creation of Bridgeport-based Wholesome Wave, started in 2007 by Connecticut chef Michel Nischan, perhaps best-known for his restaurant collaboration at Dressing Room in Westport with the late actor Paul Newman. Wholesome Wave, in general, provides programs to help underserved communities nationwide get access to affordable locally grown, healthful food.

FVRX is now in its second year of pilot programs in more than a half-dozen states, including its first year in Connecticut. The program links patients — obese or overweight children and/or pregnant women — with community health services like Fair Haven and farmers’ markets like the five run by CitySeed in New Haven.

Its premise is that combating obesity among the poor requires not only education on what to eat, how to eat it and other aspects of good health such as exercise, but also the money so they can afford the often pricier fruits and vegetables the doctors are prescribing.

A change for the entire family

The program is designed to treat the whole family, which means all family members attend monthly clinical sessions for the educational components. Those visits include a body mass index and other health checks for the actual patient. The family focus also includes the calculation for how much money is allotted — $1 a day per family member — distributed every week.

“I have two children with diabetes,” Nischan said. “So I understand you can’t just change the diet of one person living in a family of seven or two people living in a family of seven if they have a condition that relies on a lifestyle change. It’s only going to be successful if the whole family participates.”

So for Gonzalez and her three children — her 11-year-old son Ian is the actual patient — that’s $28 a week for fruit and vegetables, which she can buy at any CitySeed-run market, though Fair Haven is considered the primary one. She trades in her prescription for turquoise-painted wooden tokens with FVRX in big letters.

While she said the whole family is on a diet now because of the program, and she’d been shown how to prepare food more healthfully, she recalled what she and her kids had been eating.

“Junk food,” she groaned. A lot of rice and beans and fried chicken and pork. Now it’s: “Grilled chicken with some vegetables and some salad.”

Like other mothers in FVRX shopping on a recent Thursday at Fair Haven, Gonzalez said the results so far show Ian maintaining BMI, which measures body fat based on weight and height. Wholesome Wave has crunched data from first-year pilot programs in Maine, Massachusetts, Rhode Island and California, and Nischan said what Gonzalez and the other mothers are similar to what they’ve found.

“Thirty-eight percent of all participants lost BMI in a population that 100 percent were expected to gain BMI,” he said. “In a four-month intervention, that’s near historic.”

Mixed revenue results

Among the other data from year one: 54 percent of families said they increased their knowledge of the importance of fruit and vegetables, and more than 66 percent increased their fruit and vegetable consumption.

The data also showed that other goals of FVRX — to bring more business to farmers and to help maintain the existence of farmers’ markets in underserved, low-income communities like Fair Haven –were also achieved. More than half of FVRX patients had been non-users, or extremely infrequent users, of the markets. Participating markets increased revenue by an average of more than $8,100 per season.

Results for CitySeed markets have been a bit mixed. Some farmers said they haven’t really noticed a big revenue bump. Others, like Stacia Monahan of Stone Gardens in Shelton, said she had.

“It adds up,” Monahan said. “If these people aren’t here shopping that’s another $100 I wouldn’t be making that Saturday. $100 is $100.”

Market Manager Keren Kurti Alexander said some growers have grumbled a bit about the extra tokens — there are now six for various programs at the CitySeed markets. “Very minimal I would say for the most part.” she said. “It’s additional revenue for them so I would say that right there is big incentive.”

Result in Maine ‘phenomenal’

In Skowhegan, Maine, home to one of the earliest FVRX programs, farmers’ market market manager Sarah Smith called the program “phenomenal.” Without having to worry about taking a financial risk, participants were trying new foods and business had improved, even among farmers selling products like meat, eggs and cheese, which are not eligible for FVRX.

“I don’t think there’s a lot that isn’t working about it,” she said. “One woman, she had lost so much weight we thought she had a gastric bypass.”

Smith’s medical counterpart, Mike Lambke of Redington-Fairview General Hospital, said he’d tried for years to find ways to get anti-obesity efforts to work.

“It’s very obvious to folks who are working with this group,” he said. “It’s the best iteration of childhood obesity work we’ve seen. It’s the right combination of carrots and sticks.”

But he, like others — including Nischan himself — admitted that without the financial incentive, FVRX wouldn’t work. But Nischan is quick to point out that it’s a prescription, and like most prescriptions, is discontinued once the patient recovers. In the meantime, he said, it’s a justifiable expense.

“When you look at the cost of providing a family of four around $100 to $125 a month to prevent diabetes, that’s a lot cheaper than if one of them gets diabetes and needs medication for life,” he said. “Right now, we spend about a $1.20 per American on prevention and we spend $1,300 per American on treatment. Imagine what would happen if we could flip that.”

Among other persistent concerns about FVRX is that it only runs for four months to coincide with most farmers’ markets. Magenheimer of Fair Haven Community Health said they are looking for money to continue education and clinical visits after the program ends in a few weeks, but that will still leave patients without the actual prescription and the money.

“I get the point that it’s not a dole-out forever,” she said. “But if we think about it in relationship to those diseases which will be costing us a fortune with blindness, dialysis, heart attack, stroke, amputation and infections, then I think three months, thank you very much, it’s wonderful, but we’re going to beg for some more.”

Wholesome Wave’s research of its older program that doubles the value of federal nutrition coupons, such as food stamps, shows that once people see the benefit of eating more nutritionally they will keep buying healthful foods even if the financial assistance runs out. But no such data is being collected on FVRX to see how patients fare in the off-season.

Gonzalez and other FVRX mothers said they planned to keep trying to buy fruit and vegetables all winter. “I’m going to do my best to still do the same thing,” she said. “We need it.”