- A new study suggests that produce prescriptions may decrease risk factors for cardiovascular disease and increase fruit and vegetable consumption.
- The research indicates that produce prescriptions might lead to less food insecurity and better self-reported health status.
- Experts and researchers say the study has some limitations, as do produce prescriptions.
“Food is medicine” is a catchy phrase that plays well on social media, but a new study suggests the idea might have credence.
Individuals considered at a higher risk for heart disease who took part in “produce prescription” programs for an average of six months consumed more fruits and vegetables, according to the study, published August 29 in
The study is believed to be the largest of its kind on produce prescriptions. The findings show increased vegetable consumption was linked to improvements in:
- body mass index (BMI)
- blood sugar
- blood pressure levels
In addition, the findings indicate that produce prescriptions led to fewer instances of food insecurity.
“Over 300,000 Americans die each year from cardiometabolic illnesses like diabetes and heart failure that are directly linked to what they eat,” said lead study author, Kurt Hager, PhD, an instructor at UMass Chan Medical School in Worcester, MA.
”Our study provides encouraging evidence that produce prescription programs can play an important role in managing diet-related chronic disease, in particular among those who are food-insecure.”
Health inequities exist among low-income households, such as disproportionate rates of diet-related chronic diseases. Produce prescriptions allow doctors to prescribe subsidized fruits and vegetables.
While the idea of produce prescriptions or medically tailored meals may seem new, this study was not the first to discuss them.
In October 2022, another Hager-led
For example, there would be a maximum amount of carbohydrate for someone with diabetes or sodium for a person with blood pressure, explained Dr. Daphne Miller, a practicing family physician, science writer, and clinical professor at the University of California San Francisco, and research scientist at the University of California Berkeley School of Public Health.
Though there are distinctions, the concept fits under the same umbrella.
“All together, they are described as medically sourced food,” Miller said. “The idea behind all of them is that they are paid for, in some form or another, and are prescribed by their health care provider.”
Like the present study, the researchers proposed that a “food-as-medicine” approach that includes produce prescriptions could help address health inequities.
Still, as all three studies noted, increased accessibility of fruits and vegetables has led to improved health outcomes for both children and adults, such as better blood glucose control among individuals with a history of diabetes.
For the new study, researchers assessed whether produce prescriptions could affect clinical health outcomes by partnering with the national nonprofit Wholesome Wave.
The researchers looked at data for 3,881 participants considered at higher risk for heart disease from 12 states. Of them, 2,064 were adults ages 18 and older, and the remaining 1,817 were children ages 2 to 17. Participants received a median monthly financial incentive of $63 to buy produce at local stores and farmers’ markets, plus education via nutrition classes.
The program duration ranged from 4 to 10 months, with an average of 6 months. After the program, individuals completed questionnaires about their produce consumption, food security, and health status.
There wasn’t a control group, but researchers compared participants’ outcomes prior to and following the completion of the produce prescription program.
According to the data:
- Adults’ produce intake went up by nearly one cup daily (0.85 cups), and children’s intake increased by more than a quarter of a cup daily (0.26 cups daily).
- The chances of being food insecure declined by one-third in adult and pediatric participants.
- Self-reported health status improved by about two-thirds in adults and saw more than a two-fold improvement in children.
- Blood sugar levels declined in adult participants who entered the program with HbA1c of 6.5% or greater.
- Adults who enrolled in the study with high blood pressure saw decreased systolic and diastolic blood pressure.
- BMI decreased slightly in adults but not in children.
“This modeling study provides evidence that produce prescription programs may increase consumption of nutritious fruits and vegetables and reduce food insecurity,” Dr. Mitchell Elkind, chief clinical science officer of the American Heart Association and a tenured professor of neurology and epidemiology at Columbia University, told Healthline.
“These prescriptions also seem to improve subjective and objective health measures, such as blood pressure.”
It has long been known that a healthy, balanced diet is essential to overall health.
“Diets that include high concentrations of sodium or carbohydrates are major contributors to common cardiovascular risk factors like hypertension and type 2 diabetes and diseases, such as heart failure,” Elkind said.
“Cardiovascular disease is the No. 1 killer of Americans. For many of these disorders, diet is a major risk factor. Even modest improvements in diet could thus have a significant impact,” Dr. Elkind told Healthline.
The study’s suggestion that blood pressure and glucose levels and BMI might improve in people receiving food prescriptions caught one board-certified cardiothoracic surgeon’s eye.
“This is important because high blood pressure, diabetes, and obesity are significant risk factors for cardiovascular disease,” says Dr. Alexandra Kharazi, founder of The Heart Motivation Consulting.
Access to nutrient-dense foods may play a pivotal role in decreasing these risk factors.
Though the 2020–2025 Dietary Guidelines for Americans state that adults should eat 1.5 to 2 cups of fruits and 2 to 3 cups of vegetables daily,
“Food prescriptions can help with heart health by encouraging the consumption of fruits and vegetables rich in fiber, antioxidants, and potassium,” said Kelsey Costa, a registered dietitian and nutrition consultant for Consumer Health Digest. “These nutrients are known to reduce LDL cholesterol levels, lower blood pressure, and mitigate inflammation, all of which are crucial in preventing heart disease,” she told Healthline.
That’s why experts recommend choosing whole foods over processed foods whenever possible.
”Hypertension and heart failure are driven in part by increased sodium consumption, which is common in prepared foods,” Elkind said. “Cardiometabolic disorders such as diabetes and obesity are due in part to eating calorie-dense carbohydrates, including sugar-sweetened beverages.”
However, Elkind concedes the study has its limitations, and other experts caution that food prescriptions do, too.
While the study makes a case for food prescriptions, experts share its flaws. Notably, there isn’t a control group, and it is not a randomized control trial (RCT). Had there been, researchers could have compared people who received produce prescriptions to those who did not.
“It did not involve randomizing patients to one intervention versus another, Elkind said. “Randomization is important because it eliminates many of the differences among those who seek out healthy foods and those who don’t. Without it, we don’t know whether the patients are eating healthier food because of the prescription or because of some other underlying characteristic.”
Hager agreed the design is a limitation but hopes it prompts further research.
“Overall, our new findings support the need for large, randomized controlled trials of produce prescriptions to confirm our findings,” he said. “Scientists generally agree that these studies, in which participants would be randomized to receive or not receive produce prescriptions, provide the best evidence, and they may be required for programs to expand significantly throughout U.S. health insurance.”
Additionally, the study also relied heavily on self-reported data.
“The surveys are subjective; the only objective measures are those which were measures in the clinic — HbA1C, blood pressure, and BMI,” Kharazi said.
Costa also cautioned that the study doesn’t consider the practicality and feasibility of long-term application of produce prescriptions.
“The study…doesn’t provide information regarding the long-term sustainability and cost-effectiveness of these produce prescription programs,” Costa said. “It also does not explore the potential challenges in scaling up these programs to a national level or their applicability in different cultural contexts.”
Elkind noted there are many barriers to food access, including:
- food and nutrition insecurity
- food marketing
- access and affordability of healthy foods
- behavioral tendencies, such as a focus on immediate versus delayed gratification
Food prescriptions help fill some of these gaps, thereby improving heart health outcomes, though systemic challenges still present some barriers.
Miller said that food access can be a challenge and that the decrease in food insecurity in the new study was impressive. She noted other scaled federal initiatives that exist to address barriers to access.
“We have SNAP, WIC, Meals on Wheels, and food banks,” Miller said. “We have lots of other safety-net programs for food. SNAP, which is the modern rendition of food stamps, has been shown to achieve the same health outcomes the study has shown.”
- increase self-reports of “excellent” or “very good” health
- decrease time spent in bed sick by about 3 days annually
- lower reported office-based doctor visits by between 1 to 2 per year
For policymakers, Miller said the question is not: “Are food prescriptions a good idea?” Instead, the question is: “Are they the best way to offer these food benefits, or should we invest deeper in current programs?
Moreover, Miller said she is concerned that as the drumbeat around food prescriptions grows louder, the small community non-profits, like Community Kitchen in Boston, will get pushed aside.
She said these organizations are often sourced from local farmers and make essentially homemade meals. Now, big box chains can swoop in, and she fears the quality will decrease with mass production.
“As dollars come in, big companies are getting involved in produce prescriptions and medically-tailored meals,” Miller says. “It looks like something you’d find at Taco Bell or McDonalds. It’s highly processed…the loophole is that they are meeting the nutrient profiles and calorie requirements of medically tailored meals, so they are able to slip it in as something legitimate. But it is a highly processed food product…and less palatable and delicious.”
According to Miller, produce prescriptions are not yet widely available. However, there are ways individuals can gain access to them.
“Medicare Advantage is covering some fresh foods and medically-tailored meals,” she said.
States, including California, have waivers that allow individuals with specific conditions like type 2 diabetes to use dollars from Medicaid to purchase food for a specific amount of time.
Right now, an individual’s best bet is similar to most other, more common prescriptions.
“Key to Food Is Medicine programs is a physician’s prescription,” Elkind said. “People should discuss these programs with their physician to see whether they might be eligible. They may also want to check with their health insurance program to see whether food resources are available under their plan.”
A new study indicates that produce prescriptions could lead to higher intake of fruits and vegetables and lower risk factors linked with an increased chance of developing heart disease, including improvements in BMI and blood pressure in adults.
Researchers also indicated that adults and children who participated in produce prescriptions were less likely to report being food insecure.
Experts say that food prescriptions may help people get the nutrients they need, thereby leading to improved cardiovascular health outcomes. Moreover, the access to food for people struggling to make ends meet was also promising.
However, the study did not have a control group, and some experts caution that implementation and practicality of produce prescriptions pose a challenge.
Still, diet is a crucial part of overall health. People interested in food prescriptions should speak to a doctor and check with their insurance provider for availability.