Prescribing Veggies: A Billion-Dollar Lifesaver?

Prescriptions for fruits and vegetables could revolutionize diabetes care and slash health care costs

Created by Fei Meng

Swapping pills for peaches and medication for mushrooms could ward off heart attacks and strokes, elevate quality of life, and deliver billions in health care and productivity savings, according to a study published in the Journal of the American Heart Association.

In other words, “an apple a day” might be a fresh, economical answer to the United States’ health care crisis.

The Core of the Study—Could Food Fix Health Care?

The research was conducted through the Diabetes, Obesity, and Cardiovascular Disease Microsimulation model. This computer simulation tool allowed researchers to create a data-driven model of what a national produce prescription program could look like and what its effects would be.

Produce programs aim to get people eating higher quality foods, specifically fruits and vegetables, which offer a complex nutrient profile of synergistic compounds, vitamins, minerals, fiber, and more.

The proposed program would serve free or discounted fruits and vegetables to eligible diabetics aged 40 to 79. It’s designed to resolve the connection between Type 2 diabetes and elements such as lower socioeconomic status, food insecurity, and the shortage of nutritious options for people in urban areas that don’t have nearby supermarkets with fresh produce.

The simulation used data from the Centers for Disease Control and Prevention’s (CDC’s) National Health and Nutrition Examination Survey from 2013 to 2018 and included data on the estimated effects of various interventions and diet–disease effects from meta‐analyses of several studies. The simulation included policy‐ and health‐related costs.

The simulation found that implementing a produce prescription program for nearly 6.5 million U.S. adults with diabetes and food insecurity could prevent 292,000 cardiovascular events over the next 25 years.

Participants in the simulated social program boosted their daily fruit and vegetable consumption by 0.8 servings on average. This incremental change brought about a modest decline in body mass index.

Participants also recorded lower levels of hemoglobin A1C (HbA1c), a key measure of blood sugar management over an extended period. This drop reflects the potential for better management of blood sugar—a key health marker, especially for people with diabetes.

Co-senior author Dariush Mozaffarian, a renowned cardiologist and professor of nutrition at the Friedman School of Nutrition Science and Policy, praised the potential of produce prescriptions.

“Of the strategies that can improve nutrition and diet-related health outcomes for Americans, evidence continues to build that produce prescriptions are a terrific option,” he wrote in a Tufts University article.

But what do these improvements mean in the broader scope of life quality? The researchers quantify these improvements using a metric called “Quality-Adjusted Life-Years” (QALYs), which is a measure of years lived with good health. The study showed a gain of 260,000 QALYs among the 40- to 79-year-olds the program would target.

While the program’s roll-out would cost an estimated $44.3 billion, including patient screening, nutrition education, and administrative costs, the potential savings overshadow the investment at an estimated $44.4 billion in health care and productivity cost.

Even when evaluated over shorter periods such as 5 and 10 years, the program would cost $18,100 for each QALY gained. This figure is lower than that of many traditional health care interventions.

Notably, the benefits of the intervention were broadly distributed, with results consistent across the population—regardless of age, race, ethnicity, education level, and insurance status.

“These results suggest that a national produce prescription initiative could benefit all Americans, highlighting the potential of Food is Medicine strategies to alleviate health inequities caused by food and nutrition insecurity and diet-related diseases,” first author Lu Wang, a postdoctoral fellow at the Friedman School, reported.

In terms of real-world application, there’s potential for the integration of a national produce prescription program as a covered benefit within Medicare Advantage plans and state Medicaid programs—a shift already in motion to some degree. The study authors suggest that the U.S. Department of Agriculture could also roll out a new initiative akin to the Supplemental Nutrition Assistance Program tailored for Women, Infants, and Children.

High Cost of Chronic Illness in US

Despite its standing as a global leader in health care spending, the United States has a population in deteriorating health—with nearly 60 percent having at least one chronic ailment. Diet-related afflictions alone represent nearly a fifth of the country’s yearly health care expenditures.

These statistics underline the urgency for a more health-conscious society—something the CDC also acknowledges. As of 2019, only 12.3 percent and 10 percent of adults consume an adequate daily amount of fruits and vegetables, respectively.

The American Diabetes Association, recognizing the pivotal role of diet in managing conditions such as diabetes, also recommends a diet rich in vegetables, fruits, lean proteins, and whole grains.

Studies find that for many low-income Americans, the chief challenge in keeping a nutritious diet is its affordability. Studies further indicate that people prioritize filling calories over nutritional value when faced with financial constraints. Less nutritious ultra-processed foods offer a compelling combination of convenience, taste, and low cost that many Americans find hard to resist.

How Produce Prescriptions Are Revolutionizing Health Care

A recent initiative targeting people with Type 2 diabetes in rural northwestern U.S. health centers demonstrated promising results within a time frame of only four weeks.

The program’s effect was most notably seen in the significant drop in participants’ HbA1C levels. A striking 76 percent of participants started the program with dangerously high HbA1C levels. By the program’s conclusion, this figure had plummeted to just 41 percent.

These findings align with a 2017 study, in which individuals with uncontrolled diabetes similarly experienced a significant reduction in HbA1C levels after only 13 weeks. These concurrent results demonstrate the potential efficacy of produce prescription programs in managing Type 2 diabetes.

Thanks to these successes, produce prescription programs are rapidly gaining momentum, with robust support from public and private entities. The U.S. Department of Agriculture recently invested $59.4 million in the Gus Schumacher Nutrition Incentive Program (GusNIP). These programs enable health care providers to prescribe fresh fruits and vegetables to patients, injecting a wholesome dose of nutrition into health care.

“Since its creation in 2019, GusNIP projects have increased access to healthy foods, and this investment serves to ensure that even more consumers can provide fresh, locally-grown fruits and vegetables for their families,” Dr. Dionne Toombs, acting director of the USDA National Institute of Food and Agriculture, said in a press release.

Private health care players are also bolstering this innovative approach to health. A notable example is Geisinger Health, which has been working to extend its Fresh Food Farmacy program, mainly targeting people with diabetes and those experiencing food insecurity.

Sharing knowledge and best practices is crucial to these programs’ efficacy. In this spirit, the National Produce Prescription Collaborative, a network of produce prescription providers, is focused on facilitating knowledge exchange. The aim is to identify how this approach can integrate into existing health care payment models, thereby expanding its reach and potential effects.

Produce prescription programs are also taking root at state levels, with North Carolina, Massachusetts, and California implementing them under various Medicaid waivers.

Moreover, the White House announced a new National Strategy on Hunger, Nutrition, and Health on Sept. 28, 2022. This strategy emphasizes testing produce prescription programs in Medicaid, Medicare, Veterans Affairs, and the Indian Health Service.

Organizations such as Kaiser Permanente, the American Heart Association, the Rockefeller Foundation, the American Academy of Pediatrics, and the American College of Lifestyle Medicine have also committed substantial resources and training efforts, firmly endorsing the “food is medicine” concept.

The success of these initiatives depends on various elements. Recently established guidelines by the Centers for Medicare and Medicaid Services could present considerable challenges.

“Moving forward, states using innovative Medicaid financing will not be able to enroll members in food-as-medicine programs for more than six months, regardless of diagnosis or financial circumstance,” Adam Shyevitch, chief program officer at About Fresh, a nonprofit championing produce prescriptions, reported.

Implementing produce prescription projects is no simple feat. Beyond securing funding and staffing, research indicates that patients who benefit from these programs often wrestle with an intricate web of social issues beyond just food insecurity.

Logistical difficulties from transportation and child care to unreliable communication channels with patients can hamper patient engagement, making the delivery of these programs a demanding task. Overcoming these challenges is critical to unlocking the full potential of these initiatives in the fight against chronic diseases.

The potential benefits of the “food as medicine” concept could be transformative for society—potentially marking a profound shift in our approach to health and wellness care.

“These innovative treatments are exciting because they can not only improve health and reduce health care spending, but also reduce disparities by reaching those patients who are most in need,” Dr. Mozaffarian said.