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Published on March 23, 2021

A prescription program for healthy eating

CB Healthy Eating

It’s well-known that a healthy diet rich with fruits and vegetables promotes good metabolic health. Unfortunately, not everyone can afford to eat a healthy diet.

That is about to change for seniors on the Outer Cape, thanks to a new Fruit and Vegetable Prescription program. The produce prescription program is a partnership between Sustainable CAPE and Outer Cape Health Services, explained Sustainable CAPE founder Francie Randolph. The program was supported through a $22,500 Community Benefits grant from Cape Cod Healthcare.

“We’re looking to prevent disease at its root cause through healthful food,” Randolph said. “So, this program increases access to fruits and vegetables in a low-income rural senior population that has been specifically diagnosed with chronic cardiometabolic illnesses here on the Outer Cape.”

Through the program, doctors at Outer Cape Health Services will give qualifying patients a prescription for fresh fruits and vegetables. The seniors will then be able to take the prescription to a local farmers market. At the farmers market, the seniors can then turn their prescription in for a box of seasonal vegetables from local growers. As the seasons change, the contents of the box will change.

The emphasis is on an in-person farmers market experience whenever possible because, in addition to providing seniors with nutritious food, the produce prescription program is also designed to combat the isolation and loneliness so many seniors face. At the market, participants can interact with the market manager and the various farmers. Many markets also feature musical entertainment and multi-generational activities.

However, the produce can be delivered to those with transportation or mobility issues. “Transportation is a barrier to healthful food access,” explains Randolph. “We’ll work with participants to address this barrier specifically.”

As part of the community building, each participant in the 12-week program will also attend five nutrition classes taught by registered dietician Nicole Cormier from Delicious Living Nutrition.

“The nutrition classes will really focus on not just the food, but how to shop for the food, how to store the food, how to cook the food, and some really simple recipes,” Randolph said. They will also learn about how fruits and vegetables impact metabolic health.

Food Insecurity Has Increased

Age and poor diet are both risk factors for metabolic disease, and Randolph pointed out that Barnstable County has an older population than Massachusetts as a whole. When juggling financial obligations on a fixed income, older adults make difficult decisions to work within a limited budget. Feeding America reports that low income older adult households have made choices between food and paying for utilities (60%), transportation (58%), medical care (63%) or housing (49%).

In addition, Massachusetts is the most expensive state in terms of the cost of a meal and the Cape and Eastern Massachusetts have the most expensive food costs in the state. The pandemic has only made that situation worse. In April of 2020, the cost of food increased close to three percent, Randolph said. That is the largest monthly increase since 1974.

“The food insecurity rate before COVID was one in 11 in Barnstable County and now it is one in eight,” she said. “SNAP applications have more than tripled during the pandemic. What we’re trying to do with this Fruit and Vegetable Prescription program is introduce people to the idea that food is health, food is medicine and that health is something you can support right at home.”

Participants in the Fruit and Vegetable Prescription program will also be introduced to other food access programs run by Sustainable CAPE. The Healthy Incentive Program offers SNAP card holders an immediate refund on their card for money spent on fruits and vegetables purchases directly from participating farmers and farmers’ markets. The monthly allotment of $40 to $80 is dependent on family size.

Sustainable CAPE’s Bonus Match Programs give SNAP card holders, and recipients of WIC or Senior Discount Coupons, a matching bonus of up to $10 in produce tokens at the Market Information Table at the Provincetown, Truro, Wellfleet, Orleans, Brewster and Falmouth Farmers’ Markets.

Veterans will be encouraged to participate in Project Gratitude. They will receive $10 in produce tokens in gratitude for their service to spend at the Orleans, Truro and Provincetown Farmers’ Markets.

“Veterans have a much greater rate of chronic disease than the average rate in the U.S.,” Randolph said. “They are also at risk of social isolation. So, we want to engage with our veteran population, thank them for their service and work together to support our local farmers.”

Produce prescription programs are an evidence-based model at the national and state level, but they have also proven effective locally. In 2016 and 2017, Sustainable CAPE partnered with Kumara Sidhartha, MD, who at the time was the medical director of what was then known as Emerald Physicians for a program called FLAVORx.

That program consisted of two single-blind random-control trials designed to test their hypothesis that increasing access to fruits and vegetables among food insecure populations would improve healthy eating and lead to better health outcomes.

The program was a success. Compared to the control group, the treatment group in the studies showed improvements in blood glucose, total cholesterol, and BMI. They also showed a significant increase in knowledge about cooking a healthy meal.

“Health disparities are really rooted in the differences that exist in access to food and appropriate nutrition interventions,” Randolph said. “What we’re trying to do is to build as many avenues to reach our Cape Cod population and encourage them to participate in the consumption of fresh and nutritious local fruits and vegetables. Our work supports patients, farmers and strengthens our local food system, thereby helping us all.”