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Published on February 01, 2017

These prescriptions are for vegetables – not pillsThese prescriptions are for vegetables – not pills

Francie Randolph is an artist with two degrees from Harvard University. Gus Schumacher is a former Under Secretary of Agriculture under President Bill Clinton. Kumara Sidhartha, MD is medical director of Emerald Physicians, part of Cape Cod Healthcare.

Governor Baker with Francie Randolph as he signed the Farm to School proclamation.

Governor Baker with Francie Randolph as he signed the Farm to School proclamation.

Through happenstance they discovered each other, and together they are forging an alliance to bring fresh fruits and vegetables to more Cape Codders, especially those who cannot access or afford them.

In doing so, they also hope to cut the costs of healthcare by reducing the incidence and severity of chronic diseases, while strengthening the Cape’s growing number of farms and farmers markets.

It’s an ambitious agenda, but one that is occurring across the country as part of an organization called Wholesome Wave, which Schumacher, who owns a home in Orleans, is a Founding Board Chair.

Now in 45 states and Washington, D.C., Wholesome Wave’s National Nutrition Incentive Network’s SNAP and fruit and vegetable prescription programs now have more than 250 partners, encouraging thousands of individuals and their families not only to access healthy affordable fruits and vegetables at farmers markets and retail outlets, but also receive nutrition education to cook and serve them at home.

Wholesome Wave’s Steven Farley said his organization “has seen extreme interest in the field for the fresh fruit and vegetable prescription programming, with more than 60 new network members in the past year demonstrating interest or actively operating prescription programs in their communities.

Wholesome Wave reports [pdf] that 47 percent of those participating in the program experienced a decrease in their Body Mass Index (BMI) over four to six months. Among pediatric participants in 2011-2014, 55 percent experienced a decrease. 

Nationwide, 15 percent of Wholesome Wave’s prescription participants receive WIC (Women, Infants and Children) assistance, 61 percent get SNAP (Supplemental Nutrition Assistance) and 80 percent are on Medicaid.
The prescription program focused entirely on those people who have the most difficult time accessing fresh fruits and vegetables, said Randolph, a Truro resident who lives on an historic farm and founded Sustainable CAPE, a non-profit, non-governmental association, dedicated to local food, sustainable health and wellness.

That population may seem far away to the visitors and second homeowners who love the Cape, but in a place with thousands of multi-million-dollar homes, Barnstable County has the dubious distinction of ranking number one in Massachusetts when it comes to limited access to healthy food, noted Dr. Sidhartha.

“Nine percent of our population is low income and do not live close to a grocery store,” added Randolph. “That is more than twice the average statewide and more than any other county in the state.”

Thus was born FLAVORx, an acronym that stands for FARMERS and LOCAL HEALTH ALLIANCE for VEGETABLES and FRUIT prescription in an OUTCOME based and Rx program. It’s a collaboration between the primary care practice, Emerald Physician Services, under the medical leadership of Dr. Sidhartha and Sustainable CAPE, a local farmers’ market champion directed by its founder Francie Randolph, as well as strong support from Cape Cod Healthcare under the leadership of CEO Michael K. Lauf.

Farmers marketIt’s a collaboration between the primary care practice, Emerald Physician Services, under the medical leadership of Dr. Sidhartha and Sustainable CAPE, a local farmers’ market champion directed by its founder Francie Randolph, as well as strong support from Cape Cod Healthcare.

While inspired by the Wholesome Wave programs occurring across the country, FLAVORx took a giant and unique leap by superimposing a pilot project and clinical trial to achieve precise, measurable outcomes, explained Dr. Sidhartha, who not only is medical director of Emerald Physicians – with 13 clinics across the Cape serving 56,000 patients – but also leads its Wellness Advisory Board.

Eighteen participants were selected among Emerald Physician’s low-income patients in Dennis, Harwich, Brewster, Orleans, Eastham, Wellfleet, Truro and Provincetown who suffer some degree of chronic illness or conditions including obesity, diabetes, high blood pressure and heart disease.

With a $40,000 grant from Cape Cod Healthcare’s Community Benefits department, as well as financial support from the Cape Cod Foundation and Cape Cod Five Foundation, FLAVORx launched in late September 2016 and continued for 12 weeks under Dr. Sidhartha’s and Randolph’s guidance and with the assistance of dietician and nutritionist Nicole Cormier, who conducted a half-dozen nutritional cooking classes.

A review board at Cape Cod Healthcare studied the pilot project’s study protocols and approved it before implementation.

All 18 participants attended the classes and learned to prepare meals rich in fresh fruits and vegetables.

They were divided evenly and randomly. Sustainable CAPE created a prescription token redemption program through which the prescription group actually shopped weekly at the Orleans Farmers Market, the only one on Cape Cod currently operating year-round. The other “control” didn’t receive any free fresh fruits and vegetables but is given free gas cards.

The prescription group redeemed their prescriptions for actual tokens worth $30 each week to go from stall to stall at the outdoor farmer’s market purchasing farm fresh produce, often varieties they cannot find at supermarkets.

Those who don’t shop instead are given free gas cards as an incentive to remain in the program, explained Dr. Sidhartha. “Transportation is one of the main vulnerabilities in this demographic.”

All 18 were seen by their primary care physicians at either of Emerald’s Brewster or Harwich offices. At the start of the 12-week trial, they all were tested and measured for blood pressure, cholesterol, body mass, waist circumference, fasting glucose levels and if diabetic, Hemoglobin A1C tests.

Readings before and at the end of the 12-weeks were tracked among both groups to determine and compare the results of both regimens using standard statistical techniques.

“A fourth partner in this pilot project is the farmers’ markets and the farmers who participate,” explained Randolph. “Not only must they be fully informed and invested, but the program itself has another goal – to put a spotlight on the power of farm fresh produce and stimulate Cape’s economy. “

This collaborative pilot project aims to expand healthcare beyond the four walls of the system and to look at how we bring it into the community, explained Dr. Sidhartha.

“We see it as a win-win scenario for Cape Cod Healthcare, which owns Emerald Physicians, the farming industry and most especially every person on the Cape. What we learn here can teach and benefit everyone who is motivated to prevent chronic disease by altering the way they eat and behave. We hope to give them more proof that fresh produce really is a prescription for good health.”

That’s why Cape Cod Healthcare’s Community Benefits program, which provides more than $21 million a year in actual funding and in-kind contributions across the Cape, is so eager to participate in the FLAVORx program, explained program director, Lisa Guyon.

“We choose projects to invest in based on their anticipated outcomes and community needs,” she said. “We are very interested in tracking how much the participants accept and participate in the program, improving their nutrition knowledge and self-sufficiency, cooking healthy meals for themselves and their families.”

Equally important is to determine how the pilot projects’ results may influence physicians’ own views about the power of fresh produce, Guyon said.

“And most directly, how will a prescription of fruits and vegetables potentially reduce blood cholesterol, blood glucose, body weight and waist circumference among the treatment group.”

Note: As of 5/1/2019, Emerald Physicians joined Medical Affiliates of Cape Cod (MACC), a division of primary and specialty care physicians from Cape Cod Healthcare.