Approximately $1.24 per year per person is spent in the U.S. on preventive health versus $1,390 to treat diet-related disease. In an effort to turn the tables on these statistics, the Santa Rosa Family Medicine Residency Program, affiliated with the University of California, San Francisco, and managed by Sutter Health, is conducting a research trial that examines the effects of giving low-income women at risk for gestational diabetes mellitus (GDM) physician-prescribed vouchers for fruits and vegetables at the local Santa Rosa farmers market. The small, randomized controlled trial, called FVRx (fruit and vegetable prescription), includes approximately 100 at-risk women.
Can fresh food vouchers, along with intensive nutrition counseling, help women at risk for GDM consume at least one additional serving of fresh produce per family member per day, maintain healthy weight gain in pregnancy and reduce the risk of developing GDM?
According to Rachel Friedman, M.D., faculty physician at the Santa Rosa Family Medicine Residency, approximately 25 to 50 percent of the pregnant women who receive care at the Santa Rosa Community Health Centers are at risk for developing GDM. “These women became a natural focus for intervention since they are a cohort with regular clinic visits,” Dr. Friedman said. The study subjects were chosen because interventions with mothers-to-be at risk for GDM affect not only the mother’s heath, but also delivery outcomes, fetal well-being and ultimately the health of the entire family.
The FVRx study is part of a national collaborative sponsored by Wholesome Wave, a private foundation. Wholesome Wave promotes similar public health projects across the U.S. Its mission is to improve access and affordability of fresh, healthy, locally grown produce to historically underserved communities.
The researchers received $60,000 for the pilot study, with about half of the funding from Wholesome Wave and additional grants from the California nonprofit Roots of Change and the Kaiser Permanente Community Benefit Grant Program.
Study Design
Recruitment for participants began in September 2011 and concluded in February 2012. Eligible patients were identified during an OB intake clinic at the Vista Family Health Center (part of Santa Rosa Community Health Centers) and were invited to participate in the study. Subjects were then randomized to receive either nutrition education and healthy eating resources (control group), or education and resources, plus farmers market vouchers (intervention).
At each monthly prenatal care visit, both groups of subjects (control and intervention) fill out a brief questionnaire regarding fruit and vegetable consumption and receive standardized nutrition education explained by their provider. In addition, the intervention subjects receive an actual paper prescription redeemable for fruits and vegetables at the Santa Rosa farmers market in the amount of $7 per household family member per week, or $112 worth of fresh produce every month for a family of four. Vouchers will continue to be distributed monthly through the duration of the subject’s pregnancy.
To date, the program has enrolled 60 voucher and 43 control patients. According to Dr. Friedman, the effects of the health prescription have been immediate. “We have been thrilled to discover that many of the voucher patients are going to the farmers market and bringing their families, some for the very first time,” She said. “So far we have seen at least a 30 to 40 percent rate of the intervention group going to the public market and buying fruits and vegetables, and preliminary data shows that our patients receiving the vouchers are increasing their average intake of fruits and vegetables more than those in the control group. This is certainly encouraging.”
Dr. Friedman expects to have the final data from the small pilot project by December, and expects to publish the study in a peer review journal.
Why the farmers market?
According to Dr. Wendy Kohatsu, who is a trained chef as well as a family physician, the study puts into practice her philosophy about food and wellness. “I believe that local, fresh food is not just tastier, but also healthier because nutrients have not been degraded or processed out,” she said. Those physicians involved in the study “also believe in supporting our local farmers, reducing our carbon footprint by purchasing food grown nearby and boosting the local economy.”
She said that while it is “ironic that we are conducting a randomized trial just to prove the obvious, that fresh fruits and vegetables are good for patients, what has been most gratifying is to be ‘walking our talk,’ and actually prescribing local fruits and vegetables to some of our most vulnerable patients along with supporting our farmers and our community.” One could look at the FVRx program as uplifting the community as a whole, she said. “Each dollar invested in a program like FVRx pays forward threefold by nourishing the consumer, boosting local farm revenues” and keeping the whole community healthy.
The researchers would like to acknowledge Alicia Cohen, M.D., for helping us to develop and launch the FVRx program in Sonoma County; the Vista Family Health Center; Michael Dimock at Roots of Change; the Kaiser Permanente Community Benefit Grant Program; and Wholesome Wave, which funded the study and allowed it to be one of the sites for the FVRx program.