November/December 2020 Issue
The Retail RD: Produce Prescriptions — Connecting Health Care With Retail
By Barbara Ruhs, MS, RD
Vol. 22, No. 9, P. 18
Poor diet is a leading risk factor associated with death and disease in the United States and worldwide; in fact, nearly 3% of deaths across the globe are attributed to low fruit and vegetable intake, and these deaths also can take exorbitant tolls on nations’ economies.1
Produce prescription programs are one innovative approach to preventing diet-related chronic diseases. While produce can be more expensive than calorie-dense, heavily processed foods—especially in areas such as food deserts where there are few places to buy healthful foods—produce prescriptions offer low-income individuals at higher risk of chronic disease a financial incentive to purchase fruits and vegetables. These programs have been shown to increase fruit and vegetable consumption in both adults and children and have the potential to decrease health care costs by $40 billion over a lifetime.2-4
How They Work
Individuals eligible for produce prescriptions often are identified by health care providers serving low-income populations. These patients have been diagnosed with lifestyle-related conditions such as prediabetes, type 2 diabetes, obesity, or hypertension and qualify based on income level (evaluated via their health insurance provider and/or participation in SNAP). Although receiving SNAP benefits isn’t a prerequisite for participation in produce prescription programs, many individuals who take part in them do receive food assistance from SNAP.
Once identified, participants are given a “prescription” that includes a recommendation for the number of servings of fruits and vegetables they should eat daily; a voucher, gift card, or funds added to their SNAP EBT (electronic benefits transfer) card to be used for the purchase of fresh fruits and vegetables at participating local retailers and farmers’ markets; and referrals to community nutrition education resources to support a transition to a healthful lifestyle.
Here are some examples of produce prescription programs making a difference in the lives of many people.
Wholesome Wave is the largest and was among the first nonprofit organizations to pilot produce prescription programs in the form of its Wholesome Rx initiative, launched in 2007. Wholesome Wave’s position is that solving hunger isn’t about providing only more food but also the right food so those in need can live healthful lives. Its produce prescription programs have been implemented nationwide and have demonstrated results in increasing consumption of fresh produce in program participants. Wholesome Wave’s produce prescription programs have served as a model for community-linked, health care provider–assisted programs that have the power to impact behavior change in at-risk populations.
Another prominent but more localized produce prescription program was created by a dietitian for Giant Food, a division of Ahold-Delhaize. Initiated by Jillian Griffith, MSPH, RDN, LDN, a nutritionist for Giant Food, the nine-month program ran from April to December 2019 in partnership with DC Greens, a nonprofit organization that has been running its Produce Rx program since 2012 in partnership with Washington, D.C., farmers’ markets. In 2019, DC Greens shifted to a grocery store model to offer access to fresh produce year-round. Eligible participants must be Medicaid beneficiaries through AmeriHealth Caritas DC; be diagnosed with prediabetes, diabetes, or hypertension; and attend one of six participating health care clinics to obtain a produce prescription. Participants receive one $20 coupon per week to spend on produce at a Giant Food location in Washington, D.C. Participants also attend a nutrition store tour with one of Giant’s in-store nutritionists.
Produce prescription programs include education and peer support for participants to help them work toward lifelong healthful habits. Nutrition education organizations teach participants basic cooking skills and share easy recipes, focusing on culturally sensitive food and nutrition materials. These nutrition education programming and support systems may have an even greater influence on behavior change than the money provided for produce.4
There also are significant health care cost savings. A 2006 cost-benefit analysis of nutrition education illustrated that every dollar spent on nutrition education saved nearly $4 on delayed medical treatment costs.5 A 2016 study examining the effect of dietitian-based nutrition education on fruit and vegetable intake reported similar cost benefits and demonstrated that nutrition education contributed significantly to nutrition-related behavior changes.6
Most recently, a study published in June 2020 reported that “food as medicine” interventions, including fruit and vegetable prescription programs, might be associated with improved health outcomes and in some cases reversal of disease as well as reduced health care costs.2
How Retail RDs Can Get Involved
Retail dietitians play a pivotal role in enhancing the success of produce prescription programs by sharing their nutrition expertise and supporting customers who may need help with budgeting, preparation ideas, and connecting produce consumption with health benefits. By providing easily accessible nutrition information at multiple touchpoints in-store, online, and in publications, the possibilities for retail dietitians to make an impact are endless.
RDs can share vendor-supported coupons and produce selection and storage information to help participants maximize their budgets and nutritional intake while reducing food waste. In-store dietitians have an opportunity to offer a competitive advantage by providing their nutrition services to program participants who have a choice between multiple retailers/stores in the area.
For retail dietitians interested in supporting the success of produce prescription programs, there are many ways to get involved. Wholesome Wave’s Wholesome Rx program has been implemented in Arizona, California, Connecticut, Maine, Michigan, Massachusetts, Minnesota, New Mexico, New York, Ohio, Texas, Rhode Island, and the Navajo Nation. To learn more about Wholesome Wave’s Wholesome Rx programs and get involved, visit WholesomeWave.org. In 2016, the Nutrition Policy Institute published “Review of the Evidence: Health Promotion Strategies for Retail Food Shopping Venues,” which can help retail dietitians maximize efforts to promote produce (npi.ucanr.edu/files/263765.pdf).
Working together with community-supported produce prescription programs, dietitians are a valuable resource with the potential to finally move the needle on fruit and vegetable consumption in the United States now and into the future.
— Barbara Ruhs, MS, RD, is a retail health and wellness strategy expert. She’s the founder of MarketRD.com, a consulting firm specializing in nutrition communications and connecting brands with supermarket dietitians.
1. Krishnaswamy K, Gayathri R. Nature’s bountiful gift to humankind: vegetables & fruits & their role in cardiovascular disease & diabetes. Indian J Med Res. 2018;148(5):569-595.
2. Downer S, Berkowitz SA, Harlan TS, Olstad DL, Mozzaffarian D. Food as medicine: actions to integrate food and nutrition into healthcare. BMJ. 2020;369:m2482.
3. Trapl ES, Smith S, Joshi K, et al. Dietary impact of produce prescriptions for patients with hypertension. Prev Chronic Dis. 2018;15:E138.
4. Ridberg RA, Bell JF, Merritt KE, Harris DM, Young HM, Tancredi DJ. Effect of a fruit and vegetable prescription program on children’s fruit and vegetable consumption. Prev Chronic Dis. 2019;16:180555.
5. Amy BJ, Pradhan V, Goldman G. Cost-benefit analysis conducted for nutrition education in California. Calif Agric (Berkeley). 2006;60(4):185-191.
6. Pem D, Bhagwant S, Jeewon R. A pre and post survey to determine effectiveness of a dietitian-based nutrition education strategy on fruit and vegetable intake and energy intake among adults. Nutrients. 2016;8(3):127.