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Filling Prescriptions at the Fruit and Vegetable Stand

By Beth W. Orenstein

"Let food be thy medicine and medicine be thy food."
— Hippocrates, father of medicine, 431 BC

Doctors at Memorial Hermann Memorial City Medical Center in Houston are putting Hippocrates' time-honored advice into practice.

They're writing prescriptions for fruits and vegetables that enable their patients to get a box of fresh organic produce at a substantial discount—$15 rather than $25. 
The Memorial Hermann Foundation funds the $10 refund patients receive when given a prescription to purchase the fruits and vegetables from their doctor.

Patients must present their prescription to the "Farmacy" located in the lobby of the medical center. The stand is open to everyone year-round from 10 am to 2 pm each Wednesday, but only patients with prescriptions get the discounted price. The hospital is hoping for additional funding so patients can get the boxes for free.

The produce stand is the brainchild of Garth Davis, MD, a bariatric surgeon. He was inspired by his own battle with weight gain and high cholesterol and patients who had failed to lose weight following surgery and later returned to him to possibly undergo a second surgery. Most of the time, Davis says, "the patients don't need a second surgery; they need to learn how to eat properly for the surgery they had."

Davis says that whenever he tells patients to take pills twice a day, they're likely to do it. "But if I tell them to eat better, they don't," he says. So he decided to write prescriptions for his diet directives just as he would for medications. Davis writes food prescriptions on a pad he designed for this purpose and gives them to every one of his patients. He strongly recommends regular exercise as well.

Davis has recruited colleagues to do the same, but the response hasn't been as great as he'd hoped. "I have a few doctors writing them and am trying to get more," he says. Since the stand opened in October 2014, it has sold as many as 20 boxes per week during its peak periods. Most of the time, the stand sells seven or eight boxes per week. "We'd like to see it sell 100," Davis says. "We have room to improve."

The key, he says, is to make it worthwhile for patients to drive to the hospital, park their car, and come into the lobby and pick up their boxes. Boxes have to be ordered online by 9 am on the day before pickup.

The fruits and vegetables in the box are organic and mostly locally grown. "We don't want to spread pesticides or genetically modified organisms," Davis says. "We want our patients to get the idea of eating fresh, natural fruits and vegetables." In addition, Davis says, buying locally produced food benefits local farmers. Each box contains apples, oranges, pears, bananas, a berry of the week, lettuce, celery, carrots, spinach or broccoli, and tomatoes. Rawfully Organic, the nation's largest nonprofit organic food co-op based in Houston, packs the boxes.

Recipes are provided in the box for the various fruits and vegetables, which can change with both the seasons and availability. The recipes are similar to the instructions Davis gives patients for taking their medications, he says.

Dietitians love the concept. Kristi L. King, MPH, RD, CNSC, LD, senior pediatric dietitian at Texas Children's Hospital and a national spokesperson for the Academy of Nutrition and Dietetics (the Academy), calls Davis's initiative "great." According to Tamara S. Melton, MS, RDN, LD, a nutrition communications and wellness consultant in Atlanta and also a spokesperson for the Academy, "If patients are motivated to focus on improved health, then having access to fruits and vegetables can help support their efforts."

On the flip side, King doesn't believe it's that easy to get people to eat more fruits and vegetables. "The produce is offered at a reduced rate, but many low-income patients may still have difficulty paying for the box each week," she says. Moreover, she says, that if patients don't know how to incorporate the produce they're given into their diet, it may just go to waste.

Melton also is concerned that the prescriptions and discounts oversimplify the need for behavior modification. If patients are undergoing bariatric surgery, Melton says, they have many other factors to consider to ensure the success of their surgery, especially immediately after the procedure. "For the surgery to lead to long-term weight loss and maintenance, the patient will need to not only include fruits and vegetables," she says, "but also learn how to eat in a way that supports their new physiology."

— Beth W. Orenstein is a freelance writer in Northampton, Pennsylvania, and a regular contributor to Today's Dietitian.