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Nutrition prescriptions

Health Factors: Diet & Exercise
Decision Makers: Community Members Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Expert Opinion
Population Reach: 50-99% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Nutrition prescriptions are one way for physicians and other health care providers to outline a healthy, balanced eating plan for patients. Based on US Dietary Guidelines for adults, children, and adolescents (US DHHS-DG), nutrition prescriptions establish achievable goals for the patient and their family. Health care providers check progress at each office visit and a nutrition specialist is consulted for dietary advice as needed. Some nutrition prescription programs partner with local farmers’ markets (FVRx programs); in these programs, prescriptions for fruit and vegetables are redeemed at participating markets. Such prescriptions typically support the purchase of at least one serving of produce per day for each patient and their family members (TFAH-Levi 2014). 

Expected Beneficial Outcomes

Increased healthy food consumption
Increased fruit & vegetable consumption
Improved health-related knowledge
Improved dietary habits
Improved nutrition
Improved health outcomes

Evidence of Effectiveness

Nutrition prescriptions are a suggested strategy to increase consumption of healthy foods including fruits and vegetables and decrease consumption of unhealthy foods, especially saturated fats, trans fats, sodium, and added sugar (TFAH-Levi 2014, US EOP-Childhood obesity 2010, Let's Move-Eat healthy). Healthy eating and nutrition counseling, advice, and information given by physicians and other health care providers influences patient behavior (Bhattarai 2013, Dorsey 2011); however, additional evidence is needed to determine the effects of nutrition prescriptions specifically.

An evaluation of the Wholesome Wave FVRx program in 5 states and DC indicates that over half (55%) of program participants reported increasing daily fruit and vegetable consumption throughout the program, and over one-third (42%) of participants decreased their body mass index (BMI) between the first and last FVRx program health care visits (WW-Publications). FVRx participants also reported increases in household food security, knowledge about nutrition, and how to buy and prepare fresh local produce (WW-Publications). A UK-based study suggests that using produce vouchers and consumption messages in FVRx programs may not be sufficient to change consumption, but can improve participants’ knowledge about the recommended number of portions and portion sizes of different fruits and vegetables (Buyuktuncer 2014).

FVRx programs also generate revenue for small and mid-sized farms selling at farmers markets (WW-Publications).

Implementation

United States

The 5-2-1-0 childhood obesity prevention program is an example of a program that includes health care provider partners that give patients nutrition and physical activity prescriptions. Prescriptions encourage daily habits that include 5 servings of fruits and vegetables, 2 hours or less of screen time, 1 hour or more of physical activity, 0 sugary drinks, and increased water consumption. Providers also administer healthy habits questionnaires and monitor patients’ BMI. The 5-2-1-0 program started in Maine (MMC-5210), and has expanded to cities and states all over the country, for example, Florida (FL DOH-5210); Kentucky (KY DPH-5210); New Hampshire (FHC-5210); Baton Rouge, LA (MHCI-5210 plus 10); Chesterfield County, VA (CCHD-5210 everyday); and Palo Alto, CA (PAMF-5210 resources).

In Shawnee County, Kansas a ‘Just Add Water’ campaign includes prescription pads for physicians to prescribe increased water consumption for their patients (CDC DNPAO-Kansas profile 2012). 

Implementation Resources

AAP-Rx examples - American Academy of Pediatrics (AAP). Healthy active living prescriptions: Sample prescription pages. Accessed on February 7, 2017
ESMM NC-Nutrition prescription 2009 - Eat Smart Move More North Carolina (ESMM NC). Achieving a healthy weight in children: Medical nutrition therapy protocol and handouts. 2009. Accessed on February 7, 2017
MBC-Health care toolkit - Mary Bridge Children’s (MBC) Hospital-Clinics-Foundation. Health care toolkit: Ready, set, go! 5210. Accessed on February 7, 2017
WW-FVRx - Wholesome Wave (WW). Produce prescriptions: Redeem your FVRx prescriptions. Accessed on March 16, 2017
WW-Publications - Wholesome Wave (WW). Publications and resources: Fact sheets, reports, and toolkits. Accessed on March 16, 2017

Citations - Description

TFAH-Levi 2014 - Levi J, Segal L, St. Lauren R, Rayburn J. The state of obesity: Better policies for a healthier America 2014. Washington, DC: Trust for America's Health (TFAH); 2014. Accessed on November 11, 2017
US DHHS-DG - US Department of Health and Human Services (US DHHS). The dietary guidelines for Americans. Accessed on March 3, 2017

Citations - Evidence

Bhattarai 2013 - Bhattarai N, Prevost AT, Wright AJ, et al. Effectiveness of interventions to promote healthy diet in primary care: Systematic review and meta-analysis of randomised controlled trials. BMC Public Health. 2013;13:1203. Accessed on February 7, 2017
Buyuktuncer 2014* - Buyuktuncer Z, Kearney M, Ryan CL, Thurston M, Ellahi B. Fruit and vegetables on prescription: A brief intervention in primary care. Journal of Human Nutrition and Dietetics. 2014;27:186-193. Accessed on February 7, 2017
Dorsey 2011 - Dorsey R, Songer T. Lifestyle behaviors and physician advice for change among overweight and obese adults with prediabetes and diabetes in the United States, 2006. Preventing Chronic Disease, 2011;8(6):A132. Accessed on February 7, 2017
Let's Move-Eat healthy - Let's Move! Eat Healthy: Pediatricians as partners. Accessed on March 23, 2017
TFAH-Levi 2014 - Levi J, Segal L, St. Lauren R, Rayburn J. The state of obesity: Better policies for a healthier America 2014. Washington, DC: Trust for America's Health (TFAH); 2014. Accessed on November 11, 2017
US EOP-Childhood obesity 2010 - Executive Office of the President (US EOP). Solving the problem of childhood obesity within a generation: White House Task Force on childhood obesity report to the President. 2010. Accessed on March 23, 2017
WW-Publications - Wholesome Wave (WW). Publications and resources: Fact sheets, reports, and toolkits. Accessed on March 16, 2017

Citations - Implementation

CCHD-5210 everyday - Chesterfield County Health Department (CCHD). 5-2-1-0 Everyday! Chesterfield County's Coalition for Active Children (COACH) promotes 5-2-1-0 message to help prevent childhood obesity. Accessed on March 9, 2017
CDC DNPAO-Kansas profile 2012 - Centers for Disease Control and Prevention (CDC), Division of Nutrition Physical Activity and Obesity (DNPAO). State of Kansas nutrition, physical activity, and obesity profile. 2012. Accessed on February 7, 2017
FHC-5210 - Foundation for Healthy Communities (FHC). 5-2-1-0 Healthy NH. Accessed on March 9, 2017
FL DOH-5210 - Florida Department of Health (FL DOH), FloridaHealth Lee County. The 5-2-1-0 plan for a healthier active lifestyle. Accessed on March 9, 2017
KY DPH-5210 - Kentucky Cabinet for Health and Family Services Department for Public Health (KY DPH). 5-2-1-0: Kentucky has the prescription for significantly reducing childhood obesity. Accessed on March 9, 2017
MHCI-5210 plus 10 - Mayor's Healthy City Initiative (MHCI). Healthy Baton Rouge: 5-2-1-0+10: Numbers for your children's health! Accessed on March 9, 2017
MMC-5210 - Maine Medical Center (MMC), Healthy Maine Partnerships (HMP). 5-2-1-0 Let's go! Accessed on March 9, 2017
PAMF-5210 resources - Sutter Health Palo Alto Medical Foundation (PAMF). 5-2-1-0 Resources. Accessed on March 9, 2017

Page Last Updated

February 9, 2017

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