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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: Likely to decrease disparities

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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 patients and their families. 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 (produce prescription or fruit and vegetable prescription (FVRx) programs); in these programs, prescriptions for fruit and vegetables are redeemed at participating markets. Such prescriptions typically support 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). In general, subsidies and financial incentives for healthy foods have been shown to increase healthy food purchases (Gittelsohn 2017, Grech 2015, Jaime 2009, Kocken 2012, An 2013, AHA-Mozaffarian 2012), which enables increased healthy food consumption (Gittelsohn 2017, An 2013, AHA-Mozaffarian 2012); however, additional evidence is needed to determine the effects of nutrition prescriptions specifically.

Reports from the Wholesome Wave produce prescription (FVRx) program suggest that 69% of program participants increase daily fruit and vegetable consumption, and nearly half (47%) of participants decrease body mass index (BMI) between the first and last FVRx program health care visit (WW-FVRx, WW-Annual report 2016). FVRx participants also report increases in household food security, children’s health, knowledge about nutrition, and how to buy and prepare fresh local produce (WW-Annual report 2016). Participants in the Gorge Grown Veggie Rx program also report improved nutritional intake, increased food security, and improved mental and physical health (PCORE-Royal 2016). 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-Annual report 2016, WW-Publications).

Implementation

United States

The 5-2-1-0 childhood obesity prevention program is an example of a program that allows health care provider partners to 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, including Florida (FL DOH-5210); Kentucky (KY DPH-5210); New Hampshire (FHC-5210); Baton Rouge, LA (MHCI-5210 plus 10); Chesterfield County, VA (COACH-5210 everyday); and Palo Alto, CA (PAMF-5210 resources).

Through Gorge Grown Food Network’s Veggie Rx program participating health care providers prescribe $30 worth of vouchers for one month to families who screen positive for food insecurity to redeem at 30 local groceries, farms stands, or farmers markets (GGFN-Veggie Rx). Wholesome Wave’s produce prescription (FVRx) programs allow doctors and other providers around the country to provide $1 per day per household member in fruit and vegetable prescriptions, which can be redeemed at participating farmers markets and grocery stores. Wholesome Wave recently partnered with Target, expanding funding for produce prescriptions and stores that accept prescriptions in Los Angeles, Houston, and Miami (WW-FVRx).

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

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 May 29, 2018
GGFN-Veggie Rx - Gorge Grown Food Network (GGFN). Veggie Rx Program. Accessed on May 22, 2018
MBC-Health care toolkit - Mary Bridge Children’s (MBC) Hospital-Clinics-Foundation. Health care toolkit: Ready, set, go! 5210. Accessed on May 29, 2018
WW-FVRx - Wholesome Wave (WW). Produce prescriptions: Redeem your FVRx prescriptions. Accessed on May 17, 2018
WW-Publications - Wholesome Wave (WW). Publications and resources: Fact sheets, reports, and toolkits. Accessed on May 17, 2018

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 May 29, 2018
US DHHS-DG - US Department of Health and Human Services (US DHHS). The dietary guidelines for Americans. Accessed on May 29, 2018

Citations - Evidence

AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514–63. Accessed on September 26, 2018
An 2013* - An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: A review of field experiments. Public Health Nutrition. 2013;16(7):1215-28. Accessed on March 13, 2018
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 May 29, 2018
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 May 29, 2018
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 May 29, 2018
Gittelsohn 2017 - Gittelsohn J, Trude ACB, Kim H. Pricing strategies to encourage availability, purchase, and consumption of healthy foods and beverages: A systematic review. Preventing Chronic Disease. 2017;14(E107):170213. Accessed on April 27, 2018
Grech 2015* - Grech A, Allman-Farinelli M. A systematic literature review of nutrition interventions in vending machines that encourage consumers to make healthier choices. Obesity Reviews. 2015;16(12):1030-1041. Accessed on April 27, 2018
Jaime 2009* - Jaime PC, Lock K. Do school based food and nutrition policies improve diet and reduce obesity? Preventive Medicine. 2009;48(1):45-53. Accessed on March 13, 2018
Kocken 2012* - Kocken PL, Eeuwijk J, Van Kesteren NMC, et al. Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study. Journal of School Health. 2012;82(3):115–22. Accessed on March 13, 2018
Let's Move-Eat healthy - Let's Move! Eat Healthy: Pediatricians as partners. Accessed on May 29, 2018
PCORE-Royal 2016 - Royal N, Brown K, Rodriguez F, Fernandez B, Valle L, Bello E. Harvesting health: A community-based participatory evaluation of the Veggie Rx program. Providence Center for Outcomes Research & Education (PCORE), The Next Door, Inc. 2016. Accessed on May 30, 2018
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 May 29, 2018
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 May 29, 2018
WW-Annual report 2016 - Wholesome Wave (WW). Wholesome Wave 2016 annual report: Changing the world through food. 2016. Accessed on May 17, 2018
WW-FVRx - Wholesome Wave (WW). Produce prescriptions: Redeem your FVRx prescriptions. Accessed on May 17, 2018
WW-Publications - Wholesome Wave (WW). Publications and resources: Fact sheets, reports, and toolkits. Accessed on May 17, 2018

Citations - Implementation

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 May 29, 2018
COACH-5210 everyday - Chesterfield County's Coalition for Active Children (COACH). 5-2-1-0 Everyday! Accessed on May 10, 2018
FHC-5210 - Foundation for Healthy Communities (FHC). 5-2-1-0 Healthy NH. Accessed on May 10, 2018
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 May 10, 2018
GGFN-Veggie Rx - Gorge Grown Food Network (GGFN). Veggie Rx Program. Accessed on May 22, 2018
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 May 10, 2018
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 May 10, 2018
MMC-5210 - Maine Medical Center (MMC), Healthy Maine Partnerships (HMP). 5-2-1-0 Let's go! Accessed on May 10, 2018
PAMF-5210 resources - Sutter Health Palo Alto Medical Foundation (PAMF). 5-2-1-0 Resources. Accessed on May 10, 2018
WW-FVRx - Wholesome Wave (WW). Produce prescriptions: Redeem your FVRx prescriptions. Accessed on May 17, 2018

Page Last Updated

May 31, 2018

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