The recent blog post by Garry Welch, Ph.D., Chief Scientific Officer of Silver Fern, focused on ways to improve Americans’ fruit and vegetable intake. Dr. Welch discussed the rationale for society to invest in programs that allowed and encouraged medical personnel to prescribe food as opposed to, or in combination with medicine, to treat chronic diseases.
Currently, most fruit and vegetable prescription programs are only in the pilot phase. In most of these programs, participants are either given vouchers to local grocery stores or they are given subsidized grocery bags provided by local farmers’ markets or community gardens. Funding for these programs is generally supplied by research institutions or grant programs. Even in their infancy, these programs show positive outcomes. Patients are improving their health parameters, and patients and providers in these programs express a greater partnership in care. Unfortunately, these programs currently reach a small number of people. Major changes to federal policies and agricultural infrastructure would be needed before physicians’ offices are prepared to use nutrition prescriptions in a systematic way, however through partnership, dietitians and physicians can work together to help patients pay closer attention to their fruit and vegetable intake.
Until formal prescription programs are adopted more widely, dietitians can form relationships with physicians to guide them to write meaningful nutrition prescriptions for individual patients with chronic diseases. Research has shown that physicians using brief, evidence-based techniques can help patients change their behavior. Providing positive rationale for patient actions, such as telling them that they will feel better and have more energy, rather than saying they can avoid getting high blood pressure or diabetes, combined with an individual nutrition prescription, such as have at least three servings of a leafy green vegetable a week, can help patients set realistic goals. Dietitians, who specialize in understanding patients’ eating habits and preferences, can also coach physicians on a specific meal plan recommendation that would align with the patient’s goals and preferences.
Just as patients must understand how to interpret their medication prescriptions, the same is true for nutrition prescriptions. With the limited time physicians are allotted to see patients and their currently limited training in nutrition sciences, dietitians are the logical health care workers to help patients put nutrition prescriptions to best use. Guiding patients on ways to buy the best, freshest produce, how to store it appropriately, and ways to find and modify recipes are common skills for dietitians. Many dietitians spend considerable time talking about how nutrients, or lack thereof, relate to health when time may be better served discussing how clients can begin to tweak their current meals to reduce processed foods and introduce more produce.
Unfortunately, many patients with chronic diseases are also economically disadvantaged. Most pilot nutrition programs provide the food either free of charge or through some discount program. Physicians and dietitians working without the benefit of outside program funding can still make headway by exploring what is available to individual patients. These patients may not be taking advantage of the financial assistance programs that they are entitled to, such as SNAP (Supplemental Nutrition Assistance Program), WIC, (Women, Infants, and Children), and Medicaid, or they may not know how to access them. There may also be food banks in the community and food co-ops where discounted or free groceries are provided in exchange for volunteer hours. Dietitians can inform patients about programs such as WIC and refer them to social workers who can review the patient’s needs and match them to appropriate programs.
One way to help patients is by showing them how to determine if buying in bulk vs. single servings is best to fit their budgets and how fresh, frozen, and canned produce can help them stretch their food budget. Additionally, teaching patients how to read unit pricing in supermarkets and to use coupons can help them become more savvy consumers.
Healthy eating habits are one of the most crucial lifestyle measures we have available to combat chronic disease. Collaboration between providers and dietitians can make individual nutrition prescriptions a realistic approach until the implementation of more formal food policy changes.
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Nora Saul is a Registered Dietitian and Certified Diabetes Care and Education Specialist. Nora has more than 25 years of experience in the field of diabetes education, consulting for the Joslin Diabetes Center and other industry partners. Nora leads content development for Silver Fern’s diabetes products and training.