Prompting a Fresh Start for Adults With Food Insecurity and Increased BMI: A Case Series of Four Patients in a Food Prescription Program

Abstract

Estimates place low intake of fruits and vegetables, physical inactivity, and high BMI (overweight-obesity) as all in the top 12 causes of death. Food and dietary education are becoming a focus in how we approach disease prevention and management, and food prescription programs in particular are showing promise, especially in under-resourced, food-insecure communities. This paper describes a pilot food prescription program in a handful of uninsured patients enrolled in an interprofessional clinical and educational program of a medical school in South Florida. This case series of four patients struggling with food insecurity profiles the demographic and clinical characteristics of the participants and provides the results of standardized assessments of their dietary behaviors, physical activity levels, and attitudes toward food before and after the intervention. This four-month pilot food prescription program, Fresh Start Food Rx, involved a prospective case report of four patients seen on a mobile health center (MHC) for uninsured patients in South Miami, Florida. The MHC is part of an interprofessional health professions education, health care, and social service program of the Herbert Wertheim College of Medicine at Florida International University called the Neighborhood Health Education Learning Program (NeighborhoodHELP). A systematic review of South Miami MHC patient electronic medical records identified eligible participants for the program: patients with food insecurity and a BMI >30, with comorbid health conditions. Patients with greater BMI and more comorbidities were prioritized. Once enrolled, we provided biweekly packages of fresh fruits and vegetables along with monthly dietary education to the participants. Key measures included self-reported fruit and vegetable consumption, attitude toward healthy eating, and level of activity. Pre-and post-intervention focus groups assessed barriers the participants faced to eating healthy and pursuing physical activity, satisfaction with the program, feedback on strengths and weaknesses, and anticipated behavioral changes after completion of the program.Prior to the intervention, participants reported eating fruits on an average of 4.5 days out of the week. Postsurvey answers increased to 5.0 days per week. Though the average amount of days per week that participants reported eating vegetables decreased slightly, the average number of vegetable servings that participants reported eating in a week increased. At termination of the program, most participants agreed that a diet rich in fruits and vegetables is good for you, that it is important to eat fruits and vegetables every day, and that a diet rich in fruits and vegetables can protect against cancer. This case study demonstrates that easier access to healthy foods, such as fresh produce delivery, and regular health education have the potential to promote healthier attitudes toward foods like fruits and vegetables. This change in attitude can then influence behavior, such as choosing to try new produce or incre...

A Systematic Literature Review of Nutrition Interventions Implemented to Address Food Insecurity as a Social Determinant of Health

“…Of the 10 studies that assessed changes in BMI, 2 studies [27,32] found a statistically significant reduction in BMI, 7 [17,18,26,28,30,31,35] found non-statistically significant changes, and 1 [33] found an increase in BMI. For dietary intake in the 17 studies (81.0%), 9 (42.9%) found an increase in fruit and/or vegetable intake [19][20][21][22][23][24][25]28,32], and 5 (23.8%) found no statistically significant changes in this intake [19,26,31,33,34]. Two studies (9.5%) found an increase in whole grain consumption [24,33].…”

“…Table 1 shows an overview of the included studies, and Table 2 provides more details on all of the studies included. A total of 21 studies were reviewed, including 13 (61.9%) food or produce prescription program studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29], 4 (19.0%) medically tailored meal (MTM) program studies [5,[30][31][32], and 4 (19.0%) community-supported agriculture (CSA) studies [33][34][35]. Fifteen studies (71.4%) focused on adult populations and four (19.0%) focused primarily focused on families and pediatric populations.…”

“…Furthermore, there was no formal definition of developed countries, and, thus, some papers could have been inadvertently not included. Two of the included articles [16,23] were food vs. produce prescription programs, but we included these due to their specific focus on produce when describing the intervention. In the future, it will be important to compare the outcomes of food versus produce prescription programs.…”

Implementing a Food Prescription Program during COVID-19: Benefits and Barriers

“…This study contributes to filling this gap in the literature by examining the impact of one such program, which was implemented during COVID-19, to reduce food insecurity and its associated health consequences among patients presenting with chronic diseases. Frequently, the measure of program success comes through self-report of either increased fruit and vegetable consumption or patient satisfaction [31][32][33][34][35]. Specifically, the quantitative results reported herein attempt to extend these evaluations by isolating the impact of food redemptions as they relate to changes in food security and health.…”