Access to fresh produce improves health outcomes among diabetes patients and those on Medicaid in recent studies

In Stockton, California, nearly 60% of the city’s 320,000 residents are prediabetic or living with diabetes. Shane Bailey, a 72-year-old longtime resident and US Coast Guard veteran, is one of them. And because she lives in a neighborhood that is considered a food desert due to the lack of nearby shops, it can be a huge challenge to access healthy and affordable food.

“I live in the Central Valley with a lot of produce being grown. But in Stockton, it’s often either very expensive, or low quality, or both,” Bailey said.

However, thanks to Abbott and the Public Health Institute’s Healthy Food Rx program, she has had a boost in lifestyle changes that help her manage her condition. The program was a pilot study in which 374 patients with diabetes received biweekly healthy meal kits that included fresh produce from Emergency Food Bank Stockton/San Joaquin for one year.

“It was fun learning how to cook these healthy meals. It kept me busy and improved my mental health,” Bailey said. Each box came with recipes, and participants could join a virtual cooking class to learn how to make each meal. His favorite meal was a green vegetable stir-fry with chicken — packed with broccoli, kale, spinach and bok choy — tossed in hot olive oil and Asian spices.

The Food Rx program has been the subject of one of two recent studies, neither of which have yet been peer-reviewed, that show the benefits of produce prescription programs as a way to improve health outcomes related to diabetes and addressing food insecurity. Advocates say programs that treat food as medicine could go a long way to help low-income people and people with chronic conditions, especially those living in food deserts.

“Health disparities exist in communities of color — Latino and black communities — and people who live in those communities are more affected by diabetes because they tend to live in historically under-resourced neighborhoods,” said Maggie Wilkin, research director. and evaluation. at the Institute of Public Health’s Center for Wellness and Nutrition and lead author of the poster presentation. Access to healthy food is an important lever to address these disparities.

The results of the Food Rx pilot study were presented Tuesday at the annual meeting of the American Public Health Association. Overall, participants’ hemoglobin A1c readings — which measure average blood sugar levels over three months — dropped significantly over the year, from 9.73% to 8.93%, among those who readings were outside the target range at baseline. According to the Centers for Disease Control and Prevention, a hemoglobin A1c reading between 5.7% and 6.4% is considered prediabetic.

Researchers also found that food insecurity among participants decreased by 10%. In addition, participants reported making more lifestyle changes to manage their diabetes, such as engaging in more physical activity, checking their blood sugar daily, following diabetes meal plans, and going to the diabetes education or nutrition classes.

Bailey, who is on Medicare and receives VA health benefits, wanted the program to last even longer. “I want to participate in more programs like this that are affordable and accessible,” he said.

The involvement of community organizations such as food banks could offer a sustainable way to continue such programs in other cities or towns, according to Wilkin. She said the study’s findings support policies that provide reimbursable, medically appropriate meals for people with chronic conditions. “Organizations trying to implement product prescription programs can apply to the Gus Schumacher Nutrition Incentive Program of the United States Department of Agriculture to receive funding,” he said.

Payers may cover food like medicine programs amid growing research showing it leads to improved health outcomes, he told STAT.

Further south in California, in Los Angeles, Kaiser Permanente Southern California led a randomized control trial of a six-month product prescription program among 450 Medicaid patients.

Study participants were randomly assigned to three different groups: a control group, whose members did not receive free fresh produce, and higher and lower dose intervention groups that received weekly deliveries of produce free The production amounts were scaled to meet the family size of the participants, and valued at a range of $90-270 for the higher dose group and $90-180 for the lower dose families. All participants who purchased the free products were also offered free diet and nutrition counseling sessions with registered dietitians or nutritionists by phone.

The results, which were presented at the American Heart Association’s scientific sessions earlier this week, showed that patients in the high- and low-dose intervention groups improved their blood sugar levels, with a mean A1c reduction of 0.32 points.

In addition, the data showed a large improvement in food security and nutritional security status: the probability of being food secure increased by approximately 230% and the probability of being nutritionally secure increased by 370% for patients in the two intervention groups compared with the control group. .

“Obesity and diet-related diseases such as diabetes are leading causes of morbidity and mortality and contribute to rising health care costs,” said lead author Claudia Nau , researcher in the research and evaluation department of Kaiser Permanente Southern California. “We can provide medical care and dietary advice, but when patients cannot afford to access healthy foods, they cannot follow advice on diet and nutrition.”

Earlier in 2023, the Centers for Medicare and Medicaid Services announced an opportunity for states to address social health-related needs for people with Medicaid coverage in managed care plans with services “in lieu of” , Nau note. States can now offer alternative benefits that target a range of unmet social needs related to health, such as providing nutritious meals, prepared and healthy food or vouchers to support the health needs of members.

In the big picture, Wilkin said, programs like these are investments to inspire healthy habits in participants for years to come. “Giving people the tools and resources to try new foods and make new recipes will be sustained beyond the program and lead to better outcomes for people with diabetes in the long term,” he said.