Can physicians really urge you, cajole you or nudge you to eat a healthier diet? That is the premise of a new study published in the journal, Circulation: Cardiovascular Quality and Outcomes. Eight weeks ago I blogged about whether doctors should counsel their patients on what they eat. My opinion is that nutrition counseling is a good idea, but doctors are not trained in nutrition and don’t really have the time for lifestyle coaching. A couple weeks after I blogged about nutrition I wrote about prevention, explaining it doesn’t save money but is a good idea. I wrote:
It’s a little naïve to assume a 5-minute discussion with your doctor will change a lifetime of bad habits. It’s probably a conversation worth having though. However, does your doctor have time to discuss healthy behaviors?
Today HealthDay News and The Washington Post reported on the aforementioned study on healthy food as a prescription. This from WaPo:
When doctors and health-care providers “prescribed” fruits and vegetables, patients ate more produce, lost weight and experienced significant reductions in blood pressure, according to a new study.
“Produce prescriptions” are part of a growing effort in health care to provide food as medicine to potentially prevent or improve chronic health conditions like obesity, diabetes, heart disease and high blood pressure.
Purportedly adults who were prescribed vegetables as participation in a program increased their consumption of produce by nearly one-third (30%). In addition, the effects of increased consumption of fruits and vegetables were about equal to half of the effects of hypertensive medications. More from WaPo:
Produce prescription programs have expanded in the past decade and especially in the past two to three years since the coronavirus pandemic. Existing studies on prescription produce programs showed vouchers for produce will get people to eat more fruits and vegetables, but it wasn’t clear whether eating more apples and carrots was associated with better health outcomes, such as lower blood pressure, Hager said.
The study wasn’t just a few doctors who took the time to quiz people about their diet. It was a program specifically designed to boost healthy eating. This from HealthDay by way of US News:
For this study, researchers looked at about 1,800 children and nearly 2,100 adults who participated in a food prescription program operated by the nonprofit Wholesome Wave between 2014 and 2020. The data included 22 produce prescription sites across 12 U.S. states.
Participants attended nutrition classes and received a median $63 per month to buy produce. (Half received more money, half received less.) Programs lasted four to 10 months.
OK, this is the point where we should question the conclusion of the study. The program did not track people long term and therefore has no idea whether the effect was long lasting. Furthermore, the vegetables were free. It makes me wonder if the vegetables were even prepared by the study participants and if so, were they actually eaten? In social science research there is a phenomenon known as the Hawthorne Effect. That’s when study participants change their behavior in response to being observed. Test subjects also tend to respond in ways they think researchers want them to respond, which is known as response bias. Now for the real head scratcher.
…funding and evaluating programs might need buy-in from insurers and other organizations.
The programs studied were all short-term and funded by grants, Hager noted. Even if patients’ health improved, there wasn’t funding to continue.
“I think to scale these programs across the U.S. in a sustainable manner, especially if future research continues to show meaningful improvements in health outcomes, then there is an opportunity for federal health insurance programs like Medicare and Medicaid to begin covering the services,” Hager said.
The researchers apparently believe that health plans (including Medicare and Medicaid) should pay for enrollees to participate in expensive nutrition programs to encourage enrollees to eat more vegetables and then subsidize that consumption. That would be a rather costly benefit and no it would not pay for itself in better health. I am also skeptical that the healthy foods would be eaten rather than wasted. When school officials were required to offer healthier foods to school kids, food waste increased substantially. Hint: it wasn’t the pizza and French fries being trashed, it was the apples and healthy veggies.