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Meal Ticket: A prescription for fresh produce, better health

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For “Terry,” a 60-year-old with diabetes, it began with the bok choy. 

“Terry” was reluctant to take the Chinese cabbage found in many Asian recipes from the box of vegetables prescribed through the Farm to You Program at the West Virginia University School of Medicine’s Eastern Campus, but it came with a recipe, so they gave the stir fry a try.

“It was good; I would eat it again,” said Terry, who has been going to the Center for Diabetes and Metabolic Health since before the COVID-19 pandemic. They’ve seen results; their blood sugar levels are now under control. And Terry plans meals around what vegetables they want to have.

Terry looks forward to the beginning of the program every year.

It’s what Dr. Rosemarie Lorenzetti would call a good day with Farm to You — when patients try something new and are surprised they like it —“an a-ha moment.”

In five years, the Farm to You Program has been so successful that some doctors want to be able to use it for nearly all their patients. In 2020, the clinic began offering the boxes of vegetables twice a month, and through last year had supplied approximately 3,400 produce shares to patients.

With a $500,000 grant from the U. S. Department of Agriculture and some donor grants, Farm to You will deliver more than 10,000 shares over the next three years. That equals about 1,400 patients who will pick up their free garden-fresh “prescriptions” at their local clinics. It’s an actual surprise package bought from local farmers. Lorenzetti said that whatever farmers have an abundance of in season goes into the box.

A short film about FARMacy, a produce prescription program aimed at low-income people living with chronic health conditions.

The next phase of the program is gathering and teaching recipes to people who may have never cooked fresh vegetables. Patients can learn to cook the vegetables through demonstrations in an on-site food truck.

The program has evidence-based results that good food equals good medicine. The prescription for peppers and tomatoes, green beans and squash helps weight loss, and subsequently blood pressure, diabetes and heart disease.

“We recognized a need in our patients,” said Lorenzetti, the associate dean for student services and co-director of Culinary and Lifestyle Medicine, about the beginning of Farm to You. “It started out in clinics as we tried to advise people how to eat better, but many patients would say ‘I can’t afford fresh vegetables.’”

While Lorenzetti and her fellow physicians advised that frozen vegetables are as good as fresh and a little cheaper, cost was still at the forefront of reasons for resistance to changing eating habits.

a man and women smile in front of vegetables

A Farm to You participant and her husband pick up produce share and recipes at Ranson Family Medicine in Jefferson County.

As she sees more and more patients with metabolic disorders like hypertension, heart disease and diabetes, or those with the consequences of untreated obesity such as osteoarthritis or sleep apnea, Lorenzetti is increasingly relying on Farm to You to be a viable source of good nutrition leading to better health outcomes. And although those conditions require different prescription medications, patients who live with them can see an improvement in their conditions with the same bi-monthly box of vegetables everyone else is getting.

Lorenzetti said people know they need better nutrition; for some that might mean more fresh vegetables and fruits for antioxidants and vitamins, while for others that might mean more plant-based protein.

Even with the effort of trying to include more vegetables in a daily diet plan, mistakes can be made. Raw vegetables are good, and cooked vegetables in soups are good because cooking them in the soup retains the vitamins lost in the cooking process.

But augmenting the taste of raw vegetables with commercial dips or dressings can reduce the health benefits because many are made with soybean or safflower oil, which are much higher in inflammation-causing omega-6 fatty acids. Omega-3 fatty acids, on the other hand, are anti-inflammatory. Commercial dressings also often have high amounts of sugar, making them doubly dangerous choices for patients with metabolic disorders.

“The American diet is way too heavy in omega-6 fatty acids because of all the processed foods that are eaten,” Lorenzetti said. “The balance of omega-6 to omega-3 fatty acids is off.”

Making small changes like substituting whole fat yogurt for mayonnaise. Exchanging kale, which is higher in vitamins and has a longer shelf life, for leaf lettuce. Replacing fruits higher in sugar with those higher in fiber and limiting dried fruits. Sautéing vegetables in olive oil, higher in omega-3 fatty acids, instead of deep frying them in sunflower or saffron oil.  Small changes can add up to bigger benefits in overall health for many patients.

In the market for better health

Like Farm to You, the WVU Extension Family Nutrition Program is connecting West Virginians with fresh, local produce, although its delivery method creates more of a shopping experience.

The idea is simple but effective: doctors identify low-income patients who live with nutrition insecurity as well as chronic conditions such as heart disease and diabetes.

Doctors write these patients a prescription for a weekly supply of fresh fruits and vegetables that they fill at a local farmers market held each week at the clinic. They go through the line, filling shopping bags with vine-ripened tomatoes, colorful peppers and squash, crisp greens, cucumbers, onions and more. Farmers help participants choose their produce, answer their questions and teach them where their food is coming from.

“Families with limited food budgets are not going to spend their money on foods their families won’t eat,” said Gina Wood, a coordinator with the Expanded Food and Nutrition Education Program. “That seems obvious, but it’s something that many health initiatives do not consider. We are removing that barrier by giving families fresh produce, free of charge, and teaching them how to prepare it once they get home.”

The program is funded by two federal grants from the Supplemental Nutrition Assistance Program Education and the Expanded Food and Nutrition Education Program, both from the U.S. Department of Agriculture. Both grants have the same goal: improving the health of West Virginia’s low-income families by improving the quality of food on their tables.

Under the guidance of Kristin McCartney, who handles the SNAP-Ed side of operations, and Wood, the EFNEP coordinator, the Family Nutrition Program has made it a priority to include local farmers in this mission.

One example is the FARMacy Program, which the Family Nutrition Program administers in collaboration with health clinics around the state.

Alongside the weekly farmers markets, FNP nutrition educators organize physical fitness challenges, provide taste tests of healthy recipes and sign up participants for Eating Smart Being Active classes. These classes, held over six weeks, teach participants about nutrition, cooking skills, budget shopping strategies and exercise habits.

FARMacy has yielded significant improvements in patients’ health. Many participants lose weight and have improved their cholesterol, blood pressure and blood sugar levels. Some have improved so much their doctors have been able to reduce their prescription medications.

Creating good habits

Similar to FARMacy, the Family Nutrition Program’s long-running “Kids Markets” initiative also provides fresh fruits and vegetables, but to a different demographic. Growers set up farmers markets at elementary schools. Students receive tokens and are allowed to “shop” for fruits and vegetables, free of charge. Markets are paired with a series of age-appropriate nutrition lessons, taught by FNP health educators.

“It’s fascinating to see. Without a parent to say, ‘Don’t get that, you don’t like that,’ kids are much more willing to try new foods,” McCartney said. “It’s not unusual for a student to eat all the produce in their bag before they even get home.” 

In 2021, FNP introduced a new twist on the kids’ market model with Kids Market @ The Store. This program, open to all children ages 2-17, allows participants to “shop” for free fruits and vegetables at participating retail locations in their counties. Each family receives $30 in tokens, which children spend at a dedicated Kids Market @ The Store display.

Kids Market @ The Store is a new initiative by the West Virginia University Extension Family Nutrition Program, aimed at teaching kids healthy habits by allowing them to “shop” for free fruits and vegetables at participating retail locations in their counties.

These displays are stocked each week with fresh West Virginia-grown fruits and vegetables. At the checkout, store clerks place a sticker in the child’s Kids Market @ The Store passport. This allows families to track which foods they’ve tried throughout the program. At the end of the program, they can return their passports for WVU-themed prizes.

“The Family Nutrition Program’s school programming is really about creating consumers for our state’s agriculture industry,” McCartney said. “Someday it will be their turn to do the grocery shopping. If we introduce students to these foods and the farmers who grow them at a young age, they’ll become lifelong customers.”

The Family Nutrition Program also provides financial backing for SNAP Stretch, a program that multiplies SNAP users’ buying power at farmers markets in West Virginia. SNAP users can receive double their benefits when shopping from a local grower, while those who are over 65 or are accompanied by a child can triple their benefits.

Byproduct

The FARMacy, Kids Markets and SNAP Stretch programs all add up to one thing for West Virginia farmers — a steady paycheck.

The Family Nutrition Program leverages its federal funding to receive additional grants from foundations and nonprofits, which pay for the produce used in these programs. FNP paid producers nearly $500,000 in 2022.

“Our partner farmers love these programs because, rain or shine, they get paid. They don’t have to wonder how much they will sell, because we buy all the produce they bring,” Wood said. “A guaranteed paycheck is something you don’t often find in agriculture.”

Wood said growers have used this money to invest in new equipment for their farms. “The Family Nutrition Program’s investment is building a stronger local food system for all West Virginians,” she added.

Extra efforts

WVU School of Medicine immersion experience

WVU School of Medicine students spent a weekend in rural Pocahontas County where they were challenged to purchase food and prepare a meal from the local stores — a Dollar General Store and a gas station that doubles as a general store — using a budget based on SNAP benefits. 

“The trip opened my eyes to some of the challenges the patients I’m going to be taking care of could be facing that aren’t necessarily centered around medicine,” said Austin Goncz, a second-year medical student. The Rural Track Program collaborated with WVU Medical Weight Management and faculty from the culinary track to develop the immersion experience. Every spring AHEC hosts a “nutrition immersion weekend” where students from many different health science majors get together for a weekend to live and eat in a healthier way. The trip was funded by the WVU Institute for Community and Rural Health.

WVU Raleigh County 4-H gardening volunteers

The WVU Raleigh County 4-H has been one of the volunteer organizations working with the Raleigh County Solid Waste Authority Fresh Vegetable Initiative. The project began during spring 2021 to help address food insecurities for the greater Beckley Area. Volunteers were asked to help in the high tunnels with seeding, planting, transplanting, weeding, pruning, watering, harvesting and delivering. Fresh summer, fall and winter vegetables have been given to the Raleigh County Commission on Aging and delivered to seniors who receive meal deliveries. Raleigh County 4-H members, volunteers and agents have helped with preparing and planting.

WVU Cancer Institute's Growing Hope program

More than 15% of West Virginia’s cancer patients’ households do not have the resources to provide a healthy diet, either because of financial or access barriers. In response, the WVU Cancer Institute launched Growing Hope, a pilot project aimed at increasing access to fresh produce and healthy meals for patients and their families. 

In two areas of the state, the Institute collaborates with farms to distribute fresh vegetables and meal baskets. In the Morgantown area, the Mary Babb Randolph Cancer Center works with Homestead Farm Center, which obtained funding to build a high tunnel to extend the growing season, increasing the amount of produce. Each basket contains a “vegetable of the week,” dry ingredients and directions for meal prep. The Charleston Area Medical Center’s approach, using an existing relationship with Gritt’s Farm, provides large packages of fresh produce to patients each week. Through the pilot program, fresh produce and meals were provided to 206 cancer patients and their families in 33 of the state’s counties, as well as patients in Pennsylvania and Maryland.

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