The VeggieRx program gives low-income families in weight management and diabetes clinics “prescriptions” to purchase fruits and vegetables at local farmers’ markets. Fresh Approach first piloted the program in 2011 and has been operating VeggieRx as a core Fresh Approach program since then.
For a complete copy of the report of the first two years of VeggieRx operation, click here. An executive summary of the 2012 program year is below.
Executive Summary:
In 2012, Fresh Approach partnered with two clinics in the San Jose area to implement the VeggieRx program – Gardner Family Health Network (GFHN) and Asian Americans for Community Involvement (AACI). The VeggieRx program is a community-based process, requiring community and stakeholder input from the beginning stages. Clinics were identified based on patients’ access to healthy foods, financial needs, and obesity prevalence. Proximity to a Pacific Coast Farmers’ Market Association farmers’ market, clinic space, and personnel capacity were also taken into consideration before partnerships were secured. At each of these clinic sites, VeggieRx:
- Enrolled low-income individuals who were obese, overweight, or at-risk for diabetes and provided them with nutrition education interventions, and “prescription” vouchers to buy fresh fruits and vegetables at local farmers’ markets.
- Throughout a 16-week program, clinic staff and Fresh Approach collaborated to conduct cooking and nutrition education sessions, measure health indicators, and provide personalized resources to participants and their families at each biweekly visit.
The strong educational component of the program set the stage for participants to reduce their BMI through improved diets and to establish healthy shopping, cooking, and eating habits that could be maintained after the program ended. At the conclusion of the program, participants had new knowledge of diet and nutrition, new cooking skills, and experience in purchasing, storing and preparing healthy foods.
Allied health professionals at each clinic site tracked weight, height, and BMI data using an anonymous participant number. This number was traceable by voucher utilization, pre- and post-survey, and physiological changes. For children, BMI percentile was calculated to more accurately track growing children, whose weight gain is desirable for growth.
Seventy-one participants were enrolled in the program with two participants’ data dropped due to errors. The majority of participants (69%) attended 7 or 8 out of the 8 total sessions.
All participants enrolled at GFHN were children. From the first visit to the last, BMI percentile categories changed positively; and the percent of children who were considered overweight decreased from 48% to 43%, and the percent considered obese decreased from 43% to 39%.
Similar changes in BMI classification were seen in the adult population enrolled at AACI, but these were not as dramatic as those at GFHN. From the first to the last visit, participants identified with a normal BMI increased from 47% to 49%, and those identified as overweight dropped from 38% to 33%.
The positive changes in participants’ BMIs correlated with behavioral changes which indicated improvements in both consumption and shopping behavior. At the last clinic visit, 95% of survey respondents stated that they plan to continue shopping at farmers’ markets, while at the beginning of the program many did not know about farmers’ markets in their neighborhood, and some knew about a farmers’ market in their neighborhood but had not shopped there in the past 30 days.
In addition, nearly 100% of survey respondents agreed or strongly agreed that since the beginning of the program “my family eats more fruits and vegetables,” “I understand more about the importance of eating fruits and vegetables,” “I prepare more meals in the house,” “I cook more using fruits and vegetables,” and “I eat more fruits and vegetables.”
Behavioral Sustainability:
Upon completion of the program, 64% of participants stated that they agree or strongly agree that they will continue to buy the same amount of fruits and vegetables; and to buy fruits and vegetables, 55% of program participants agree or strongly agree that they will use the federal assistance programs WIC or EBT. These behaviors indicate potential for maintained healthy shopping habits once the program has finished.
Shopping Patterns:
Data on the farms with whom customers redeemed their VeggieRx vouchers was recorded for 80.1% of the utilized vouchers, showing 46 different farmers redeemed vouchers. Each of these 46 farms were classified according to the types of products grown and sold at farmers’ markets to estimate what VeggieRx participants were purchasing. The largest percentage of sales (36.8%) was by farms selling Asian specialty vegetables. The next most popular category was farms selling various kinds of fruit, which reflected 26.1% of voucher redemption.
Over the course of the program, every participant spent vouchers with more than one farm – the fewest number of farmers visited by a participant was three. The average participant visited 12.5 farmers over the course of the program. When voucher redemption is separated by the type of produce a farm sells, and broken out by clinic partner, the results show a clear difference between the shopping patterns of AACI participants who were primarily Asians, and the GFHN participants who were mostly Latinos.
Next Steps:
Fresh Approach will receive funding from the California Department of Food and Agriculture Specialty Crop Block Grant to implement the VeggieRx program over 2013 and 2014. The 2013-2014 VeggieRx program will collaborate with 16 community-based clinics throughout the San Francisco Bay Area.
Acknowledgements:
Fresh Approach would like to thank The Health Trust for their generosity in funding this project. Additionally, we would like to thank clinic partners, Asian Americans for Community Involvement, Indian Health Center of the Santa Clara Valley, and Gardner Family Health Network for their collaborative partnerships.