Could a USA system of prescribing fruit and veg work in the UK?

New research carried out by The Food Foundation finds that in the UK, healthy foods are three times as expensive as less healthy foods per kilocalorie. Meanwhile, one in 10 over 40s has Type 2 diabetes, according to Diabetes UK. Earlier this year, NHS England warned ‘record-high’ numbers of people are at risk of developing the disease.

Could prescribing fruit and veg help in the fight against Type 2 diabetes? It might seem like an unusual step for doctors to take, but a study in Pennsylvania, USA, is doing just that – and they’re seeing results. We spoke to two people involved, Michelle Passaretti and Dr John Bulger, and asked British dietician Dr Ann Ashworth if something similar could work in the UK.

Why prescribe fruit and veg?

The Fresh Food Farmacy was set up by Central Pennsylvania Food Bank and medical group Geisinger to see if prescribing fruit and veg and offering lifestyle support to people whose diet was contributing to their poor health could be effective.

“Central Pennsylvania Food Bank had a desire to show that food can be medicine, but they lacked the provision of health care. And we at Geisinger believed that healthy nutritious foods can lead to healthy outcomes, but we didn’t necessarily have the skillset in the provision of food”, says Passaretti, Senior Director of Innovations at the Steele Institute for Health Innovation, part of the Geisinger organisation.

The first six participants all had a Type 2 diabetes diagnosis that was causing poor health. The Fresh Food Farmacy looked at how their diet was contributing to their illness and found ‘food insecurity’ was a big issue. Some were living in poverty and reliant on food banks, while others were living in ‘food deserts’ (where people don’t live near to, and struggle to get to, food shops) or ‘food swamps’ (where there’s food available but it’s not fresh).

How the scheme works

The Fresh Food Farmacy prescribed fresh fruit and veg (giving participants the ingredients for two meals a day for the whole family, five days a week) and provided information about a healthy diet. “They still rely on food outside of that, so when they go to a grocery store they need to know how to shop and where to look – including where the bargains are. That’s where our registered dieticians... really helped”, says Passaretti.

She reports the six gained better control of their Type 2 diabetes and made big lifestyle changes.

Over the last four years, the scheme has expanded to three Pennsylvania communities – all areas where food insecurity is increasing and the rate of Type 2 diabetes “far exceeds the national average”, according to Dr Bulger, Chief Medical Officer at Geisinger. Participants aren’t required to pay or have medical insurance, but they must experience food insecurity. There are now 700 people in the study, and universities, including MIT and Stanford, are partnering the scheme to offer insights.

Medically, “we see really quick outcomes”, says Passaretti. But that doesn’t mean it’s a short-term fix. As long as people are food insecure they stay in part of the programme. “The food is the least expensive part in this, so they graduate from the programme, but still come in every week and pick up the food. But the care team is always there in the background and can be reintroduced at any point. We’re still monitoring their outcomes and carrying out glycated hemoglobin (A1C) tests [a blood test to measure sugar/glucose levels] – so if it increases, we re-engage them with the care team”, says Passaretti.

They are now investigating enabling more people to participate, and looking into piloting similar schemes for other medical conditions that are impacted by poor diet.

Could a similar scheme work in the UK?

We spoke to dietitian Dr Ann Ashworth, media spokesperson for the British Dietetic Association….

Are there similar schemes in the UK?

“The Healthy Start scheme provides vouchers for [pregnant women and children under four in low-income families] on income support such as Universal Credit. These can be for fresh or frozen fruit and vegetables – whole or chopped, packaged or loose.

“Also, according to the new National Food Strategy, some retailers have agreed [in principle] to supplement these vouchers with additional free fruit and veg.

“There are also research projects that have used vegetable boxes. For example, I did a study supplementing the diets of healthy women with green-leafy vegetables and found a significant reduction in blood pressure. But a similar study in men was not significant.”

Do you think a similar scheme could help people struggling with severe obesity (and related health issues) in the UK?

“It’s a great idea – and could be included in the Government’s new Obesity Strategy.

“Eating enough fruit and vegetables is key to a healthy, balanced diet.... We should all be eating at least five 80g portions daily of a variety of fruit and vegetables to achieve the WHO target of 400g in total. Children’s portions should be ‘the amount that fits into the palm of a child’s hand’.

“People with diabetes should still eat at least five portions a day. Diabetes UK advises that people following a low-carbohydrate diet try lower-carb options, such as spinach, lettuce, mushrooms, cauliflower, broccoli, celery, blackberries and raspberries.”

What advice would you give to someone who’s concerned about the impact their diet and weight is having on their health?

“Check your weight, height and Body Mass Index, which can be done easily online. If you’re overweight (BMI 25-30) or obese (BMI>30), you can follow the weight-loss plan on the NHS choices website. If you feel you need more support or are concerned about other health issues, such as diabetes or high blood pressure, ask your GP for further advice and support. Finally, swap an unhealthy snack for a healthy snack, such as a piece of fruit.”