An apple a day so the doctor says

The farm stand is becoming the new apothecary, dispensing apples –
not to mention artichokes, asparagus and arugula – to fill a novel kind of
prescription.

Doctors at three health centres in
Massachusetts have begun advising patients to eat “prescription produce” from
local farmers’ markets, in an effort to fight obesity in children of low-income
families. Now they will give coupons amounting to $1 a day for each member of a
patient’s family to promote healthy meals.

“A lot of these kids have a very
limited range of fruits and vegetables that are acceptable and familiar to
them. Potentially, they will try more,” said Dr. Suki Tepperberg, a family
physician at Codman Square Health Centerin Dorchester, one of the program
sites. “The goal is to get them to increase their consumption of fruit and
vegetables by one serving a day.”

The effort may also help farmers’
markets compete with fast-food restaurants selling dollar value meals. Farmers’
markets do more than $1 billion in annual sales in the United States, according
to the Agriculture Department. Massachusetts was one of the first states to
promote these markets as hubs of preventive health. In the 1980s, for example,
the state began issuing coupons for farmers’ markets to low-income women who
were pregnant or breast-feeding or for young children at risk for malnourishment.
Thirty-six states now have such farmers’ market nutrition programs aimed at
women and young children.

Thomas M. Menino, the mayor of
Boston, said he believed the new children’s program, in which doctors write
vegetable “prescriptions” to be filled at farmers’ markets, was the first of
its kind. Doctors will track participants to determine how the program affects
their eating patterns and to monitor health indicators like weight and body
mass index, he said.

“When I go to work in the morning,
I see kids standing at the bus stop eating chips and drinking a soda,” Menino
said in a phone interview earlier this week. “I hope this will help them change
their eating habits and lead to a healthier lifestyle.”

The mayor’s attention to healthy
eating dates to his days as a city councilman. Most recently he has appointed a
well-known chef as a food policy director to promote local foods in public
schools and to foster market gardens in the city.

Although obesity is a complex
problem unlikely to be solved just by eating more vegetables, supporters of the
veggie voucher program hope that physician intervention will spur young people
to adopt the kind of behavioral changes that can help forestall lifelong
obesity.

Childhood obesity in the United
States costs $14.1 billion annually in direct health expenses like prescription
drugs and visits to doctors and emergency rooms, according to a recent article
on the economics of childhood obesity published in the journal Health Affairs.
Treating obesity-related illness in adults costs an estimated $147 billion
annually, the article said.

Although the vegetable prescription
pilot project is small, its supporters see it as a model for encouraging obese
children and their families to increase the volume and variety of fresh produce
they eat.

“Can we help people in low-income
areas, who shop in the centre of supermarkets for low-cost empty-calorie food,
to shop at farmers’ markets by making fruit and vegetables more affordable?”
said Gus Schumacher, the chairman of Wholesome Wave, a non-profit group in
Bridgeport, Connecticut, that supports family farmers and community access to
locally grown produce.

If the pilot project is successful,
Schumacher said, ‘farmers’ markets would become like a fruit and vegetable
pharmacy for at-risk families.”

One month after Leslie-Ann Ogiste,
a certified nursing assistant in Boston, and her 9-year-old son, Makael
Constance, received their first vegetable prescription vouchers at the Codman
Center, they have lost a combined four pounds, she said. A staff member at the
center told Ogiste about a farmers’ market that is five minutes from her
apartment, she said.

“It worked wonders,” said Ogiste,
who bought and prepared eggplant, cucumbers, tomatoes, summer squash, corn, bok
choy, parsley, carrots and red onions. “Just the variety, it did help.”

Ogiste said she had minced some
vegetables and used them in soup, pasta sauce and rice dishes – the better to
disguise the new good-for-you foods that she served her son.

Makael said he did not mind. “It’s
really good,” he said.

Some nutrition
researchers said that the Massachusetts project had a good chance of improving
eating habits in the short term. But, they added, a vegetable prescription
program in isolation may not have a long-term influence on reducing obesity.
Families may revert to their former habits in the winter when the farmers’
markets are closed, these researchers said, or they may not be able to afford
fresh produce after the voucher program ends.

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