Access to fresh produce improves health outcomes among people with diabetes and Medicaid

In:In Stockton, California, nearly 60% of the city’s 320,000 residents are prediabetic or living with diabetes. One of them is 72-year-old Shane Bailey, a longtime resident and US Coast Guard veteran. And since she lives in a neighborhood that’s considered a food desert because of the lack of nearby grocery stores, accessing healthy, affordable food can be a huge challenge.

“I live in the Central Valley, where a lot of produce is grown. But in Stockton, it’s often either too expensive, or of poor quality, or both,” Bailey said.

However, thanks to Abbott and the Public Health Institute’s Healthy Food Rx program, she has fostered lifestyle changes that help her manage her condition. The program was a pilot study in which 374 diabetes patients received healthy food packages, including fresh produce, from the Emergency Food Bank Stockton/San Joaquin for one year.

“It was fun learning how to make these healthy meals. It kept me busy and improved my mental health,” Bailey said. Each of the boxes had recipes, and participants could join a virtual cooking class to learn how to prepare each meal. Her favorite meal was green vegetable stir-fried chicken packed with broccoli, kale, spinach and bok choy, tossed with warm olive oil and Asian spices.

The Food Rx program has been the subject of two recent studies, neither of which have yet been peer-reviewed, that demonstrate the benefits of product prescription programs as a way to improve diabetes-related health outcomes and address food insecurity. Advocates say food-as-medicine programs can greatly help low-income people and people with chronic illnesses, especially those living in food deserts.

“Health disparities exist in communities of color, Latino and black communities, and people living in these communities are most affected by diabetes because they tend to live in historically under-resourced neighborhoods,” said Maggie Wilkin, director of research and evaluation. at the Center for Health and Nutrition, Institute of Public Health, and lead author of the poster presentation. Access to healthy food is an important lever to address these disparities.

The results of the Food Rx pilot study were presented Tuesday at the annual meeting of the American Public Health Association. Overall, participants’ hemoglobin A1c scores, which measure average blood sugar levels over a three-month period, fell significantly over the year, from 9.73% to 8.93%, among those whose scores were outside the target range at baseline. : According to the Centers for Disease Control and Prevention, a hemoglobin A1c between 5.7% and 6.4% is considered prediabetic.

The researchers also found that food insecurity among the participants decreased by 10%. In addition, participants reported making more changes to manage their diabetes, such as getting more physical activity, checking their blood sugar daily, following a diabetes diet, and attending diabetes education or nutrition classes.

Bailey, who is on Medicare and receives VA health benefits, wished the program had lasted longer. “I want to participate in programs like this that are accessible and affordable,” she said.

Engaging community organizations such as food banks can offer a sustainable way to continue such programs in other cities or towns, according to Wilkin. He said the study’s findings support policies to provide reimbursable, medically tailored meals for people with chronic illnesses. “Organizations trying to implement prescription drug programs can apply to the USDA’s Gus Schumacher Nutrition Incentive Program for funding,” he said.

Payers may cover nutrition as drug plans amid growing research showing it leads to improved health outcomes, he told STAT.

Further south in Los Angeles, California, Kaiser Permanente Southern California led a randomized control trial of a six-month prescription drug program among 450 Medicaid patients.

Study participants were randomized into three different groups: a control group, whose members did not receive free fresh produce, and higher and lower dose intervention groups, who received free produce weekly. Product portions were scaled to match participant household size and ranged from $90-270 for the higher portion group and $90-180 for the lower portion households. All participants who received free products were also offered free dietary and nutritional counseling by phone with registered dietitians or nutritionists.

The findings, presented at the American Heart Association’s Scientific Sessions earlier this week, showed that patients in both the high- and low-dose intervention groups improved their blood sugar levels, with an average reduction in A1c of 0.32 points.

In addition, the data showed a large improvement in food security and nutrition security status; the odds of being food safe increased by about 230% and the odds of being nutritionally secure increased by 370% for patients in both intervention groups compared to the control group. .

“Obesity and diet-related diseases such as diabetes are major causes of morbidity and mortality and contribute to increased health care costs,” said lead author Claudia Nau, a research scientist in the Division of Research and Evaluation at Kaiser Permanente Southern California. “We can provide medical care and dietary advice, but when patients can’t afford healthy food, they can’t follow diet and nutrition advice.”

Earlier in 2023, the Centers for Medicare & Medicaid Services announced that states would be able to address social health needs in managed care plans for people with Medicaid coverage through “in-lieu” services, Nau noted. States can now offer alternative benefits that address a variety of unmet health-related social needs, such as providing nutritious, prepared meals and healthy foods or vouchers to support enrollees’ health needs.

In the big picture, Wilkin said, programs like this are investments to instill healthy habits in participants for years to come. “Giving people the tools and resources to try new foods and prepare new recipes will sustain beyond the program and lead to better long-term outcomes for people with diabetes,” she said.