No Bitter Pill: Doctors Prescribe Fruits And Veggies

Sep 12, 2013
Originally published on September 17, 2013 3:21 pm

It was the Greeks who first counseled to let food be thy medicine. And, it seems, some doctors are taking this age-old advice to heart.

In New York City physicians are writing prescriptions for fresh fruits and vegetables. That's right, 'scripts for produce.

If you listen to my story on All Things Considered, you'll hear that the program is the creation of Wholesome Wave, a nonprofit that connects low-income people with local produce.

It's led by chef Michel Nischan, who was motivated to make healthful food more accessible after his two sons were diagnosed with juvenile diabetes. After learning that the Type 2 diabetes can be controlled or even reversed by good nutrition and exercise, he's made this his life's commitment.

On a recent Tuesday I met up with Nischan in New York, where we checked in on the Rx Fruit and Vegetable program.

Nischan told me he has pursued this partnership with doctors because so many people rely on their trusted advice. When docs write prescriptions for drugs, people fill them. So why not prescribe healthful food?

Basically, the initiative is designed to nudge the families of overweight kids and teens to change the way they eat. And the big incentive? Free produce as well as tips on how best to cook and economize.

Kids enrolled in the program at Lincoln Medical and Mental Health Center in the Bronx meet with a doctor or nutritionist once a week. During the appointment, doctors measure their blood pressure, insulin levels and weight.

At the end of the appointment they leave with a prescription that can be swapped for Health Bucks accepted at 140 farm markets in the city. Participants receive $1 per day for each person in their family. So a family of four get $28 of free produce a week.

"It's a little unusual," says Lincoln Hospital pediatrician Katherine Szema, because doctors are accustomed to writing prescriptions for drugs.

I met up with Szema and one of her patients, 14-year-old Johanna Terron, at the farm market just outside the hospital. Terron has been struggling with a weight problem and serious asthma.

"I'll be honest with you," Terron says. "I never touched vegetables." She says she used to hit Burger King almost every day and ate lots of junk, "like chips, candy, soda, ice cream." She'd never eaten a pear or cantaloupe, she said.

But over the past year, she's swapped greasy fries for peppery radishes and greens. And she says she's pretty certain her taste buds are changing.

"I don't know how to explain it, but [the fresh food] tastes better."

Szema says she's lost more than 20 pounds and her asthma's much better.

"She's healthier. She doesn't have to use her rescue pump as much," Szema says. And it's easier for her to exercise, now that her weight is down.

Szema says the simple act of prescribing fruits and vegetables doesn't change anything overnight.

It's just the first step of a long process to slim down. But, she says, she's impressed by what a powerful nudge it can be.

She's no longer just telling her patients to eat healthfully — she is actually helping them do it by making it affordable and accessible.

"You're coaching [your patients] to put what's healthy in their body," Szema says.

And in Johanna's case, the people around her are eating better, too. "The whole family is making changes" Szema says.

For Wholesome Wave's Nischan, who spent years imagining how such a program could work, the results are satisfying. There are now two years of data from pilots showing that many people who participate actually lose weight.

"The first year 38.1 percent [of the participants] dropped their body mass indexes," Nischan told me. And in the second year it was 39 percent of the participants. "So it's working; we're excited about it."

And he says he's looking forward to expanding it. "We have interest from all over the country," Nischan says, and smiles.

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It was the Greeks who first advised: Let food by thy medicine. It's a directive that may seem naive in this age of powerful pharmaceuticals. But some doctors in New York are starting to take this age-old advice to heart again.

NPR's Allison Aubrey reports that in New York City, doctors are writing prescriptions for fruits and vegetables. You heard right - scripts for produce.

ALLISON AUBREY, BYLINE: Katherine Szema is a pediatrician at the Lincoln Medical Center in the Bronx, who spent many years inside her hospital's exam rooms treating kids with asthma, diabetes and weight problems. And until recently, the main thing she did was write prescriptions for drugs.

DR. KATHERINE SZEMA: I think before, it was kind of like medication, medication - you know, take your medicine; you'll be fine.

AUBREY: But over the last year, Szema has become part of an experiment to really switch things up. When I caught up with her, she was at the farm market set up right outside the hospital. With her white doctor's coat on and a stethoscope around her neck, she was meeting up with her patients.

SZEMA: It's a little unusual 'cause you're used to giving out medications. So now, we're actually giving out prescriptions for fruits and vegetables.

AUBREY: Fourteen-year-old Johanna Terron, who is here today, is one of Szema's patients. She's been fighting a weight problem and a serious asthma condition. She's one of about 110 kids enrolled in the New York program. Each week, she comes to the hospital where they check her weight, her blood sugar and blood pressure. And then she leaves the appointment with a prescription she can exchange for free produce.

As she walks by bins of radishes, lettuce and some greens, Johanna says until a few months ago, she'd never tasted any of these things.

JOHANNA TERRON: I'm telling you the truth. In my life, I never touched no vegetables - no nothing - because I don't like it.

AUBREY: It's not the kind of food she had at home.

TERRON: I never ate - you know how they have pumpkin?

AUBREY: Uh-huh.

TERRON: But then the things inside of it?

AUBREY: Like butternut squash...

TERRON: Yeah, that. I never ate that before. I never ate melon before.

AUBREY: Never had eaten melon.

TERRON: Never, no.

AUBREY: Johanna says she went to Burger King almost every day, and ate a lot of junk.

TERRON: Like chips, candy; like soda, ice cream...

AUBREY: But over the last year, Johanna has completely overhauled her diet. She's lost more than 20 pounds. She swapped greasy fries for peppery radishes and greens. And she says she thinks her taste buds are changing.

TERRON: I don't know how to explain it, but it tastes like - it tastes better.

AUBREY: And Dr. Szema says it's easier for Johanna to exercise now because her asthma is better.

SZEMA: She's healthier. She doesn't have to use her rescue pump as much, and it doesn't limit her activity.

AUBREY: Now, the idea of prescribing fruits and vegetables was not hatched in a pharmacy, or by doctor. It's actually the vision of a chef named Michel Nischan. And the idea came to him years ago in the New York City subway, as he commuted to and from the fancy restaurant in Manhattan where he worked.

MICHEL NISCHAN: So this is how far down I used to have to ride up the...

AUBREY: And you did that six days a week.

NISCHAN: Yeah, it was nutty - six days a week.

AUBREY: After spending two hours a day on the train in order to serve up $40 entrees to people who could afford to eat anything, Nischan says he started to notice all these faces on the train - the people around him, those who couldn't afford it.

NISCHAN: It was a horrible feeling.

AUBREY: It started to feel like "A Tale of Two Cities" right here within one subway car; the Wall Street banker sitting next to a mom dressed in a fast food uniform who works two part-time jobs.

NISCHAN: Yeah, I actually almost quit the restaurant business 'cause I felt so guilty.

AUBREY: At about the same time, one of Nischan's young sons was diagnosed with juvenile diabetes. And as he learned more about the disease, especially Type 2 - how it could be controlled, or even reversed, with good nutrition and exercise - he knew he wanted to do something. So why not team up with doctors? If they could prescribe medicine to help people get better, why not prescribe healthy food?

NISCHAN: Would it make a difference?

AUBREY: Well, fast forward 10 years; and after lots of fundraising and browbeating to get this initiative going, he's beginning to find out. There have been pilots in seven states, and Lincoln is one of two hospitals in New York participating.


NISCHAN: OK. OK. All right, we're going to do this for real now. OK, so...

AUBREY: On this day at the farm market, there's a cooking demonstration going on.

NISCHAN: OK, so I do one jalapeno...

AUBREY: As physician Katherine Szema looks on, she says just telling her patients to eat well is not enough. You've got to show them. You've got to open up access to the right food. Teach them - that's the appeal here.

SZEMA: You're coaching them to put what's healthy into their body.

AUBREY: Now, Szema says, the simple act of prescribing fruits and vegetables obviously doesn't change things overnight. It's just one step in a long process. But she says the program is proving to do more than just nudge patients like Johanna in the right direction.

SZEMA: The whole family is actually making changes, too.

AUBREY: Nischan says his organization, which is called Wholesome Wave, now has two years of data showing many people in these programs do lose weight.

NISCHAN: The first year, 38.1 percent dropped BMI. The second year, 37.9 percent dropped BMI. So it's working. I mean, it's pretty nutty, but we're excited about it.

AUBREY: And he says the prescription produce program could go nationwide.

NISCHAN: We have interest from all over the country.

AUBREY: In an age when diet-related diseases such as Type 2 diabetes are costing our nation billions of dollars, Nischan says this is the kind of prevention that can work.

Allison Aubrey, NPR News.

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