Access to fresh produce improves health outcomes in patients with diabetes and those on Medicaid in recent studies

IIn Stockton, California, nearly 60% of the city’s population of 320,000 have prediabetes or are living with diabetes. Shane Bailey, a 72-year-old longtime resident and U.S. Coast Guard veteran, is one of them. And since she lives in a neighborhood that’s considered a food desert because there are no nearby grocery stores, accessing healthy, affordable food can be a big challenge.

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

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

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

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

Health disparities exist in Latino and black communities of color, and people living in those communities are most affected by diabetes because they tend to live in under-resourced neighborhoods, said Maggie Wilkin, director of public health research and evaluation. Center for Wellness and Nutrition of the Institute and main author of the poster presentation. Access to healthy food is one important lever in addressing these disparities.

Findings from the Food Rk pilot study were presented Tuesday at the annual meeting of the American Public Health Association. Overall, participants’ hemoglobin A1c values, which measure their average blood sugar levels over three months, decreased significantly over the year, from 9.73% to 8.93%, among those whose readings 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 participants decreased by 10%. In addition, participants reported making major lifestyle changes to manage their diabetes, such as being more physically active, checking their blood sugar daily, following diabetes meal plans, and attending diabetes education or nutrition classes.

Bailey, who is on Medicare and receives VA health benefits, wanted the program to last even longer. I want to participate in more programs like this that are affordable and accessible, she said.

Involving community organizations such as food banks could offer a viable way to continue such programs in other cities or towns, Wilkin says. She said the study’s results support policies that provide reimbursable, medically tailored meals for people with chronic illnesses. Organizations trying to implement prescription programs can apply for the U.S. Department of Agriculture’s Gus Schumacher Nutrition Incentive Program, she said.

Payers can cover food like medicine amid growing research showing it leads to improved health outcomes, she told STAT.

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

Study participants were randomly assigned to three different groups: a control group, whose members did not receive free fresh produce, and higher and lower dose intervention groups that received free weekly deliveries of produce. Product quantities were scaled to accommodate participant household size and estimated to range from $90-$270 for the higher-dose group and $90-$180 for the lower-dose households. All participants who received free products were also offered free phone advice on diet and nutrition with a registered dietitian or nutritionist.

The findings, which were 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 nutritional security status: the odds of being food secure increased by about 230% and the odds of being food secure increased by 370% for patients in both intervention groups compared with a control group. .

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

Earlier in 2023, the Centers for Medicare & Medicaid Services announced an opportunity for states to address the health social needs of people covered by Medicaid in managed care plans in lieu of services, Nau notes. States can now offer alternative benefits that target a range of unmet health-related social needs, such as providing nutritious, prepared meals and healthy foods or vouchers to support enrollees’ health needs.

In the bigger picture, Wilkin said, programs like these are investments that will inspire participants to adopt healthy habits for years to come. Giving people the tools and resources to try new foods and make new recipes will last beyond the program and lead to better outcomes for people with diabetes in the long term, she said.