Nutrition prescriptions
Nutrition prescriptions are one way for physicians and other health care providers to outline a healthy, balanced eating plan for patients. Based on U.S. Dietary Guidelines for adults, children, and adolescents1, nutrition prescriptions establish achievable goals for patients and their families. Health care providers check progress at each office visit and a nutrition specialist is consulted for dietary advice as needed. Some nutrition prescription programs partner with local farmers markets (produce prescription or fruit and vegetable prescription (FVRx) programs); in these programs, prescriptions for fruit and vegetables are redeemed at participating markets. Such prescriptions typically support purchase of at least one serving of produce per day for each patient and their family members2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
- Increased healthy food consumption
- Increased fruit & vegetable consumption
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
- Improved health-related knowledge
- Improved dietary habits
- Improved nutrition
- Improved health outcomes
- Reduced emissions
What does the research say about effectiveness?
Nutrition prescriptions are a suggested strategy to increase consumption of healthy foods including fruits and vegetables and decrease consumption of unhealthy foods, especially saturated fats, trans fats, sodium, and added sugar2, 3, 4. Healthy eating and nutrition counseling, advice, and information given by physicians and other health care providers influences patient behavior5, 6. In general, subsidies and financial incentives for healthy foods have been shown to increase healthy food purchases7, 8, 9, 10, 11, 12, which enables increased healthy food consumption7, 11, 12; however, additional evidence is needed to determine the effects of nutrition prescriptions specifically.
Participants in the Gorge Grown Veggie Rx program report improved nutritional intake, increased food security, and improved mental and physical health13. A UK-based study suggests that using produce vouchers and consumption messages in FVRx programs may not be sufficient to change consumption, but can improve participants’ knowledge about the recommended number of portions and portion sizes of different fruits and vegetables14.
Nutrition prescriptions may increase fresh produce consumption and cooking from scratch, which may reduce emissions from fossil fuels used to produce, process, and transport food15, 16, 17. Nutrition prescriptions may also reduce the energy intensity of an individual’s diet if more plant-based foods are consumed in place of animal products15.
Implementation Examples
The 5-2-1-0 childhood obesity prevention program is an example of a program that allows health care provider partners to give patients nutrition and physical activity prescriptions. Prescriptions encourage daily habits that include 5 servings of fruits and vegetables, 2 hours or less of screen time, 1 hour or more of physical activity, 0 sugary drinks, and increased water consumption. Providers also administer healthy habits questionnaires and monitor patients’ BMI. The 5-2-1-0 program started in Maine18 and has expanded to cities and states all over the country, including Florida19; New Hampshire20; Baton Rouge, LA21; Chesterfield County, VA22; and Palo Alto, CA23.
Through Gorge Grown Food Network’s Veggie Rx program participating health care providers prescribe $30 worth of vouchers for one month to families who screen positive for food insecurity to redeem at 30 local groceries, farms stands, or farmers markets24. Wholesome Wave’s produce prescription (Rx) program allows doctors and other providers around the country to prescribe fruits and vegetables to prevent or manage diet-related illnesses25.
In Shawnee County, Kansas a ‘Just Add Water’ campaign includes prescription pads for physicians to prescribe increased water consumption for their patients26.
Implementation Resources
WW-Rx - Wholesome Wave (WW). What we do: Produce prescription (Rx) program, healthy choice initiatives, and SNAP doubling.
GGFN-Veggie Rx - Gorge Grown Food Network (GGFN). Veggie Rx Program.
MBC-Health care toolkit - Mary Bridge Children’s (MBC) Hospital-Clinics-Foundation. Health care toolkit: Ready, set, go! 5210.
ISU-Food and sustainability resources - Iowa State University (ISU), Sustainable Food Processing Alliance. Online resources for food and sustainability.
Footnotes
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1 US DHHS-DG - U.S. Department of Health and Human Services (U.S. DHHS). The dietary guidelines for Americans.
2 TFAH-Levi 2014 - Levi J, Segal L, St. Lauren R, Rayburn J. The state of obesity: Better policies for a healthier America 2014. Washington, D.C.: Trust for America's Health (TFAH); 2014.
3 US EOP-Childhood obesity 2010 - Executive Office of the President (U.S. EOP). Solving the problem of childhood obesity within a generation: White House Task Force on childhood obesity report to the President. 2010.
4 Let’s Move-Eat healthy - Let's Move! Eat Healthy: Pediatricians as partners.
5 Bhattarai 2013 - Bhattarai N, Prevost AT, Wright AJ, et al. Effectiveness of interventions to promote healthy diet in primary care: Systematic review and meta-analysis of randomised controlled trials. BMC Public Health. 2013;13:1203.
6 Dorsey 2011 - Dorsey R, Songer T. Lifestyle behaviors and physician advice for change among overweight and obese adults with prediabetes and diabetes in the United States, 2006. Preventing Chronic Disease, 2011;8(6):A132.
7 Gittelsohn 2017 - Gittelsohn J, Trude ACB, Kim H. Pricing strategies to encourage availability, purchase, and consumption of healthy foods and beverages: A systematic review. Preventing Chronic Disease. 2017;14(E107):170213.
8 Grech 2015 - Grech A, Allman-Farinelli M. A systematic literature review of nutrition interventions in vending machines that encourage consumers to make healthier choices. Obesity Reviews. 2015;16(12):1030-1041.
9 Jaime 2009 - Jaime PC, Lock K. Do school based food and nutrition policies improve diet and reduce obesity? Preventive Medicine. 2009;48(1):45-53.
10 Kocken 2012 - Kocken PL, Eeuwijk J, Van Kesteren NMC, et al. Promoting the purchase of low-calorie foods from school vending machines: A cluster-randomized controlled study. Journal of School Health. 2012;82(3):115-122.
11 An 2013 - An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: A review of field experiments. Public Health Nutrition. 2013;16(7):1215-1228.
12 AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: A scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514-1563.
13 PCORE-Royal 2016 - Royal N, Brown K, Rodriguez F, Fernandez B, Valle L, Bello E. Harvesting health: A community-based participatory evaluation of the Veggie Rx program. Providence Center for Outcomes Research & Education (PCORE), The Next Door, Inc. 2016.
14 Buyuktuncer 2014 - Buyuktuncer Z, Kearney M, Ryan CL, Thurston M, Ellahi B. Fruit and vegetables on prescription: A brief intervention in primary care. Journal of Human Nutrition and Dietetics. 2014;27:186-193.
15 Ringling 2020 - Ringling KM, Marquart LF. Intersection of diet, health, and environment: Land grant universities’ role in creating platforms for sustainable food systems. Frontiers in Sustainable Food Systems. 2020;4(70).
16 SSSA-McIvor 2017 - McIvor K. Soils in the city: Community gardens. Soil Science Society of America (SSSA). 2017.
17 CCAFS-Campbell 2012 - Campbell B. Is eating local good for the climate? Thinking beyond food miles. Research Program on Climate Change, Agriculture and Food Security (CCAFS), CGIAR Research Programs. 2012.
18 MH-Let’s go - MaineHealth (MH). Let's go!
19 FL DOH-5210 - Florida Department of Health (FL DOH), FloridaHealth Lee County. The 5-2-1-0 plan for a healthier active lifestyle.
20 FHC-5210 - Foundation for Healthy Communities (FHC). 5-2-1-0 Healthy NH.
21 MYAC-5210 plus 10 - Mayor's Youth Advisory Council (MYAC). Eat Right. Play Hard. Live Well. Mayor's Healthy City Initiative: 5-2-1-0+10 health and wellness campaign.
22 COACH-5210 everyday - Chesterfield County's Coalition for Active Children (COACH). 5-2-1-0 Everyday!
23 PAMF-5210 resources - Sutter Health Palo Alto Medical Foundation (PAMF). 5-2-1-0 Resources.
24 GGFN-Veggie Rx - Gorge Grown Food Network (GGFN). Veggie Rx Program.
25 WW-Rx - Wholesome Wave (WW). What we do: Produce prescription (Rx) program, healthy choice initiatives, and SNAP doubling.
26 CDC DNPAO-Kansas profile 2012 - Centers for Disease Control and Prevention (CDC), Division of Nutrition Physical Activity and Obesity (DNPAO). State of Kansas nutrition, physical activity, and obesity profile. 2012.
Related What Works for Health Strategies
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