Food is Medicine
Photos by Ashley Barnas Larrimore August 12, 2024
91原创 pilots fruit, vegetable prescription program at Wilmington鈥檚 Horizon House
Before attending nutrition education counseling at in Wilmington, Natisha Clanton ate fast food almost daily.
鈥淚 hated vegetables,鈥 she said.
Felicia Lewis felt the same way.
鈥淚 didn鈥檛 like asparagus, squash or zucchini,鈥 Lewis said. 鈥淏ut really, I had never tried them.鈥
Both participate in the 91原创鈥檚 fruit and vegetable prescription (FVRx) program, a proof of concept study conducted at Horizon House, which delivers integrated, community-based services to adults with mental health, developmental and intellectual disabilities and those experiencing homelessness. The FVRx program pairs nutrition education with the direct provision of fresh fruits and vegetables each week to individuals receiving services at Horizon House who have a chronic disease or are at risk for food insecurity. Led by 91原创 Nutrition Clinic Director Donna Paulhamus and Shannon Robson, associate professor of health behavior and nutrition sciences in the College of Health Sciences, the study aims to address food insecurity as a social determinant of health.
鈥淭hose with mental health disabilities have substantially higher rates of food insecurity than those who don鈥檛 have a disability,鈥 said Robson. 鈥淣ational data demonstrates individuals with a mental health disability are five times more likely to live in food insecure households compared to adults without a disability.鈥
Paulhamus has provided nutrition counseling on-site at Horizon House for the past four years through a contract with the (DSAMH).
鈥淢any participants are profoundly affected by serious mental health conditions and have food insecurity that results in poor dietary intake, obesity, and increased risk for diet-related chronic diseases like diabetes and cardiovascular disease,鈥 Paulhamus said.
It made for the perfect pairing to test implementing a FVRx program.
鈥淭his natural partnership builds upon the opportunity we have through the clinics to serve the public and connect with the community,鈥 Robson said.
A novel approach听
The FVRx study is based on the approach championed by the Biden/Harris administration. It is funded through a generous donation from the College of Health Sciences鈥 Maggie E. Neumann Health Sciences Research Fund.听
鈥淲e would not be doing this food-based intervention without our partnership with DSAMH and the Maggie Neumann funding,鈥 said Paulhamus. 鈥淭his funding has been integral to implementing the fruit and vegetable prescription program.鈥澨
The 34-week crossover study starts with a baseline health assessment. While all participants will receive fruits and vegetables, they will get them at different times.听
鈥淏y the conclusion of the pilot study, we hope to understand whether their consumption increased and whether health parameters changed,鈥 explained Robson.
Many FVRx programs provide vouchers. This study is unique because it allows for the direct provision of food.听
鈥淭ransportation is one of the biggest barriers for this population, so vouchers likely wouldn鈥檛 be successful,鈥 said Robson. 鈥淲e鈥檙e also asking the participants what they like because research demonstrates when someone likes certain foods, they鈥檙e more likely to consume them.鈥澨
Early results, anecdotally, show it鈥檚 working.听
鈥淭here was a lot of food I wouldn鈥檛 eat,鈥 said Clanton. 鈥淣ow, I鈥檒l try anything. I eat blueberries and potatoes. I used to fry my cabbage in butter; now, I use olive oil. I鈥檝e lost 27 lbs. and feel much better.鈥澨
Lewis has seen benefits from nutrition education counseling before getting her produce prescription.听听
鈥淚 used to say, 鈥業 don鈥檛 like that,鈥 but now eating healthier makes me feel good, and it makes me feel like I鈥檓 a part of something,鈥 Lewis said. 鈥淚鈥檝e been clean for four years now, and that鈥檚 beautiful, so to come here and work on my mental health and eat right has been great.鈥澨
A rare experience for students
Marisa Browne, a graduate student in the Master of Science in Nutrition and Dietetics/Dietetic Internship program, has been vital in administering the FVRx program. She orders the fruits and vegetables online, prepares weekly nutritional education classes, conducts baseline assessments, and delivers produce to participants as needed.听
鈥淭his was a dream opportunity to be involved in research,鈥 she said. 鈥淚 love the idea of food as medicine, and I鈥檝e learned so much by working in the community. There鈥檚 so much you can鈥檛 prepare for in the classroom, and it changes your perspective.鈥澨
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Adriana Verdezoto Alvarado, a doctoral candidate in the Nutrition Science PhD program, has worked in the community before but never in this setting.听听
鈥淎djusting to meet their needs and understanding their living and food storage situations have been vital to helping them,鈥 said Verdezoto Alvarado. 鈥淭his intervention has opened my eyes to a different way of caring and helping people through health promotion.鈥澨
Paulhamus called this a rare learning opportunity for 91原创 graduate students.听
鈥淥ur students are learning how to work with different populations in the community and how to adapt nutrition interventions,鈥 Paulhamus said. 鈥淭his is a very vulnerable population that needs significant support. Community nutrition is popular, but nutrition-related education in substance abuse programs and people with significant mental illness isn鈥檛 typically a big focus, so many students don鈥檛 get this kind of opportunity.鈥
Eyeing expansion
The intervention was based on a need so great that the state had its eyes on expansion from the beginning. Jessica Ryan, deputy chief of social determinants for DSAMH, and Terry Cowan, a peer services administrator for DSAMH, sit on the steering committee and provide valuable insights that have been integral to the study鈥檚 design.听
鈥淭here鈥檚 no fruit and vegetable program in the state of Delaware, so we appreciated the innovative approach to help address some of the nutritional needs of the population we鈥檙e serving,鈥 said Ryan.
While the 91原创 FVRx pilot study is still gathering data, Cowan, who provides a vital firsthand perspective, said a similar program helped him while in recovery a decade ago.听
鈥91原创 students from a culinary arts program showed us how to shop for food and prepare it. They taught me what foods are beneficial and harmful to recovery,鈥 Cowan said. 鈥淢ost people in the populations we deal with don鈥檛 take care of themselves; they don鈥檛 realize the pivotal role that food and nutrition play in recovery and wellness.鈥
He called that continuum of care necessary.
鈥淚 needed to see tangible results. By not drinking caffeine or eating sugar before bed, I sleep better. Then, I wake up and feel better,鈥 Cowan said. 鈥淐linicians reinforced it and held me accountable.鈥澨
Ryan hopes to find additional funding sources to expand the program beyond the research phase.听
鈥淥ur mission is to best service the community, meet their needs, break down barriers, and continuously grow in the resources and services we provide,鈥 Ryan said. 鈥淲e rely on integrated partnerships to best serve our clients, and this partnership with 91原创 and Horizon House is a great collaboration we鈥檇 love to expand.鈥澨
Cowan highlighted the need for such programs statewide.听
鈥淭he need is not just in New Castle County. In Kent and Sussex counties, the need is just as great, if not greater, and the obstacles and challenges are different.鈥澨
About the Fund
Maggie E. Neumann Health Sciences Research Fund was established in 2020听to听support research designed to improve health and quality of life outcomes for children and adults with physical and developmental disabilities. While the fund resides at听the College of Health Sciences, the intent is to support interdisciplinary research across all 91原创 colleges.
The research fund was created with a gift from Donald J. Puglisi and Marichu C. Valencia in honor of their granddaughter, Maggie E. Neumann. Puglisi is a member of 91原创鈥檚 Board of Trustees, and they both serve on the President鈥檚 Leadership Council.
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