A new prescription: Eat your veggies

One of Minnesota's largest health care providers is going to a new extreme in its struggle to combat the epidemic of childhood obesity.

It's started writing prescriptions for vegetables.

For now, it's just a pilot project at HealthPartners clinics in Hugo and White Bear Lake. But if the experiment succeeds, the Bloomington-based health organization could expand the project across the Twin Cities to address the high — and rising — rate of childhood obesity. Nearly a quarter of the state's ninth-graders are overweight or obese, according to last year's Minnesota Student Survey — a trend mirrored in skyrocketing youth obesity rates nationwide.

"What we're doing hasn't been working," said Dr. Thomas Kottke, HealthPartners' medical director for population health. "Obesity in kids has taken off in the last 20-25 years. And so we need to do something differently."

Emily Miller was a skeptic. The Forest Lake mom tried cutting junk food and putting out healthier snacks with the only results being whining children and rotting fruit.

But after her 12- and 10-year-old daughters got their veggie prescriptions at checkups earlier this year, they demanded to go straight to the grocery store.

"I didn't realize how much it would spark an interest in my girls," Miller said.

Participating doctors issue the prescriptions to children ages 5 to 12 who could use healthier diets and encourage them to make their own choices and try something new; area supermarkets accept the prescriptions and track the varieties of produce purchased. The prescriptions are actually just vouchers funded by HealthPartners, rather than formal scripts billed to health insurance companies. But the idea is to make them look official so they send the message to children that good eating is good health care.

While braced for critics, who might object to "medicalizing" diet and using health care dollars for family food budgets, health system officials think it's a sound investment.

"It could save us a huge amount of money down the road in our cholesterol-lowering drugs, in our heart-saving procedures," assuming that healthy children grow into healthy adults, said Dr. Elsa Keeler, a pediatrician at the White Bear Lake clinic.

And those costs can be staggering. A study late last month estimated that an obese child will incur $19,000 in additional lifetime medical costs, given the elevated risks for diabetes and heart disease as adults.

"Obesity ... affects our communities. It's raising our health care costs," said Dr. Ed Ehlinger, Minnesota's state health commissioner. "I think physicians should be very concerned about it."

Fruit pizza

Miller's daughters differ in their eating habits, though both craved treats like Nutty Bars and gummy snacks as much as the next kid.

Her oldest girl, Alena, is picky. She tolerates apples, though, so she used her prescription to buy multiple varieties and took a chance on spinach. Now the family uses her favorite apples in applesauce and to make a substitute for cooking oil. She even liked the spinach and soon progressed to zucchini in salads and bread.

"If I had even said that before," Miller said, "it was like, 'Ewwww, egh!' "

Her younger daughter, Amelia, is more adventurous. She used her prescription on tropical fruits such as kiwi and papaya for a yogurt-based fruit "pizza.''

"I think it was [successful] because it was their thing," Miller said. "It wasn't me encouraging them to do it. It was their choice."

Whether a one-time opportunity to test new fruits or vegetables will be equally transformative for other families is unclear. HealthPartners will study that question after the two clinics use up their 100 trial prescriptions.

Research on the issue has been inconclusive. Last month, a British study of fruit and vegetable prescriptions for 1,184 people in a low-income neighborhood found that most were used, but that they didn't change long-term habits because people still considered fresh produce too expensive.

Ehlinger said such strategies will work only in conjunction with broader efforts to make healthier choices easier. Some lower-income parents, for example, find it hard to choose fresh produce when it is more expensive than high-calorie packaged foods that fill their families up for less money.

Junk food marketing and fast-food availability — compared to the scarcity of produce markets in some communities — also present challenges, he said. "We have to change the policies and systems in an environment, in a community, if we are going to get people to move and eat properly. It's not just about an individual choice."

Kids' choice

The prescription trial is part of Bear Power, a collaboration of HealthPartners, Children's Hospitals and Clinics of Minnesota, and schools and civic groups in White Bear Lake to improve community health.

School "move-a-thons" and Bear Power bracelets are among the tools to spread awareness. Local grocers have already been participating in a variety of ways, such as putting healthy options in the "impulse buy" shelves next to the registers.

This "is about being proactive about health," said Tom Clasen, a vice president for Knowlan's Supermarkets, which has three Festival Foods stores that accept the prescriptions. "Our medical system is so built around a reactive stance to problems."

Clasen said children have used prescriptions to buy everything from cilantro to mangoes to jicama.

While cost is a barrier to healthier eating, Kottke said there are other barriers that the prescription program might address. Even doctors tiptoe around subjects such as personal diet and weight with patients, so the prescriptions give them an excuse to be more direct. The prescriptions also appeal to the American desire to sample foods first, and to children's love of gifts and opportunities to pick things out for themselves "without having to put 10 bucks at risk," Kottke said.

"One $10 coupon every year or two isn't going to change things," he added. "That ... is trivial to the annual grocery bill. So this is about sampling and it's about signaling the parents that we are serious about this."

Miller is left with a chicken-and-egg question: Did she spur her children's junk food cravings with her own purchases, or did their cravings push her to buy foods she never really wanted?

Snack times and dinners at the Miller home still aren't perfect, but they have improved.

Miller's 13-year-old son grumbled about the changes — he had no say because he didn't receive a prescription — and loathed the lack of pop in the fridge. But he was OK with the new foods on his plate.

"He eats whatever is put in front of him," Miller said. "He's kind of a human garbage disposal."

Jeremy Olson • 612-673-7744