Making the case for food as preventive health care

One decade ago, Ronit Ridberg managed a farmer’s market in downtown Boston directly across the street from Burger King and Dunkin Donuts. That experience set her on a path to evaluate the potential of food as a prescription for health.

“At the peak of the season, we were selling heirloom tomatoes for $5 a pound. Some were so big, one tomato was a pound,” recalled Ridberg, a doctoral candidate in the Class of 2018 at the Betty Irene Moore School of Nursing at UC Davis. “Faced with the option of one tomato versus an entire meal for five bucks, many people opted for fast food. That realization led me back to school to understand the root of food disparities and how to use policy and science to address them.”

Doctoral candidate Ronit RidbergDoctoral candidate Ronit Ridberg aims to evaluate the potential of food as a prescription for health.

Ridberg, who is a food systems policy analyst, achieved a master’s degree in Nutrition and Food and Agriculture Policy from Tufts University in Massachusetts, then headed to the West Coast and enrolled in the School of Nursing doctoral program in 2014. Her research builds from Hippocrates’ credo, “Let thy food be thy medicine and medicine be thy food.” Her dedication to a prevention-based model created at the intersection of health care, nutrition and sustainable agriculture, coupled with the school’s interdisciplinary focus, proved a perfect fit.

“Whenever I’ve brought the idea of a food-based program to health care providers, they always want the proof: proof that a provider prescribing healthy food and health care systems investing in vouchers or reimbursements for that food results in better health outcomes,” Ridberg said. “My dissertation has been an exercise in gaining quantitative research skills, understanding the complexity of health care systems and critically examining that hypothesis.”

The estimated annual costs of obesity-related illness are a staggering $190.2 billion or nearly 21 percent of overall health care spending in the United States. Childhood obesity alone is responsible for $14 billion in direct medical costs. Ridberg’s research also addressed the issue of food insecurity.

“In 2016, 15.6 million American households experienced food insecurity (i.e., lacked consistent, dependable access to enough food for active, healthy living) with higher rates among Hispanic-headed or Black, non-Hispanic-headed and lower income households. Food insecurity creates a negative impact on children’s health, academic performance, social development and health care utilization. Food-insecure adults experience higher probabilities of chronic disease and food-insecure households see higher annual health care costs.

Ridberg connected with a national operator of a food prescription collaboration between health care providers, farmer’s markets and community organizations. She analyzed data from 12 locations in five states and Washington, D.C., focusing on clinically obese children whose providers enrolled them in a four-to-six-month program. They received clinical nutrition education, obesity counseling and a prescription for fruits and vegetables for the whole family, which caregivers could take and exchange for healthy food from local farmers. “Preliminary results are really encouraging. Households are increasing food security and children are increasing their consumption of fruits and vegetables. Plus the program supports local farmers who grow these healthy options,” Ridberg said. “One of the challenges of working with observational data from a real-world program is the lack of a control group. I’ve learned what I need to a put a program in place to study outcomes in a more scientific way.”

Ridberg shared her research through podium and poster presentations at the Western Institute of Nursing, the American Public Health Association and the Nutrition Policy Institute at Berkeley research conferences. She will present her findings at the School of Nursing’s annual Academic Symposium June 8. Long term, she hopes to contribute to the evidence base to support these and related programs, secure additional funding for them and build a business case for system-wide integration.

“Ultimately I’d love for health care systems and providers to see the value of fruit and vegetable based programs to fund them and wrap them into their care portfolio,” Ridberg said. “Early evidence suggests that these programs may save money and improve health in the long run.”