Impact of a fruit and vegetable prescription program on health outcomes and behaviors in young Navajo children

Background: Rates of childhood obesity are higher in American Indian and Alaska Native populations, and food insecurity plays a major role in diet-related disparities. To address this need, local healthcare providers and a local nonprofit launched the Navajo Fruit and Vegetable Prescription (FVRx) Program in 2015. Children up to 6 y of age and their caregivers are enrolled in the 6-mo program by healthcare providers. Families attend monthly health coaching sessions where they receive vouchers redeemable for fruits, vegetables, and healthy traditional foods at retailers participating in the FVRx program.

Objectives: We assessed the impact of a fruit and vegetable prescription program on the health outcomes and behaviors of participating children.

Methods: Caregivers completed voluntary surveys to assess food security, fruit and vegetable consumption, hours of sleep, and minutes of physical activity; healthcare providers also measured children's body mass index [BMI (kg/m2)] z score at initiation and completion of the program. We calculated changes in health behaviors, BMI, and food security at the end of the program, compared with baseline values.

Results: A total of 243 Navajo children enrolled in Navajo FVRx between May 2015 and September 2018. Fruit and vegetable consumption significantly increased from 5.2 to 6.8 servings per day between initiation and program completion (P 0.001). The proportion of participant households reporting food insecurity significantly decreased from 82% to 65% (P 0.001). Among children classified as overweight or obese at baseline, 38% achieved a healthy BMI z score at program completion (P 0.001). Sixty-five percent of children were retained in the program.

Conclusions: The Navajo FVRx program improves fruit and vegetable consumption among young children. Children who are obese or overweight may benefit most from the program.

Keywords: American Indians; Navajo; body mass index; indigenous; produce prescription program, childhood obesity; rural.