How produce prescriptions work at Giant Food

If you ascribe to the Food as Medicine movement even just a little bit, it’s not a stretch to think of your local supermarket as a health care provider — a key partner to the medical sector of physicians and nurses.

Leslie Jefferson, a certified nutrition specialist and community health manager at Giant Food, expands what it means for a grocery store by factoring in equal access to healthy opportunities for all.

The food retailer has about six nutritionists in its 165 stores in the “DMV plus D area” — District of Columbia, Maryland, Virginia plus Delaware — that do health, education and nutrition education. Jefferson was able to spin off and create food-as-medicine programming for communities that they serve.

“I take on all things food-as-medicine and communities of need, health equity, looking at organizations that really want to work on the social determinants of health, and then looking at organizations working primarily with chronic disease,” Jefferson said.

How it began

Gordon Reid, company president until 2019 and a board member of Partnership for a Healthier America, worked to make healthy eating easier and more affordable, expanding the nutrition program led by Lisa Coleman, one of the first nutritionists at Giant Food. The goal is to guide the stores' communities toward healthier eating habits, Jefferson said.

These retail dietitians served as concierges and ambassadors of healthy eating, providing nutrition education. The early ambassadors worked in-store with store operations and management to partner with the pharmacy teams to offer diabetes and heart-health classes and store tours to the public. They set up Giant Food nutrition tables at community events, churches and schools.

“Anywhere that people wanted to learn more about healthy eating, healthy food and have nutrition education, we were willing and ready to go,” Jefferson said.

Focusing on food-as-medicine and health equity, Jefferson represents one of the three pillars the Healthy Living team works under today: nutrition education, merchandising and community outreach.

She collaborates with organizations focusing on the social determinants of health and those that primarily handle chronic disease. That includes nongovernmental organizations, hospital systems and medical insurance companies working to help the public prevent and manage chronic disease.

“One link there is food,” Jefferson said.

Produce prescriptions

Jefferson and the Healthy Living team works with these organizations on different types of programs, mainly produce prescriptions.

“Linked to our loyalty card, we’re able to provide additional benefits to their programming. Maybe that's $80 a month in-store that the organization is funding for their participants to come in and shop for specific healthy items, like fresh and frozen produce, and things that can help benefit their health,” Jefferson said.

Those organizations can receive a listing of what participants purchased to research the health results.

The beauty of this system is that Giant Food doesn’t own the program. Each individual organization controls its own program, choosing which people are eligible, how much money they can spend within a predetermined time frame, what grocery items are eligible and maintaining the shopper’s privacy.

“We are — just as groceries should be — that center in the wheel that allows different organizations to create programs that help their participants,” she said. “We’re just that place where they can exercise the benefit.”

This iteration of the program is a result of a lot of trial and error, from the technology at the register to billing, and it started with paper vouchers that didn’t work too well. Organizations were used to the gift card model, but that doesn’t solve data security, pricing and reporting needs, Jefferson said.

Using the same loyalty card that all shoppers use is the best answer so far.

These organizations can be individual medical offices or nonprofit groups that act as a hub for multiple clinics to funnel in participants — anyone with funding for Nutrition Incentive Programs.

Layering nutrition incentive programs

Some organizations don’t have the bandwidth or funding for a long-term project with many participants. The program could be a class that teaches healthy cooking.

Giant Delivers can be involved to deliver meal-inspiration kits. And a Giant Food Healthy Living team member could give a demonstration of those meals.

“We can demonstrate what healthy living and healthy food looks like, that it doesn't have to be expensive or take a long time to do,” Jefferson said. “It can be quick and easy, and then you can have dinner on the table.”

Those meal kits are based on the USDA’s recommended MyPlate plan, a visual reminder to eat a varied diet from the five food groups of fruits, vegetables, protein, grains and dairy. And it starts with filling half that plate with produce.

One example is a MedStar Health diabetes class that includes meals for the students, which they buy through the loyalty card or receive through Giant Delivers. Then Giant Food nutritionists will come in to demonstrate how to make those meals. At graduation, students will go on a store tour, showing them how to make healthy shopping choices.

Eligibility all relies on the type of problem the program is trying to solve, anything from heart disease to food insecurity.

Giant Food doesn’t receive the names of these recipients, just loyalty card numbers, to protect individual privacy.

While the dollar amount that participants receive is up to the organization’s discretion, the most effective amount seems to be $20 a week on the loyalty cards. After all, fresh produce can go bad if unused within a week. But then there’s the problem of store access for some people in the community, so $80 a month has become the go-to recommendation. And whatever money isn’t used in that month goes back to the organization.

It’s hard to calculate the dollar value of how much produce has been sold through this program because there are many versions of programing, including a Visa card managed by a third party, Jefferson said.

“There are many different ways to do it. It gives organizations variety. I have a little Nutrition Incentives Program brochure that outlines all the ways you can partner for that,” she said.

Guidance labels

Then there are in-store and online labels that provide shoppers with guidance in their purchase decisions.

The HowGood label offers social and environmental impact guidance. It’s an independent research company and data platform that analyzes each ingredient against environmental and social criteria, including farming practices, treatment of animals, labor conditions and chemical use. Any product with one, two or three leaves is one of the most sustainable products on the market. Shoppers can make choices based on these labels.

“You can also download the HowGood app, and when you’re in-store, you can scan the UPC code and find out if that item qualifies for a HowGood rating. Pretty cool,” Jefferson said.

The GuidingStars program is another independent rating system, not owned by Giant Food. It focuses on rating nutrient content in the product as good, better or best.

These guidance symbols can be on shelf tags and on the packages of private-label products.

Outcomes

Any organization that can get nutrition incentive program funding should go for it, Jefferson said.

The programs really help people.

Yes, Giant Food can see larger basket size in shopper participants who receive these produce prescriptions. But it’s not about that, Jefferson said.

The goal is improving public health.

“We’ve gotten great feedback from the participants with great health outcomes,” she said. “People learn what's possible, and they learn that ‘healthy eating,’ for them, turned out to be not so hard. They just needed a little bit to help them learn what it looked like for them.

“We could do a lot with a little of this.”