Impacts of the Navajo Fruit and Vegetable Prescription (FVRx) Program on Childhood Obesity in an American Indian Community: A Mixed-Methods Study in Northern Navajo Nation

Abstract

In the United States, American Indian and Alaskan Native (AI/AN) populations continue to experience poor health status and high levels of food insecurity when compared to the rest of their U.S. counterparts. In Navajo Nation, 20% of adults suffer from diabetes, while 50% of children are either overweight or obese. Furthermore, it is estimated that 75% of the Navajo population is considered food insecure due to various systemic barriers. The Navajo Fruit and Vegetable Prescription (FVRx) program is a locally-implemented program which aims to increase the fruits and vegetable consumption of participating families, and to promote a healthy lifestyle in the Navajo community. Methods: In order to better understand benefits and the long-term impacts of the FVRx program on the health of participating children and their families, we conducted a mixed-methods study that utilized both quantitative and qualitative analyses in the Northern Navajo Nation. The changes in the pediatric patients’ BMI-for-age percentiles between baseline, exit, and post-intervention follow-up were analyzed. Qualitative in-person interviews were also conducted with caregivers of the patients who completed FVRx. Results: While the number of healthy weight, at-risk for overweight and overweight patients decreased between exit and post-intervention follow-up, the number of obese children doubled between these two time periods. The qualitative results revealed 1) barriers faced by the participating patients and their families; 2) the benefits and values of the FVRx program delivered to the participating families and community members; and 3) the meaningful and desirable changes the participating families made throughout and after FVRx. Both the quantitative and qualitative findings suggest that some of the pediatric patients might experience weight gain or rebound after weight loss once FVRx terminated after six months due to the families’ financial challenges in purchasing the same amount of fresh produce without the FVRx vouchers.