If an apple a day keeps the doctor away, why are our doctors prescribing so few apples? This is what Sarayna Schock asked herself as she developed plans for Penn State ProduceRx.

ProduceRx will allow physicians and providers within the Penn State health system to prescribe a full box of fresh fruits and vegetables to patients who have been identified as high-risk or under-served.

“The program aims to support patient health and improve patient outcomes, make quality produce more accessible and affordable to patients, and make a difference in the longitudinal eating behaviors in ways consistent with the hospital’s wellness initiative,” Schock said.

Schock, a student at the Penn State Hershey College of Medicine, is inspired to help those who struggle with being overweight because of the difficult battle she faced with her own weight growing up.

“I was overweight throughout my adolescence — my parents both worked full-time and I grew up on fast food and sugary beverages as they were easily accessible and affordable on my family’s income. I had an amazing pediatrician, but my time in his office was spent tackling my weight-related health issues, leaving very little time to talk about nutrition and specific diet education,” she said. “My family and I would return home from an office visit and try to incorporate canned peas and artificially-sweetened applesauce into a dinner meal to get what we thought at the time were adequate vegetable and fruit servings.”

Schock later enlisted in the United States Air Force to pay for college, where she found herself surrounded by information about proper nutrition and exercise habits.

“The Air Force eventually took me to Okinawa, a famous ‘Blue Zone’ known for having the highest ratio of centenarians [read: people over 100 years old] per 100,000 inhabitants in the world,” Schock said. “Coincidentally, the Okinawa diet consists largely of vegetables, potatoes, rice, and a little fish.”

The Air Force later introduced Schock to the “Farmacy” program started by Dr. Garth Davis, a bariatric surgeon at Memorial Hermann Memorial City Medical Center in Houston, Texas. Dr. Davis’ concept is based on the benefits of a diet high in fruits and vegetables, which he claims can prevent disease and help people live longer. It was through this program and her experience in Okinawa that inspired Schock’s ideas for ProduceRx.

Schock approached faculty physicians at Hershey Medical to gauge prescriber interest in January before polling the community through the local Hershey Facebook page. “I received a great deal of feedback from the community, more so than I had anticipated, and the majority of it was positive and encouraging,” she said.

Schock spoke with administrators at the Hermann Memorial City Medical Center in February. Though she used their Farmacy concept as inspiration, she quickly recognized the large societal differences in the needs of her own local area to those of Houston. She made several changes to adapt the program to Central Pennsylvania and the Penn State Health System.

ProduceRx emphasizes the importance of treating the cause of the problem before treating its symptoms. Rather than treating an overweight patient with medications to combat possible high blood pressure or heart disease, physicians will have the option of prescribing ProduceRx. After receiving a prescription, patients can go online to sign up and choose a pick-up site.

“On August 1, ProduceRx will roll out a pilot program working with Strites Orchard, a local farm that already has a CSA [Community Supported Agriculture] program established and is willing to extend their current CSA delivery sites across the local area to participating patients,” Schock said. “Volunteer medical students from the Food as Medicine interest group and dietitians will collaborate to form a nutritional education component for participating patients. Possible educational opportunities include a weekly newsletter in each box, education via social media, or YouTube cooking videos with the opportunity for guest physicians.”

“Furthermore, the program will allow for large-scale longitudinal research on nutrition and how it relates to health outcomes within defined patient populations,” Schock explained. This research can provide information to improve systems of nutrition and health care for areas with similar issues.

The program is currently pursuing grant funding to subsidize the costs of weekly boxes down to a $10 co-pay for patients. This will allow the program to be both more affordable and more sustainable long-term. On August 1, two or three providers will begin identifying patients and writing “prescriptions” for the program using funds allotted by the Hershey Medical Center.

Schock hopes to expand ProduceRx to additional patients and physicians as funding increases.

“I hope that eventually any Penn State Health physicians (or prescribers in general) will be able to write ‘prescriptions’ for patients to enter the program,” Schock said. “This includes the Hershey Medical Center, but also satellite clinics Penn State has in the area.”