How do we get children to eat more fruit and vegetables?

Increasing Fruit and Vegetable Consumption in Children

How do we get children to eat more fruit and vegetables?

A vital question. Low intakes of fruit and vegetables are associated with higher rates of many types of cancer. Good eating habits are important to establish in childhood, especially when the lure of high fat and high sugar foods may be much more appealing.

Message


This study showed that children (10 to 12 years old) ate slightly more fruit and vegetables after receiving a school based programme. However, children would have to increase their fruit and vegetable consumption still further to make such a programme worthwhile. Further investigation is needed to address the shortcomings of this study to see whether such increases are possible.

Study


This study aimed to increase fruit and vegetable consumption among children using a multi component school based programme.

Twenty schools with children from diverse ethnic backgrounds participated. Schools were matched, for example, on the basis of their size and the ethnic background of their students. Ten were then randomly assigned to receive the programme and ten were used as a comparison.

The programme consisted of 3 main parts:
  1. curriculum consisting of twice weekly, 40 to 45 minute classes for 8 weeks (included skill building/problem solving activities, snack preparation/taste testing, role models in comic books and team competitions/prizes);
  2. parental involvement and education (eg. activities for parent/child participation);
  3. changes in lunchtime service (eg. promotion of fruit and vegetables, increasing variety and choice of fruit and vegetables).

Fruit and vegetable consumption was measured by observing the children during one lunchtime session and asking them to remember what they had eaten from the previous 24 hour period. Daily servings of fruit and vegetables were calculated separately, as well as adding fruit and vegetable servings together. (Although this study does not define a serving, the standard definition is one piece of fruit, eg. an apple, or one portion of vegetables, eg. a carrot.) Parents answered a telephone survey and children completed a behaviour questionnaire, both relating to fruit and vegetable consumption (the validity of which is not reported).

Results

Out of all the children and parents asked to participate, between 72% and 99% did so (which is a good number of responses).

Based on the lunchtime observations of 424 children, those receiving the programme ate slightly more fruit and vegetables. Another observation was that girls ate slightly more vegetables than boys. Based on the recall of 407 children from the previous 24 hours, those receiving the programme ate slightly more fruit and more fruit and vegetables (when added together). They did not, however, eat any more vegetables than children not having received the programme. Details of these results can be seen in Table 1.

Table: Effect of intervention on lunchtime and daily fruit and vegetable intake

  Lunchtime observations average intake (servings) 24 hour recall average intake (servings)
  Intervention Comparison Difference Intervention Comparison Difference
Fruit 0.7 0.4 0.3 2.8 2.1 0.6
Vegetable 0.8 0.6 0.2 2.5 2.5 0.0
Fruit/Veg. 1.5 1.1 0.5 5.2 4.7 0.6

Some differences were seen in children's responses to the behaviour questions after the programme. For example, based on between 1028 and 1271 answers, children receiving the programme thought people should eat more fruit and vegetables (5.0 versus 4.5 daily servings) and reported eating slightly more daily servings of fruit and vegetables themselves (4.1 versus 3.3).

The parents of children receiving the programme did not show any more knowledge concerning fruit and vegetable consumption than parents not involved in the programme (based on 321 to 324 responses).

Comment

Although fruit and vegetable consumption was reported as significantly higher in children receiving the programme, the actual differences were small (half a piece of fruit). Children's memories are notoriously bad and asking them to remember what they have eaten over the previous day is unlikely to produce accurate results. Furthermore, the results are based on looking at children's diets on only one day , which is unlikely to give a representative assessment of their overall consumption. Asking children to record what they are eating in a dairy, over a seven-day period, would be a more satisfactory way of recording what they eat.

Average fruit and vegetable intake is interesting, of course, but it may not tell us all we want to know. For instance, we were not given the range of servings a day eaten by children, or even a standard deviation to play with. This is a shame, because we don't know whether any effects were due to children with a low intake being converted into children with a sensible intake (the real goal), or children already with a sensible intake eating even more and those with low intake unaffected. What a shame.

Another interesting observation is that few parents involved themselves in this programme, despite the activities for parent participation. This is likely to have contributed to the small changes in fruit and vegetable consumption and points towards the importance of parental support when trying to implement changes to children's diets.

Reference

  1. CL Perry et al. Changing fruit and vegetable consumption among children: The 5 a Day Power Plus Program in St. Paul, Minnesota. American Journal of Public Health 1998 88: 603-609.