July, 2013

Research Perspective and Comments & Analysis

Boosting School Kids' Familiarity With Produce May Increase Consumption

By Jessica Thomson, Research Epidemiologist, USDA Agricultural Research Service & Lisa Tussing-Humphreys, Assistant Professor, Department Of Medicine, University Of Illinois at Chicago & University Of Illinois Cancer Center

 

Childhood obesity is a national public health threat with approximately 15 percent of children 2 to 19 years of age classified as overweight and 17 percent classified as obese. Once believed to be adult onset conditions, hypertension, dyslipidemia, osteoarthritis, and Type 2 diabetes are now commonly seen in child populations. One strategy to fight childhood obesity, advocated by the pediatric medical community, is for children to eat the government-recommended daily amount for fruits (1.5 servings) and for vegetables (2 to 2.5 servings).

However, children’s unwillingness to try healthy foods, such as fruits and vegetables, has been given as the reason for their low consumption of these foods. Therefore, we conducted a fruit and vegetable snack-feeding trial to determine: (1) elementary school children’s familiarity with and willingness to try fruit and vegetable snacks; (2) if a school-based fruit and vegetable snack-feeding intervention can increase children’s familiarity with, and consumption of, fruits and vegetables; and (3) associations between familiarity, willingness to try, and consumption of fruits and vegetables.

 

Methods

The School Kids Access to Treats to Eat (SKATE) study was a school-based, fruit and vegetable snack-feeding trial conducted with students enrolled at a rural elementary school located in Mississippi. Participation rate for free or reduced school meals was 95 percent, although 100 percent of children at this school were eligible. All 4th- to 6th-grade children were invited to participate in the study. Fruit and vegetable snacks were offered three times per week in the six-week study period. The snacks consisted of 12 fruits (green and red apples, apricots, cantaloupe, red and green grapes, kiwis, mandarin, Clementine, and Navel oranges, pears, and tangerines) and five vegetables (broccoli, baby carrots, yellow squash, grape tomatoes, and zucchini). 

Before beginning the study, we measured the children’s familiarity (recognition of and prior eating experience with) and willingness to try selected fruits and vegetables. Responses for willingness to try were recorded as “no,” “maybe,” and “yes” with higher scores corresponding to greater willingness to try a food.

The educational component of our study consisted of a short presentation in which the fruit or vegetable was named and fun facts about the food were shared with the children. Subsequently, the children were given time to eat the snack. Snack containers were weighed prior to distribution and after the snacking period to determine the amount eaten.

 

Results

Our sample size consisted of 187 of the 214 (87 percent) 4th- to 6th-grade students enrolled at the rural elementary school. Prior to the study, children’s recognition ranged from 9 percent (apricot) to 100 percent (baby carrot and red grape); previous eating experience ranged from 46 percent (apricot) to 100 percent (red apple); willingness to try ranged from 30 percent (grape tomato) to 96 percent (red grape); and unwillingness to try ranged from 0 percent (red apple) to 5 percent (cantaloupe).

Average familiarity and willingness to try scores indicated that children recognized and had previous eating experience with most (80 percent) of the selected 12 fruits and vegetables, and were willing to try them. In general, if children had previous eating experience with a fruit or vegetable, they were more likely to recognize it and more willing to try it.

Average consumption amounts for the fruit and vegetable snacks ranged from 50 percent (baby carrots and grape tomatoes) to almost 100 percent (kiwis and red grapes). Average consumption amount for all snacks combined was 67 percent. In general, there was a positive association between consumption amount and willingness to try — such that, higher willingness resulted in greater consumption. While recognition did increase during the course of the study, it was not predictive of consumption.

 

Industry Implications

Our study provides evidence that a school-based, fruit and vegetable snack-feeding program can increase children’s familiarity with, and potentially, the consumption amount of fruits and vegetables. While familiarity was not predictive of consumption, it is possible that an indirect effect was present given that greater familiarity was associated with higher willingness to try the fruits and vegetables.

Importantly, our results show that willingness to try fruits and vegetables was high in these children, and even those indicating they were unwilling to try a specific fruit or vegetable did eat at least a small portion of the food when it was offered. Hence efforts to introduce fruits and vegetables into school meal programs through education and repeated offerings may increase students’ demand for such healthy foods, both in the school and home environments.   pb

 

Why Not Study Obscure Items?

It is not surprising that the comeuppance of many research reports is that more research is required. This is true more often than not, and it is especially true when it is children and their perceptions that are being studied.

Still this research includes several oddities. The study starts with a sort of “straw man,” with the researchers claiming that “…children’s unwillingness to try healthy foods, such as fruits and vegetables, has been given as the reason for their low consumption of these foods.” Presumably someone has made this claim, but it is not a common analysis of the cause of low produce consumption.

The recognition of childhood aversion toward many of the healthiest vegetable items, such as spinach, is a fair assessment; but there is no category-wide aversion to fruits and vegetables. After all, children almost ubiquitously eat lots of fruits and vegetables — bananas, berries, grapes, potatoes, corn, baby carrots, etc. There is no evidence that children are more recalcitrant about trying fruits and vegetables than other food groups — try offering tykes some liver or limburger cheese!

Some of the numbers reported are logically inconsistent indicating that the children may have not known certain terms or that they were answering in a way they thought pleased the questioners. For example, how is it possible that only 9 percent of the participants recognized an apricot while, supposedly, 46 percent of the children had eaten apricots?

Other findings are just odd. The maximum percentage of students who were unwilling to try an item was only 5 percent — and this was cantaloupe? Does this mean that more students were unwilling to try cantaloupe than broccoli?

The analysis also seems to disregard the researchers’ own findings. The researchers explain that “While recognition did increase during the course of the study, it was not predictive of consumption.” Since this explains that recognition alone doesn’t prompt consumption, the researchers’ conclusion is quite a stretch: “Our study provides evidence that a school-based, fruit and vegetable snack feeding program can increase children’s familiarity with, and potentially, the consumption amount of fruits and vegetables. While familiarity was not predictive of consumption, it is possible that an indirect effect was present — given that greater familiarity was associated  with higher willingness to try the fruits and vegetables.”

Familiarity doesn’t seem to actually be a problem — at least on the 12 fruit and vegetable items studied here. No more than 9 percent of these students were unfamiliar with any item. If you expanded the subject population to include children raised in more affluent families, the number would probably fall further.

Raising familiarity on these items seems to be a very marginal activity if one’s goal is to increase consumption. In fact, with only 5 percent of the children unwilling to try any of these items, there is unlikely to be a lot of upside in increasing willingness to try these items.

Although the researchers explain, “…efforts to introduce fruits and vegetables into school meal programs through education and repeated offerings may increase students’ demand for such healthy foods,” the study does not establish any fact or sure solution to increased consumption. Yes, such efforts “may” do this, but they also “may not” do this. This study, though well intentioned, is just not particularly illuminating on this point.

One can think of some interesting ways to do this type of study in the future. A possibility is to repeat the study with less familiar items. It may well be that the children who gain familiarity with items they have never heard of will be more likely to consume them. But if you do the study on apples, you can’t really find that out.

Another interesting possibility would be to distinguish between availability and education. If one school simply started featuring kale salads and another featured them and included education, it would be interesting to see how the education component impacted trial and consumption.

Many of the nutritional benefits of produce come from eating more bitter produce items rather than sweet snack fruit. It is not clear if trialing these items actually favors consumption. A study as to the impact of trial on the sustained consumption of bitter greens by children would be enlightening.

Also, the relationship between increased consumption of any one item and total produce consumption is uncertain. Among adults, for example, there has been a boom in kale consumption. Yet it is not at all clear that the sudden rage for kale is increasing produce consumption. Perhaps consumers are simply replacing a lettuce-based salad with a kale-based salad.

Finally, the researchers begin their piece by pointing out the national problem with obesity. The obesity crisis, serious as it is, cannot be solved by shifting consumer preferences from apples to oranges. In order for produce consumption to play a role in reducing obesity, total consumption of produce must increase and replace less healthy alternatives. So instead of a candy bar, children have to eat an apple. Instead of a Big Mac, they go for a spinach salad. This study, though raising intriguing questions, doesn’t dig deep enough to give us the answers we need. Someone needs to give these researchers another grant so that they can proceed to Round II.          pb