Abstract
BackgroundResearch has consistently indicated that most children do not consume sufficient fruit and vegetables to provide them with a healthy, balanced diet. This study set out to trial a simple, low-cost behavioural nudge intervention to encourage children to select and consume more fruit and vegetables with their lunchtime meal in a primary school cafeteria.MethodsFour primary schools were randomly allocated to either the control or the intervention condition and baseline data were collected over two days in each school. Following this, changes were made to the choice architecture of the school cafeterias in the intervention schools and maintained over a three-week period. The intervention included improved positioning and serving of fruit, accompanied by attractive labelling of both fruit and vegetables on offer. Next, data were collected over two days in each school, with menus matched in each instance between baseline and follow-up. We employed a validated and sensitive photographic method to estimate individual children’s (N = 176) consumption of vegetables, fruit, vitamin C, fibre, total sugars, and their overall calorie intake.ResultsSignificant increases were recorded in the intervention schools for children’s consumption of fruit, vitamin C, and fibre. No significant changes were observed in the control condition. The increases in fruit consumption were recorded in a large proportion of individual children, irrespective of their baseline consumption levels. No changes in vegetable consumption were observed in either condition.ConclusionsThese results are the first to show that modest improvements to the choice architecture of school catering, and inclusion of behavioural nudges, can significantly increase fruit consumption, rather than just selection, in primary-age children. This has implications for the development of national and international strategies to promote healthy eating in schools.Trial registrationAsPredicted: 3943 05/02/2017. URL: https://aspredicted.org/see_one.php?a_id=3943
Highlights
Research has consistently indicated that most children do not consume sufficient fruit and vegetables to provide them with a healthy, balanced diet
Daily fruit, vegetable, fibre, vitamin C, and sugar consumption at lunchtime were calculated for each participant, for the two measurement points (T1, baseline and T2, follow-up)
After controlling for any possible group-cluster effects, significant increases were found in the intervention condition for consumption of fruit (F (1, 86) = 17.21, p = .001), vitamin C (F (1, 86) = 11.39, p = .001), and fibre (F (1, 86) = 22.78, p = .001), from baseline to follow-up
Summary
Research has consistently indicated that most children do not consume sufficient fruit and vegetables to provide them with a healthy, balanced diet. The UK Department of Health [5] has continued to advocate national-level efforts to encourage healthier childhood eating patterns, pledging to support healthy food provision in schools. While this is a positive step, provision does not equate to consumption, and structured behavioural programmes may be necessary to increase fruit and vegetable uptake. Multicomponent interventions targeting school lunch nutrition have shown success [6, 7], but they are time costly and require substantial resources to implement effectively This limits their potential for national-level support. It is perhaps not surprising that, at present, despite being familiar with the health benefits associated with a plant-rich diet [9], most primary-age children in the UK do not eat their recommended five portions of fruit and vegetables each day [10]
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