Promoting Fruit and Vegetable Consumption for Childhood Obesity Prevention

Currently, food marketing for unhealthy foods is omnipresent. Foods high in fat, salt, and sugar (HFSS) are advertised intensively on several media platforms, including digital platforms that are increasingly used by children, such as social media, and can be bought almost everywhere. This could contribute to the obesity epidemic that we are facing. As the majority of children and adolescents do not eat the recommended amount of fruits and vegetables (F&V), which leads to chronic diseases, we need to change the obesogenic environment to a healthogenic environment. Reducing the marketing of energy-dense snacks to children and increasing the promotion of healthier foods, such as fruits and vegetables, may be an effective and necessary instrument to improve the dietary intake of children and reduce the risk of their experiencing some chronic diseases later in life. With this focused narrative review, we provide an overview of how children and adolescents react to food promotions and how food promotional efforts might be a useful tool to increase the attractiveness of fruit and vegetables. This review therefore contributes to the question of how changing the advertising and media environment of children and adolescents could help create a world where the healthy choice is the easier choice, which would reduce childhood obesity and improve children’s health, as well as to make the food system more sustainable.     

School Lunch Environmental Factors Impacting Fruit and Vegetable Consumption

Objective

Assess impact of school lunch environmental factors on fruit and vegetable (F&V) consumption in second and third grade students.

A Randomized Controlled Trial Evaluating the FIT Game’s Efficacy in Increasing Fruit and Vegetable Consumption

Few children eat the recommended amounts of fruits and vegetables (FV). Although incentive-based interventions can increase FV consumption, this approach is costly and may be viewed as controversial due to the possible negative effects on intrinsic motivation. The FIT Game was designed to address these challenges. Four elementary schools were randomly assigned to either cooperatively play the FIT Game (n = 881) for ~8 weeks or to a no-game Control condition (n = 978). The FIT Game was presented daily as comic-book formatted episodes projected onto a large screen in the school cafeteria throughout lunchtime. All children could see the episodes which communicated daily whole-school vegetable-eating goals and illustrated the progress of the game’s heroes when these goals were collectively met. Photo estimates of FV consumption and skin carotenoid concentrations (biomarker of carotenoid consumption) were collected at baseline, during the last 5 days of the FIT Game, and 3 months after the intervention concluded. Control schools followed the same FV consumption-monitoring procedures for the same duration. At the conclusion of the intervention phase, children attending the FIT Game schools consumed more vegetables (d = 0.41), more fruit (d = 0.39), and had higher skin carotenoids (d = 0.66) than at baseline. These statistically significant increases were maintained at a 3-month follow-up for vegetables (d = 0.21, the food targeted for change) and carotenoids (d = 0.53). Thus, the no-cost virtual incentives of the FIT Game increased FV consumption in the short- and long-run, without negatively impacting intrinsic motivation.     

Reports: Quantity and Variety of Fruit and Vegetable Consumption and Cancer Risk

The recommendation of the American Cancer Society Nutrition and Physical Activity 2001 Guidelines regarding ovarian cancer prevention was that “there are no firmly established nutritional risk factors for ovarian cancer, though vegetable and fruit consumption may lower risk.” Since then, a number of studies have been published including several large cohort studies. The main objective of this review was to evaluate the literature from the past 5 yr and determine whether any more firm recommendations could be made at this point. Searches were conducted from 2000 to July 2006, and relevant citations were reviewed. Although population-based case-control studies have fairly consistently shown an increased risk with increase body mass, cohort data are inconclusive. The role of physical activity is also unclear. The current epidemiologic evidence for dietary factors is generally inconsistent to warrant public health recommendations regarding any of these factors.     

A Qualitative Investigation of Teachers' Information,Motivation, and Behavioral Skills for Increasing Fruit and Vegetable Consumption in Preschoolers

ObjectiveUsing the Information–Motivation–Behavioral Skills model as a framework, researchers qualitatively assessed preschool teachers' perceived motivation, facilitators, and barriers related to getting preschool children to eat fruits and vegetables (FV).MethodsIndividual, semi-structured interviews with 28 Head Start teachers in central North Carolina.ResultsParticipants reported the need for FV-related information (Information) to improve FV consumption in children, perceived themselves to be parents at school (Motivation), and reported using conditional rewards and punishment statements to get preschoolers to eat FV (Behavioral Skills).Conclusions and ImplicationsNutrition educators may use the Information–Motivation–Behavioral Skills model to develop education materials targeting increases in preschoolers' FV consumption. To motivate preschool teachers who see themselves as parents at school (Motivation), nutrition educators can provide teachers with FV-related information that was reported as their needs (Information), and supportive feeding practices (Behavioral Skills) to get preschoolers to consume FV.     

Wellness in the Schools: A Lunch Intervention Increases Fruit and Vegetable Consumption

Wellness in the Schools (WITS) is a national non-profit organization partnering with public schools to provide healthy, scratch cooked, less processed meals (called an Alternative Menu), and active recess. This study examined the effects of WITS programming on school lunch consumption, including fruit and vegetable intake, in second and third grade students in New York City public schools serving a high proportion of students from low-income households. The intervention was evaluated with a quasi-experimental, controlled design with 14 elementary schools (7 that had initiated WITS programming in fall 2015 and were designated as intervention schools, and 7 matched Control schools). School lunch consumption was assessed by anonymous observation using the System of Observational Cafeteria Assessment of Foods Eaten (SOCAFE) tool in the fall of 2015 (Time 0, early intervention) and the spring of 2016 (Time 1) and 2017 (Time 2). There were no baseline data. Data were also collected on the types of entrées served in the months of October, January, and April during the two school years of the study. Across time points, and relative to students in the Control schools, students in WITS schools ate more fruits and vegetables (units = cups): Time 0: Control 0.18 vs. WITS 0.28; Time 1: Control 0.25 vs. WITS 0.31; and Time 2: Control 0.19 vs. WITS 0.27; p < 0.001. They also had more fruits and vegetables (cups) on their trays, which included more vegetables from the salad bar. However, students in the WITS schools ate fewer entrées (grain and protein) and drank less milk than students in the Control schools. Compared to the Control schools, WITS schools offered more homestyle entrées and fewer finger foods and sandwich entrees, i.e., less processed food. Students in WITS schools who received the Alternative menu and all of the WITS programming at all data collection time points selected and consumed more fruits and vegetables. Replication studies with randomized designs and true baseline data are needed to confirm these findings and to identify avenues for strengthening the effects of the program on other school lunch components.     

A Garden Pilot Project Enhances Fruit and Vegetable Consumption among Children

Fruit and vegetable intake among children is inadequate. Garden-based nutrition education programs may offer a strategy for increasing fruit and vegetable intake in children. A 12-week pilot intervention was designed to promote fruit and vegetable intake among 4th to 6th grade children (n=93) attending a YMCA summer camp. Children participated in garden-based activities twice per week. Weekly educational activities included fruit and vegetable taste tests, preparation of fruit and vegetable snacks, and family newsletters sent home to parents. The pilot intervention was evaluated using a pre and post survey to determine participant satisfaction and the short-term impacts of the program. The process evaluation focused on program satisfaction, whereas the short-term impact evaluation assessed fruit and vegetable exposure, preference, self-efficacy, asking behavior, and availability of fruits and vegetables in the home. Data from the impact evaluation were compared from baseline to follow-up using McNemar's test (dichotomous variables) and Wilcoxon signed rank test (scales/continuous variables). Children reported high levels of enjoyment in the intervention activities. Most children (97.8%) enjoyed taste-testing fruits and vegetables. Children also liked preparing fruit and vegetable snacks (93.4%), working in their garden (95.6%), and learning about fruits and vegetables (91.3%). Impact data suggest that the intervention led to an increase in the number of fruits and vegetables ever eaten (P<0.001), vegetable preferences (P<0.001), and fruit and vegetable asking behavior at home (P<0.002). Garden-based nutrition education programs can increase fruit and vegetable exposure and improve predictors of fruit and vegetable intake through experiential learning activities. Participation in the “seed to table” experience of eating may help promote healthful eating behaviors among youth. Food and nutrition professionals should consider garden-based nutrition education programs that connect children with healthful foods through fun, hands-on activities.     

Innovative Newsletter Interventions Improve Fruit and Vegetable Consumption in Healthy Adults

Objective To evaluate the effectiveness of computer-tailored newsletter interventions in improving the number and variety of fruits and vegetables eaten by adults.Design The 4-group randomized trial with pre- and post-intervention measures consisted of a control group and 3 intervention groups receiving nontailored newsletters, computer-tailored newsletters, or tailored newsletters with tailored goal-setting information. Intervention groups received 1 newsletter each month for 4 months.Subjects Baseline surveys were completed by 710 health maintenance organization clients. Postintervention surveys administered 6 months after baseline were completed by 573 participants (80.8%).Intervention All newsletters contained strategies for improving fruit and vegetable consumption. Tailored newsletters used computer algorithms to match a person's baseline survey information with the most relevant newsletter messages for promoting dietary change.Main outcome measures Daily intake and weekly variety of fruits and vegetables were measured using a food frequency questionnaire.Statistical analyses performed Analysis of covariance and Tukey's honestly significant difference test were used to assess differences in the number and variety of fruits and vegetables consumed among intervention groups.Results For persons completing postintervention surveys (n=573), all 3 newsletter groups had significantly higher daily intake and variety scores compared with the control group. Although there was a trend of improved intake and variety with each added newsletter element, there were no significant differences at follow-up among the newsletter groups.Conclusions Newsletters can be effective in improving the fruit and vegetable consumption of adults. In this study, a computer-tailoring system did not significantly enhance the effect of the nutrition newsletters on fruit and vegetable intake. J Am Diet Assoc. 1999;99:705–709.     

High-Fiber Diet during Pregnancy Characterized by More Fruit and Vegetable Consumption

Higher dietary fiber intakes during pregnancy may have the potential health benefits of increasing gut microbiome diversity, lowering the risk of glucose intolerance and pre-eclampsia, achieving appropriate gestational weight gain, and preventing constipation. In this observational cohort study, we have assessed the dietary fiber intakes of 804 women in late pregnancy, using a semi-quantitative food frequency questionnaire (SQ-FFQ). Overall, the median (interquartile range) dietary fiber intake was 24.1 (19.0–29.7) grams per day (g/day). Only 237/804 (29.5%) women met the recommended Adequate Intake (AI) of dietary fiber during pregnancy of 28 g/day. Women consuming the highest quartile of fiber intakes (34.8 (IQR 32.1–39.5) g/day) consumed more fruit, especially apples and bananas, than women consuming the lowest quartile of fiber intakes (15.9 (IQR 14.4–17.5) g/day). These women in the highest fiber-intake quartile were older (p < 0.01), more had completed further education after secondary school (p = 0.04), and they also consumed more vegetables (67 g/day) compared to the women in the lowest fiber consumption quartile (17 g vegetables/day). Bread intakes of 39–42 g/day were consistent in quantities consumed across all four fiber-intake quartiles. Our findings suggest that antenatal education advice targeting increased fruit and vegetable consumption before and during pregnancy may be a simple strategy to achieve increased total dietary fiber intakes to reach recommended quantities.     

Family Influence: Key to Fruit and Vegetable Consumption among Fourth- and Fifth-grade Students

ObjectiveTo assess social and familial environmental influences on fruit and vegetable (FV) consumption of fourth- and fifth-graders living in a culturally diverse, urban setting.DesignIn 2006, students from 9 fourth- and fifth-grade classrooms from a public school in the Washington-Baltimore Metropolitan Region were recruited as part of the Food Stamp Nutrition Education's initiative to increase FV consumption among school-aged children in low-income schools. This intervention was conducted in partnership with the school.ParticipantsNinety-three fourth- and fifth-grade students and their parents.Main Outcome MeasureThe average daily FV consumption of elementary school students was the dependent variable. Home engagement (eg, student participation in menu planning and food selection at home), parental modeling, school environment, peer influences, and individual characteristics were the independent variables.AnalysisMultiple regression analysis.ResultsFamily and home environment factors explained more than 50% of the variance in students' FV consumption.Conclusions and ImplicationsInterventions designed to influence school-aged children's FV consumption should target family members and consider incorporating strategies to reach families and promote meal planning activities with the children in their homes.     

Innovation as a Factor Increasing Fruit Consumption: The Case of Poland

Due to the low level of fruit consumption in relation to dietary recommendations in many European countries, including Poland, multidirectional actions should be taken to increase the consumption of these products. One of the ideas could be the introduction of innovative products. The main goal of the study is to determine the relationship between consumer propensity to purchase innovative products and the frequency of consumption of fruits and their preserves of consumers. The research sample consisted of 600 respondents who declared to consume fruit and were responsible for food shopping in their households. The results obtained indicate that consumers with a higher propensity to purchase innovative products consumed fruit and fruit preserves more. In addition, statistically significant differences were found between innovators and non-innovators in terms of income, expenditures on fruit purchases, places where fruit and fruit preserves were purchased and product characteristics that determined the purchase decision. The logistic regression results indicate that a higher frequency of supermarket/hypermarket and online shopping, a higher weekly spending on fruit and a greater importance attributed to the biodegradability of the packaging increased the favorability of innovation relatively to fruit products (by 23.8%, 31.4%, 32.7% and 21.6%, respectively). The relationships found may have important implications for both private and public stakeholders in the fruit and vegetable sector.     

Association Between Fruit and Vegetable Consumption and Sleep Quantity in Pregnant Women

Introduction To determine the association of fruit and vegetable consumption with overall sleep duration among pregnant women. Methods Data from the 2011 and 2012 Behavioral Risk Factors Surveillance System (BRFSS) were used. All women (n?=?2951) of childbearing age (18–44 years) who were pregnant and responded to all fruit and vegetable consumption and sleep duration questions were included. Covariates included age, race, education level, exercise, and marital status. Data were analyzed using linear and ordinal logistic regression. Results Total daily fruit and vegetable consumption was not associated with sleep duration among pregnant women, controlling for confounders [β?=??0.03, (?0.07, 0.00)]. Orange and green vegetable consumption were both inversely associated with sleep duration [β?=??0.19, (?0.38, ?0.01) and β?=??0.20, (?0.33, ?0.08) respectively]. Ordinal logistic regression found that the odds of meeting or exceeding sleep time recommendations increased slightly with each unit increase in total fruit and vegetable consumption [OR?=?1.05 (1.003, 1.092)] and for every unit increase in fruit consumption [OR?=?1.12 (1.038, 1.208)]. Women who exercised within the past 30 days reported approximately 20 min of additional sleep compared to those who did not [β?=?0.32 (0.16, 0.49)]. Age, employment status, and marital status were also independently associated with sleep duration. Discussion Sleep duration in pregnant women was associated with exercise and other demographic factors, but only mildly associated with fruit and vegetable consumption. Future research should investigate the effects of additional factors including sleep quality, gestational age, family status and other medications as potential confounders.     

Measuring Children's Self-Efficacy and Proxy Efficacy Related to Fruit and Vegetable Consumption

BACKGROUND:  Social cognitive theory describes self-efficacy and proxy efficacy as influences on fruit and vegetable consumption (FVC). Proxy efficacy was defined as a child's confidence in his or her skills and abilities to get others to act in one's interests to provide fruit and vegetable (FV) opportunities. The purpose of this study was to develop a scale assessing children's self-efficacy and proxy efficacy for FVC at after-school programs and at home.
METHODS:  Elementary-aged children (n = 184) attending 7 after-school programs completed a self-efficacy questionnaire relevant to FVC. Questionnaire validity was investigated with exploratory factor analysis and mixed-model analysis of covariance. Internal consistency reliability and readability were also assessed.
RESULTS:  The questionnaire assessed 4 constructs: self-efficacy expectations for fruit consumption, self-efficacy expectations for vegetable consumption, proxy efficacy to influence parents to make FV available, and proxy efficacy to influence after-school staff to make FV available. Children perceiving FV opportunities in after-school had greater self-efficacy expectations for FVC and greater proxy efficacy to influence after-school staff compared to students who did not perceive FV opportunities. Children attending schools of higher socioeconomic status (SES) and less diversity were more confident they could influence their parents to make FV available than students attending lower SES and less diverse schools. Adequate internal consistency and test-retest reliabilities were established.
CONCLUSIONS:  Self-efficacy is a multicomponent construct that can be assessed in children using the reliable and valid instrument evaluated by the current study.     

Social-Cognitive Correlates of Fruit and Vegetable Consumption in Minority and Non-Minority Youth

ObjectiveInadequate fruit and vegetable (FV) consumption signals a need for identifying predictors and correlates of intake, particularly in diverse adolescents.DesignParticipants completed an on-line assessment in early 2010.SettingComputer classrooms in 4 high schools.ParticipantsOne hundred twenty-two Caucasian and 125 minority (African American and Hispanic) high school students (mean age = 15.3 years, SD = 1.0) with parental consent. Response rate was 89%.Variables MeasuredSelf-efficacy as measured by confidence in goal setting and decision making about healthful eating; perceived benefits and barriers to eating FVs; healthful eating-related social support; body esteem; and FV intake.Analysist tests were used to examine group differences, and binary logistic regression analyses were conducted to explore the predictors of 5-A-Day FV consumption.ResultsThirty-four percent of the non-minority group and 28% of the minority group reported eating 5 or more portions of FVs a day (P = .34). Self-efficacy and perceived benefits predicted consumption in minority participants, whereas barriers and social support were significant predictors in the non-minority group.Conclusions and ImplicationsThese findings suggest different variables predict consumption for minority and non-minority groups and that self-efficacy is an important variable to consider in dietary change programs for minority adolescents.