Friday, April 30, 2010

How do we get our children to eat fruits and vegetables?

This is a paper that I wrote while working on my MS degree. I thought it was a nice follow up to Nancy's post last Friday; and my post on Monday. It is rather long for a blog post, so I bolded points of interest. You can kind of get the idea if you just read the bolded sections. However, if you feel like reading the whole thing, you can!

I. Epidemiological Background

Fruit and vegetable consumption in America is, unfortunately, much less than desirable. Consuming two to four fruits and three to five vegetables daily is imperative for optimal health; however, the majority of people in America rarely meet this goal. In 2005, it was found that the median percent of Americans who consumed at least five fruits and vegetables daily was 23.2% (USDHHS, 2007). In South Carolina, a mere 21.2% of residents consumed at least five fruits and vegetables daily (USDHHS, 2007). From this data, it is obvious that there is certainly a need for improvement as the lack of fruit and vegetable consumption puts individuals at risk for many diseases.

Increasing consumption of fruits and vegetables is related to prevention of type II diabetes, obesity (Bazanno, 2006), and some cancers (Adams, Pelletier, Zive, & Sallis, 2005). “At least nine prospective cohort studies have been conducted relating intake of fruits and vegetables to risk of coronary heart disease (Bazzano, 2006, p. 1364). Of those, four found significant inverse associations, whereas five found inverse associations that trended toward but did not reach statistical significance after appropriate adjustment” (Bazzano, 2006, p. 1364). Studies have also supported that fruits and vegetables have a strong association with lower blood pressure and decreased risk for stroke (Bazzano, 2006).

Chronic diseases do not form over night; neither do eating habits. This is why it is so imperative that children are reached at a young age and taught about the delicious varieties of fruits and vegetables available to them. After all, obesity is nothing new to children, and chronic diseases are showing up in people much younger than in previous decades. According to the Youth Risk Behavior Surveillance System in 2005, only 20.1% of all children consumed greater than or equal to five fruits and vegetables daily within a seven-day period (USDHHS, 2006). It is apparent that some intervention is needed to change this statistic.

II. Summary of Current Research and Intervention

Examining the current programs and evaluating which ones are successful is important in continuing the fight against poor nutrition. The first area of interest is to understand whether or not children will increase their fruit and vegetable consumption if it is simply more available.

A study was completed to find out if providing salad bars in schools rather than having pre-portioned servings would cause children to increase their intake (Adams et al., 2005). The results showed that the availability of the salad bars did not significantly increase children’s consumption (Adams et al., 2005). However, “fruit and vegetable consumption was positively related to the number of fruit and vegetable items offered at salad bars (P<.05), adjusting for sex and grade” (Adams et al., 2005, p. 1789). Schools that offered a larger variety of fruits and vegetables had a greater mean of consumption (Adams et al., 2005). It is possible that students were able to find items that that agreed with their particular tastes when the variety was larger, yielding a better outcome (Adams et al., 2005).

Pinellas county in Florida took a different approach to the same idea. They began offering prepackaged fruit and vegetable salads in the schools’ cafeterias (USDHHS, 2007). The difference with their tactic was that they did not stop at just offering these foods (USDHHS, 2007). Administrators and staff were educated about the advantages and importance of fruit and vegetable consumption (USDHHS, 2007). In addition, setting up a farmers’ market display kicked the program off each year so that children had the opportunity to see, taste, and touch the different fruits and vegetables (USDHHS, 2007). This program resulted in 3,750 students and staff members increasing their intake of fruits and vegetables (USDHHS, 2007). The program has now expanded to many other schools in the surrounding areas (USDHHS, 2007). Success is attributed to the evidence supporting the idea that offering healthier foods in cafeterias and vending machines is linked to increased intake of healthier foods in the student population (USDHHS, 2007).

From 1991 to 1994, the National Cancer Institute (NCI) and the Center for Disease Control (CDC) provided grants to evaluate the effectiveness of the 5-A-Day promotion in many different venues, including schools (USDHHS, 2000). Through the evaluation, it was found that students in grades two through four ate significantly more fruits and vegetables when exposed to the promotion (USDHHS, 2000). The children also “had higher good nutrition knowledge scores and better attitudes towards the school lunch program than those who did not participate” (USDHHS, 2000).

A more involved, yet successful, study was complete in which garden-based nutrition education was evaluated (McAleese & Rankin, 2007). The study involved a control group and two treatment groups (McAleese & Rankin, 2007). The treatment groups consisted of a twelve-week nutrition education program and a garden-based nutrition education group (McAleese & Rankin, 2007). The children in the garden-based nutrition group helped to maintain gardens with in-season fruits, vegetables, and herbs (McAleese & Rankin, 2007). While maintaining the gardens, they learned proper care for the garden, ways to incorporate the produce into their diets, and a class cookbook was produced (McAleese & Rankin, 2007). Three, 24-hour food recalls were completed before and after the intervention to evaluate effectiveness (McAleese & Rankin, 2007). The children in the garden-based group significantly increased their consumption of fruits and vegetables whereas the students in the control and nutrition education groups experienced little to no improvement. (McAleese & Rankin, 2007)

During the 2002-2003 school year, the Nutrition Title of the 2002 Farm Act provided six-million dollars for the United States Department of Agriculture (USDA) to start a Fruit and Vegetable Pilot Program (FVPP) (USDA, 2003). Schools that participated were given free fruits and vegetables to provide to their students (USDA, 2003). During the pilot, it was reported that students consumed 93% percent of the fruits and vegetables provided in November; and 92% percent in December (USDA, 2003). Of the schools that participated, 93% offered nutrition education and promotion in conjunction with the free fruits and vegetables (USDA, 2003). “School staff believed that the pilot lessened the risk of obesity, increased attention in class, reduced consumption of less healthy food, reduced number of unhealthy snacks brought from home, increased students’ awareness and preference for a variety of fruits and vegetables, helped children who would otherwise be hungry get more food, and increased students’ consumption of fruits and vegetables at lunch.” (USDA, 2003, p. 4)

Schools are not the only places where children can learn to increase their fruit and vegetable intake. A study that examined intake for preschool-aged children living in more rural areas in Missouri where fruits and vegetables were homegrown showed that those children had higher intakes than other children living in areas where fruits and vegetables were not constantly available (Nanney, Johnson, Elliott, & Haire-Joshu, 2007). From this study one could theorize that if fruits and vegetables are made more readily available to children and their parents, children may consume higher amounts. Educating parents on the nearest farmers’ market and the need to have an abundance of fruits and vegetables available to children in their homes just may make a difference.

III. Recommendations for Future Health Programs/Interventions

Knowledge may be power, but it is not powerful enough. Most children know and understand that fruits and vegetables are good and important in any nutritious diet. Although they may not understand the long-term detriment of not including fruits and vegetables in their diet, they typically do understand that they are “good for you”.

From the research discussed in this paper, it can be concluded that children tend to respond well to hands-on activities. After examining the Nanney study, it was seen that when children’s families have home gardens, they tend to consume more fruits and vegetables (Nanney et al., 2007). Obviously, not every child is going to have the opportunity to have a home garden; however, that can be a reality in schools. It would be wise to implement activities in elementary schools where children learn to maintain a garden full of in-season fruits, vegetables, and herbs as was demonstrated in the McAleese study (McAleese & Rankin, 2007). Just as people are more likely to taste a dish that they have prepared in the kitchen, children are probably more likely to taste produce that they have grown and cared for.

With this activity sprouts many more opportunities. Children can be taught how to make easy snacks with their produce, and take home recipes to experiment with their parents. If this garden activity also takes place in middle and high schools, it would be a perfect opportunity to take the program to the next level by involving them in cooking classes that utilize their produce and herbs.

When children do reach high school-age, fruit and vegetable education should include long-term benefits of consuming a diet high in produce. Also, they should be made aware of the damaging effects and risks of excluding produce. With the practical skills from the garden activities and cooking classes, in addition to the knowledge gained from learning about the benefits of fruits and vegetables, we may be able to begin changing the diets of future generations. With these programs, fruits and vegetables can be made a part of life and hopefully, the incidence of type II diabetes, obesity, heart disease, and cancer will be decreased as a result.

IV. References

Adams, M. A., Pelletier, R. L., Zive, M. M., & Sallis, J. F. (2005, November). Salad
bars and fruit and vegetable consumption in elementary schools: a plate waste
study. Journal of the American Dietetic Association, 104(11), 1789-1792.

Bazzano, L. A. (2006, September). The high cost of not consuming fruits and
vegetables. Journal of the American Dietetic Association, 106(9), 1364-1368.

McAleese, J. D. & Rankin, L. L. (2007, April). Garden-based nutrition education affects
fruit and vegetable consumption in sixth-grade adolescents [Electronic version].
Journal of the American Dietetic Association, 107(4), 662-665.

Nanney, M. S., Johnson, S., Elliott, M., & Haire-Joshu, D. (2007, April). Frequency of
eating homegrown produce is associated with higher intake among parents and
their preschool-aged children in rural Missouri [Electronic version]. Journal of
the American Dietetic Association, 107(4), 577-584.

U.S. Department of Agriculture, Food Assistance and Nutrition Research Program.
(2003, May). Evaluation of the USDA fruit and vegetable pilot program:
report to Congress. Washington, District of Columbia: U.S. Department of
Agriculture. Retrieved September 19, 2007 from

U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention. (2007). Promoting fruits and vegetables in schools. Atlanta,
Georgia: U.S. Department of Health and Human Services. Retrieved September
19, 2007 from

U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention. (June 2006). Youth risk behavior surveillance – United States 2005.
Atlanta, Georgia: U.S. Department of Health and Human Services. Retrieved
September 19, 2007 from

U.S. Department of Health and Human Services, National Center for Chronic Disease
Prevention & Health Promotion. (2007, April). Behavioral risk factor
surveillance system prevalence data. Atlanta, Georgia: National Center for Chronic Disease Prevention & Health Promotion. Retrieved September 19, 2007 from

U.S. Department of Health and Human Services, Center for Disease Control and
Prevention. (2000). 5 a day for better health [Electronic version]. Chronic
Disease Notes and Reports, 13(1), 11-13.


  1. I'm thankful that I passed along the vegetable (and fruit)-eating gene to the boys, especially given their pickiness for other things.

    How many boys do you know who will willingly eat raw green peppers, carrots, and cucumbers, but won't touch a PB sandwich?

  2. Busy-Dad-E: That is certainly a great thing! Fruits and vegetables are like medicine! Good boys!

  3. Interesting post. People are always surprised when I tell them that not getting enough fruits and vegetables is a cardiac risk factor.