This might just turn out to be the most important piece we’ve ever run. Certainly every member of the board of the Produce for Better Health Foundation should take a look. In fact anyone concerned with increasing produce consumption and enhancing the health of children should pay careful attention.
As the Produce for Better Health Foundation prepares for the grand kickoff of its new Fruits & Veggies — More Matters campaign, an interesting and important program from across the pond is now rolling out in every school in Ireland with the goal of increasing produce consumption and developing produce-rich eating habits in children. The program is called Food Dudes and it is not your conventional promotional program. Here is how the program’s sponsors explain it:
How can children be influenced to change their eating habits for the better?
The traditional approach has been to inform people through health education campaigns about what they should and should not eat in the hope that they will alter their eating habits accordingly. Unfortunately, the research evidence shows that this approach has very limited success.
In spite of the enormous quantity of information about the health-giving properties of fruit and vegetables that has been issued over recent years, children’s eating habits have remained largely unaltered. Clearly, children’s knowing what they should do does not mean that that is what they will do. What they need is not simply to be given information, but help to change their actual eating behaviour.
This program is unusual because it was developed by psychologists not marketers. They’ve researched interesting questions such as whether children will change their minds when continuously exposed to produce items they think they don’t like. The answer is that they do.
Unlike many programs aimed at children that only focus on sweet fruits, this one also covers vegetables such as celery, carrots and green beans.
Unlike many programs that focus on only the most popular items, this program includes items such as prunes, kiwi and apricots.
It covers boys and girls, it covers the whole spectrum of family income and it has all been subjected to academic study.
And it has gotten results:
At this point we had conducted 14 separate studies, involving more than 450 children. In all of the studies the effects of the programme were:
- highly reliable — results were consistently positive, regardless of particular food, children or context.
- very large — the least achieved was usually a doubling of consumption, but increases were often much greater, up to several hundred percent.
- extended to a wide range of fruit and vegetables — the effects were not confined to the particular foods featured in the intervention, but extended to all items the children were able to identify as fruit and vegetables. It is an important part of the programme that children are helped to learn what foods are included in the concepts of ‘fruit’ and ‘vegetables’.
- general across contexts — in the school studies, the consumption of fruit and vegetables of a sub-set of children was also recorded at home and reflected the same changes as took place at school; in the nursery study the effects of the snack-time intervention carried over to lunch. This generalising effect across contexts was also supported in the responses to a questionnaire issued to parents of children participating in one of the school studies: 100% of them said their children benefited from taking part in the study at school; 88% noticed that their children had increased their intake at home of either fruit, vegetables or both; and 77% of children asked their parents to buy fruit/vegetables not previously on the family shopping list. Parents and teachers alike have consistently expressed considerable enthusiasm for the programme.
- very long lasting — when the children were followed up, as long as 15 months after the intervention, the changes in consumption still persisted.
Obviously we don’t have lifetime studies that tell us what the effect of this program will be on the kids when they are 90, but, from all we have, it seems like a remarkably effective program.
In fact the Irish government decided to stop a three-year pilot that the Irish produce industry was contributing to — mid-way — and roll it out nationally because the research was so convincing that this program was working.
We asked Mira Slott, Pundit Investigator and Special Projects Editor to learn more about this exciting program:
Mary Coughlan, Ireland’s Minister for Agriculture and Food
with the Food Dudes kids
FOOD DUDES VERSUS JUNK PUNKS
The Food Dudes Programme is a behavioral-based concept developed by the University of Wales Bangor in the United Kingdom to encourage children to eat more fruits and vegetables both in school and at home. It is designed using a three-pronged approach of integrating positive role models, repeated tastings and rewards to create a healthy eating culture and fundamentally influence and change children’s eating habits long-term.
For several years, the program has been tested and evaluated for its effectiveness in homes, nurseries, and primary schools in a number of areas in England, Wales, Scotland and Ireland. An expanded school pilot program in Ireland is now rolling out nationally.
Research studies using scientifically controlled measurements find that children participating in the program significantly increased their produce consumption over time with continued long-term results as far out as 18 months later, regardless of gender, school size, geographic and socio-economic factors.
To get expanded information on the program Mira interviews two people instrumental in the program’s development and growth… The first is Fergus Lowe, Deputy Vice-Chancellor, University of Wales Bangor, and co-founder of the Food Dude Programme.
The second is Michael Maloney, Director of Horticulture and Quality, Board Bia (The Irish Food Board), Dublin, Ireland, who took the lead in building the program at primary schools across the country.
INTERVIEW WITH FERGUS LOWE:
Q: How did the Food Dudes concept evolve?
A: Dr. Pauline Horne and I developed the project at the Food and Activity Research Unit (FARU), School of Psychology at the University of Wales Bangor over the past 15 years now. We have pursued extensive research to identify the key psychological factors influencing children’s food choices. On the basis of that knowledge, we devised a behavior-based intervention to enable children to enjoy eating healthy diets rich in fruits and vegetables.
It has taken us quite a while to build it on a large scale in schools and to have it administered and run entirely by the schools. We had to make sure it worked and evaluate it over time. Persuading governments to pick it up takes time. We’re in a British University where the program was developed, but the first government to take it up is the Irish government. It will soon be available to all young primary schools throughout Ireland. The country first piloted the program. This led to a three-year trial involving 150 schools funded by the European Union and the Irish Government. But it was so successful in its first year, the government came to the conclusion there was no point in delaying further and keeping the program from all the children in Ireland, so it decided to press ahead and make it available nationwide. The success of the program was also recently recognized with the awarding, to the program, of a World Health Organization Counteracting Obesity Award.
We’re now in discussion with other countries as well, especially in the UK. We are excited about the potential of the British government taking the program up. We are also hoping to broaden the program to other European countries and translate its applications to North America.
Q: Persuade our readers on why such a program could benefit U.S. school children.
A: The most compelling case for the program is the obesity epidemic, the single most overpowering reason to take it up. There are two reasons why kids are obese; what they eat, and their activity levels.
Our program is very much about changing what people eat. It is hugely important that children in North America, where obesity and other diet health issues are a major problem, eat more fruits and vegetables and less junk foods. We realize it’s also necessary children become more active. We’re in the process of developing the physical activity part now based on the same psychological principles we used to influence kids to eat more fruits and vegetables. We will eventually combine the two.
Q: What are those principles? There have been all kinds of attempts at getting kids to eat more produce, yet not all strategies have been successful. What makes your program unique?
A: We’re child psychologists, and approach the problem from the perspective of the child. In the past, a generally accepted method has been preaching to children, but changing eating habits is complicated and preaching can be counter productive.
This program incorporates two key elements, peer-modeling and rewards. The first is a series of videos we show the children. The program starts out with an intensive 16-day intervention. For 16 days, 15-20 minutes daily, the children watch a series of fun video episodes featuring the Food Dudes, a group of positive role model kids who gain superpowers when they eat fruits and vegetables that help them in their battle with General Junk and the Junk Punks who are taking away the energy of the world by depriving it of healthy food.
Q: How does this actually change behaviors?
A: The videos are designed to set up a strong role modeling context for the children. The kids strive to imitate the behaviors of the hero figures who always win. The second key element is a reward system. When the children eat fruits and vegetables or taste a portion, they get rewarded with Food Dude collectible items, like a pen or toy. They’ll taste foods they think they don’t like.
Q: What happens after the 16 days are up? Wouldn’t there be a likelihood that the kids would fall back into their old eating habits?
A: The program continues throughout the year in a scaled down version, but besides that, there are biological and psychological factors that prove otherwise. We’ve focused on younger children, really when you can most influence behavior and set eating patterns for life. Once they hit high school it becomes much more difficult.
Overall our research evaluation has shown that there are foods that kids initially don’t like, but if they taste it 10 to 15 times they’ll tend to like it. It’s a biological effect taste buds learn to like it.
Identifying with the Food Dude hero figures together with the rewards system for emulating their cause motivates kids to repeatedly taste these foods. Gradually you can phase rewards out but behavior is maintained.
Use of these videos has changed culture of schools. In most schools it isn’t cool to eat vegetables. The strategy is to make it cool and trendy and change the whole consciousness level of eating fruits and vegetables. Schools get behind it.
Q: Do children have easy access to produce after watching the videos. Do you have some type of partnership with produce companies to insure there is ample selection of fresh fruits and vegetables available?
A: If you take the British context, here there are school canteens, food is made available at lunch time and access is less of a problem. Now by law in Britain, the schools have to supply fruits and vegetables.
In Ireland, kids bring in their school lunch box each day. There is no canteen. If fresh product is not readily available, you have to make it available at least for those 16 intervention days. This is a critical component of the program’s success.
What’s interesting about our approach is it triggers children to want to eat fruits and vegetables. The program provides the incentives, but the fruits and vegetables need to be there.
Q: In the case of Ireland, is supply provided by a governmental organization, or through private produce companies?
A: In Ireland, fruits and vegetables were made available through private produce companies. Produce companies were very keen to get involved. This has worked out well for these companies, now that government has taken on the whole scheme, those companies that had the wisdom to be supportive in the early stages are now involved in the distribution.
Q: So many factors influence a child’s eating behaviors. How do you verify the program’s success? How do you measure changes in produce consumption over time?
A: We’ve compiled much research with very tight behavioral and scientifically controlled measurements that have been validated in peer reviewed journals. [You can view details attached.] Early studies involved 450 children ages 2 to 7 in their homes, nurseries and primary schools to perfect the learning program and confirmed use of these principles brings about major and long lasting increases in children’s produce consumption. The program was then developed as a stand-alone package that could be administered by primary schools across the full age range of students 4 to 11 and it was tested in schools in England, Wales and Ireland. These trials showed increases in consumption of fruits and vegetables that generally ranged from 100 to 200 percent on average across all children to several hundred percent for children who initially ate very little fruits and vegetables (the poorest eaters). The effects are long lasting and evident in evaluations conducted up to 18 months after the initial intervention.
Q: How do you know what goes on once the child leaves school. What if the family meal plan is void of fresh fruits and vegetables?
A: In addition to tight monitoring of increased consumption in school, other techniques involve telephone diary calls to check carry over at home. If you want to increase consumption at home, you must involve the parents. We have found the parents are hugely supportive and can help by reminding kids what they should be doing.
The program provides an informational brochure to the parents, who have opportunities to put reward stickers on cards the children bring home when they eat fruits and vegetables. Then the child brings back the completed card to school. It becomes a competitive game with the other children to see who can fill up their card first.
Evaluation in Ireland has shown that the program not only changes the kids’ behavior but the parents as well. The kids pester their parents to eat more fruits and vegetables.
Q: Have you connected the program to retail stores?
A: We’ve avoided attaching the program to any retail brand because that could turn people off. We see an opportunity for all major retailers to become involved, get behind the campaign and make Food Dudes produce available to support the program. Basically we’ve been waiting for this moment for it to go national to explore these different avenues to grow the program. We’re hoping, for example, that one day we could get Food Dudes to become a T.V. show.
INTERVIEW WITH MICHAEL MALONEY
Q: Michael, what spurred your interest in Food Dudes?
A: It started back in 2002/2003. I work for Board Bia, the state-funded board responsible for development, promotion and marketing of Irish food, drink and horticulture. Increasing consumption of fruits and vegetables falls within that. Of course we’re conscious that eating healthy, fresh fruits and vegetables is good for the country, but my interest was seeing the good from the production side and that is the angle from which we approached it. I came across work Fergus did with the pilot in the UK.
Although Fergus showed the program could work in the UK, our school lunch systems were different and I had to make sure it would translate. In the UK, the children get meals provided at school. In our system we don’t have that provision and the vast majority of children bring lunch to school. We would really need buy in from the parents, more so than in the UK system, so it was important to do a scientific study first.
Q: Since you’re now rolling it out nationally, I assume the program translated well. Could you tell us how?
A: The system works on the simple concept that if you can get kids to taste fruits and vegetables repeatedly they’ll start to develop a liking. Food Dudes are real characters age 13 or 14, slightly older than the group we’re looking to attract. We send the videos to the schools and provide in service training to teachers, who play an important role in the program’s initial and continued success through the year. The first phase lasts 16 days, where the children watch the videos and are given four different fruits and four different vegetables to taste, and are consequently rewarded. As they progress through the program they go beyond tasting to eating portions to receive a series of rewards including coloring pencils, rulers, pocket radios, bouncing balls all branded with Food Dude characters.
Q: How do you maintain interest after the 16 day Food Dudes inundation comes to a close?
A: At the end of the 16 day period, the kids are given two small Tupperware style lunch boxes, one for vegetables, and one for fruit and parents provide the portions in the containers.
In the classrooms, wall charts that stay up all year long reward pupils for bringing in their produce portions, getting check marks by their names and moving forward on the chart. The rewards continue to be given, but are gradually phased out and then certificates keep up the motivation. If teachers and parents keep it going, we find that the kids are motivated too. But if the teachers don’t fill in the wall chart it won’t work well. In some ways the parents need to be supportive, but if teachers buy in, the children will too.
We don’t specify the particular produce item, and the portion wouldn’t have to be completely eaten because the idea is to make it fun and enjoyable. On the fruit side it may be pears, apples, small easy peeler oranges, and for vegetables, cucumbers, cherry tomatoes, baby carrots or red peppers. We’re looking for what could be easily prepared. We provide training for teachers to keep it positive. This is not scientific measuring of portion size but if they show a decent effort. They can get the credit for salad on a sandwich.
We’ve measured what children were given to eat and what they did and didn’t eat at the end of lunch period, after six months went back to compare, and then a full year later, and found increased consumption of fruits and vegetables was sustained. We have done questionnaires with teachers and parents and the response has been overwhelmingly positive. Parents are giving more fruits and vegetables to kids, teachers are tracking the result at schools and it’s a remarkably close correlation of an additional one, two or three more portions daily.
Q: How did the program grow from the initial pilot in 2002/2003?
A: We put an application to the European Commission to look for funding for a broader pilot. We got 50 percent of the funding to roll out to 50 additional schools for each year of the next three school years. The rest was split 20 percent from the national government, and 30 percent from the produce industry.
Fresh Produce Ireland (FPI), the representative body for the fruit and vegetable industry in Ireland, was a key contributor to the three year program. In addition to the 30 percent of capital funding required, FPI has also played a hands on role in day to day implementation, as well as contributing additional financial and logistical support in supplying and distributing produce to 10,000 students a year.
As this pilot program was rolling out to 150 schools, Mary Coughlan, The Minister of Agriculture and Food, made the decision that the program was too valuable to wait till the end of the three year period, so in a parallel move approved funding for a national roll out. Mary Coughlan, as a woman minister who has small children herself, understands these things. On a practical basis, who feeds the children, who does the shopping, who understands the difficulties of getting children to eat healthy? It’s the mother.
Q: As the program reaches a wider school population across the nation, could demographics and other various factors like the types of schools impact the results?
A: In the pilot, every component was small scale. Now we are rolling out to a large number of varied schools. Does it work in large, rural, more affluent, religious, non-denominational, boys only, girls only and co-ed? In these 150 schools in the pilot, we checked to be sure the program would represent a plethora of combinations. Then we’d be in a strong position to go to the government to say the program is working in all kinds of schools. We didn’t have to wait until the end of the three-year period because evidence was showing it was working.
Q: What adjustments will be made on the funding side?
A: With the national program, 100 percent of the funding will come from the government. In the national rollout, we’re contracting with a company to provide the produce to the schools because it’s a big logistical undertaking.
Q: What would you say to produce industry executives about the potential of developing a program like this in the United States?
A: The message to the industry in the U.S. is they should not be looking to the national government to run it. They should at least fund the program 50 percent, present a proposal that they are prepared to make a major funding commitment. The children of the U.S. will certainly benefit from a healthcare point of view. But also, the industry benefits directly. In the Irish context, production doesn’t benefit from a huge percent increase, because a lot of the fruits and vegetables are imported here. Even though from a production side, if the general population is exposed to fruits and vegetables, it will be open to eating more produce in general, which benefits the produce industry here and elsewhere.
A former prime minister used to profess that a rising tide will lift all boats. This is a similar concept.
This is really something. An American pilot is a no-brainer. PBH has a lot on its plate right now, but we shouldn’t let this opportunity pass.