Chefs, offering choice may increase vegetable, kids' fruit selections in schools

More than 30 million students get school meals daily and many of them rely on school foods for up to half of their daily calories. Therefore, school-based interventions that encourage the selection and consumption of healthier foods, such as fruits and vegetables, can have important health implications, according to the study background.

Juliana F.W. Cohen, Sc.M., Sc.D., of the Harvard T.H. Chan School of Public Health, Boston, and coauthors conducted a randomized clinical trial to examine the effects of short-term and long-term exposure to meals made more palatable with the help of a professional chef who taught school staff culinary skills and extended daily exposure to "choice architecture" in a smart café intervention where fruits were placed in attractive containers, vegetables were offered at the front of the lunch line and white milk was placed in front of sugar-sweetened chocolate milk.

The study involved 14 elementary and middle schools in two urban, low-income school districts, including 2,638 students in grades 3 through 8. Intervention schools received a professional chef who collaborated with them and then students were repeatedly exposed to new recipes on a weekly basis during a seven-month period. The modifications made to school cafeterias as part of the smart café intervention were applied daily for four months.

Baseline food selection and consumption were measured at all 14 schools and afterward four schools were assigned to receive chef-enhanced meals, while the remaining 10 received standard school meals. After three months of exposure to chef-enhanced meals, food selection and consumption were measured, again, after which two chef-enhanced schools and four control schools were assigned to receive the smart café intervention. The remaining six schools continued as a control group. After four more months of exposure to chef-enhanced meals, the smart café intervention or both, food selection and consumption were measured again.

The authors found that after three months of chef-enhanced meals, entree and fruit selection were unchanged but the odds of vegetable selection increased compared with control schools. After seven months, entree selection remained unchanged in the intervention schools compared with control schools. However, the odds of students selecting fruit increased in the chef, smart café and chef plus smart café schools compared with controls. Among the students who selected fruit, the servings consumed were greater in chef schools compared with control schools but there was no effect of the smart café intervention.

The odds of students selecting vegetables also increased in the chef, smart café and chef plus smart café schools compared with control schools. The percentage of vegetables consumed increased by 30.8 percent in chef schools and by 24.5 percent in chef plus smart café schools compared with control schools, according to the study. Selecting a meal component and consuming a meal component were measured separately.

There were no changes in the selection or consumption of white or sugar-sweetened chocolate milk in the smart café schools where students had access to both, the results indicate.

"Efforts to improve the taste of school foods through chef-enhanced meals should remain a priority because this was the only method that increased consumption. This was observed only after students were repeatedly exposed to the new foods for seven months. Therefore, schools should not abandon healthier options if they are initially met with resistance," the study concludes.

Editorial: Nudging Students Toward Healthier Food Choices

In a related editorial, Mitesh S. Patel, M.D., M.B.A., M.S., and Kevin G. Volpp, M.D., Ph.D., of the University of Pennsylvania, Philadelphia, write: "Childhood obesity is a national concern. Despite numerous efforts to improve the food consumption of America's youth, rates of obesity among school-aged children have not changed over the past decade. Strategies that are most likely to encourage healthier food choices are those that reflect individuals' rational preferences (e.g. making food taste better) and apply insights from behavioral economics to better design choice architecture."