A combination of nutrition education and simple and inexpensive changes in elementary school cafeterias can lead children to make healthier eating choices, new research from Oregon State University shows.
[Photo: Dr. Stephanie Grutzmacher]
The findings indicate that an integrated approach to child nutrition in schools could help address a nationwide child obesity epidemic. It also supports the “smarter lunchroom” movement that is gaining steam in school cafeterias around the country, said Dr. Stephanie Grutzmacher, an assistant professor of nutrition in the College of Public Health and Human Sciences at OSU.
The goal of the smarter lunchroom concept is to encourage kids to make better food choices through subtle changes in the cafeteria.
“They are all low-cost behavioral nudges, such as placing healthy food items at the front of the cafeteria line, using verbal prompts to encourage children to try something new, or posting fun facts about the healthy food items,” said Dr. Grutzmacher, who led the study while on the faculty at the University of Maryland.
The researchers’ goal was to test the effectiveness of those kinds of changes as well as the effectiveness of a companion classroom-based nutrition education program. The program, called Project ReFresh, was tested in public and private Maryland schools.
The findings were published recently in the Journal of School Health. Co-authors of the study are Dr. Hee-Jung Song of the University of Maryland and Dr. Ashley L. Munger of California State University, Los Angeles. The project was supported by grants from the U.S. Department of Agriculture’s Supplemental Nutrition Assistance Program, the USDA’s Team Nutrition program and the Maryland State Department of Education.
One group of students received classroom nutrition education as well as the cafeteria intervention program; another group received only the cafeteria intervention; and the third group did not receive either component of the program.
For the cafeteria intervention, researchers developed a toolkit of tips and ideas for cafeteria workers as well as training food service supervisors and staff to implement suggested changes. The researchers focused on small changes that might encourage students to make healthier food choices and encouraged cafeteria workers to evaluate their environments and pick a few changes that made the most sense in their school.
For example, asking things such as “Which fruit would you like: apples or peaches?” instead of “Would you like a fruit?” might help encourage the children to make a healthier choice, Dr. Grutzmacher said.
“We developed about 100 ideas for elementary school cafeterias, knowing that not all of the ideas were going to work in all of the cafeterias,” Dr. Grutzmacher said. “Moving the salad bar is not practical at every school, because of locations of plug-ins or other setup issues.”
The classroom education included visits by trained nutrition educators as well as teacher training and lessons for the classroom teacher to use. The lessons were designed to integrate other school lessons, including math skills, writing prompts and reading.
Students reported their healthy food intake, including fruit and vegetable consumption, on a daily and weekly basis; before they started the program; and again once it was complete.
While researchers noted some improvements in healthy eating among students who received the cafeteria intervention, they found a larger improvement among the children who received both the classroom education program and the cafeteria changes. Students in that group reported eating more fruits and vegetables and enjoying foods such as whole grain pasta, Dr. Grutzmacher said.
The findings support the researchers’ belief that programs that address both individual and environmental factors may be most effective in improving children’s diets, she said.
“Vegetable consumption typically declines over time in school cafeterias,” Dr. Grutzmacher said. “It is pretty rare to find kids who are still choosing vegetables by the fifth grade. With this program, we saw an increase in vegetable consumption among these kids.
“We need more research but we think that integrating these approaches is a good idea.”
The findings are particularly valuable for low-income schools where children rely on school breakfast and lunch each day. Those children often have less opportunity to try new foods or eat a diet with a wide variety of fruits or vegetables, Dr. Grutzmacher said, and the school cafeteria plays a special role in helping to expose them to new fruits, vegetables and whole grain foods.
“If I could get every school to make one change, I would encourage them to offer tasting opportunities, so kids have a chance to try some new healthy food items and new recipes,” Dr. Grutzmacher said. “And I would give the kids a chance to vote on them, so they have a say in what ends up on their menus.”