Using Incentives to Encourage Healthy Eating in Children

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Harvard study: kids are eating the healthier lunches

Moi wrote in School lunches: The political hot potato:
There are some very good reasons why meals are provided at schools. Education Bug has a history of the school lunch program http://www.educationbug.org/a/the-history-of-the-school-lunch-program.html

President Harry S. Truman began the national school lunch program in 1946 as a measure of national security. He did so after reading a study that revealed many young men had been rejected from the World War II draft due to medical conditions caused by childhood malnutrition. Since that time more than 180 million lunches have been served to American children who attend either a public school or a non-profit private school.

The U.S. Department of Agriculture (Agriculture Department) has a School Lunch Program Fact Sheet http://www.fns.usda.gov/cnd/lunch/aboutlunch/NSLPFactSheet.pdf
According to the fact sheet, more than 30 million children are fed by the program. Physicians for Responsible Medicine criticize the content of school lunch programs

In Healthy School Lunches the physicians group says:

Menus in most school lunch programs are too high in saturated fat and cholesterol and too low in fiber- and nutrient-rich fruits, vegetables, whole grains, and legumes (see PCRM’s 2008 School Lunch Report Card). Major changes are needed to encourage the health of the nation’s youth and to reverse the growing trends of obesity, early-onset diabetes, and hypertension, among other chronic diseases, in children and teens. http://www.pcrm.org/health/healthy-school-lunches/changes/key-changes-recommended-for-the-national-school

A 2003 General Accounting Office (GAO) reached the same conclusion. See, School Lunch Program: Efforts Needed to Improve Nutrition and Encourage and Healthy Eating http://www.gao.gov/products/GAO-03-506 https://drwilda.com/2011/11/03/school-lunches-the-political-hot-potato/

Science Daily reported in the article, New school meal standards significantly increase fruit, vegetable consumption:

New federal standards launched in 2012 that require schools to offer healthier meals have led to increased fruit and vegetable consumption, according to a new study from Harvard School of Public Health (HSPH) researchers. The study, the first to examine school food consumption both before and after the standards went into effect, contradicts criticisms that the new standards have increased food waste.
“There is a push from some organizations and lawmakers to weaken the new standards. We hope the findings, which show that students are consuming more fruits and vegetables, will discourage those efforts,” said lead author Juliana Cohen, research fellow in the Department of Nutrition at HSPH.
Some 32 million students eat school meals every day; for many low-income students, up to half their daily energy intake is from school meals. Under the previous dietary guidelines, school breakfasts and lunches were high in sodium and saturated fats and were low in whole grains and fiber. The new standards from the United States Department of Agriculture (USDA) aimed to improve the nutritional quality of school meals by making whole grains, fruits, and vegetables more available, requiring the selection of a fruit or vegetable, increasing the portion sizes of fruits and vegetables, removing trans fats, and placing limits on total calories and sodium levels.
The researchers collected plate waste data among 1,030 students in four schools in an urban, low-income school district both before (fall 2011) and after (fall 2012) the new standards went into effect. Following the implementation of the new standards, fruit selection increased by 23.0%; entrée and vegetable selection remained unchanged. In addition, consumption of vegetables increased by 16.2%; fruit consumption was unchanged, but because more students selected fruit, overall, more fruit was consumed post-implementation.
Importantly, the new standards did not result in increased food waste, contradicting anecdotal reports from food service directors, teachers, parents, and students that the regulations were causing an increase in waste due to both larger portion sizes and the requirement that students select a fruit or vegetable. However, high levels of fruit and vegetable waste continued to be a problem — students discarded roughly 60%-75% of vegetables and 40% of fruits on their trays. The authors say that schools must focus on improving food quality and palatability to reduce waste…..
http://www.sciencedaily.com/releases/2014/03/140304071040.htm

Citation:

New school meal standards significantly increase fruit, vegetable consumption
Date: March 4, 2014
Source: Harvard School of Public Health
Summary:
New federal standards launched in 2012 that require schools to offer healthier meals have led to increased fruit and vegetable consumption, according to a new study. The study, the first to examine school food consumption both before and after the standards went into effect, contradicts criticisms that the new standards have increased food waste. “There is a push from some organizations and lawmakers to weaken the new standards. We hope the findings, which show that students are consuming more fruits and vegetables, will discourage those efforts,” said the lead author.
Journal Reference:
1. Juliana F.W. Cohen, Scott Richardson, Ellen Parker, Paul J. Catalano, Eric B. Rimm. Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection, Consumption, and Waste. American Journal of Preventive Medicine, March 2014 DOI: 10.1016/j.amepre.2013.11.013

Here is the press release from Harvard:

New school meal standards significantly increase fruit, vegetable consumption
For immediate release: Tuesday, March 4, 2014
Boston, MA — New federal standards launched in 2012 that require schools to offer healthier meals have led to increased fruit and vegetable consumption, according to a new study from Harvard School of Public Health (HSPH) researchers. The study, the first to examine school food consumption both before and after the standards went into effect, contradicts criticisms that the new standards have increased food waste.
“There is a push from some organizations and lawmakers to weaken the new standards. We hope the findings, which show that students are consuming more fruits and vegetables, will discourage those efforts,” said lead author Juliana Cohen, research fellow in the Department of Nutrition at HSPH.
Some 32 million students eat school meals every day; for many low-income students, up to half their daily energy intake is from school meals. Under the previous dietary guidelines, school breakfasts and lunches were high in sodium and saturated fats and were low in whole grains and fiber. The new standards from the United States Department of Agriculture (USDA) aimed to improve the nutritional quality of school meals by making whole grains, fruits, and vegetables more available, requiring the selection of a fruit or vegetable, increasing the portion sizes of fruits and vegetables, removing trans fats, and placing limits on total calories and sodium levels.
The researchers collected plate waste data among 1,030 students in four schools in an urban, low-income school district both before (fall 2011) and after (fall 2012) the new standards went into effect. Following the implementation of the new standards, fruit selection increased by 23.0%; entrée and vegetable selection remained unchanged. In addition, consumption of vegetables increased by 16.2%; fruit consumption was unchanged, but because more students selected fruit, overall, more fruit was consumed post-implementation.
Importantly, the new standards did not result in increased food waste, contradicting anecdotal reports from food service directors, teachers, parents, and students that the regulations were causing an increase in waste due to both larger portion sizes and the requirement that students select a fruit or vegetable. However, high levels of fruit and vegetable waste continued to be a problem—students discarded roughly 60%-75% of vegetables and 40% of fruits on their trays. The authors say that schools must focus on improving food quality and palatability to reduce waste.
“The new school meal standards are the strongest implemented by the USDA to date, and the improved dietary intakes will likely have important health implications for children,” wrote the researchers.
Other HSPH authors included Eric Rimm, senior author and associate professor in the departments of Epidemiology and Nutrition, and Paul Catalano, senior lecturer on biostatistics.
Support was provided by Arbella Insurance and Project Bread. Cohen is supported by the Nutritional Epidemiology of Cancer Education and Career Development Program (R25 CA 098566).
“Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection, Consumption, and Waste,” Juliana F.W. Cohen, Scott Richardson, Ellen Parker, Paul J. Catalano, Eric B. Rimm, American Journal of Preventive Medicine, 46(4):388-394, online March 4, 2014
For more information:
Todd Datz
tdatz@hsph.harvard.edu
617.432.8413
photo: © XiXinXing/Alamy
###
About Harvard School of Public Health
Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory and the classroom to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.

The challenge is getting kids to eat the food mandated by the rules and for school districts to find “kid tasty” foods which are affordable. A Child’s health is too important to be the subject of tawdry political wrangling and high pressure tactics from big money interests. Our goal as a society should be:

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©

Resources:

USDA changes school lunch requirements
http://thehill.com/blogs/blog-briefing-room/news/271813-usda-changes-school-lunch-requirements

USDA backpedals on healthy school-lunch rules
http://grist.org/news/usda-backpedals-on-healthy-school-lunch-rules/

National School Lunch Program Fact Sheet http://www.fns.usda.gov/cnd/lunch/aboutlunch/NSLPFactSheet.pdf

Related:
School dinner programs: Trying to reduce the number of hungry children
https://drwilda.wordpress.com/2012/01/28/school-dinner-programs-trying-to-reduce-the-number-of-hungry-children/

School lunches: The political hot potato
https://drwilda.wordpress.com/2011/11/03/school-lunches-the-political-hot-potato/

The government that money buys: School lunch cave in by Congress
https://drwilda.wordpress.com/2011/11/16/the-government-that-money-buys-school-lunch-cave-in-by-congress/

Do kids get enough time to eat lunch?
https://drwilda.com/2012/08/28/do-kids-get-enough-time-to-eat-lunch/

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Dr. Wilda Reviews ©
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Tags: fruits and vegetables, Harvard School of Public health, Healthy, history of the school lunch program, Hunger Free Kids Act of 2010. Hunger Free Kids Act of 2010, Hungry Vs. Healthy: The School Lunch Controversy, Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection Consumption and Waste, medicine, New school meal standards significantly increase fruit, politics, School Lunch, School Lunch Program, School Lunches, School Lunches To Be Allowed Unlimited Meats Grains USDA Announces, school meals, Study Pay Kids to Eat Fruits Vegetables, The Food Action Research Center, USDA, Using Incentives to Encourage Healthy Eating in Children, vegetable consumption

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Categories Dr Wilda

Brigham Young University study: Paying kids gets them to eat vegetables

21 Dec

President Harry S. Truman began the national school lunch program in 1946 as a measure of national security. He did so after reading a study that revealed many young men had been rejected from the World War II draft due to medical conditions caused by childhood malnutrition. Since that time more than 180 million lunches have been served to American children who attend either a public school or a non-profit private school.

The U.S. Department of Agriculture (Agriculture Department) has a School Lunch Program Fact Sheet http://www.fns.usda.gov/cnd/lunch/aboutlunch/NSLPFactSheet.pdf

According to the fact sheet, more than 30 million children are fed by the program. Physicians for Responsible Medicine criticize the content of school lunch programs
In Healthy School Lunches the physicians group says:

Menus in most school lunch programs are too high in saturated fat and cholesterol and too low in fiber- and nutrient-rich fruits, vegetables, whole grains, and legumes (see PCRM’s 2008 School Lunch Report Card). Major changes are needed to encourage the health of the nation’s youth and to reverse the growing trends of obesity, early-onset diabetes, and hypertension, among other chronic diseases, in children and teens. http://www.pcrm.org/health/healthy-school-lunches/changes/key-changes-recommended-for-the-national-school

Science Daily reported in the article, Study: Pay Kids to Eat Fruits, Vegetables:

The good news: Research suggests that a new federal rule has prompted the nation’s schools to serve an extra $5.4 million worth of fruits and vegetables each day.
The bad news: The nation’s children throw about $3.8 million of that in the garbage each day.
Researchers from Brigham Young University and Cornell observed three schools adjust to new school lunch standards that require a serving of fruits or vegetables on every student’s tray — whether the child intends to eat it or not. As they report in the December issue of Public Health Nutrition, students discarded 70 percent of the extra fruits and vegetables.
“We saw a minor increase in kids eating the items, but there are other ways to achieve the same goal that are much, much cheaper,” said BYU economics professor Joe Price.
Strange as it sounds, directly paying students to eat a fruit or vegetable is less expensive and gets better results.
With Cornell’s David Just, Price conducted a second study to measure the effect of small rewards in the lunchroom. The week-long experiments took on different twists in the 15 different schools — some could earn a nickel, others a quarter, and others a raffle ticket for a larger prize. But the results were generally the same. As the scholars report in The Journal of Human Resources, offering small rewards increased the fruit and vegetable consumption by 80 percent. And the amount of wasted food declined by 33 percent.
Which begs the question: Is benevolent bribery a better way?
“Parents are often misguided about incentives,” Price said. “We feel a sense of dirtiness about a bribe. But rewards can be really powerful if the activity creates a new skill or changes preferences.”
The case against using bribes in parenting is perhaps best articulated in Alfie Kohn’s 1999 book “Punished by Rewards.” In many scenarios, the use of rewards can crush internal motivation. With healthy eating, for example, some fear that prizes will prevent children from developing their own motivation to eat things that are good for them. Another danger, known as a boomerang effect, is the possibility that some children would eat less fruits and vegetables when the rewards disappeared.
That’s why Price and Just measured fruit and vegetable consumption before and after the week-long experiments. When the week of prizes ended, students went back to the same level of fruit and vegetable consumption as before — no lasting improvement, but no boomerang effect either.
Now the researchers are studying whether extending the experiments over three to five weeks might yield lasting change. So far things look promising….
http://www.sciencedaily.com/releases/2013/12/131217104601.htm#.UrPzdFGb0KY.email

Citation:

Journal References:
1.David Just, Joseph Price. Using Incentives to Encourage Healthy Eating in Children. The Journal of Human Resources, December 2013
2.David Just, Joseph Price. Default options, incentives and food choices: evidence from elementary-school children. Public Health Nutrition, 2013; 16 (12): 2281 DOI: 10.1017/S1368980013001468
Brigham Young University (2013, December 17). Study: Pay kids to eat fruits, vegetables. ScienceDaily. Retrieved December 21, 2013,

Here is the press release from Brigham Young University:

News Release
Study: Pay kids to eat fruits & veggies with school lunch
Small rewards bring less waste, better results than new school lunch rule
The Washington Post
Slate
The Salt Lake Tribune
Fox News
Yahoo News
Huffington Post
The good news: Research suggests that a new federal rule has prompted the nation’s schools to serve an extra $5.4 million worth of fruits and vegetables each day.
The bad news: The nation’s children throw about $3.8 million of that in the garbage each day.
Researchers from Brigham Young University and Cornell observed three schools adjust to new school lunch standards that require a serving of fruits or vegetables on every student’s tray – whether the child intends to eat it or not. As they report in the December issue of Public Health Nutrition, students discarded 70 percent of the extra fruits and vegetables.
“We saw a minor increase in kids eating the items, but there are other ways to achieve the same goal that are much, much cheaper,” said BYU economics professor Joe Price.
Strange as it sounds, directly paying students to eat a fruit or vegetable is less expensive and gets better results.
With Cornell’s David Just, Price conducted a second study to measure the effect of small rewards in the lunchroom. The week-long experiments took on different twists in the 15 different schools – some could earn a nickel, others a quarter, and others a raffle ticket for a larger prize. But the results were generally the same. As the scholars report in The Journal of Human Resources, offering small rewards increased the fruit and vegetable consumption by 80 percent. And the amount of wasted food declined by 33 percent.
Which begs the question: Is benevolent bribery a better way?
“Parents are often misguided about incentives,” Price said. “We feel a sense of dirtiness about a bribe. But rewards can be really powerful if the activity creates a new skill or changes preferences.”
The case against using bribes in parenting is perhaps best articulated in Alfie Kohn’s 1999 book “Punished by Rewards.” In many scenarios, the use of rewards can crush internal motivation. With healthy eating, for example, some fear that prizes will prevent children from developing their own motivation to eat things that are good for them. Another danger, known as a boomerang effect, is the possibility that some children would eat less fruits and vegetables when the rewards disappeared.
That’s why Price and Just measured fruit and vegetable consumption before and after the week-long experiments. When the week of prizes ended, students went back to the same level of fruit and vegetable consumption as before – no lasting improvement, but no boomerang effect either.
Now the researchers are studying whether extending the experiments over three to five weeks might yield lasting change. So far things look promising.
“I don’t think we should give incentives such a bad rap,” Price said. “They should be considered part of a set of tools we can use.”
The first study documenting the impact of the new rule appears in the December 2013 issue of Public Health Nutrition. The second study is titled “Using Incentives to Encourage Healthy Eating in Children” and is available to subscribers of The Journal of Human Resources. An earlier version of the paper is available at Price’s website.
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Story Highlights
•A new federal rule requires a serving of fruits or vegetables on every tray
•70 percent is thrown away, wasting an estimated $3.8 million daily
•Offering a small reward doubles fruit and vegetable consumption without the waste
http://news.byu.edu/archive13-dec-veggies.aspx