You can lead a child to fresh fruits and vegetables, but how do you entice them to eat healthful foods when you aren't watching?
“Simply offering healthy options is not enough to motivate children to make healthy choices,” said Sheri Zidenberg-Cherr, UC Cooperative Extension specialist in the Department of Nutrition at UC Davis.
“Moreover, imposing restrictions rather than providing children with options to make healthy choices can have long-term negative effects,” said Rachel Scherr, assistant project scientist, also in the UC Davis Department of Nutrition.
In 2012, more than one-third of children in the U.S. were overweight or obese, according to the Centers for Disease Control and Prevention. Studies have shown that obese children are more likely to be obese as adults, increasing their risk for health problems including heart disease, type 2 diabetes, stroke, cancer and osteoarthritis.
To target the complex issue of eating habits, Zidenberg-Cherr and her UC Cooperative Extension and UC Davis colleagues designed a school-based program and tested it in Sacramento and Stanislaus counties through the leadership of UC Cooperative Extension nutrition, family and consumer science advisors Terri Spezzano and Yvonne Nicholson.
“Parents shared with me that their children are voicing input on meals and asking if they can add fruit to their salads,” a participating teacher told the researchers.
During the first year that the Shaping Healthy Choices Program was implemented in Sacramento County schools, the number of children classified as overweight or obese dropped from 56 percent to 38 percent. The participating students also improved their nutrition knowledge, ability to identify different kinds of vegetables and amounts of vegetables that they reported eating.
“I tried zucchini and yellow squash when I was little and didn't like it, but now I tried it and I love it!” said a 9-year-old student.
A team effort
The Shaping Healthy Choices Program takes a multifaceted approach, combining nutrition education with family and community partnerships, regional agriculture, foods available on school campus and school wellness policies.
The garden-enhanced, inquiry-based nutrition curriculum was developed by Jessica Linnell, a doctoral candidate in the Graduate Group in Nutritional Biology; Carol Hillhouse, the School Garden Program director at the UC Agricultural Sustainability Institute; and Martin Smith, a UC Cooperative Extension specialist in the departments of human ecology and population health and reproduction.
The family and community partnerships featuring family newsletters were developed by Carolyn Sutter, a graduate student in the Graduate Group of Human Development, and Lenna Ontai, a UC Coperative Extension specialist in the Department of Human Ecology. Lori Nguyen, a doctoral candidate in the Graduate Group in Nutritional Biology; Sheridan Miyamoto, postdoctoral scholar in the Betty Irene Moore School of Nursing at UC Davis; and Heather Young, dean of the Betty Irene Moore School of Nursing, organized community-sponsored health fairs.
Gail Feenstra, deputy director and food systems analyst for the UC Agricultural Sustainability Institute, helped the schools set up systems to add fresh, locally grown produce to their menus. Jacqueline Bergman, a postdoctoral scholar in the Department of Nutrition, coordinated school-site specific wellness committees.
The UC Cooperative Extension and UC Davis team worked with classrooms to use Discovering Healthy Choices, a standards-based curriculum that incorporates interactive classroom nutrition, garden and physical activity education for upper elementary school students. Teachers partnered with UC Cooperative Extension to incorporate cooking demonstrations to show the connections between agriculture, food preparation and nutrition.
To reinforce the lessons at home, Team Up for Families — monthly newsletters containing nutrition tips for the parents — were sent home with the students. School Nutrition Services purchased fruits and vegetables from regional growers and distributors to set up salad bars and prepare dishes made with fresh produce. The Shaping Healthy Choices Program activities were integrated into the school wellness initiatives.
“My students shared things they learned about safe food handling and safety in cooking,” said a teacher who participated in the study. “Parents said their children want to help in preparing meals at home.”
“My daughter is more interested in trying new foods and eating more fruits and vegetables,” reported one parent. “She often surprises the family by making a surprise salad snack for everyone.”
Preliminary analysis shows that nine months after the classroom education ended, the decrease in the students' body mass index percentiles, or BMI percentiles, was sustained.
“This is a big deal,” said Zidenberg-Cherr, while cautiously encouraged by the program's success. “We are in the process of analyzing several aspects of the program — the data set is so complex and I have to feel 100 percent confident in our statements.”
Through a partnership with UC CalFresh, the researchers have expanded the comprehensive program to schools in Placer, Butte and San Luis Obispo counties. Determining feasibility for expansion of the program for broader dissemination is planned for the 2015-16 school year.
This project was funded by grants from the UC Division of Agriculture and Natural Resources and the U.S. Department of Agriculture.