Promoting Fruit and Vegetable Consumption by Offering Healthy Appetizers and Increased Item Choice in School Cafeterias

Consistent access to nutritious and affordable foods and beverages is critical to student health and academic success (Community Preventative Services Task Force, 2022). Fruit and vegetable consumption are essential for growth and development and prevention of excess weight gain and chronic disease, yet more than 90% of children fail to meet recommended intake of fruits and vegetables (Folkvord et al., 2021).
Schools provide a practical and structured environment to promote healthy eating (Gold et al. 2017). A child’s health and nutritional status are heavily influenced by their environment (Brown 2019), and youth spend a significant portion of their day in school. Factors that have been shown to affect school-age children’s dietary attitudes, preferences, and health-related behaviors include social support; peer norms and beliefs; behaviors modeled by parents, teachers, and fellow students; and repeated exposure and opportunity to sample new foods (Snelling et al., 2012, 2013, Gold et al., 2017). For example, previous research has indicated that after taste-test interventions, which encouraged students to try vegetables multiple times in different recipes, participating students were more likely to choose and eat vegetables when researchers followed up weeks or months later (Snelling et al., 2017, Reynolds et al., 2000, Wardle et al., 2003). Multicomponent interventions that target students’ knowledge, attitudes, values, and beliefs; reinforce positive behaviors in the school and home environments; and provide students a chance to experience new foods, have been shown to increase nutritional intake (Gold et al., 2017).
Food consumed during the school day accounts for nearly half of children’s daily caloric intake (Schwartz and Wootan, 2019). Stronger nutrition standards set by the Healthy, Hunger Free Kids Act of 2010 (HHFKA) ensure high nutritional quality of meals and snacks served through federally funded Child Nutrition Programs, such as the National School Lunch Program (NSLP). The NSLP serves more than 30 million students each school day in approximately 95,000 public and private schools nationwide (United States Department of Agriculture, 2022). As a result, many U.S. children are served their most nutritious meals at school (Liu, Micha, and Mozaffarian, 2021). Receiving a reliable, nutritious meal at school can improve academic achievement, help maintain student health and play a role in combatting food insecurity (Snelling et al., 2015).
When it comes to implementing school-based child nutrition programs, however, urban and rural schools face unique socioeconomic barriers to achieving the nutritional goals set out in federal and local policies (Hamdi et al., 2020). Even when fruits and vegetables are offered to students as part of a reimbursable meal, previous research in DC schools indicated that only 60-75% of students consume offered fruits and only 35-40% of students consume offered cooked vegetables, thus not receiving the nutritional benefit of these items (Young et al., 2013). One increasingly popular solution, due to feasibility and low cost of implementation, is environmental change-style interventions, which modify the physical environment to promote and facilitate healthy eating behaviors (Hamdi et al., 2020). A behavioral economic concept called “nudging” works to influence behavior by altering the environment in subtle yet meaningful ways (Hamdi et al., 2020, Snelling and Kennard, 2009). In a school-based nudge intervention, desirable health-related behaviors are encouraged by making healthy choices easy, convenient, and appealing. Research indicates that principles of environmental change drive the positive results of the Smarter Lunchrooms framework, including visibility, convenience, and social norms, improve fruit and vegetable consumption (Green et al., 2017, Snelling et al., 2009).
In the current study, the research team evaluated the efficacy and feasibility of improving fruit and vegetable consumption by altering the timing of serving a fruit and vegetable item and expanding fruit and vegetable options. The research team worked closely with the Food Service Management Company (FSMC), including administrative and front-line school-based staff to assess feasibility of intervention methods, following a Community-Engaged Research model.
By Dr. Anastasia Snelling, Jessica Green, Robin McClave, MS, CHES, Charis V. R. Edwards, Travertine Garcia, MPH, RD, Samantha Reilly, MS, RD