Promoting healthy snacks and lunches to children

Nutritional Epidemiology GroupCentre for Epidemiology and Biostatistics

Promoting healthy snacks and lunches to childrenJanet Cade

HDC/STC Spring Conference. 19th April 2010


How to move from….

this ……. to this….


Background

•Children’s fruit and vegetable intake is low.•Typical intake is 2.5 portions per day.•10-20% eat no fruit or vegetables daily•Low intakes are associated with higher CVD and cancer rates• obesity - growing problem(NDNS, 2001; Ransley et al, 2007)


Foresight Report, 07

By 2050, 60% of males and 50% females could be obese

Costs to NHS would be £5.5 billion by 2050, plus wider costs to society and business of £49.9 billion

The size of the problem:


91.4

79.8

84.2

71.7

62.3

77.1

58.1

92.4

88

88

86.6

76

71.9

64.1

30 40 50 60 70 80 90 100

Ideal WeightObese

Obese Kids – the corporate threat?

W/S 2002 Average 2 weekly penetration


Obesity system map


National priority (UK)

‘Our ambition is to be the firstmajor nation to reverse the risingtide of obesity and overweight inthe population by ensuring thateveryone is able to achieve andmaintain a healthy weight. Ourinitial focus will be on children:by 2020, we aim to reduce theproportion of overweight andobese children to 2000 levels’.



Potential areas for intervention:

Healthy snacks/lunches

school

curriculum whole school approaches Lunches gardening

home

TV viewing Costs Cooking availability


Key ingredients…..

FamiliarisationRepetitionActivitiesModellingEnvironment


‘I don’t like it!’Food neophobia

• the innate fear of new foods – most common in children between 2 to 3y but which can persist into adulthood. Savage J, Fisher J and Birch L. Parental influence on eating behaviour: conception to adolescence. Journal of Law, Medicine and Ethics 2007; 35, 22-34

• Children prefer some tastes to others

• however children learn preferences for foods made available to them. Birch, L. (Development of food preferences. Annual Review of Nutrition 1999; 19, 41-62


Reducing fear of eating new foods in children

• give repeated opportunities to taste small amounts of the new food without punishment for refusal/dislike.

• 2 - 12 tastes of new food before accepted; fear of foods can be changed.

• support children in trying new tastes in safe and non-

coercive settings

Cooke L, Wardle J, et al Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children. Public Heath Nutrition 2003;7,295-302Birch L. and Fisher J. (1998) Development of eating behaviours among children and adolescents. Paediatrics 1998;101, 539-549


School Fruit & Vegetable Scheme (SFVS)

• provides a piece of fruit or vegetable free to all 4-6 years olds

• the biggest health initiative for child nutrition since free milk in 1946

• Since 2004 over 2 million children in 18 000 schools receive an item of fruit/vegetable everyday

• cost £42 million to set up with further £77 million + from the Department of Health


Follow up Reception Year 1 Year 2

Fruit & vegintake portions

3 months

0.5 (0.3 to 0.7)

0.7 (0.3 to 1.0)

0.5 (0.2 to 0.9)

7 months

0.2 (0 to 0.4)

0.2 (-0.2 to 0.6)

-0.2 (-0.5 to 0.2)

School Fruit & Vegetable Scheme: intake after 3 & 7 months

Ransley et al Journal Of Epidemiology and Community Health 2007

Impact of SFVS (mean difference, 95% CI)


Complex Interventions: eg. Project Tomato school elements

• National curriculum: Science; Design and Technology; PHSE & Citizenship lessons (lessons)

• Tasting sessions: 4 -12 per term• Gardening and growing (linked with RHS Grow it, cook it,

eat it programme)• Cooking• Project Tomato Team• Project manual


Intervention - home

Examples of the different types of items sent home to parents

and children


Did it work?


BUT .. Did they use the material?

0

10

20

30

40

50

60

70

80

90

100

44%

25%7% 8%

21%

Teacher’s average implementation scores of the Project Tomato school items (range 0-100)


Results: home items

Children’s average implementation scores for Project Tomato Home items (range 0-100)

020406080

100

44.8% 40% 40%56%


What about those who did use the materials?

High implementation by parents

• Children ate 2x as much fruit and veg as low implementation

High implementation by children

• Children ate @40% more fruit and veg

• Adjusted for baseline fruit and vegetable intake, gender, IMD, and ethnicity.


Packed lunches:School meals standards

Food based standards. A lunch should have:1. starchy food2. protein food3. dairy food4. fruit 5. VegetablesA lunch should not contain savoury snacks (crisps), confectionery,

sweetened drinksNutrient based standards. A lunch should contain 6. 557 kcal (+/- 5%)7. Less than 21g of fat8. Less than 16g of Non milk extrinsic sugars (NMES)9. Less than 499mg of sodium


National survey of packed lunches: food provided

8773

61 55

18

39

20

0102030405060708090

100

Freq

uenc

y (%

)

Proportion of children’s packed lunches meeting the school meal standards

Evans et al, 2010


SMART lunchbox intervention

UK Survey of children’s packed lunches


Results: Foods provided & consumedcontrol vs intervention

sand

wichfru

it

dairy

confe

ction

ery

savo

ury s

nack

veg/s

alad Food consumed - control

Food consumed - intervention

S3Food provided - control

Food provided - intervention

*

*

* *

**

* * 0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0


New project

• new Regional Advisor based in London• to work closely with 10 Partner primary schools• twilight training sessions for other local schools –

Associate Schools

• can gardening support increasing intake of fruit & veg?


Home

• parents are key!• TV• costs• cooking/environment• availability


Control of TV advertising

April 2007, Ofcom broadcasting restrictions to reduce exposure of children to TV advertising of foods high in fat, saturated fat, salt and sugar (HFSS).

At that time, 80% of all food advertising expenditure in children's airtime on terrestrial channels was for HFSS foods. • estimate that 40% of all food

and drink TV ads seen by children were for HFSS foods


Has it made any difference?Ofcom report Dec 2008

• 34% decrease in HFSS ads to children 4-15y (July 07-08)

• 22% increase in use of celebrities in HFSS ads – all in adult airtime

• estimate further decline following ban to children’s channels from Jan 09.


For every £1 spent by governments and the W.H.O promoting healthy foods the food industry spends £500 promoting ‘unhealthy foods’.


Home – food availability:

Food prices – fruit and vegetables considered expensive

Taxing policies? – fat tax/thin subsidy (too blunt, disadvantage poorest)


Cooking skills

• 50% of all ready meals in Europe consumed in UK

• we are forgetting how to cook!


if prepared food is so easily accessible,why bother to learn to cook?

If you haven’t acquired cooking skills, then fast foods are the most efficient answer.

(Lang and Caraher, 2001)


Conclusions:

• school based interventions can improve children’s diet (especially those with lowest fruit and veg intake)

(Summerbell et al, 2007)

• home environment more challenging


People are like Potatoes!

Some people never seem motivated to participate, but are content to watch others ... They are called "Speck Tators."

Some are always looking to cause problems and really get under your skin ... They are called "Aggie Tators."

There are those who are always saying they will, but somehow, they never get around to doing ... We call them "Hezzie Tators."

(From the laughalot-owner on the Net)

Documents

Promoting healthy snacks and lunches to children