When given a choice between fruit and sweets,
children tend to pick the unhealthy option, according to a recent
study from the University of South Carolina and published in the
September issue of the Journal of the Academy of Nutrition and
Dietetics. Researchers looked at children ages 5 to 10-years
old in out-of-school-time programs (OST, afterschool programs and
summer day camps) during a 2-week period representing 18 snack
occasions and found that more children consumed sugary and salty
snacks compared with fruit.
OST programs serve millions of kids annually, and
these programs serve kids one to two snacks each day. Therefore,
the influence these types of programs can make on healthy eating
habits is significant. Over the past several years, concerted
effort has been put towards making snacks served in OST
programs "healthier". As part of this, policies and standards have
been developed and adopted by leading organizations that call on
programs to serve more healthful foods, like fruits and vegetables.
These efforts are well intentioned and can lead to marked
improvements in the amount of fruits and vegetables children
consume every day.
While policies and standards ask program providers to
increase more healthful foods, often there is no, or ambiguous,
policy language that limits serving less healthful foods, such as
cookies and chips, alongside the more healthful foods. In
fact, three leading organizations - The National Afterschool
Association, The YMCA of the USA and the Harvard School of Public
Health Prevention Research Center - have developed policies that
recommend offering healthy options like fruits and vegetables in
these after school programs, yet only The National Afterschool
Association recommends offering only fruits and vegetables and not
offering sugar-sweetened or salty snacks.
"What is important about this study it that we used
existing policy language to deliberately create snack options that
mimic how we see providers interpret what types of snacks they can
serve. For instance, some policies call for serving a fruit or
vegetable without eliminating alternative, less healthful snack
options. Thus, if a program serves fruit alongside cookies and
chips, on the one hand the program would be compliant with the
policy; on the other hand what impact would this have on children's
fruit intake? We wanted to know, when provided the opportunity
to choose among competing snack options, such as cookies, chips or
fruit, what children will select and how much will they eat," says
Dr. Michael Beets, study author.
In the study, children got to choose from whole or
sliced fruit, sugar-sweetened snacks and flavored salty snacks.
Sliced fruit was selected more than whole fruit across all
conditions. But when served sliced or whole along with sugar
sweetened snacks (6% vs. 58%), flavored salty snacks 6% vs. 38%) or
unflavored grain snacks (23% vs. 64%), more children selected the
less healthy option. And more children consumed 100% of the
sugar-sweetened (89%) and flavored salty (82%) snacks compared with
fruit (71%). When fruit was selected alone, 37% of the children
selected the sliced apples/oranges, 17% selected whole
apples/oranges, and 24% selected bananas.
Interestingly, the way fruit is presented to children
can also increase their chance of eating it. In this study, sliced
fruit was selected more than whole fruit across all conditions.
Since waste in both cafeterias and OST programs is an issue as well
- approximately 15% to 47% of fruit was wasted in this study,
compared with 8% to 38% of sugar-sweetened, flavored salty, and
unflavored grain snacks - presenting fruit in a way that kids like
could both reduce waste and improve healthy eating habits. Here,
researchers found that when fruit was served alone, whole apples
and oranges were associated with higher waste (47%) than sliced
apples and oranges (26%) and bananas (15%).
"One of the most common perceived challenges to
serving only fresh fruits and vegetables in OST programs is budget.
Depending on seasonality, location of the program, and type of
produce purchased, prices vary widely. Typically oranges, other
citrus and tropical fruits are more expensive. Apples and baby
carrots are more moderately priced, with bananas and celery being
by far the most affordable. By serving half portions of the fruits
and vegetables, paired with half portions of less expensive plain
grains, such as unflavored pretzels, the cost remains neutral (no
increase or decrease). Also, many of the programs we work with
are unaware of the amount budgeted for snack and where to purchase
snacks at an affordable price. My group works closely
with providers to assist them in understanding what they have
to spend and where they can get prices on snacks that meet policy
guidelines and their budget," says Beets.
Beets says one more common challenge is
spoilage. Close monitoring of snack consumption to ensure
proper ordering and flexibility with snack menus based on ripening
of available fruits can maximize consumption and minimize waste.
Proper storage of fruit is essential to minimizing spoilage.
They've found that apples, bananas, and oranges will easily stay
fresh for up to one week at room temperature. For vegetables,
refrigeration is required.
"Some OST program staff worry that children will
become bored of fresh fruits and vegetables as snacks every day.
What's interesting about these perceptions is that often, the same
programs, before serving more fruits or vegetables, were serving
the same chips or cookies every day. The issue of boredom never
came up with these snack offerings. We've found that once programs
start serving more healthful snacks, this perception quickly
dissipates," says Beets.
Another problem with solely offering fruit and
veggies (and no other options) is that there will be a percentage
of children who do not select a snack at all. In this study, that
number was 21%. A variety of strategies, says Beets, can be used to
encourage the children that opted out of eating fruit to consume
the fruit in the future. These strategies include
encouragement, promotion and role modeling by the staff, nutrition
education, and providing alternative fruit options and/or taste
testing. Nutrition education can further familiarize the children
with the various fruits and healthy snacks while emphasizing why
they are important for the children's overall health.
If the goal is to truly improve children's dietary
habits and increase their consumption of healthy foods, future
policies in this area must have specific, clear language regarding
not only serving fresh fruits and/or vegetables as snacks, but also
serving fruits and/or vegetables without alternative
options. The most critical finding for policy makers to learn
in terms of planning for future snack times, says Beets, is that
fruits and vegetables are much more likely to be consumed by
children when offered alone rather than alongside less healthful
alternatives. Thus, policy language needs to be crafted with
the understanding that limits on the other types of foods that can
be served together is required in order to ensure children eat the
more healthful options.
"We believe not serving an unhealthy snack option is
an option because we know from national data that children are not
lacking in sugar-sweetened foods or highly processed, artificially
flavored grains. It all gets down to what we want to
accomplish. My impression is everyone would like to improve
children's dietary intake and, perhaps, have an impact on unhealthy
weight gains. To do this we need to create environments where the
healthy option is the only option," says Beets.
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