From the latest issue of Food, Nutrition & Science.
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.