A recent study (Cohen JFW et al. JAMA Pediatr 2015; 169: 431-7; thanks to Ben Gold for this reference) showed both the short-term and long-term effects of targeted interventions to improve food selection at schools.
The Modifying Eating and Lifestyles at School Study (MEALS study) was a randomized trial in 2 urban, low-income school districts in Massachusetts. After a one month baseline, there was an initial 3 month randomization period in which there were 4 “chef” schools and 10 control schools. As you may have guessed, the “chef” schools were assigned a chef to improve food palatability and to teach the cafeteria staff.
The recipes are available at the following link: www. projectbread.org/reusable-components/accordions/download-files/school-food-cookbook.pdf. The recipes in this cookbook are great if you need to put together meals serving 100. Recipes include Cachupa, Quinoa, Squash, and Kale.
During the next study period of 4 months, both groups were further divided into schools with “smart cafe” design or control design. The smart cafes encouraged both vegetable and fruit selection/healthy food selection:
- Veggies offered at beginning of lunch line
- Fruits placed in attractive containers
- Fruit options placed by cashier
- Improved signage and images promoting fruits and veggies
- White milk placed in front of sugar-sweetened milk (eg. chocolate milk)
Did these interventions work? Yes, pretty much.
- After 3 months, vegetable selection increased in chef schools with odds ratio (OR) of 1.75
- At conclusion of study, vegetable selection increased in the chef (OR 2.54), smart cafe (OR 1.91) and chef plus smart cafe (OR 7.38)
- At conclusion of study, fruit selection increase in the chef (OR 3.08), smart cafe (OR 1.45) and chef plus smart cafe (OR 3.10)
- Actual consumption (not just selection) increase in chef and chef plus smart cafe schools but there was no lasting effect of smart cafe by itself. The amount of vegetable intake approximately doubled in the chef or chef plus smart cafe, consuming an additional 0.75 cups of vegetables per week.
Conclusions (from the authors): “While using choice architecture [i.e. smart cafe design] “may be a good short-term strategy to increase healthier food consumption, it does not appear to be a successful long-term strategy…This study also reaffirms that a chef intervention focusing on school food quality, palatability, and variety is an effective method …over time…This study also confirms the importance of repeated exposures to new school foods.”
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