Encouraging Healthy Eating in Hospitalized Children

Full Text (from J Peds twitter feed): All Aboard Meal Train: Can Child-Friendly Menu Labeling Promote Healthier Choices in Hospitals?  S Basak et al. J Pediatr 2019; 204: 59-65

Conclusion: “The combination of menu labeling techniques targeted to children in the inpatient hospital setting was an effective short-term tool for increasing the intake of healthier foods, although the effect of labeling waned over time.”

From the discussion: “Our findings in this study show a significantly higher odds of ordering green-light healthier option foods and lower odds of ordering red-light foods when exposed to child-friendly menu labeling. This effect waned over time, such that after 8 meals, proportions of red-light and green-light choices were similar with both menus…

Although most children’s hospital food environments include food items that have low nutritional value, this study highlights that nutrition education using menu labeling can be successfully implemented and can encourage children and their families to make healthier choices. It is our hope that labeling may also encourage hospital food providers to improve food quality at the hospital by decreasing red-light foods and increasing healthy food options at every meal. More research is needed to determine optimal techniques for various age ranges and develop menus that are age-appropriate and tailored for specific patient populations.”

My take: 1. This study from Sick Children’s is important.  We can determine more effective healthy eating strategies on a ‘captive’ audience.  2. I remember several years ago when one of my partners ruffled some feathers by asking the hospital to reconsider promoting sugar-sweetened beverages while at the same time posting billboards of obese children.

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Lunchroom Makeover

A recent pilot study indicates that $50 and three hours can increase the chances that teens will eat their fruits and vegetables (J Pediatr 2013; 162: 867-9).  While the US Department of Agriculture has mandated alterations in what foods that schools offer for lunch, schools cannot force students to eat specific foods.  As such, the authors tried changing the convenience, attractiveness, and ‘normative nature of healthy foods’ in the lunchroom. These changes are part of a behavioral science called “libertarian paternalism.”

These field studies took place at two schools in western New York with students at 7-12 grade levels.  After implementing changes in the lunchrooms, researchers recorded tray waste on multiple dates.

Specific changes included the following:

Improved convenience:

  • “Healthy convenience line” with only submarine sandwiches and healthier sides (fruits/vegetables)
  • Salad served in see-through to-go containers

Improved attractiveness:

  • Lunch menu posted with nice color photos of fruits and vegetables
  • Fruit displayed in nice bowls or tiered stands

Normative behavior:

  • Verbal prompts by staff: “Would you like to try…”, “No veggie? How about…” “You can get another side with your meal. How about grabbing a piece of fruit?”
  • “Last chance for Fruit” sign displayed next to fruit basket at the cash register

The impact of the “smarter lunchroom:” actual fruit consumption increased by 18% and vegetable consumption increased by 23%.  The limitations of this study: no control school, did not track individual consumption, and small number of measured days.

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