What Worked

We collected lunch-time consumption data at 66 elementary schools, with 2005 school-day observations, and over 485,000 child-day observations. These data provide a unique look at both the current consumption patterns in elementary schools in Utah as well as some effective solutions to augment the number of children eating fruits and vegetables during lunch.

Our baseline data collection indicates that about 38% of children eat a serving of fruits and vegetables as part of their school provided lunch on any given day. This rate increases by about 1.5 percentage points for each grade and is about 5.4 percentage points higher for girls. These data provide a rich source for helping us better understand which items children are most likely to eat and which items they are most likely to throw away.

Our data also allow us to examine the degree to which different approaches increase the fraction of children eating fruits and vegetables during lunch.

1. One approach is to increase the variety of items that are offered during lunch. We find that the fraction of children eating fruits and vegetables increases by 3.3 percentage points for each additional fruit or vegetable item that is offered.

2. Another approach, one that is part of the new lunch guidelines, is to switch from “offer” to “serve” and place fruit and vegetable items directly on each child’s tray. We evaluated this approach using two comparisons. The first was to compare the consumption and waste rates across school districts with different policies (the figure on the left) and the second was to compare the consumption and waste rates at a set of schools that change their policy. In the key below “default” refers to when items were placed automatically on the child’s tray.

These results suggest, at best, that requiring the items be placed on each child’s tray will increase the consumption of fruits and vegetables by 8 percentage points, but will also result in a dramatic increase in the number of servings thrown away. A rough estimate based on the cost of these items suggests that this policy leads to $1.72 in fruits and vegetables in the trash for each additional serving of fruits and vegetables that ends up in a child’s stomach.

3. A more cost-effective method to encourage fruit and vegetable consumption is to move recess from after lunch to before lunch. When recess comes after lunch, many children will skip eating their fruits or vegetables so that they can go to recess. In our study, involving 7 elementary schools, we found that moving recess to occur before lunch increased the number of servings of fruits and vegetables the average child ate by 54% and increased the number of children eating at least one serving of fruits and vegetables by 45%. The table below shows that all of the schools that implemented the recess time change saw an increase in the percent of children eating fruits or vegetables.

4. We also looked at a possible method to improve fruit consumption at school breakfasts. We measured the change in fruit consumption when a Utah middle school and high school both started offering fruit smoothies as a breakfast fruit option. The smoothies were provided thanks to funding from the Utah Dairy Council. Fruit consumption dramatically increased when smoothies were offered, rising from 4% to 45%. Since the smoothies were made with milk as well as pureed fruits, the smoothies contributed to an increased amount of students drinking milk as well. Offering fruit smoothies is a simple way to increase the nutritional quality of breakfast for many students.

5. In another project, we implemented a small rewards program at 15 schools. In our initial pilot of this approach, we used a variety of rewards, including small cash rewards and raffle tickets. The figure below shows the change in the fraction of children who ate a serving of fruits or vegetables across each of the different types of rewards.

The results indicate that immediate rewards generally have a larger effect and that small cash rewards work better than receiving a raffle ticket for a larger prize. However, there are a number of concerns with using cash rewards in educational settings, so we developed a special Veggie Token that children can earn during lunch. Schools could allow children to use these tokens at the school store or contribute them to a common pile to be used for a larger school goal.

The veggie token rewards progam was eventually implemented in 42 elementary schools across Utah. The results of the program are shown below:

The chart shows what percent of fruits and vegetables a child ate and threw away before, during, and after the small rewards program was implemented. These three periods are referred to as “baseline”, “tokens”, and “follow up,” respectively.

6. One of the most p​romising results of the veggie project is that the small rewards programs actually contributed to building long-run habits of fruit and vegetable consumption. This can be seen from the significantly higher levels of fruit consumption that occur in the follow up period as compared to the baseline period.

We tested habit formation through a 3-week and 5-week incentives program using Veggie Tokens. We found an increased level of fruit and consumption up to two months after the incentives were removed. Effects were greater for the 5-week program than for the 3-week program. The following figure gives a visual representation of these results.