What does it take to get kids to eat healthy foods?

ResearchBlogging.orgi-901306ceef427d46974bf8e9c263fa35-jimlunch.JPGWhen Jim and Nora were in elementary school, both Greta and I worked challenging jobs, so we did whatever we could to save time. Instead of bringing lunches made by their parents, the kids bought hot meals at school. The school was proud of its cafeteria. Kids had credit accounts, which meant they didn't have to carry lunch money to school (thus making them less of a target for bullies). The children were encouraged to make "healthy choices" instead of just getting a ladleful of mystery meat plopped on their trays.

After a few billing cycles, however, we noticed that Jim was spending more and more money. A complete lunch was supposed to cost about $3.50, but his bill was nearly $50 a week! We asked the cafeteria what he was buying and a printout was sent home. Here's a typical day's meal:

Chocolate milk (2)
French Fries (2)
Jello (3)

Needless to say, Greta and I soon resigned ourselves to making lunches for the kids. While "healthy choices" sounds appealing, if these were the choices our child was making, then we were going to choose for him.

Parents want their children to make good food choices -- we can't be there to decide for them all the time -- but we also want them to eat well now, even when they don't seem capable of making healthy decisions. And of course not all parents have the time or even the capacity to make good decisions for their kids, so for decades, the school lunch has been thought to be an important key to getting kids to eat better.

Unfortunately, many programs designed to get kids to eat well have failed. If children are rewarded for eating good foods, then what happens when they aren't being rewarded? Requiring them to eat a certain amount fruits and vegetables can backfire: even if kids don't mind the taste, too much of anything eventually ends up being unappealing. Comprehensive educational programs sometimes work, but require so much parent and teacher involvement that they aren't always practical.

So Helen Hendy, Keith Williams, and Thomas Camise devised a simpler approach: give kids a choice of fruits and vegetables in addition to their preferred meats, carbs, and milk, and reward them for eating even a little bit. They trained experimenters to observe 346 first-, second-, and fourth-graders for 6 days to see what fruits and vegetables they ate when given a choice of one of two fruits and one of two vegetables. Just one-eighth of a cup was considered a serving.

Then they started their reward program. Each student got to wear a Penn-State lion-paw necklace when the experimenters were in their school. The experimenters watched the students eat in groups of 12, recording which children ate 1/8 cup of fruit or vegetables. Half the groups were rewarded for eating fruits by getting a hole punched in their lion paw. The other kids were rewarded for eating vegetables. At the end of each week, any child who had three hole-punches could cash them in for a small prize like a colorful pencil or a decal. Did the reward system work? Here are the results for first-graders:


The graph on the left shows fruit consumption for each group of four meals observed, first during the baseline, then for three rounds of rewards. As you can see, when fruit consumption was rewarded, the kids ate significantly more fruit. Fruit consumption increased for the first round when vegetable-eating was rewarded, then dropped off in subsequent weeks. Similarly, the graph on the right shows vegetable consumption. Once again, vegetable consumption went up significantly when eating vegetables was rewarded, but only increased temporarily when fruit-eating was rewarded.

So rewarding kids for eating a type of food does increase the amount of food they eat. An important aspect of this study is that even though the kids were given a choice each day, that doesn't mean they got exactly what they wanted. They could only pick one of two fruits and one of two vegetables (and unlike Jim, they had to pick one of each; they couldn't just feast on jello and French fries).

The researchers also asked the students to rate which foods they liked on three separate occasions: before the study, two weeks after the end of the reinforcement phase, and seven months after the end of the reinforcement phase. After two weeks, the kids had a significantly higher rating for the fruits they were served during the study compared to before the study began. Their ratings for vegetables also increased, but the difference was not significant. After seven months, however, the kids ratings for both fruits and vegetables had returned to pre-study levels.

Hendy's team says this is an encouraging result. After all, in many other studies, children actually said they liked fruits and vegetables less after the study period. They suggest that extending the reinforcement period longer than they did in their study might lead to kids liking these healthy foods for a longer period of time.

They are backed up by other research suggesting that children need to be exposed to new foods 8 to 10 times before a preference for that food can be developed. This is something we saw in Jim and Nora when they were kids. If we introduced a new food, the first time they might not even touch it. After a couple of meals, they might try it but say they didn't like it. After a longer period, they might even decide they liked it.

In any case, it's easy to see how horrible the approach at Jim and Nora's school cafeteria was. Yes, they gave the kids choices, but the choices were both healthy and unhealthy. Few kids are going to pick a vegetable when they could take an extra dessert instead.

HENDY, H., WILLIAMS, K., & CAMISE, T. (2005). "Kids Choice" School lunch program increases children's fruit and vegetable acceptance Appetite, 45 (3), 250-263 DOI: 10.1016/j.appet.2005.07.006

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It's not scientific, alas, but the answer (as implemented in many UK schools at least) is not to offer any unhealthy options at mealtimes. They eat healthy or.. well, they don't eat.

I suspect this is hard to try universally, though, because of the big business of providing school meals. If they can get $50 a week out of enough parents who don't care as much as you, they're going to keep selling trash to our kids.

their youngest group was 1st graders? that sounds like attempting to fix a problem that already exists (and evidently, it's not going too well).

I remember reading about programs in France that taught kids that were just starting with solid foods to eat veggies (brussel sprouts, no less), so that by the time the kids were making conscious choices about food, they would already be familiarized with eating fruit and veggies more. When I compare this with what I see people in the U.S. feeding their toddlers, I'm not surprised 1st graders hated veggies. shit, I repeatedly saw people getting cups of whipped cream for their toddlers to eat!
And it's not just parents who get kids used to unhealthy food way too early. Sometimes it's well-meaning grandparents, babysitters, organizers of toddler-and-parent activities, etc. The way things are right now, it seems near impossible to give kids good eating habits from the start.

We're going to be getting a lunch program at our school. I intend to keep giving my kids home lunches. I remember when I was a kid my friends' purchased lunches: consisting of donuts.

I think the main reason why kids don't eat vegetables is (1) the quality of vegetables they eat is poor (same goes for fruit) and (2) they aren't prepared well. Just put a little bit of butter or cheese w/ the veggies and it becomes more savory and delicious. As a kid, my mom would just boil frozen vegetables and try to make us eat them. Disgusting (but cheaper I guess - which is also a piece of the puzzle).

i gave my kids healthy choices to put in their bag lunches -- that they made -- the night before a school day.

it worked out very well -- my grown-up kids have since told me they ate what they put in their lunch bags.

Back when ah were a lass, and walked ten miles uphill each way to and from school, in t' snow, there were no burgers and fries and sodas in school lunches. With my "lunch order" money I could buy sandwiches, fruit, milk, juice and yoghurt any day. There were also marginal things like spacefood sticks (remember them?) and ice lollies and sesame snaps, but you were only allowed one a day. Once a week there was a junk food thing, hot dogs or meat pies or something.

Of course, back then school lunches were run by volunteer parents (ie, Mums), not corporations. In fact, in my earliest primary school, the tuckshop was only open on Mondays, because your Mum would make your lunch - but she would not have been able to buy fresh bread on Sunday. I don't think we want to go back to those days, but surely some better regulation of food sold in schools makes sense.

Also, when did children's restaurant meals become nothing but deep fried shit and chips? I travelled a lot when I was young, and I used to get small portions of the adult food, with salads and vegetables.

I went to a boarding school for a few years, and I had a friend who was flunking out. It was obvious to me that he ate much too much sugar. One day, he needed money to purchase junk food in the snack bar. I bet him five or ten dollars that he could avoid refined sugar for two whole weeks. He took the bet seriously; he could've cheated quite a bit and I never would've known, but he made it a point to keep to the letter of the agreement. What I specifically wanted was for him to lose his taste for adding sugar to the already sugary cereal he had for breakfast.

My ruse worked. He won the bet, and for the rest of the year, I could see he was eating well, choosing a wide variety of foods instead of always choosing the sugariest option. His grades improved so much that he was invited to repeat the year. He told me he couldn't stand eating foods so sweet any more.

For the rest of my life, I will feel as though I ruined this boy's life. He went home for the summer and ate whatever his family fed him at home. The next year his eating habits were back to what they had been in the first place, he wouldn't take another bet, and he flunked out. The last time I saw him, he still had the same four years of high-school ahead of him that he'd had the day I first met him.


I salute every parent who ignores the television advertisements and makes their children lunches, or teaches their children to make their own lunches. Pay attention to those television advertisements for quick pre-packaged lunches. They all harbor the same message: you don't have time for your children, and you really shouldn't have to. Your kids will get the message. They watch the same ads.

I recall school lunches with as much disgust as anyone, back in the old days when they didn't care whether it was nutritious OR appetizing. Beans and cornbread twice a week, mystery meat, soy burgers, or industrial fish sticks. Kids stayed a lot skinnier back then.

I'd get yelled at for eating poorly. What I ate became as much of a rigid set of rules as being respectful to old people, not running across the road without looking, and finishing my homework.

That isn't to say it was abusive, nor is it to say I never had junk food...snacks were part of the daily routine. But moderation was very important, and I was always asked what I ate during the day and had to ask permission to have sweets outside of normal dessert times. And yes, I bagged-lunched my way through seventh grade.

I don't think kids can be left to make their own decisions for the simple fact that they are kids. They don't have the same reasoning skills as adults (which is probably often a good thing) and simply won't do the best thing if there is an easier or more popular alternate decision. If a parent isn't quizzing and understanding what their kid is eating every day, then the kid will get away with eating poorly. And, if there is no fear of repercussion for eating poorly, they will continue to do so.

I belong to a very different culture and, FWIW, my experience with my two children is quite different - they were started on healthy eating when they started on solids (eg, no added sugar, no added salt, no added fat/oil); as they started on "adult" food they gradually learned that one (even token!) helping of whatever was on the table was to be taken (except for a very few exceptions, such as bitter gourd), and food left on the plate meant the child was unwell (if too much had been taken, the leftover was finished at the next meal). We never kept carbonated soft drinks at home - all of us followed this system, and we never had eating problems with our children! They both have their own (very young) children now, are introducing the same system slowly and, so far, successfully. Yes, junk food does occasionally get eaten by all of us - but none of us craves it. All of us prefer home-cooked food as the routine. Oh yes, when being weaned, they did get Farex once a day, but otherwise they had rice boiled with a lentil and vegs (carrot, tomato, spinach, gourd, peas, beet, potato......), egg, oats, dairy products, a variety of fruit. Really, all through their childhood their eating habits never became a worry for us.

My kids have always eaten fresh fruits and veggies since they were very little. It is always eye opening to us to have a friend over and find out how little they will eat and how much pre-packaged food makes up their daily meals. School lunches are what they are, not that great, and fortunately in our district, not that horrible. They do offer choices that are healthy, but unfortunately, many kids take them and just throw them away. My husband and I created a lunch website to give ourselves (and others) ideas for all those years of lunches we'll be packing for our kids! Every item has nutrition information and a picture. Check it out for some inspiration or to add your own item (we'll calculate the nutrition for you)! Have fun packing lunches :) http://lunchtaker.com

The best way to get kids to eat healthy foods (if you don't start them on them when they are babies) is to have them grow their own fruits and vegetables and help prepare their own meals. After they have put in the labor to grow the foods and fix the meals most of them cannot resist at least trying them.

We served Brussel sprouts and fish one night for dinner and one of my kids got a Brussel sprout leaf caught in her throat and couldn't cough it up. We took her to the emergency room, and this doctor examined her and asked us, "How did you get her to eat Brussel Sprouts?" Because these Brussel sprouts were delicious--and made with butter. Typically the vegetables served at US schools are steamed and sit in the steam tray for a long time; they taste like limp cardboard. Tasty food, and vegetables can be delicious, is always attractive. The meats they serve in school a=cafeterias are nothing to write home about either. Cheap crap.

By paul schulman (not verified) on 23 Oct 2009 #permalink

While I agree that kids will eat vegetables if they taste good, I disagree that slapping butter on it is the way to go. Roasted vegetables with herbs and seasonings are much tastier than boiled, and don't have the added fat and calories of butter. Even boiling veggies in broth adds a good flavor to them, it's just important to not over boil them. Raw veggies and fruits with low fat dips are great, too. Making 'green' smoothies is a way I've got my kids eating lots of vegetables - kale, spinach, broccoli in the blender with bananas, melon, blueberries, a little orange juice or yogurt, and they can't even taste the greens.

The bigger problem than what kind of foods we give our kids to eat is that too many parents are worried that their kida are not eating enough and continue to push foods on them even when the kids tell them they have had enough. I ran into this problem as an adult when I cut back on my food intake to lose weight and my wife was always pushing food in front of me telling me to finish it off. I had to be pretty nasty with her to break her of the habit.

My kids have always enjoyed veggies, though one is more fanatical about fruit (will eat just about anything) than the other (who will eat any fruit, provided it is a banana). Recently, CalliBaby 1.0 has become picky about veggies, even the broccoli and green beans she used to love. I think it's just a phase. CalliBaby 2.0, meanwhile, will try any food that's put in front of her, and will often try a food two or three times before deciding that she really doesn't like it, which is totally part of her methodical personality.

CalliBaby 1.0 is eating in the school cafeteria now, and although it's a similar system for paying (credits are loaded into the system by the parents, and the kid can use them at will), the kid basically gets to choose between having lunch and not having lunch; the menu is fixed, and everybody gets the same thing unless they're on some kind of special diet. I've been pleased with the nutritional content so far; it always covers the bases. They obviously can't force the kids to eat their greens, but the greens will be available.

BTW, the best means of curing a picky eater that I've found is not a reward system. (Reward systems can backfire, so should be used with caution.) It's a wilderness camping trip. You can only eat what you've packed in, and you *will* be working up an appetite. (Warning: watch carefully to make sure a hungry kid doesn't decide to try the hunter-gatherer route. There are some very yummy-looking berries that are not at all safe to eat.)

And Guy makes a good point about overeating. That's another potential danger of a reward system. It encourages kids to eat when they're not hungry. This is sensible if you don't know where your next meal will be coming from, but unwise if food is abundant in your life.

By Calli Arcale (not verified) on 29 Oct 2009 #permalink

We will receive lunch programs in our schools. I intend to have my children home for lunch. I remember when I was a friend of my child buy lunch "consists of donuts.

At meal time kids could be proposed to chose among several balanced sets of dishes/fruit/drink.