Professor Dominic Upton Increasing children’s fruit and vegetable consumption: an evaluation of the Food Dudes programme Professor Dominic Upton Dr Penney Upton Charlotte Taylor ISBNPA Conference, May 2012.

The Food Dudes Programme (Horne, Lowe, Fleming & Dowey, 1995) School-based intervention (4-11 years); Encourages children to eat more fruit and vegetables both at school and at home; Changes the ‘culture’ of a school to one that strongly supports healthy eating.

The 3Rs Based on psychological principles of behaviour change Role modelling Rewards Repeated Tasting Increased FV consumption

The Food Dudes Programme Phase 1 (16 days) Children are read a letter from the Food Dudes and watch a DVD episode Given a portion of fruit and a portion of a vegetable Children are given a reward if they eat both Home Pack Phase 2 (Maintenance) Children still given rewards Classroom wall charts to review progress Some evidence of effectiveness but based on experimental model

The Study Ecological approach 8 intervention (n=1282) and 7 matched control (n=1151) schools Evaluate impact on consumption at school and home of: fruit and vegetables unhealthy snack foods Assess maintenance of any behaviour change 1 year after intervention

Overview of study design Intervention schools Control schools Baseline (pre intervention) Phase 3 (12 months post intervention) Phase 2 (3 months post intervention) Food Dudes intervention Baseline (pre intervention) Phase 3 (12 months post intervention) Phase 2 (3 months post intervention) No intervention

Measures Weighed intake method (school prepared lunch); Visual estimation of intake (packed lunch); Observation and child report (recess); Photographic diary (home consumption); Measures taken over 5 consecutive days.

Lunchbox Example Baseline 3 month follow-up PRE POST

Results: Snack choice at recess Fig 1. Mean consumption of FV – Recess snacks Levels of FV consumption already higher in intervention schools Increase in FV consumption for intervention schools at Phase 2, but Non significant The increase in FV consumption displaced unhealthy snacks FV consumption decreased over time in the control schools, whilst unhealthy snacks increased.

Results: School prepared lunch (FV) Fig 2. Mean consumption of FV – School meals Significant increase in FV consumption at Phase 2 (t=-2.54, p<0.05, d= 0.26, CI= -5.39-6.10) for intervention schools But not control schools (t=-0.97, p>0.05, d=0.07, CI=-4.46-4.01); FV consumption decreased in both groups at Phase 3; BUT no displacement of unhealthy foods seen

Results: School prepared lunch (FS) Fig 6. Mean consumption of Fat/sugary foods– School meals Significant increases for intervention (t=-4.87, p<0.05, d=0.49, CI=- 5.33-5.59); and control schools (t=-4.49, p<0.05, d=0.35, CI=-3.78-4.05) at Phase 2;

Results: Packed lunches (FV) Fig 3. Mean consumption of FV – Home prepared lunches Significant increase in FV consumption at phase 2 for children in the control schools (t=-2.55, p<0.05, d=0.26, CI=-0.12-0.38), but no change for intervention schools However this was not maintained over time Consumption of unhealthy food increased in intervention school

Results: Packed Lunches (FS) Fig 7. Mean consumption of Fat/sugary foods– Home prepared lunches Significant increases at phase 2 in the intervention schools (t=-2.66, p<0.05, d=0.31, CI=-0.18-0.42); Reduction in this consumption means this is no longer significant at Phase 3 for intervention schools (t=-1.22, p>0.05, d=0.14, CI=-0.01-0.25); Non significant increase at phase 3 for control schools (t=-1.25, p>0.05, d=0.13, CI=0.01-0.24).

Results: Home study (FV) Non significant decrease in FV consumption at phase 2 for intervention (t=1.52 (19), p>0.05, d=-0.48, CI=-1.51-0.64); and control schools (t=0.67 (24), p>0.05, d=-0.19, CI=-0.87-0.60); Continued reduction in consumption at phase 3 also non significant for intervention (t=-1.73 (19), p>0.05), d=-0.55, CI=-1.60-0.58); and controls (t=1.43 (24), p>0.05), d=0.41, CI=-1.26-0.39) Fig 4. Mean consumption of FV – Food diary

Results: Home study (FS) Consumption of unhealthy foods decreased in both the intervention and control schools over time; Non significant at Phase 2 and 3 for intervention (t=0.88 (19), p>0.05, d=-0.29, CI=-0.74-0.06); Significant at phase 3 for control schools (t=3.10 (24), p>0.05, (d=-0.88, CI=-1.21--0.53). Fig 8. Mean consumption of Fat/sugary foods– Food diary

Do the ‘Food Dudes’ change behaviour? An improvement in children’s eating behaviours was seen in the short term for school-supplied food; This was particularly noticeable at recess; Are school policies most important factor? Impact on food supplied from home less clear; Packed lunches continued to be high in fatty sugary foods and low in FV; Consumption of unhealthy foods decreased at home, but so did FV consumption;

Food Dudes…… Winning the battle against the Junk Punks…….. But is it enough to win the war on obesity?