Changing children’s eating habits for life The Food Dudes Healthy Eating Programme Presented by Dr Sally Pears

Overview - The Food Dudes programme: background & behavioural principles. - Programme impact: children’s F&V and ‘unhealthy’ snack consumption data. - DVD of a school in Wolverhampton before & after Food Dudes. - Take-up of the programme and awards. Changing children’s eating habits for life

Behavioural Goal: To increase consumption of fruit and vegetables in primary school children Changing children’s eating habits for life +=

Why Increase Fruit and Vegetable Intake? Changing children’s eating habits for life Recommended daily intake = 5 portions a day (400g) 70 % of adults in the UK fail to meet this target (2006) Average British daily intake = 250g Worldwide obesity crisis We must change eating habits

Health Benefits of Fruit and Vegetables Changing children’s eating habits for life Help prevent obesity Protect against many cancers Reduce the risk of coronary heart disease Help prevent diabetes Protect against asthma Keep skin, teeth and hair healthy

Changes knowledge, beliefs and attitudes but not actual eating habits/behaviour. Changing children’s eating habits for life Changing F&V consumption is key! Traditional Approach: Health Education

Designed by psychologists, based on behavioural principles and theory. Changing children’s eating habits for life Brings about major and long-lasting change The Food Dudes Programme

The Food Dudes 3 Rs Role Modelling Rewards (extrinsic) Repeated Tasting – intrinsic rewards in eating F&V Changing children’s eating habits for life help to establish and maintain behaviour

The Food Dudes 3 Rs Role Modelling Rewards Repeated Tasting Changing children’s eating habits for life

Role-Modelling is more effective when: - The model is of similar age or slightly older than the observer. - The model is liked or admired by the observer. - The model’s behaviour is rewarded. - The observer’s imitation of the model is rewarded. - Multiple models are presented. Role-modelling

The Food Dudes

- Rewards should be potent. - Need to be tied to the Food Dudes system. - Reward delivery should be given very soon after the desired behaviour. - Instructions (to children) should clearly specify the reward contingency. - Children’s actual consumption of F&V should be rewarded (rather than verbal statements of what they eat or prefer). Rewards

- Repeated tastings (10-15) of a particular food generates liking. - A biological / physiological phenomenon. - Well-researched (though only for a limited range of foods). Repeated Tasting

Phase 1 (16 days) - Each day children given a portion of fruit and a portion of veg. - DVD episodes and letters from the “Food Dudes” – role-models for children to imitate. - Children who eat a portion of fruit AND veg (repeated tasting) are given a small reward. - A ‘Home Pack’ encourages children to eat more f&v at home.

Changing children’s eating habits for life Phase 1 (16 days) Days 1-4: Children earn a reward by tasting both their fruit and vegetable. Days 5-16: Children earn a reward by eating a portion of their fruit and a portion of their veg. A portion is roughly the amount that fits into the child’s cupped hand

Changing children’s eating habits for life Phase 2 (ongoing) -Focus shifts to F&V eaten at school lunchtime. Day 17: - Reward given for home consumption during Phase 1. -Homepack 2 (letter and F&V boxes). Ongoing: -Children receive handstamps for eating F&V at lunchtime. -Teachers record progress on a classroom Wallchart. -Rewards given when children achieve targets on the Wallchart.

Why Does Food Dudes Work? The DVD episodes and rewards encourage children to taste fruit and vegetables repeatedly. Children discover the intrinsically rewarding properties of these foods and develop a taste for them. Children come to see themselves as fruit and vegetable eaters and are proud of it. The Programme creates a culture, both at school and at home, that strongly supports the eating of fruit and vegetables.

Changing children’s eating habits for life Results - Large increases in consumption - Greatest increases in consumption shown by those children who are the ‘poorest eaters’. - Increases in consumption are long-lasting. - Increases extend across a wide range of fruit and vegetable varieties. - The Programme works for all children aged 4-11yrs old. - The effects generalise across contexts, ie. School to home. - The Programme is equally effective for boy and girls. - Effects are highly reliable, regardless of school location and social deprivation.

NB. Average daily portion weight presented = 83g of fruit or 60g of vegetables % consumed Fruit Control SchoolFood Dudes School Before After 16 Days After 4 Months Before After 16 Days After 4 Months Before After 16 Days After 4 Months Before After 16 Days After 4 Months Vegetables London Schools Poorest Eaters Horne et al. (2004) Increasing children's fruit and vegetable consumption: a peer-modelling and rewards-based intervention. Eur. J. Clin. Nutr. 58, p

Changing children’s eating habits for life Food Dudes in Ireland 2004 After seeing the overwhelmingly positive results of experimental evaluations of the Food Dudes programme in England and Wales, the Irish Government decided to run an experimental evaluation of the programme in schools in Ireland. Ireland has no school meal system – effectiveness of Food Dudes would be dependent on parents providing F&V in children’s lunchboxes! The results of the evaluation were as strong as those of previous studies, with the programme resulting not only in large increases in children’s consumption of F&V but also in parental provision of F&V in children’s lunchboxes.

Food Dudes School Control School grammes provided Food Dudes School Control School grammes consumed Fruit and Vegetable CONSUMPTION (from packed lunches) Fruit and Vegetable PROVISION (in packed lunches) Before After 12 months Horne et al. (2009) Increasing parental provision and children's consumption of lunchbox fruit and vegetables in Ireland: the Food Dudes intervention. Eur. J. Clin. Nutr. 63, p Ireland Experimental Evaluation

Changing children’s eating habits for life Food Dudes in Ireland continued… 2005 The Irish Government, with support from the European Union and Industry, launched a pilot roll-out of the programme in 150 primary schools in Ireland Based on the pilot roll-out’s success, the Irish Government made the Food Dudes programme available to every primary school in Ireland (3,300 schools over 7 years) on a budget of 28 million euro. To date 200,000 children have participated in the programme In recognition of its success after one year, the programme was awarded a World Health Organization Best Practice Award.

Changing children’s eating habits for life Food Dudes in Wolverhampton In 2009 a 3 year roll-out of the programme began in Wolverhampton, funded by Wolverhampton City PCT. 6 of the 10 schools that received the programme in 2009 were chosen as Experimental Schools to evaluate the impact of the Programme. A24 hour food diary (DIET24) recorded fruit, vegetable and snack consumption at different eating occasions throughout the day, both at home and at school.

PRE POST Portions Consumed PRE POST Poorest Eaters (<2portions per day) Whole School 1.92 * 1.37 * * * Wolverhampton Evaluation: Results 1 Daily Fruit & Veg Consumption (at Home and School) Fruit Vegetables

PRE POST Portions Consumed Wolverhampton Evaluation: Results 2 Unhealthy Snack Consumption (in School) As F&V consumption increased, ‘unhealthy’ snack food consumption decreased. Suggests that F&V displaced other snack food in children’s diets. 20% reduction 0.63 *

Wolverhampton DVD

Award Winning Programme 1998: Caroline Walker Trust - changing children’s diets 2006: World Health Organisation - combating obesity 2009: Social Marketing Centre - Showcase Award 2010: Chief Medical Officer’s Public Health Awards – Gold Medal

Take Up England- (SFT; DoH; HDC; Worshipful Company of Fruiterers) : Wolverhampton regional roll-out to 84 schools, 20,000 children : Bedfordshire pilot roll-outs to 13 schools : Coventry: roll-out to 30 schools, 9,000 children. Other regions are also interested in piloting the scheme. Ireland : National Roll-out to all primary schools (3,300 schools; 450,000 children). Worldwide Pilot projects in Sicily, California (US) and Utah (US). Interest expressed from Australia, Mauritius, Brazil and Greecr.

Changing children’s eating habits for life Some testimonials from parents…… “ I think that the Food Dudes Programme is an excellent initiative. It appears to stop children saying, "I don't like" various fruit/veg when they haven't even tried it.” “Food Dudes should be introduced into every Primary School.” “The children ate more fruit and veg and asked for less chocolate and crisps!” “I found I was buying more fruit than usual.” “I think it was beneficial, it has helped and encouraged all the family to eat healthy. My son is trying to encourage other family members to eat healthy.”

Changing children’s eating habits for life Contacts:   Fax: +44 (0)  Write to: Bangor Food and Activity Research Unit, School of Psychology, Bangor University, Gwynedd, UK, LL57 2AS. Food Dudes Co-ordinator (Pauline Kelly)   Tel: +44 (0) Food Dudes Strategy and Business Development (Tracey Anthony)   Tel: +44 (0)