Nutrition, choice, and the school cafeteria: an ecological approach to encouraging consumption of fruits and vegetables

Abstract

Growing rates of childhood obesity continue to be a major public health issue for this country. In order to impact childhood obesity at the population level it is necessary to shift our focus away from individual behaviors and towards the critical examination of the role that settings have in promoting or discouraging healthy eating. One relevant setting in the fight against childhood obesity is the school cafeteria. Since 1946, the National School Lunch Program has worked to ensure that schools can provide their students with affordable daily access to nutritional, well-balanced meals. However, "food served" does not necessarily equal "food consumed;" high rates of waste, especially of fruits and vegetables, are well documented. The current, mixed-method study examines the effectiveness of a low-cost intervention designed to increase student consumption of fruits and vegetables by altering the choice architecture of the cafeteria. This was done through the introduction of an active, forced choice into the school lunch service. Consumption was measured by observing (n=2,064) and weighing (n=84) student plate waste over two ten-day periods pre-intervention and during implementation. Results show an average daily 15% increase in consumption of both fruits and vegetables during the intervention period. Qualitative interviews (n=34) were conducted in order to better understand the environment of the school cafeteria and identify any barriers to healthy eating that may exist within the setting. Both quantitative and qualitative findings suggest that local schools can actively encourage students to take advantage of fruits and vegetables offered through the NSLP by implementing setting-level changes to the cafeteria environment.