Decaying behavioral effects in a randomized, multi-year fruit and vegetable intake intervention

Hoffman, Jessica A.; Thompson, Douglas; Franko, Debra L.; Power, Thomas J.; Leff, Stephen S.; Stallings, Virginia A.

doi:10.1016/j.ypmed.2011.02.013

Cited by 59 publications

(91 citation statements)

References 26 publications

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“…Middle-to long-term increases are mostly reported in portions per day, ranging from about 0?09 and 0?07 more portions in fruit and vegetables, respectively (74) , to 0?28 portions of fruit and vegetables (75) , or 10 % daily increases in consumption of fruit (76) . The 0?23 and 0?15 portion increases in our preschool study thus are comparable with previous evidence on intervention effects in older children.…”

Section: Discussionmentioning

confidence: 99%

Positive impact of a pre-school-based nutritional intervention on children's fruit and vegetable intake: results of a cluster-randomized trial

Bock

Breitenstein

Fischer

2011

Public Health Nutr.

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Objective: To assess the short-term impact of a nutritional intervention aimed at reducing childhood overweight in German pre-school children. Design: Using a cluster-randomized study design with waiting-list controls, we tested a 6-month intervention administered once weekly by a nutrition expert consisting of joint meal preparation and activities for children and parents such as tasting and preparing nutritious, fresh foods. At baseline, 6 and 12 months, a parent-completed questionnaire assessed fruit and vegetable intakes (primary outcomes) and water and sugared drinks consumption (secondary outcomes). Direct measurement assessed BMI, skinfold thickness and waist-to-height-ratio. An intention-to-treat analysis used random-effects panel regression models to assess the intervention effect, adjusted for each child's age, gender, immigrant background and maternal education. Setting: Eighteen pre-schools from three south German regions. Subjects: Healthy children aged 3-6 years. Results: Three hundred and seventy-seven (80 %) eligible pre-school children participated in the study. Of these, 348 provided sufficient data for analysis. The sample mean age was 4?26 (SD 0?78) years; the majority (53?2 %) were boys. Children's fruit and vegetable intakes increased significantly (P , 0?001 and P , 0?05, respectively); no significant changes in the consumption of water, sugared drinks or anthropometric measurements were noted. Conclusions: Nutritional interventions in pre-schools have the potential to change eating behaviours in young children, which in the long term might reduce risk for developing overweight.

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Section: Discussionmentioning

confidence: 99%

Positive impact of a pre-school-based nutritional intervention on children's fruit and vegetable intake: results of a cluster-randomized trial

Bock

Breitenstein

Fischer

2011

Public Health Nutr.

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“…The included studies were of varying study designs, with 42 48,50,53,54,[57][58][59]62,63,[67][68][69]71,[73][74][75][76][77][78][79][80][81]83,84,86,87,89,90,[93][94][95][96][97]98,102,103,[106][107][108][109][110][111][112][113][114][115][116][117][118][119]124 experimental (largely cluster trials) and 34 [40][41][42][43][44][45][46][47]49,51,…”

Section: Studies Included In the Reviewmentioning

confidence: 99%

“…studies seldom reported means and standard deviations), it was possible to conduct meta-analysis for only a small subset of interventions in this category (n = 13 targeted interventions). The fifty-two studies are therefore synthesised narratively in terms of whether they followed a universal (n = 16 44,45,57,64,[74][75][76][77]86,88,[96][97][98][100][101][102]104,105 ) or a targeted (n = 36 54,56,[58][59][60][61][62][63][65][66][67][68][69][70][71][72][73][78][79][80][81][82][83][84][85]87,[89][90][91][92][93][94][95]99,103,106 ) approach. The results are also summarised in Table 41 (universal-approach studies) and …”

Section: Targeted Interventionsmentioning

confidence: 99%

“…Sixteen 44,45,57,64,[74][75][76][77]86,88,[96][97][98][100][101][102]104,105 followed a universal approach and either included subgroup analysis of different SES groups or explored associations between SES and intervention outcomes. The remaining 36 studies 55,56,[58][59][60][61][62][63][65][66][67][68][69][70][71][72][73][78][79][80][81][82][83][84][85]87,[89][90][91][92][93][94][95]99,101,103,106 were targeted at low-SES or disadvantaged groups or areas.…”

Section: Reducing Inequalities In Obesity Among Childrenmentioning

confidence: 99%

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How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews

Bambra

Hillier

Cairns

et al. 2015

Public Health Research

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BackgroundTackling obesity is one of the major contemporary public health policy challenges and is vital in terms of addressing health inequalities.ObjectivesTo systematically review the effectiveness of interventions (individual, community and societal) in reducing socioeconomic inequalities in obesity among (1) children aged 0–18 years (including prenatal) and (2) adults aged ≥18 years, in any setting, in any country, and (3) to establish how such interventions are organised, implemented and delivered.Data sourcesNine electronic databases including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and NHS Economic Evaluation Database were searched from database start date to 10 October 2011 (child review) and to 11 October 2012 (adult review). We did not exclude papers on the basis of language, country or publication date. We supplemented these searches with website and grey literature searches.Review methodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Experimental studies and observational studies with a duration of at least 12 weeks were included. The reviews considered strategies that might reduce existing inequalities in the prevalence of obesity [i.e. effective targeted interventions or universal interventions that work more effectively in low socioeconomic status (SES) groups] as well as those interventions that might prevent the development of inequalities in obesity (i.e. universal interventions that work equally along the SES gradient). Interventions that involved drugs or surgery and laboratory-based studies were excluded from the reviews. The initial screening of titles and abstracts was conducted by one reviewer with a random 10% of the sample checked by a second reviewer. Data extraction was conducted by one reviewer and independently checked by a second reviewer. The methodological quality of the included studies was appraised independently by two reviewers. Meta-analysis and narrative synthesis were conducted focusing on the ‘best-available’ evidence for each intervention type (defined in terms of study design and quality).ResultsOf 56,967 papers of inequalities in obesity in children, 76 studies (85 papers) were included, and of 70,730 papers of inequalities in obesity in adults, 103 studies (103 papers) were included. These studies suggested that interventions that aim to prevent, reduce or manage obesity do not increase inequalities. For children, there was most evidence of effectiveness for targeted school-delivered, environmental and empowerment interventions. For adults, there was most evidence of effectiveness for primary care-delivered tailored weight loss and community-based weight loss interventions, at least in the short term among low-income women. There were few studies of appropriate design that could be included on societal-level interventions, a clear limitation of the evidence base found.LimitationsThe reviews located few evaluations of societal-level interventions and this was probably because they included only experimental study designs. The quality assessment tool, although described as a tool for public health interventions, seemed to favour those that followed a more clinical model. The implementation tool was practical but enabled only a brief summary of implementation factors to be made. Most of the studies synthesised in the reviews were from outside the UK and related to women.ConclusionsThe reviews have found some evidence of interventions with the potential to reduce SES inequalities in obesity and that obesity management interventions do not increase health inequalities. More experimental studies of the effectiveness and cost-effectiveness of interventions (particularly at the societal level) to reduce inequalities in obesity, particularly among adolescents and adult men in the UK, are needed.Study registrationThe studies are registered as PROSPERO CRD42011001740 and CRD42013003612.FundingThe National Institute for Health Research Public Health Research programme.

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“…37 Lastly, multicomponent interventions may require significant funding and involvement from teachers, cafeteria staff, and parents. 38 Many of the published multicomponent studies were funded by large research organizations such as the National Cancer Institute, 37,[39][40][41][42][43] the National Institute of Health, 44,45 and the Centers for Disease Control and Prevention. 41,44 Therefore, simple cafeteria interventions may be more practical for many schools with limited resources.…”

Section: Discussionmentioning

confidence: 99%

Simple interventions to improve healthy eating behaviors in the school cafeteria

Kessler

2016

Nutr Rev

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The National School Lunch Program in the United States provides an important opportunity to improve nutrition for the 30 million children who participate every school day. The purpose of this narrative review is to present and evaluate simple, evidence-based strategies to improve healthy eating behaviors at school. Healthy eating behaviors are defined as increased selection/consumption of fruits and/or vegetables, increased selection of nutrient-dense foods, or decreased selection of low-nutrient, energy-dense foods. Data were collected from sales records, 24-hour food recalls, direct observation, and estimation of plate waste. The review is limited to simple, discrete interventions that are easy to implement. Sixteen original, peerreviewed articles are included. Interventions are divided into 5 categories: modification of choice, behavior modification, marketing strategies, time-efficiency strategies, and fruit slicing. All interventions resulted in improved eating behaviors, but not all interventions are applicable or feasible in all settings. Because these studies were performed prior to the implementation of the new federally mandated school meal standards, it is unknown if these interventions would yield similar results if repeated now.

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Decaying behavioral effects in a randomized, multi-year fruit and vegetable intake intervention

Cited by 59 publications

References 26 publications

Positive impact of a pre-school-based nutritional intervention on children's fruit and vegetable intake: results of a cluster-randomized trial

Positive impact of a pre-school-based nutritional intervention on children's fruit and vegetable intake: results of a cluster-randomized trial

How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews

Simple interventions to improve healthy eating behaviors in the school cafeteria

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