Efficacy of the Lunch is in the Bag intervention to increase parents’ packing of healthy bag lunches for young children: a cluster-randomized trial in early care and education centers

Abstract

BackgroundLunches that parents pack for their young children to eat at school or the Early Care and Education (ECE) center fall short of recommended standards. Lunch is in the Bag is a multi-level behavioral nutrition intervention to increase parents’ packing of fruit, vegetables, and whole grains in their children’s lunches. Designed for implementation in ECE centers, the five-week long intervention is followed three months later with a one-week booster.MethodsEfficacy of Lunch is in the Bag was tested in cluster randomized trial. Participants were 633 families from 30 ECE centers (15 intervention, 15 control) across Austin, San Antonio, and Houston, Texas, USA. Primary outcomes were servings of fruit, vegetables, and whole grains observed in the children’s parent-packed bag lunches. Servings of refined grains, meats/beans/eggs/nuts, dairy, chips, and sweets also were observed. Data were collected at baseline, post-intervention (6-week follow-up), pre-booster (22-weeks follow-up), and post-booster (28-week follow-up). Time-by-treatment interactions were analyzed separately for each of the food groups using multi-level models to compare changes from baseline. Analyses were adjusted for relevant demographic variables and clustering within centers and parents.ResultsThe intervention effected increases from baseline to 6-week follow-up in vegetables (0.17 servings, SE = 0.04, P < 0.001) and whole grains (0.30 servings, SE = 0.13, P = 0.018). The increase in whole grains was maintained through the 28-week follow-up (0.34 servings, SE = 0.13, P = 0.009). Fruit averaged more than 1.40 servings with no differences between groups or across time. The intervention prevented increase in sweets (-0.43 servings, SE = 0.11, P < .001, at the 22-week follow-up). Parents persisted, however, in packing small amounts of vegetables (averages of 0.41 to 0.52 servings) and large amounts of sweets and chips (averages of 1.75 to 1.99 servings).ConclusionsThe need for and positive effects of the Lunch is in the Bag intervention at ECE centers where parents send bag lunch for their preschool-aged children was confirmed. An important direction for future research is discovery of more options for leveraging the partnership of ECE centers and families to help young children learn to eat and enjoy vegetables and other healthy foods in preference to less healthy choices such as chips and sweets.Trial registrationThe Clinical Trials Number is NCT01292434.

The effectiveness of lunchbox interventions on improving the foods and beverages packed and consumed by children at centre-based care or school: a systematic review and meta-analysis

“…Of the 10 included trials, three were conducted in the U.S., [31–33] three in U.K., [21, 34–36] two in Australia [37, 38], one in Mexico [39] and one in Israel [40]. Eight of the studies employed cluster randomised-controlled trial designs, [21, 31, 32, 34, 37–40] and two were conducted using quasi-experimental designs [24, 35]…”

“…Four trials were conducted in centre-based care [24, 32, 37, 38] with the number of participating centres ranging from six to 31. These trials recruited samples of between 132 and 560 children with the age of participants ranging from 3 to 6 years.…”

“…All trials included intervention strategies to increase parent knowledge via delivery modes such as pamphlets, newsletters, posters or parent workshops. The majority of interventions (8/10) included an education component for children through videos, games, curriculum or activities [24, 31, 32, 34, 35, 37, 38, 40]. Four interventions, all school based, provided physical resources (e.g.…”

“…Only two interventions, both centre-based care studies, incorporated the development of a policy and the communication of this to parents [37, 38]. Seven of the studies were stand-alone lunchbox interventions [21, 24, 31, 32, 34, 35, 39] whilst three were part of a larger child obesity prevention program, two occurring in centre-based care which included strategies to support centres to deliver physical activity (e.g. manuals, training, equipment) or information to parents targeting small screen recreation reduction [37, 38] and one in schools which included 15 × 45 min physical activity delivered to children by trained professionals [40].…”

Position of the Academy of Nutrition and Dietetics: Benchmarks for Nutrition in Child Care

“…After the 5-week intervention and a 1-week booster training, parents increased the number of whole grains and decreased the number of sweet foods in sack lunches provided to children. 22 Nutrition and dietetics practitioners can help providers communicate with parents about healthy and appropriate foods to provide in packed lunches.…”