Familiarizing children with healthy food

Between 1982 and 1999, French researchers recorded the food choices of about 400 toddlers who were given lunch at the kindergarten. When they revisited these children in the new millennium — now aged between 4 and 22 — the researchers found their preferences had barely changed. The subjects who had often chosen fruit as toddlers still liked fruit; the ones who had preferred savoury food still did. The eating habits the participants had acquired as little children had stayed with them.

It is not just food preferences that can be traced back to childhood: overweight kids are more likely to be overweight as adults, says Gertrude Zeinstra, a senior researcher at Wageningen Food & Biobased Research. She has been researching children’s eating behaviour for 20 years. ‘The latest figures from Statistics Netherlands (CBS) show 12 per cent of children are now overweight. A third of that group, 4 per cent, are obese. There is nothing to indicate that the upward trend is going to stop. That also means increasing risks of diabetes, heart disease and liver problems.’

To turn things around, Zeinstra and her colleagues are developing and studying strategies that help schools teach healthy eating habits to children aged 4 to 12 — strategies that go further than just a lesson on the importance of vitamins in food. ‘It’s much harder to get children to adopt healthy eating habits if, for example, they aren’t familiar with the textures of fruits and vegetables or don’t know how to peel a mandarin.’ Healthy eating habits will only stick if children are actively introduced to the smells, textures and tastes of fruits and vegetables in addition to learning the facts about food.

One of the programmes that does more than just teach the facts is the Taste Classes programme. It was developed by WUR, and schools have now been using it for 15 years. The programme is used in 75 per cent of primary schools. ‘It combines lessons with what we call experience-focused activities, in which children get used to the smells, textures and tastes of fruits and vegetables,’ explains Taste Classes project manager Els van Coeverden. ‘The children also have cookery lessons where they learn how to prepare healthy food.’

‘It is about learning to experience a product with all your senses, so that an aubergine, carrot or tomato doesn’t feel strange any more,’ explains Van Coeverden. ‘The precise content depends on the age of the children, but the principle is the same.’ In the case of young children, the teacher first explains why eating breakfast is important. The children then taste fruits and vegetables blindfolded. Finally, they prepare a simple treat during the ‘taste feast’ that concludes the series of lessons. ‘A tasty wrap with a selection of Dutch vegetables, for example.’

The cookery lesson is just as important as the tasting practice, says Zeinstra. ‘It starts with food on a skewer and ends in the exam year with them making a veggie burger with pulses. The children develop skills, and that gives them self-confidence in eating healthily. In addition, if you are involved in preparing the fruit and vegetables you eat, you tend to find them tastier. This is termed the IKEA effect in the scientific literature: you appreciate something more if you had to put an effort into it.’

The Taste Classes programme has been included in the ‘Healthy Living Portal’ intervention database created by the National Institute for Public Health and the Environment (RIVM). This is a resource where schools can find tried-and-tested lesson packs and programmes. At present, Zeinstra is carrying out an extensive new study of the programme’s effectiveness in the long term.

Vegetable gardens are another effective form of experience-focused food education, as is shown in a study by Zeinstra and her colleagues. ‘In this study, we looked at the literature and held three sessions with experts with practical experience. Our study revealed a range of beneficial effects.’

Children who grow their own fruit and vegetables in a vegetable garden often have a more positive attitude to those products. They are more prepared to try fruits and vegetables, develop a stronger preference for these products and may even eat more fruit and vegetables. ‘They also know more about food. While knowledge isn’t enough in itself, it does help give children the confidence and competence that they need to make healthy choices.’ That illustrates the power of the IKEA effect.

In practice, school vegetable garden projects are quite variable and not all are effective at present. Zeinstra and her colleagues analysed which key elements and criteria are crucial in creating a vegetable garden project that is supported by the scientific evidence. ‘For example, we found that every child has to be actively involved, needs to work in the garden at least ten times and the class needs to repeatedly try the vegetables they have grown,’ says Zeinstra.

‘Now the Healthy Living Portal uses those criteria to assess school garden projects,’ continues Zeinstra. Zeinstra and her colleagues have now developed a ‘model intervention’ based on their findings — essentially a template for a vegetable garden programme. Like the Taste Classes, that programme has been added to the RIVM database.

‘So far, I’ve mainly been talking about the knowledge, skills and preferences of children and how we could help develop them,’ says Zeinstra. ‘But I should also be talking about the environment in which children learn about eating, as that is also very important.’

Take the school cafeteria. ‘Research shows that children and teenagers actually like fruit as a sweet snack, but fruit can’t compete with chocolate bars and high-fat snacks. So if you want children to choose healthy options, it’s important not to offer those unhealthy competitors during the break.’ In other words, make it easy to opt for healthy food.

The ten o’clock break — the moment halfway through the morning when children have a small snack — is a thorny issue in primary schools,’ says Zeinstra. Do they have a pre-wrapped biscuit or a couple of mini-cucumbers in their lunch box? ‘We looked at schools that have a snack policy. It turns out that requiring parents to give their children something healthy to take to school is very effective. Children eat twice as much fruit and vegetables at school if that is the rule. But it only works if the school is prepared to take parents to task if they don’t stick to that rule.’

‘For young children especially, parents are the most important factor in their food environment,’ continues Zeinstra. ‘However, it has long been unclear how you can best get parents involved in children’s food education. That was an important reason for us to investigate the involvement of parents in food education.’ In their research, Zeinstra and her colleagues looked at various forms of parental involvement. They investigated how appealing each form was to the parents, schools and teachers, how feasible it was and how many parents it reached. The initial findings show that food education is more effective when parents are actively involved.

The schools that don’t just teach children facts but also give them experiences and new skills, create a healthy food environment and encourage parents to do the same at home are the schools that are most effective in getting children to adopt healthy eating habits. ‘This is termed the “whole school approach”. It is not limited to a series of lessons; the school seizes every opportunity to encourage healthy eating habits.’

‘This approach combines different programmes or elements from those programmes. But more importantly, it considers healthy eating to be a core value. That means for example that teachers don’t just teach the lesson pack, they should also set a good example by eating healthily themselves. And no sugary drinks in the cooling bags on sports days; instead, bananas are handed out.’ The key is to make healthy eating an intrinsic part of the school experience. ‘The children at such schools develop their preferences and food skills in an environment where fruit and vegetables are eaten as a matter of course.’

At present, it is still up to the school whether to be so ambitious in working on healthy eating habits. ‘It would help if certain types of food education were to become a compulsory element in education. I know that’s not easy — teachers already have so much to do. But even a couple of simple programmes could make such a difference.’