Reasons for eating 'unhealthy' snacks in overweight and obese males and females.

BACKGROUND: Snack foods are often high in fat and sugar. Thus, reducing snack consumption may be a useful weight management strategy. However, individuals may snack for a variety of reasons with different implications for intervention. The present study examined the perceived reasons for eating main meals, 'unhealthy' snacks (i.e. snacks high in fat or sugar) and 'healthy' snacks in overweight and obese participants. METHODS: Over a period of 5 days, 28 males and 27 females completed a food diary every time they ate. As well as providing details about the type of eating episode and food eaten, they also rated their agreement with 13 different reasons for eating (identified from relevant literature and a pilot study). RESULTS: Across a total of 1084 eating episodes, 358 were coded as snacks, 79% of which were high in either fat or sugar. The results showed that hunger and temptation (external eating) were reported as a reason for eating unhealthy snacks in 49% and 55% of all episodes, respectively. Eating because the individual was feeling fed up, bored or stressed (emotional eating) was given as a reason in 26% of episodes. CONCLUSIONS: These findings point to the potential utility of intervention strategies that target cravings, enhance self-control or promote stimulus control.

Free healthy breakfasts in primary schools: a cluster randomised controlled trial of a policy intervention in Wales, UK.

OBJECTIVE: The present study evaluated the impact of a national school programme of universal free healthy breakfast provision in Wales, UK. DESIGN: A cluster randomised controlled trial with repeated cross-sectional design and a 12-month follow-up. Primary outcomes were breakfast skipping, breakfast diet and episodic memory. Secondary outcomes were frequency of eating breakfast at home and at school, breakfast attitudes, rest-of-day diet and class behaviour. SETTING: Primary schools in nine local education authority areas. SUBJECTS: A total of 4350 students (aged 9-11 years) at baseline and 4472 at follow-up in 111 schools. RESULTS: Students in intervention schools reported significantly higher numbers of healthy food items consumed at breakfast and more positive attitudes towards breakfast eating at 12 months. Parents in intervention schools reported significantly higher rates of consumption of breakfast at school and correspondingly lower rates of breakfast consumption at home. No other significant differences were found. CONCLUSIONS: The intervention did not reduce breakfast skipping; rather, pupils substituted breakfast at home for breakfast at school. However, there were improvements in children's nutritional intake at breakfast time, if not the rest of the day, and more positive attitudes to breakfast, which may have implications for life-course dietary behaviours. There was no impact on episodic memory or classroom behaviour, which may require targeting breakfast skippers.

Feeding strategies used by primary school meal staff and their impact on children's eating.

BACKGROUND: In parent-child interactions, feeding strategies including pressure, restriction, modelling, rewards, encouragement and repeated taste exposure have been reliably shown to influence children's eating. Because there is no evidence that the psychosocial interactions inherent in the strategies are context-dependent, the present study investigated their utilisation during primary school meal supervision. METHODS: A case study of one Local Authority in Wales was conducted involving eleven primary schools stratified into socio-economic quartiles. Focussed observations were carried out over two to three lunchtimes per school to explore the feeding strategies, outcomes and behaviours inherent in the dining hall context. These were supplemented by semi-structured interviews with catering staff and midday supervisors, which were carried out after the observation session. RESULTS: Most feeding strategies used by school meal staff reflected those reported in the literature (e.g. pressure, encouragement and rewards), although purposeful modelling of eating behaviours was not found and the imposition of food norms, such as eating dessert last, was common. Dining hall staff readily, if not consistently, used these strategies, although the constraints and opportunities of each dining hall context influenced their selection and implementation. However, even if children left the service point with nutritionally balanced meals, they often failed to eat them. CONCLUSIONS: Because repeated taste exposure is known to increase liking for foods, further studies are recommended to investigate how the naturally occurring feeding strategies evident in primary school dining halls could be harnessed to encourage children to taste the nutritionally balanced schools meals that school meal transformation programmes will expose them to.

Increasing parental provision and children's consumption of lunchbox fruit and vegetables in Ireland: the Food Dudes intervention.

BACKGROUND/OBJECTIVES: Previous research in the United Kingdom, where there is a school canteen system, has shown that the Food Dudes intervention substantially increases children's fruit and vegetable consumption. The current study evaluated its effectiveness in Ireland where school meals are not provided and children bring food to school in lunchboxes. SUBJECTS/METHODS: Participants were 4- to 11-year-old children attending two primary schools; the schools were randomly assigned to experimental or control conditions (n=228 and 207, respectively). During the 16-day intervention in the experimental school, children watched video adventures featuring the heroic Food Dudes, and received small rewards for eating fruit and vegetables provided. In both schools, parental provision and children's consumption of fruit and vegetables in the lunchboxes were assessed at baseline and 12-month follow-up (Lunchbox measures). Fruit and vegetables were provided in both schools over an 8-day baseline phase and the 16-day intervention, and children's consumption was measured (school-provided food measures). RESULTS: Relative to baseline, consumption of the school-provided foods increased during the intervention in the experimental school (P<0.001), whereas in the control school it showed a significant decline. At 12-month follow-up, parents in the experimental school provided and their children consumed significantly more lunchbox fruit, vegetables and juice relative to baseline and to the control school (P<0.001 in all instances). CONCLUSIONS: The Food Dudes intervention was effective in changing parental provision and children's consumption of lunchbox fruit and vegetables in Ireland.

The impact of school fruit tuck shops and school food policies on children's fruit consumption: a cluster randomised trial of schools in deprived areas.

AIMS: To estimate the impact of school fruit tuck shops on children's consumption of fruit and sweet and savoury snacks. DESIGN: Cluster randomised effectiveness trial with school as the unit of randomisation. SETTING: 43 primary schools in deprived areas in south Wales and south-west England with a range of school food policies. INTERVENTION: Schools operated fruit tuck shops throughout one academic year. Control schools did not do so. MEASURES: Repeated cross-sections of children aged 9-11 years completed a computerised 24-hour recall questionnaire at baseline (n = 1902) and at 1-year follow-up (n = 1924), when a brief questionnaire was also completed (n = 1976). RESULTS: Approximately 70,000 fruits were sold in the 23 intervention schools over the year, equivalent to 0.06 fruits per student per day. Children in intervention schools were more likely to report eating fruit as a snack at school 'often' (OR 1.49, 95% CI 1.15 to 1.95). There were no significant differences in children's intake of fruit or other snacks. There was a significant interaction (p<0.02) between the intervention group and school food policy: where students were only allowed to bring fruit to school, fruit consumption was 0.37 portions per day (0.11 to 0.64) higher in intervention schools, compared to 0.14 portions (-0.30 to 0.58) where no food was allowed and -0.13 portions (-0.33 to 0.07) where there were no restrictions. CONCLUSIONS: In isolation, fruit tuck shops were not effective in changing children's snacking behaviour in schools. However, the results suggest that fruit tuck shops had a greater impact when reinforced by school policies restricting the types of foods students were allowed to bring to school.

Development of a scale to measure 9-11-year-olds' attitudes towards breakfast.

OBJECTIVE: Development and validation of a questionnaire to measure children's attitudes towards breakfast. DESIGN: A pilot study was used to select questionnaire items and assess test-retest reliability. The questionnaire was then administered to a larger sample of children together with a dietary recall questionnaire. Randomly selected subsets of these children also completed a dietary recall interview or their parents were asked to complete a questionnaire relating to their child's breakfast eating habits. SETTING: Primary schools in south, west and north Wales, UK. SUBJECTS: A total of 2495 children (199 in pilot testing, 2382 in the main study) in years 5 and 6 (aged 9-11 years). RESULTS: The 13-item scale showed good construct validity, high internal reliability and acceptable test-retest reliability. Boys displayed more positive attitudes towards breakfast than girls but differences between the two age groups did not reach statistical significance. Children who did not skip breakfast displayed more positive attitudes than children who skipped breakfast. In addition, more positive attitudes towards breakfast were significantly correlated with consumption of a greater number of 'healthy' foods for breakfast (i.e., fruit, bread, cereal, milk products), consumption of fewer 'unhealthy' foods for breakfast (i.e., sweet items, crisps) and parental perceptions that their child usually ate a healthy breakfast. CONCLUSIONS: The breakfast attitudes questionnaire is a robust measure that is relatively quick to administer and simple to score. These qualities make it ideal for use where validity at the individual level is important or where more time-consuming dietary measures are not feasible.

Validation of a self-completion measure of breakfast foods, snacks and fruits and vegetables consumed by 9- to 11-year-old schoolchildren.

OBJECTIVE: To evaluate the validity and reliability of a dietary recall questionnaire, designed for group-level comparisons of foods eaten at breakfast and intake of fruits, vegetables, sweet items and crisps. DESIGN: Validity was assessed relative to 24-h dietary recall interviews, and reliability by comparing the baseline data with 4-month follow-up data. SUBJECTS AND SETTING: Fifty-eight schools took part in the validity assessments, with 374 children completing both measures. Reliability was assessed using 29 schools, with 1233 children at baseline and 1033 at follow-up. Children were aged 9-11 years and schools were located in socio-economically deprived areas of Wales. RESULTS: Results indicated moderate to substantial agreements for most foods eaten at breakfast on the day of reporting and fair to moderate agreements for breakfast foods the previous day. For items throughout the rest of the previous day, agreement was fair to substantial during school hours, but slight after school. Correlations were moderate in terms of 'healthy' items and 'unhealthy' items consumed at breakfast on the day of reporting, but weaker for the previous breakfast. Correlations between measures in terms of fruits, vegetables, sweet items and crisps throughout the rest of the previous day were fair to moderate. The measure demonstrated fair to substantial group-level reliability. CONCLUSIONS: The questionnaire, while subject to a number of limitations, gives an adequately valid and reliable overview of selected aspects of children's diet. It is likely to be of value at group-level in randomized controlled trials of school-based interventions.

Development and testing of a computerised 24-h recall questionnaire measuring fruit and snack consumption among 9-11 year olds.

OBJECTIVE: To evaluate the validity, reliability and sensitivity of a computerised single day 24-h recall questionnaire designed for the comparison of children's fruit and snack consumption at the group (school) level. DESIGN: Relative validity and reliability were assessed in relation to (i) intake at school and (ii) intake throughout the whole day, using diary-assisted 24-h recall interviews and a 7-day test-retest procedure. Sensitivity was assessed in relation to intake by comparing results from schools with differing food policies, and by sex. SUBJECTS AND SETTING: Eight schools took part in the validity and reliability assessments, with 78 children completing the 24-h recall interviews and 195 children completing the test-retest procedure. A total of 43 schools (1890 children) took part in the sensitivity analysis. All children were aged 9-11 y. All schools were in South Wales and South-west England. RESULTS: For fruit intake at school, the questionnaire showed fair levels of validity at the individual level (kappa = 0.29). At the group level, there were little or no differences in fruit intake at school between the two measures and two occasions. The questionnaire was sufficiently sensitive to identify statistically significant differences between girls and boys, and between schools with different food policies. For snack intake at school, validity at the individual level was slightly lower (kappa = 0.220.25), but the data remained of value in analyses at the group level. For fruit and snack intake throughout the whole day there was little agreement at the individual level (kappa = 0.00-0.06), and at the group level there tended to be substantial differences between the two measures and two occasions. CONCLUSIONS: The computerised questionnaire is a quick and cost-effective means of assessing children's consumption of fruit at school. While further development is required to improve validity and reliability, it has the potential to be particularly useful in randomised controlled trials of school-based dietary interventions.

Increasing children's fruit and vegetable consumption: a peer-modelling and rewards-based intervention.

OBJECTIVE: To evaluate a peer-modelling and rewards-based intervention designed to increase children's fruit and vegetable consumption. DESIGN: Over a 5-month period, children in an experimental and a control school were presented with fruit and vegetables at lunchtime. Children aged 5-7 y also received fruit at snacktime (mid-morning). The intervention was implemented in the experimental school and levels of fruit and vegetable consumption were measured at baseline, intervention and at 4-month follow-up. SETTING: Two inner-city London primary schools. SUBJECTS: In total, 749 children aged 5-11 y. INTERVENTION: Over 16 days children watched video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves. After 16 days there were no videos and the rewards became more intermittent. MAIN OUTCOME MEASURES: Consumption was measured (i) at lunchtime using a five-point observation scale; (ii) at snacktime using a weighed measure; (iii) at home using parental recall. RESULTS: Compared to the control school, lunchtime consumption in the experimental school was substantially higher at intervention and follow-up than baseline (P<0.001), while snacktime consumption was higher at intervention than baseline (P<0.001). The lunchtime data showed particularly large increases among those who initially ate very little. There were also significant increases in fruit and vegetable consumption at home (P<0.05). CONCLUSIONS: The intervention was effective in bringing about substantial increases in children's consumption of fruit and vegetables.

Effects of a peer modelling and rewards-based intervention to increase fruit and vegetable consumption in children.

OBJECTIVE: To measure children's consumption of, and liking for, fruit and vegetables and how these are altered by a peer modelling and rewards-based intervention. DESIGN: In this initial evaluation of the programme, children's consumption of fruit and vegetables were compared within and across baseline and intervention phases. SETTING: Three primary schools in England and Wales. SUBJECTS: In total, 402 children, aged from 4 to 11 y. INTERVENTION: Over 16 days, children watched six video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves. MAIN OUTCOME MEASURES: Fruit and vegetable consumption was measured (i) in school at lunchtime and snacktime using a five-point observation scale, with inter-rated reliability and weighed validation tests; and (ii) at home using parental recall. A questionnaire measured children's liking for fruit and vegetables before and after the intervention. RESULTS: Consumption during the intervention was significantly higher than during baseline at lunchtime and at snacktime (P<0.001 in all instances). Consumption outside school was significantly higher during the intervention on weekdays (P<0.05) but not weekend days. Following the intervention, children's liking for fruit and vegetables also showed a significant increase (P<0.001). CONCLUSIONS: The peer modelling and rewards-based intervention was shown to be effective in bringing about substantial increases in children's consumption of, and expressed liking for, fruit and vegetables. SPONSORSHIP: : Horticultural Development Council, Fresh Produce Consortium, ASDA, Co-operative Group, Safeway, Sainsbury, Somerfield, Tesco and Birds Eye Wall's.