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Children and healthy eating: a systematic review of barriers and facilitators

What do we want to know?

Healthy eating is encouraged amongst children in the belief that they will benefit from the long-term physiological consequences of a good diet in childhood, and that healthy eating in childhood is more likely to lead to healthy eating later in life. An over-consumption of energy-dense foods has been linked with obesity, and the proportion of children classed as obese is rising. Diets high in fruit and vegetables have been associated with reductions in a range of diseases. Recent surveys have found that British children are eating less than half the recommended five portions of fruit and vegetables per day. There is also evidence to suggest that material and social context affect children’s intake.  This report describes a systematic review surveying what is known about the barriers to and facilitators of healthy eating amongst children aged four to 10 years old. It focuses in particular on barriers and facilitators in relation to fruit and vegetables.

Who wants to know?

Policy-makers, practitioners, researchers, parents, children.

What did we find?  

  • The types of interventions evaluated by the studies in the review were largely school-based, and often combined learning about the health benefits of fruit and vegetables with ‘hands-on’ experience in the form of food preparation and taste-testing. The majority also involved parents  in intervention delivery, alongside teachers and health promotion practitioners. Some included environmental modification, involving for example changes to the foods provided at school. Some interventions targeted more than one outcome and aimed to increase, for example, physical activity as well.  The results of our analysis revealed that these kinds of interventions have a small but statistically significant, positive effect.
  • Bigger effects are associated with targeted interventions for parents with risk factors for cardiovascular disease and possibly also with those interventions which do not ‘dilute’ their focus on fruit and vegetables by trying to promote physical activity or other forms of healthy eating (for example, reduced intake of sodium and fat) in the same intervention.
  • There was no evidence of the effectiveness of single component interventions, such as classroom lessons alone or providing fruit-only tuck shops.
  • Six main issues emerged from the studies of children's views: (1) children do not see it as their role to be interested in health; (2) children do not see messages about future health as personally relevant or credible; (3) fruit, vegetables and confectionery have very different meanings for children; (4) children actively seek ways to exercise their own choices with regard to food; (5) children value eating as a social occasion; and (6) children see the contradiction between what is promoted in theory and what adults provide in practice.
  • The studies of children's views suggested that interventions should treat fruit and vegetables in different ways, and should not focus on health warnings. Interventions which were in line with these suggestions tended to be more effective than those that were not.

What are the implications?

  • Promoting healthy eating can be an integral and acceptable component of the school curriculum

  • Effective implementation in schools requires skills, time and support from a wide range of people.

  • It is easier to increase children's consumption of fruit than vegetables.

  • Implications for interventions derived from the studies of children's views ranged from simple strategies such as ‘branding fruit and vegetables as tasty rather healthy’ or ‘do not promote fruit and vegetables in the same way’ to more challenging strategies such as ‘make health messages relevant and credible to children’ and ‘create situations for children to have ownership over their food choices’.

How did we get these results?

Nineteen outcome evaluations were entered into a statistical meta-analysis, and the findings from eight studies of children's views were synthesised. The findings of both syntheses were then brought together to see whether interventions which matched children's views were more effective than those that did not.

This summary was prepared by the EPPI-Centre

This report should be cited as: Thomas J, Sutcliffe K, Harden A, Oakley A, Oliver S, Rees R, Brunton G, Kavanagh J (2003) Children and healthy eating: a systematic review of barriers and facilitators. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.

  
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