Promoting fruits and vegetables using a theory-based, comic book approach

The purpose of our study1 was to pilot test the Comics for Health program, a theory based-child obesity prevention program (afterschool intervention), which contained four lessons:

  • Lesson 1: engaging in no more than two hours of screen time per day;
  • Lesson 2: consuming water and sugar-free drinks instead of sugar-sweetened beverages;
  • Lesson 3: participating in at least 60 minutes of physical activity per day;
  • Lesson 4: consuming 5 servings of fruits and vegetables (F&V).

Each lesson was broken down into the following four modules, each lasting 30 minutes.

This article is focus on F&V consumption (Lesson 4).

During the Introduction & Purpose of Lesson module, the instructor introduced and reviewed the lesson’s key objectives and covered necessary knowledge and skills in order to perform the targeted behavior. With regards to F&V consumption, a number of issues were discussed. First, F&V were broken down into subcategories, which were classified by the MyPyramid food system (now replaced by MyPlate). Fruits were broken down into Melons, Berries, Mixed Fruit, and Other Fruits. Vegetables were broken down into Green Leafy Vegetables, Orange Vegetables, Beans, Starchy Vegetables, and Other Vegetables. After F&V were identified, the instructor challenged the children to think about foods that may appear to be a fruit or vegetable, but in fact are not. For example for fruits, children were asked about ‘fruitflavored’ foods, such as fruit snacks, or pastries such as a strawberry pop tart. For vegetables, children were asked about deep-fried foods, such as potato chips, French fries, and onion rings. In both cases, it was made clear that these types of foods do not count as fruits or vegetables, and healthier alternatives were discussed. Finally, the recommended daily amounts of F&V were discussed.

In the Benefits module, children learned positive health-related benefits associated with the targeted health behavior and sketched a comic-panel showing at least one benefit. With regards to F&V, children were able to identify a number of benefits. Some included: helps you stay healthy, cleans out your body, have a healthy weight, helps you have healthy skin and hair, and helps your eyes stay healthy.

In the Role-Playing module, children participated in role-plays as themselves and the instructor played the role of a friend or family member. Each role-play was set up as follows:

# First a scenario was given, such as: “In this role-play Jonny will be himself, and I will be Jonny’s best friend. We are going to pretend that it is afterschool, we were playing basketball and now we are both hungry for a snack. I want to have potato chips, and Jonny is going to try to teach me why having a fruit or a vegetable is better.” # Second, goals were established for the role-play. During the role-play, it was Jonny’s job to tell his best friend:

  • What is a fruit and what are the different types of fruits?
  • How are they different from fruit-flavored foods?
  • What are vegetables and what are the different types of vegetables?
  • How are they different from fried vegetables like potato chips and French fries?
  • How many fruits and vegetables should we have each day?
  • Why would we want to have fruits or vegetables in the first place?

Finally, during the Goal Setting module the instructor reviewed the key objectives of the lesson, and children were asked to sketch a comic-book panel of themselves setting goals, monitoring and self-rewarding themselves for consuming five servings of F&V per day.

We show in this study that F&V consumption significantly increased between baseline and post-test and baseline and threemonth follow-up tests (p<0.005). Additionally, children’s selfefficacy, or personal confidence, in their ability to choose and consume F&V significantly increased between baseline and posttest (<0.015).

During the Comics for Health program, children were also instructed on the core elements of creating an original comic book or comic strip, with hopes that they would create a story that incorporated a healthy behavior, such as consuming more F&V. The basics of this component of the intervention is covered here, but is further elaborated upon in another study2.

Comic Book Basics During this activity, children were instructed upon the essential elements of comic books, such as caption boxes, word balloons, thought balloons, and comic book panels.
Basic Storytelling In this activity, children were instructed upon how to build a cast of characters, including a main character, supporting characters, and opposing characters, such as villains or foils. In addition, children were shown how to organize their stories into a three-act structure.
Integrating It All In the final activity children were asked to put all of the elements together, and create an original comic book or comic strip.


Using a comic book approach may be one way to attract a child’s attention

In today’s world children have access to a number of technologies, which can distract them and shorten their attention span. When promoting a healthy diet, it is our job as health professionals to develop innovative and exciting programs, which include more than lecturing to children about what to eat and what not to eat.

  1. Branscum, P., Sharma, M., Wang, L., Wilson, B., & Guyler, L. (2013). A true challenge for any superhero: An evaluation of a comic book obesity prevention program. Family & Community Health, 36(1), 63-76.
  2. Branscum, P., & Sharma, M. (2012). Creating healthy heroes: Helping children create comic books to reinforce healthy lifestyles. Health Education Teaching Techniques Journal, 2(1), 88-102.
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