Perfect timing for a national fruit and vegetable nutrition policy
The Effectiveness of A School-Based Nutrition Intervention on Children’s Fruit, Vegetable and Dairy Product Intake
Even though obesity is recognized as a complex and multifactorial problem, unhealthy eating habits are one important factor contributing to the emergence of childhood obesity and its healthrelated consequences1. The last Canadian Health Survey revealed that children’s eating habits are not optimal and that fruit and vegetables (F&V) and dairy products (DP) represent the two food groups where the largest proportion of children and adolescents do not meet recommendations2.
In addition to having a high nutrient density, F&V and DP could play an important role in childhood obesity treatment and prevention. In one previous study, we observed that among 41 food groups, an increase in whole fruit and low-fat milk intake appeared to be the two specific groups consistently associated with better weight control, however, this was observed in adults3. Acute studies have demonstrated that the incorporation of F&V into children’s meals can decrease energy intake by lowering energy density4. One intervention study also showed a beneficial effect of increasing F&V and DP on children’ eating habits compared to a more restrictive intervention that included a reduction in fat5. This is line with studies showing that an increase in F&V or DP often results in a concomitant decrease in unhealthy snacks/foods6-8. Thus, a high consumption of these two food groups appear to represent a useful strategy to prevent or treat obesity. At Laval University, our research group has developed a nutrition program called “Team Nutriathlon” where the objective is to increase and diversify the consumption of F&V and DP in children/adolescents.
What is Team Nutriathlon?
Team Nutriathlon is an eight-week, school-based nutrition program where students are encouraged to reach individual and team goals regarding the quantity and variety of F&V and DP consumption (and dairy alternatives) based on Canada’s Food Guide9. The individual goals require students to attain a specific quantity of servings per day while the team goals are based on both quantity and variety. During the program, students are invited to report their daily consumption of F&V and DP for each weekday during the eight-week period. This self-monitoring process permits the production of summary reports every two weeks. These reports are then analyzed every two weeks during a “regulation period” where students meet in teams, read the report and then analyze their results with respect to the team goals. They also revise their individual and team achievement objectives and identify strategies in order to maintain or increase their F&V and DP consumption. Thus, the program is designed to develop children’s autonomy (i.e. decision-making and control over their food choices) towards the gradual adoption and maintenance of healthy eating habits.
What is the program efficacy?
In our first study, we evaluated the effectiveness of the program, which included 404 children from grades five and six (intervention n=242, control n=162), and used paper and pencil to record intakes9. At the end of the intervention and even 10 weeks after the program, Nutriathlon participants showed a significant increase in their F&V and DP consumption compared to children in the control group. These positive results prompted us to investigate the efficacy of the program in adolescents. Since school-based programs which incorporate internet use to prevent obesity in youth have been identified as effective strategies to modify eating habits in the school environment10-14, a Web-based version of the Team Nutriathlon was developed for this group to record intakes. Therefore, the second study assessed the impact of the Web-based Team Nutriathlon among 282 high school students (intervention n=193, control n=89)15. Accordingly, the Web-based version significantly increased the consumption of F&V and DP in this group of adolescents. Thus, Team Nutriathlon appears to be an effective and innovative approach to promote F&V and DP intake in children and adolescents, at least in the short-term.
What are the next Steps?
Because our previous results have shown that parental involvement is a key factor in the program’s success, the next step of this initiative is to evaluate its effectiveness among families that have at least one obese child. Results from our pilot project, which includes 13 families randomized to either Nutriathlon or a control group, has shown that the intervention increased the consumption of F&V and DP in children and the global quality of their diet compared to the control group (Drapeau et al., unpublished). Overall, these results suggest that this program represents a promising, positive and non-restrictive obesity prevention program in school settings as well as a clinical tool used in childhood obesity.
1. Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity.
Int J Obes Relat Metab Disord 1999;23 Suppl 2:S2-11.
2. Garriguet D. Vue d’ensemble des habitudes alimentaires des canadiens, 2004. In:
canadiennes RdlEslsdlc, ed.: Statistique Canada, 2006.
3. Drapeau V, et al.Modifications in food-group consumption are related to longterm
body-weight changes. Am J Clin Nutr 2004;80(1):29-37.
4. Pourshahidi LK, et al. Livingstone MB. Influencing and modifying children’s
energy intake: the role of portion size and energy density. Proc Nutr Soc
5. Epstein LH, et al. Increasing fruit and vegetable intake and decreasing fat and
sugar intake in families at risk for childhood obesity. Obes Res 2001;9(3):171-8.
6. Tak NI, et al.The effects of a fruit and vegetable promotion intervention
on unhealthy snacks during mid-morning school breaks: results of the Dutch
Schoolgruiten Project. J Hum Nutr Diet 2010;23(6):609-15.
7.Bere E, et al. One year of free school fruit in Norway–7 years of follow-up. Int J
Behav Nutr Phys Act 2015;12:139.
8. Andersen LB, et al. The effects of water and dairy drinks on dietary patterns in
overweight adolescents. Int J Food Sci Nutr 2016;67(3):314-24.
9. Drapeau V, et al.The Effectiveness of A School-Based Nutrition Intervention on
Children’s Fruit, Vegetables, and Dairy Product Intake. J Sch Health 2016;86(5):353-
10. Hamel LM, Robbins LB. Computer- and web-based interventions to promote
healthy eating among children and adolescents: a systematic review. J Adv Nurs
11. Di Noia J, et al.Computer-mediated intervention tailored on transtheoretical
model stages and processes of change increases fruit and vegetable consumption
among urban African-American adolescents. Am J Health Promot 2008;22(5):336-
12. Mauriello LM, et al. Results of a multi-media multiple behavior obesity
prevention program for adolescents. Prev Med 2010;51(6):451-6.
13. Winett R, et al.. The Effects of the Eat4Life Internet-Based Health Behavior
Program on the Nutrition and Activity Practices of High School Girls. Journal of
Gender, Culture and Health 1999;4(3):239-54.
14. Randi Schoenfeld E, et al.Using the internet to educate adolescents about
osteoporosis: application of a tailored web-education system. Health Promot Pract
15. Chamberland K, et al. The impacts of a computer-assisted school-based nutrition
intervention on the consumption of vegetables, fruits, and dairy products in
adolescents. ISBNPA online abstract book 2015;190:335.