Side effects of fruit and vegetable promotion

In this issue of the IFAVA newsletter three short papers are presented focussing on possible positive ‘side effects’ of promoting fruit and vegetable intakes. Because children across Europe eat fewer fruits and vegetables than is recommended by health authorities, interventions to promote fruits and vegetables among youngsters are developed and implemented in many countries in Europe. Such interventions include health education efforts and fruit and vegetable schemes aiming to make these foods more available and accessible.

It has been argued that increasing fruits and vegetables may also contribute to preventing overweight and obesity in children. But this can only be the case if increased fruit and vegetable consumption is compensated by lower intakes of other foods that are higher in calories.

Dr. Elling Bere from the University of Agder, Kristiansand, describes results from the Norwegian free school fruit program. Fruit and vegetable schemes in Norway have been accompanied by good-quality scientific research in the development, implementation and dissemination phases, and Norwegian school fruit programs are therefore among the best researched school health promotion efforts.

In one of these studies it was analysed if the free school fruit had dietary effects beyond increasing fruit and vegetable intakes. Bere reports that the free fruit program resulted in lower consumption of unhealthy snack foods, and these effects were still apparent one year after the intervention had ended; and some evidence for effect was even observed at three years follow-up. Further analyses indicate that these effects were especially present among children from lower socio-economic backgrounds. This is very encouraging, because most health promotion interventions are more effective in high socio-economic status groups, leading to larger health disparities instead of helping to decrease the socio-economic health gap. The Norwegian school fruit scheme may be an exception to the rule, and may indicate that interventions focussing on improving availability of healthy foods, rather than mere education, have potential in contributing to reducing health disparities.

Dr. Nannah Tak and colleagues from the VU University Medical Center in Amsterdam present similar results. In their study of a Dutch fruit and vegetable scheme it was found that children participating in the free fruit and vegetable scheme were less likely to bring unhealthy snack foods to school. This study further supports that fruit and vegetable promotion may have valuable ‘side effects’ on unhealthy snacking.

The third paper in this newsletter, by Dr. Gomes from the National Cancer Institute of Brazil argues that fruit and vegetable promotion should be part of, or accompanied by, discouraging consumption of unhealthy snack foods. However, Dr. Gomes argues that such unhealthy snack foods are more interesting to the food industry. He also claims that the industry’s efforts to contribute to higher intakes of fruit and vegetables, by bringing new products on the market that contain fruit and vegetable-ingredients, may have negative side effects. Such products may lead to reductions in real fruits and vegetables, and thus contribute to lower intakes.

These three IFAVA newsletter papers build a case for promotion of the “real thing” – fruits and vegetables – and if successful, this may even contribute to somewhat lower intakes of less healthy snack foods.