Children are three times as likely to make healthier eating decisions after watching cooking shows

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Television programs featuring healthy foods can be a key ingredient in leading children to make healthier food choices now and into adulthood.

A new study in the Journal of Nutrition Education and Behavior, found kids who watched a child-oriented cooking show featuring healthy food were 2.7 times more likely to make a healthy food choice than those who watched a different episode of the same show featuring unhealthy food.

Researchers asked 125 10- to 12-year-olds, with parental consent, at five schools in the Netherlands to watch 10 minutes of a Dutch public television cooking program designed for children, and then offered them a snack as a reward for participating.

Children who watched the healthy program were far more likely to choose one of the healthy snack options – an apple or a few pieces of cucumber – than one of the unhealthy options – a handful of chips or a handful of salted mini-pretzels.

“The findings from this study indicate cooking programs can be a promising tool for promoting positive changes in children’s food-related preferences, attitudes, and behaviors,” said lead author Frans Folkvord, PhD, of Tilburg University,Tilburg, Netherlands.

This study was conducted at the children’s schools, which could represent a promising alternative for children learning healthy eating behaviors.

Prior research has found youth are more likely to eat nutrient-rich foods including fruits and vegetables if they were involved in preparing the dish, but modern reliance on ready-prepared foods and a lack of modeling by parents in preparing fresh foods have led to a drop in cooking skills among kids.

“Providing nutritional education in school environments instead may have an important positive influence on the knowledge, attitudes, skills, and behaviors of children,” Dr. Folkvord said.

This study indicates the visual prominence of healthier options in both food choice and portion size on TV cooking programs leads young viewers to crave those healthier choices then act on those cravings.

The effect that exposure to healthier options has on children is strongly influenced by personality traits.

For example, children who don’t like new foods are less likely to show a stronger desire for healthier choices after watching a TV program featuring healthier foods than a child who does enjoy trying new foods.

As they grow older, though, they start to feel more responsible for their eating habits and can fall back on the information they learned as children. Researchers believe this may indicate watching programs with healthier options can still have a positive impact on children’s behavior, even if it is delayed by age.

This study indicates the visual prominence of healthier options in both food choice and portion size on TV cooking programs leads young viewers to crave those healthier choices then act on those cravings.

“Schools represent the most effective and efficient way to reach a large section of an important target population, which includes children as well as school staff and the wider community,” Dr. Folkvord commented.

“Positive peer and teacher modeling can encourage students to try new foods for which they exhibited distaste previously.”

Poor dietary habits during childhood and adolescence have multiple negative effects on several health and wellness indicators, including achievement and maintenance of healthy weights, growth and development patterns, and dental health.

“The likelihood of consuming fruits and vegetables among youth and adults is strongly related to knowing how to prepare most fruits and vegetables.

Increased cooking skills among children can positively influence their consumption of fruit and vegetables in a manner that will persist into adulthood,” Dr. Folkvord added.


Nutrition education is the cornerstone of public health nutrition interventions [1], and increasingly there is a focus on improving practical food skills using experiential approaches. Food literacy has emerged as a term to conceptualise the knowledge, skills and behaviours required to achieve healthy dietary intake/diet quality covering four domains of planning and management, selection, preparation and cooking and eating [2].

Food literacy programs including cooking skill interventions are funded to address concerns about declining use of or devaluing of skills and therefore association with poor diet quality [3].

Programs work on the assumption that improvements in food literacy behaviours are likely to have positive impacts on dietary intakes as documented in logic models [4,5]. Reviews of programs addressing food literacy show a proliferation of community-based, government and other organisation funded efforts to teach people the planning, selection, preparation and eating behaviours thought to promote healthy diets [6,7,8,9].

Evaluation data from these programs need to be used in ways that can inform best practice in program delivery.

Systematic and other reviews of interventions focused on food literacy or those that have included a cooking component have found evidence of changes in confidence and behaviours and diet quality with a caveat that it is difficult to make conclusive comments on effectiveness due to a number of factors.

Firstly, most programs are single group prospective designs as they are funded as community programs, not as research trials and do not include a control group [6,8,9,10]. Where a control group is included there is evidence that these programs show dietary intakes change significantly [9] where it is measured, as either self-reported dietary behaviours or total dietary intakes are not always included in the evaluation [7,8].

Secondly, there is wide variability in the duration, target groups, program curriculums and, generally, small sample sizes that limit the ability to make conclusions about what these programs do and how they work [9].

Most studies to date include some hands on cooking experiential learning component and this is usually in addition to other components such as nutrition education which may provide an indication of pragmatic approaches to design [9,11].

Programs report a wide range of sessions (3-year to multiyear), and evidence of application of theoretical basis for change and definitive logical models of relationships between inputs and outcomes is limited [4,12,13]. Finally, evaluation designs without validated tools are common.

The proliferation of program delivery is occurring at the same time that research is still elucidating the conceptualisation and measurement of food literacy [14,15].

There is currently no consensus on the best way to measure food literacy behaviours for program delivery and there are a number of efforts looking to validate monitoring and surveillance measurement tools [15,16,17].

The food literacy behaviours referred to as food resource management targeted by the US Expanded Food and Nutrition Education Program (EFNEP) have been used as the basis for evaluation for over thirty years and the 10–15 item food behaviour checklist is used extensively by other programs [18,19,20,21].

EFNEP is delivered typically over 8 to 12 weeks and is effective at increasing self-reported positive behaviours [22] with statistical analysis of pre–post evaluation demonstrating changes in mean scores. There is a lack of detail on how effective these programs are when segmenting participants on enrolment to focus on those with low food literacy at the start and who benefits most from the program.

The Foodbank of Western Australia (WA) has invested in food literacy programs since the mid-nineties in an effort to improve the nutritional status of disadvantaged populations [23]. Foodbank WA’s Food Sensations® for Adults (FSA) is an adult food literacy program targeting individuals from low-to-middle income households who would like to increase their food literacy skills.

The program is promoted as a free nutrition and cooking program with participants recruited through existing community groups or able to self-enrol in public programs. Programs are delivered primarily face to face and videoconferencing is used to extend the reach into regional areas.

FSA is marketed extensively to all adult Western Australians using social and traditional media, websites, health professional referral and word of mouth. The only inclusion criterion is the ability to shop and cook independently.

FSA was first implemented in 2011, but underwent extensive redevelopment in 2015 to align with an Australia Food Literacy Model [2] and Best Practice Criteria for Food Literacy Programs commissioned by the Western Australian Department of Health (Department) [24].

The current version of FSA, funded by the Department was contracted for a period of two and half years up until June 2018. The contract service level outcomes include increased food literacy knowledge, skills and confidence and increased intentions to regularly select, prepare and eat nutritious foods.

Programmatic funds supported independent external evaluation which has enabled further analysis of service level data to contribute to the evidence base for food literacy program effectiveness. A reference group of stakeholders with members from the Department, including the WA Country Health Service, community organisations and other informants review the evaluation data and provide advice on directions for program delivery twice a year.

FSA is a four session program, each session with a two and half hours in duration equating to ten hours of contact time for each program (see Figure 1).

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Figure 1
Food Sensations for Adults (FSA) Program Curriculum.

The program’s curriculum comprises of eight lesson plans that are divided into four core modules and four optional modules. All curriculum lesson content has been mapped to the four domains of food literacy (Planning & Management, Selection, Preparation & Cooking and Eating) and 11 components of food literacy outlined in the empirically tested Australian Food Literacy Model [2].

The four core modules taught over the first three sessions were developed to address all 11 components of food literacy. These sessions cover the Australian Guide to Healthy Eating food groups, using the nutrition information panel and other features of food labels to select healthier foods and budgeting tips, and suggested ways to plan meals and each week participants prepare, cook and eat several recipes demonstrating healthy eating and budget friendly meals and snacks.

Optional modules are offered in session four, to reinforce the food literacy components and enable to the contextualisation of content to meet the needs of various different subgroups of participants [25]. The groups may select one of the four optional modules to be delivered as part of the program.

The optional modules are as follows; Healthy lunchboxes and snacks, Healthy mind, healthy body, Supermarket tour and Gardening for health. These optional modules relate directly to the four domains of food literacy being covered by the program. Hands-on cooking, offered in the second half of every session, is over half the program duration allowing participants to learn and practice basic cooking skills in safe environment and taste new foods, while preparing healthy recipes.

Foodbank WA have produced a number of visual cookbooks, designed specifically for low literacy groups, and each participant receives at least one recipe book to take home, with the intention of encouraging continued healthy home cooking.

Sessions are tailored for each group’s abilities in consideration of recipes to be cooked, and facilitators have a strong commitment to delivering relevant, informative and practical information.

The delivery of the FSA program is guided by the Health Belief Model (HBM) as well as Social Learning Theory. These models have been utilised to ensure the program moves beyond the simple dissemination of information to include strategies to build confidence, self-efficacy and motivation.

The program emphasises the link between poor diet and risk of chronic diseases, and therefore the benefits of a healthy diet using the constructs of the HBM perceived susceptibility, perceived severity, perceived benefits and perceived barriers to influence behaviour change [26]. Perceived barriers are addressed through the provision of reassurance and strategies to overcome diet and nutrition related obstacles.

The nutrition education component of the program operates as a cue to action and the individual goal setting activity encourages self-efficacy as a key factor for behaviour change [27]. Both observational learning, practice and repetition of skills and knowledge will also contribute to behaviour change which in turn builds self-confidence [27].

Participants who attend FSA observe the facilitators and their peers cooking and enjoying nutritious foods. These observations drive the individuals to model this positive behaviour at home [28] and within their wider personal environment. Additionally, adult learning considerations have been included to increase the likelihood of participants attempting to modify dietary intake outside of the session’s context.

The program’s design aims to maximise educational impact by providing multiple opportunities for the application of critical thinking skills, experiential learning and demonstration of technical proficiency to create a sense of accomplishment.

The purpose of this article is to assess how effective FSA is in changing food literacy and selected dietary behaviours.

The paper objectives are to (1) establish the relationship between pre and post food literacy behaviour scores, (2) assess if there a significant change between mean pre and post food literacy and selected dietary behaviour scores, (3) determine if the program is effective at moving participants most at risk of low food literacy and finally (4) identify variables associated with different food literacy components in participants who move from low food literacy behaviour.


Source:
Elsevier
Media Contacts:
Eileen Leahy – Elsevier
Im

Original Research: Open access
“Watching TV Cooking Programs: Effects on Actual Food Intake Among Children”. Frans Folkvord, PhD, Doeschka Anschütz, PhD, Marieke Geurts, MSc.
Journal of Nutrition Education and Behavior doi:10.1016/j.jneb.2019.09.016.

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