Changing the diet of America's children: What works and why?

Executive summary This paper examines educational efforts and programming designed to change the diet of America's children. These programs are frequently part of school-based nutrition education; however, other outreach methods, including school-wide environmental change efforts, family-focused interventions, mass media messages, community-based interventions, and federally funded nutrition programs, also target eating behavior change in children. We identified six elements of successful nutrition education programming: (1) programs are behaviorally based and theory driven; (2) family involvement is incorporated into programs for elementary-aged children; (3) programs for middle school to senior high students include self-assessment of eating patterns; (4) behavior change programs include intervening in the school environment; (5) behavior change programs include intervening in the larger community; and (6) programs include intensive instruction time. Successful programs included most of the identified elements. Emerging trends and innovative approaches were also reviewed, though few of these have been rigorously evaluated. We found that nutrition education is increasingly included as part of multidisciplinary educational programs. For example, school-based interventions simultaneously target eating and activity behaviors. We also saw a resurgence of integrating nutrition curricular information into other core subject areas. This integration reflects the growing demands on instructional time in our schools. We also found that the mass media is becoming more powerful in influencing the diet of America's children. This influence occurs not solely through food advertisements targeted at children, but also through industry-sponsored public service announcements and curricula teaching children about basic nutrition concepts. Interactive computer technology is one of the most exciting innovations for nutrition education. Computer-based learning allows children to move at their own pace in instructional settings that require much less teacher time. The recommendations call for five broad-reaching objectives to more effectively improve the diet of American children. Ftrst, schools, school districts, and local, state, and federal governments need to commit to comprehensive, school-based nutrition education. Effective nutrition education requires thoughtful consideration of scope and sequence so that behavioral skills can be established in early elementary grades and enriched with more abstract problem-solving skills in junior and senior high school. Teachers need to be adequately trained, and the school environment must provide healthful options for children. Second, we call for multiple instructional techniques for nutrition education. Didactic lessons are insufficient for behavior change. Experiential, hands-on learning, problem solving in group settings, and interactive computer opportunities will be most effective in promoting learning and behavior change. Third, we call for viewing diet change for children from an environmental perspective that includes family, community, the media, and the food industry. Even the best quality classroom-based education is not sufficient for teaching and modeling healthful eating behavior in children. Children learn about what to eat and why to eat, and are provided reinforcements and incentives for food-related activity from their families and larger environment. If the diet of America's children is to change for the better, our environment must be supportive. Fourth, it is imperative that rigorous outcome evaluation be an integral part of nutrition education programs developed with the intent of national distribution. Such evaluation may be enriched by forming partnerships that draw on industry's expertise in market research. Lack of outcome evaluation and publication inhibits the acceptance and dissemination of creative and innovative approaches. Simpler evaluation is appropriate for programs disseminated locally. Fifth, it is imperative that federal and state governments develop and/or promote a system to disseminate effective nutrition education materials. Effective materials are underutilized in this country, in part due to unawareness of their existence and in part due to inaccessibility. A clearinghouse or network to collect, describe, rate, and share these programs nationally may be an important first step. Partnerships with industry, professional organizations, and private sources to reproduce and disseminate nutrition education materials may be beneficial as well; however, nutrition educators also need to be encouraged to work collectively, that is, to produce fewer, higher quality materials on the same topics. Incentives should be built into the dissemination system to encourage collective sharing of educational materials. To conclude, we can improve our interventions if the principles presented in this paper are incorporated into nutrition education programming for children. These improvements will require commitment to nutrition education at the federal, state, and local levels and the development of partnerships among government, industry, schools, families, communities, and the media. The benefits of this commitment and partnership will be realized through America's most precious resource, the health and well-being of our children.