The Modifying Eating and Lifestyles at School Study

Study Overview
=================
Brief Summary
-----------------
The purpose of this study is to examine the impact of introducing healthier, chef-enhanced foods and/or environmental modifications (choice architecture) on selection and consumption of school foods among elementary and middle school students.

Detailed Description
-----------------
Project Modifying Eating and Lifestyles at School (MEALS) was a school-based study developed by the nonprofit organization Project Bread (www.ProjectBread.org) and the Harvard School of Public Health. Project Bread hired a professional chef to work with several schools in a low-income, urban school district in Massachusetts to enhance the palatability and nutrient profile of the school meals. Four schools were randomly assigned to receive the professional chef. Additionally, two schools in that district and four schools in a second school district were randomly assigned to receive a behavioral psychology intervention to influence the selection and consumption of the healthier foods offered. Selection and consumption were assessed at baseline, up to 3 months post-implementation (short-term implementation for chef-enhanced meals), up to 4 months post-implementation (long-term implementation for behavioral psychology) and/or up to 7 months post-implementation (long-term implementation for chef-enhanced meals). Primary Aim 1: to examine the impact of introducing healthier, chef-enhanced foods with increased palatability on selection and consumption among elementary and middle school students. It is hypothesized that there will be an increase in the selection and consumption of entrees, fruits, and vegetables in schools where healthier, chef-enhanced foods are served. Aim 2: to examine the impact of physical modifications to the placement and displays of foods in the cafeteria on selection/consumption among elementary and middle school students. It is hypothesized that there will be an increase in selection and consumption of entrees, milk, fruits, and vegetables when modifications are made.

Official Title
-----------------
The Modifying Eating and Lifestyles at School (MEALS) Study

Conditions
-----------------
Food Habits, Meals

Intervention / Treatment
-----------------
* Behavioral: choice architecture
* Other: Chef-enhanced meals


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Students in grades 1-8 attending a participating school and receiving a school meal on a study day Exclusion Criteria: Bringing a lunch from home on a study day or not eating lunch in the cafeteria on a study day
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: control<br>Students received standard meals in a standard cafeteria environment | |
| Experimental: Chef<br>Students were exposed to chef-enhanced meals | Other: Chef-enhanced meals<br>* meals prepared by a professional chef with enhanced palatability<br>|
| Experimental: choice architecture<br>Students were exposed to modifications to the physical environment in the cafeteria to nudge students towards healthier choices | Behavioral: choice architecture<br>* Place vegetables at the beginning of the lunch line. Place fruits in attractive bowls or trays lined with appealing fabric, and place other fruit options next to the cash registers. Promote fruits and vegetables with prominently displayed signage and images. Place white milk selection in front of sugar-sweetened milk (e.g. chocolate milk) or at eye-level.<br>* Other names: Smart Cafe;|
| Experimental: Chef and choice architecture<br>Students were exposed to both chef-enhanced meals and modifications to the physical environment in the cafeteria to nudge students towards healthier choices | Behavioral: choice architecture<br>* Place vegetables at the beginning of the lunch line. Place fruits in attractive bowls or trays lined with appealing fabric, and place other fruit options next to the cash registers. Promote fruits and vegetables with prominently displayed signage and images. Place white milk selection in front of sugar-sweetened milk (e.g. chocolate milk) or at eye-level.<br>* Other names: Smart Cafe;Other: Chef-enhanced meals<br>* meals prepared by a professional chef with enhanced palatability<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the selection of meal components (Selection of entrees, milk, fruits, and vegetables) | Selection of entrees, milk, fruits, and vegetables | baseline, up to 3 months post-implementation, and up to 7 months post-implementation | 
| Change in the consumption of meal components (consumption of entrees, milk, fruits, and vegetables) | consumption of entrees, milk, fruits, and vegetables | baseline, up to 3 months post-implementation, and up to 7 months post-implementation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to eat (Estimated amount of time spent eating foods) | Estimated amount of time spent eating foods | up to 24 months | 
| Hunger (Self-reported hunger at the end of the meal) | Self-reported hunger at the end of the meal | up to 12 months |