Critical appraisal of fruit and vegetable promotion intervention effects on school snacking

¶ … processed foods and diet has had a negative effect upon many populations, particularly contributing to obesity and potential Type-II diabetes and a host of other problems. Medical doctors, scholars, researchers are all in agreement that there is a complete link between what we eat and drink, and the consequences to our overall health. Technology has certainly done wonders for learning, but has also contributed to children preferring video games to outdoor exercise. This, in combination with diet and sugary sodas at school has negatively impacted children's health. Dutch researchers in public health and epidemiology were so alarmed by these trends they developed a study to measure the effects of using fruits and vegetables as an intervention during mid-morning school breaks (Tak, et.al., 2010). These researchers are very well qualified on this topic, as they are professionals in Epidemiology, Biostatistics, and Public Health with major universities in Holland. The information contained in this study has certainly been studied before, and in various quantitative measures. For instance, studies evaluating the relationship between consumption of sweet snacks and dietary preferences found that there are a number of influencing favor that contribute to a child's preference in food (Kalsbeek and Verrips, 1994).

Research Problem and Questions- The study aims to investigate whether a primary school based intervention of healthy fruits and vegetables would decrease the intake of unhealthy, high caloric snacks during school breaks on a population of elementary school children (ages 9-10). The basic assumption is that the health-enhancing effects of eating more fruits and vegetables will become so habitual, and tasty, that children will avoid sugary snacks and provide a way to treat obesity prior to onset. There are some quantitative difficulties within the approach to this study, acknowledged by the authors, in that the data was self-reported and the Dutch government already indicated the intervention cities (p. 614). There were really no unrealistic demands, although perhaps not enough details were forthcoming on a 2-year longitudinal study for self-reported data. Even though self-reported data use is necessary in many circumstances due to budgets or the overall design of the research, there are problems with its use in terms of validity, extrapolation, and even tabulation of data sets (Gonyea, 2005).

Literature Search - For children and adults, eating right involves two things: a balanced approach to nutrition and the proper mindset to utilize the proper foods in the proper amount. The balanced approach to nutrition does not require depriving oneself of everything one likes -- it simply indicates that we eat in moderation, and, when possible, try to include more fresh fruits and vegetables, limit processed foods and sugars, eat whole foods, limit alcohol, and most especially limit sugary drinks and candies with only processed empty calories and very little nutritional value. More than anything else, Childhood Obesity is a direct result of lifestyle and overeating. Children of today tend towards highly refined products with heavy sugar content, sugary sodas, and snack foods with high carbohydrates and low nutritional value. When combines with a greater sedentary lifestyle, for example, splaying games on the internet instead of working out. Most children, in fact, fail to exercise because the prefer stationary ones: computer games, internet surfing, chatting via text messages, and watching television. This leaves fat stored in the body, storing fat, and cycling feelings of less energy all over again (Lluch, et.al. 2000).

The actual literature review in the study was rather cursory, primarily focusing on earlier studies that indicate taste preferences are one of the primary determinants of food choices with children. That being said, some studies show that the key to increasing fruit and vegetable intake is repeated exposure to a wide variety of seasonal products as well as a combined educational program showing the nutritional value of natural snacks (Wardle, et.al., 2003). Still, there is an ample bibliography and list of further reference materials that focus more on the manner in which restrictive dietary considerations can lead to more positive outcomes (Gonzales, et.al., 2009), as well as the manner in which children are taught about food and nutrition and the way they approach healthier snacks (Baranowski, et.al., 1999).

Sample Selection- The study included 705 mixed gender children aged 9-10 years old in 4th grade. Fifty-five schools participated; 31 segmented for intervention and 24 as control. There were schools in five cities that met all participation criteria and there were slightly more girls who completed the study than boys. Enough extra participants were recruited during the initial stages of the study to result in the 705 completed; thus having a large enough population that was statistically viable and longitudinally appropriate. However, the Schoolgruiten research group selected the intervention cities, set the control parameters, and although there were baseline differences between the intervention and control groups, quantitatively speaking there was not necessary adequate adjustments for many demographic or psychographic variables within the study groups. From a quantitative perspective, a more clustering of variables (income, age of parent, educational level, and more) should have been structured into the study as opposed to using governmental mandates for certain groups (Halkidi and Vazirgaiannis, 2001). The research groups provided consent, teachers knew which groups had fruit and vegetable intervention, but the governance of the research was more administrative and political than scholarly in orientation.