EXCLUSIVE PRESENTATION AT NEW YORK PRODUCE SHOW
Non-Profit Brighter Bites Takes Scientific Approach To Increase Produce Consumption And Create Long Term Consumers
Jim Prevor’s Perishable Pundit, December 8, 2018
The issue of “food deserts” has a bit of chicken-and-the-egg dynamic to it. Certain neighborhoods do not offer great selection when it comes to fresh fruits and vegetables. This puts up a barrier to consumption as what is available is limited in variety, often not the best in quality and tends to be expensive.
Of course, we do have a very aggressive retail sector, and the reason there is not a broader assortment available is because there is not sufficient demand. Price is often a factor, but prices are heavily influenced by things like the cost of rent, security, insurance, labor etc., that are not in the control of the produce industry.
Brighter Bites is a nonprofit that both delivers fresh produce into the hands of needy children and families while also educating the families on how to utilize the fresh produce and do it all in a fun way that avoids the nannyisms that turn off everyone. And they try and do it in a consistent way that can actually lead to behavioral change.
Perhaps most importantly, they have done this in a controlled way that is put under the scrutiny of real peer reviewed research.
There is a lot more to do, of course… we want research compelling enough to move private foundations, the government and other non-produce entities to endorse these efforts. We would like demand to be so robust that everyone will gladly pay for their fruits and vegetables. But the journey of a thousand miles begins with a single step, and this just might be the start of an incredible journey for the produce industry and the future of lots of children.
This year, Brighter Bites is holding its board meeting in conjunction with The New York Produce Show and Conference, so we knew that the founders of the program will be there. We were thrilled that they were willing to explain the Brighter Bites initiative to attendees during one of the Educational Micro-sessions on the Show Floor on Wednesday afternoon.
We asked Pundit Investigator and Special Projects Editor Mira Slott to find out more:
Q: I could talk with you for hours about your intriguing presentation surrounding the Brighter Bites program model, and the scientific peer-reviewed research measuring its impacts, both short-term and longer-term. This opens a floodgate of questions, but I know this is just a preview! There are two standout important elements I’m hoping we can focus on:
FIRST: Free or subsidized fresh fruit and vegetable programs at schools often bring wonderful vignettes of success, both in increasing produce consumption, and the ensuing health and wellness benefits, from curbing childhood obesity to disenfranchised students being more energized and getting better test scores, etc.
However, what’s been more problematic, costly and subsequently rarer to find is scientifically-based research and hard evidence, especially to prove sustained success after the free produce programs end, as opposed to anecdotal, subjective stories, and one’s instincts.
There are many different variables influencing outcomes to consider and isolate out; cause and effect are not always what they seem. Further, it can be difficult to track the same children over extended periods of time, and compare them to a control group, etc.
Sometimes with surveys, what people say or believe they’re doing may not actually parallel their actions, when monitoring their produce intake accurately. Changing eating behaviors is challenging... [Editor’s note: we’ve covered this topic extensively here, here and here.]
SECOND: The Brighter Bites’ model integrates and hinges on a three-pronged formula: 1) produce distribution (50 servings per week); 2) nutrition education (school & home), and 3) a fun food experience (recipe tastings). Does the research support this multi-faceted approach?
LISA: We are very proud of our research. I say this as the non-researcher in the partnership, and we are happy to talk about that because measuring outcomes to determine impact is a critical component. It validates the Brighter Bites program and the demand we’re building for your industry.
SHREELA: I could talk data for five days, no problem! Our team of researchers at UTHealth School of Public Health conducted a two-year case study evaluating the impact of Brighter Bites on 760 students and their families at nine schools in Houston during the 2013-15 school years. Results from this study have been published in a scientific peer-reviewed journal Preventive Medicine. The purpose was to evaluate the effectiveness of this new school-based food co-op program, Brighter Bites, to increase fruit and vegetable intake, and home nutrition environment among low-income first graders and their parents. [Editor’s note: you can read the full study here]
Q: What were the scientific parameters, and how did you collect data?
SHREELA: This was a non-randomized controlled comparative effectiveness trial. Six schools received Brighter Bites and six comparison schools implemented a coordinated school health program. Brighter Bites is a 16-week school-based food co-op comprising weekly distribution of fresh product (50 servings/week), nutrition education in schools and for parents, and weekly recipe tastings.
Measurements included parent-reported home nutrition environmental surveys and food frequency questionnaires for parent and child. Intervention effects were examined using multivariate analyses. At baseline, the sample was 71 percent Hispanic, 24 percent African American; 42 percent of first graders were overweight or obese.
Q: Did your study glean meaningful findings?
SHEELA: Children receiving Brighter Bites had significant increases in intake of fruit servings, vegetable servings and decreased intake of added sugars. Further, among parents, there were significant increases in fruit consumed, vegetable intake increased baseline to midpoint but not post-intervention. Among Brighter Bite families, there were significant improvements in the home environment including understanding and usage of nutrition facts labels to make food purchases, frequency of cooking, rules and practices regarding eating family meals, serving fruits and vegetables at meals, and limiting portion sizes.
Our study shows promising results in improving dietary habits and home nutrition environment among low-income families.
Q: For perspective, could you brief us on Brighter Bites’ evolution, and then we can delve further into the science behind it and potential impacts going forward...
LISA: I participated in a fruit and vegetable co-op with my children, and I watched their eating habits dramatically change when having access to fresh produce. We got a box of produce every week, and my boys, who at the time were three and six, went from asking for bagels for breakfast to eating apples and pears and oranges, and wanting fresh vegetables at night. Then at a birthday party, a critical moment for me occurred. My older son called me over and said, “Do I have to eat this Mommy? It’s too sweet, I would rather have fruit.” I looked down at his plate. It was cake. I was dumbfounded by this response from a six-year-old.
I was working at a major children’s hospital as an attorney, not in the field of nutrition, but I was noticing prevention was largely missing from the hospital’s food offerings. I thought, if I can have this success in my house... understanding food is a large contributor to our health, and that access to fresh food is lacking in low-income areas, and diabetes and high blood pressure and health epidemics are high… I came up with this formula —produce distribution, nutrition education, and a sensory experience, making eating produce fun, I believed would change behavior.
I immediately looked for partnerships to pursue my mission, and that’s when I joined forces with the Houston Foodbank, and the president became my partner and advocate, and I met Shreela. I wanted to find someone to research this to determine the impact.
Q: Can you elaborate on why you thought it was important to have the research element?
LISA: There were two reasons: One, because I was doing this in my spare time and I had no benefit to gain personally. I wasn’t going to be paid for this; I was doing this because I believed in the mission of creating health for people through fresh food, produce specifically, and if it wasn’t working, then why would we do this?
This is about how eating produce impacts societal health, and I wanted to know this model was effective and the strategy was working. Then if it was working, and we got to the point where we are today, I wanted to show our partners and donors with evidence we were making an impact and give them tangible results, because I don’t think we should move forward unless we can show value.
Shreela is a nationally-recognized epidemiologist in childhood obesity at one of largest research medical facilities in the country. I was introduced to her as one of the best and brightest in the field. Shreela told me at the time the Institute of Medicine had just come out and said if we want to curb childhood obesity and work on prevention, we not only need to teach kids literacy, we also need to combine with food access, so she was excited about the program.
No one was doing food delivery, and that’s what we realized six years into this program, we are one of the only non-profits that gets the product into the home, and it goes the last mile, we like to say. That’s not only trying to change the children’s behavior but also the parents, who are the buyers of the product, and the influencers.
We believe that the kids cross-pollinate with the parents and cross influence their behavior, and that’s why it becomes sustainable longer term, and Shreela can show this more through her data, but that’s the secret sauce of our program, attaching it to the whole family, and those holding the money to purchase the produce.
SHREELA: The other side of the program is how the research is anchored. When people think about research, most think it’s about collecting data on existing programs. Ours is different in that regard. Not only are we collecting data on Brighter Bites, but our formula is anchored in what we know is true in science and nutrition, so our research team anchored the idea inside scientific evidence, and the program was formalized with nutrition-based evidence that has proven obesity reduction effects on children.
This gives you an idea of the other part of what makes Brighter Bites different. That the program itself is anchored and developed in scientific evidence, which is critical for research, because then you know what you are evaluating, and the program can become streamlined and effective, otherwise you might be measuring the wrong things or going down the wrong path.
Lisa’s idea of bringing in the academic institution to anchor the research really was critical to ultimately developing the evidence. The other thing that’s important...one of the pitfalls of a program, if you’re not collecting data, you could be doing something wrong, and you could be doing the wrong thing for many years. Anchoring the program with data allows us to learn what’s working and what’s not working.
Q: Could you point to instances where this played out in your research?
SHREELA: A great example is mushrooms that first year. We collected qualitative data from focus groups and found they were bringing home the mushrooms but didn’t know what to do with them. It seems like if you give the families food, they’d know what to do to prepare it. Through our data, we learned about the issues families had with different kinds of food items, and to go above and beyond what the families focused on.
Q: You mentioned your expertise in childhood obesity and its connection to produce intake, and I was curious to know if this was part of your research with the Brighter Bites program. For instance, did you monitor the kids’ weight and/or body fat and compare with the control group, short-term and long-term?
SHREELA: We had done some research studies where we monitored kids weight. One of the things we found was the maintenance effect of body weight. For the rest of the country, you know there’s an upward trajectory, and in implementing Brighter Bites, we have seen weight maintenance. We haven’t see weight loss, but our research shows it’s pretty normal for the kids to be eating more fruits and vegetables and eating less added sugar. This is what you want — that substitution effect. So eventually over a period of time that substitution effect could affect their weight loss trajectory.
At the same time, I’d say we’re not a weight loss program. We think healthy not skinny, and in terms of weight maintenance. We want children to grow into their weight. They are still growing so we want to cultivate healthy eating habits, and that they’re eating more of the fresh fruits and vegetables. And that’s what our data has been showing as well.
Q: So, just to clarify, the Brighter Bites case study results showed an increase in produce intake and reduction of sugary foods, and kids maintained their weight but did not lose weight...yet they were healthier? I assume you didn’t do blood tests, or physical exams...or ask about physical activity?
LISA: No, but from the research, we know they are building and sustaining healthier eating habits, which are tied to a healthier lifestyle and healthier lives, less sugar intake, more family meal time, parents reading nutrition labels, more servings of fruits and vegetables for snacks instead of processed food. So, we have all of these markers that are scientifically relevant, and I can let Shreela speak more to this.
SHREELA: That’s what we’re tying together — all these scientifically significant changes in behavior patterns that lead to health. There are anecdotes from the parents and their children about their health, the way they feel, and less doctor visits, but we don’t use this as our specific data; it just guides how we’re doing things.
Having worked in the obesity field — my research book is on childhood obesity, you should not expect a drastic reduction in weight in growing children in one or two years in their lifestyle. What we’re trying to do is a holistic approach in improving fruit and vegetable intake and to see that the kids are experiencing a healthier home environment and school environment, but this is not a weight loss program.
So, we’ve been very careful in couching that.
Q: It sounds like this is an important point in the Brighter Bites approach...
SHREELA: There’s a lot of literature on childhood obesity and you have to be very cautious in approach. There are school-based programs out there that are doing weight-loss intervention. That’s not what we’re doing. I did not actually recommend that approach. It can be detrimental to the health of the children.
Brighter Bites is very positive. It empowers the families. It’s a co-op concept where the families can participate in the bagging and distribution of the produce. Lisa can share more. Parents can come to the schools now. They don’t need to know computers or a language; they come in and they volunteer and enjoy the experience of participation.
Q: The program triggers more parental involvement...
Shreela: Yes. This wasn’t happening before. There are low literacy rates in these schools of the parents. There are low education levels, and the parents don’t think they are of value in the school and don’t participate in their children’s education because they are largely intimidated by the school environment.
In these lower income neighborhoods, it hurts the children not to have their parents engaged in their education.
I know from my own experiences, being so engaged with my own children, and through the stories I hear from a lot of public school educators that it’s very hard for the parents to engage. I’ve had school counselors, literally in multiple cities, say they’ve never experienced parental engagement like this with the Brighter Bites program. Not only are they volunteering, one of the pillars of the program is parent involvement. We make them come into the school to pick up the product. We want to create this fun environment. But we want it to be dignified and caring and thoughtful, so we do make meaningful change.
It can be difficult. Some parents are walking into the school for the very first time. Not to be cliché, but this “carrot” of free food, on average, saves them $35 a week. But it’s a way to encourage engagement. We demystify the school environment. We demystify fresh food. All these things can change the fabric of their lives.
LISA: Furthering Sheela’s point about not focusing on obesity, and more on healthier behavior, this is a fun program.
Q: That’s an ongoing discussion in the industry on how to market fresh produce to increase consumption...
LISA: Nobody eats more produce just because it’s good for you. We want to highlight the fun in eating produce and also that it tastes good.
Shreela and I were talking to a child and asked him, what is your favorite fruit. He took an orange out of the Brighter Bites bag, and said, “I’ve never had one before.” As he tried it, he exclaimed, “It’s so juicy!” It was so great. Houston, Texas, a major city in America… Can you imagine? This was not a kiwi or a pomegranate. We actually have to show people and teach people this product is good.
Q: In an effort to get children to eat more produce, sometimes produce items are supplemented with other products to sweeten or disguise the true flavor; such as a package of sliced apples with a side of caramel for dipping, maybe celery with peanut butter or cream cheese, or broccoli with cheese sauce. What’s your view on this strategy? Have you done research on this technique?
SHREELA: It’s funny. There is no literature to support any of those views that you need to put apples with caramel, or cereal with more milk... It’s the same philosophy -- that products are created to sell more of another product. It’s sustained by companies as a method to sell more products.
What we do know is that kids need more exposure, and continued exposure to healthy food, and it has to be tasty, which is why we don’t just give families product, but we show them how to use it and include recipes. We give them a tasty, healthy treat when they pick up their bags of produce, and it may be an item they haven’t tried before, and they see their child trying a new food item.
A true story: When Lisa and I first started the program, Lisa would bring the Vitamix every week to the school, and we would make the smoothies there for the kids. She’d mix this signature kale concoction, that looked as green as the Hulk and the kids would grimace, and the parents would be even worse, but the kids tried it… kids are more adventurous than parents, and they loved it to the point where they were craving more, and now there are smoothies in the cafeteria.
LISA: No sugar, and no milk. Kale, strawberry, apple, banana, and water. It’s delicious.
I have a great example of the behavior change that is relevant for our New York Produce Show audience that I can share. We have a produce supplier that helps us in every market, and in New York City, it’s D’Arrigo Bros. of New York. Jim Prevor helped us with the introduction, along with Rich Dachman at Sysco.
D’Arrigo supplies us with many extra items that the City Harvest Foodbank doesn’t, so we have a lot of unique and different items. So, our director of New York operations, Melanie Button, asked the students at one of the schools to write notes to the D’Arrigo family during the Thanksgiving holiday to say thank you.
To show you how much the program matters to the children, I sent you one of the notes that caught my attention.
That’s it in a nutshell. We changed her perspective on eating produce. We have many more letters like that, but to me, that’s the quintessential example.
Q: Quite refreshing, albeit not in the scientific research realm...
LISA: Based on our studies in Houston and Dallas, we know if we send broccoli home, the children are more likely to eat broccoli slaw on their lunch tray and not throw it away. We know we have less plate waste when we introduce Brighter Bites, and it’s making eating produce part of the fabric of their lives.
Q: How do you measure that?
SHREELA: We just finished a plate waste study to see how many fruits and vegetables kids were wasting on their school lunches. I had my data collectors actually weigh the kids’ plates after they were done eating. We compared the kids participating in Brighter Bites to the control group that was not. We saw that the kids in the Brighter Bites program wasted less produce in their school lunch at the end of the program compared to kids that did not participate in Brighter Bites.
Even more interesting, this was tied into the produce we were giving in the bags, and the number of times they received that produce. So, for example, they got broccoli five times, and peaches maybe two times, and they wasted less broccoli at their school lunch because of the added exposure. And we found that’s actually the truth, which was surprising to me.
This correlated with our hypothesis that the 16 weeks matter when we developed the formula. Replication is important. (The process repeats for 8 weeks during the fall, 8 weeks during the spring, and 8 weeks during the summer). We knew that kids need about a dozen times exposure to a new fruit or vegetable to really develop the taste. I wanted to test this hypothesis and find out if it holds true to the specific produce piece, and we found that it actually did. We’re about to publish those findings as well. So, exposure matters is the headline.
Q: Attendees will be interested to read your latest research... In addition to repeated exposure, does it matter what age the child starts on the program? We’ve interviewed researchers on this topic advocating that taste receptors can be influenced when the baby is in the womb! Is it better to catch children earlier before their eating habits are formulated...?
SHREELA: We found kids are an easier sell when they’re younger and parents are an easier sell when their kids are younger as well. A lot depends on the parents and the family structure. We find the parents are much more likely to offer new foods to their child when he or she is younger, believing that eating habits are already established once their child is in elementary school.
We know from research, introduction to new foods drastically goes down as the child gets older and the child tends to only eat foods that are familiar; i.e., “my child only wants to eat chicken nuggets and mac and cheese.”
In our study, the kids were first graders when we started, and the program ended when they were in fourth grade — 42 percent of the first graders in our study sample of 760 kids were overweight or obese.
Q: Did you monitor the children’s eating behavior and that of their families once the Brighter Bites program concluded? Isn’t that a true indicator of the program’s impact, but also a challenge to prove...
A: Yes. One of the data points from a sustainability perspective is we found long term impact of Brighter Bites, where two years later after the program ended, we followed the same families we had done the study on, and saw the effects maintained; not only was produce consumption maintained, in some cases effects were enhanced, cooking produce had become part of their routine, and some families were eating 19 additional servings of fruits and vegetables a week compared to when they started the program.
We started the study in 2013 and followed the same families again in 2017, and asked the same questions of produce intake in their home environment, and found the effect had sustained… they continued to eat more fruits and vegetables.
LISA: These were the same families, and they are now buying more produce on their own.
Q: That’s a big takeaway... Are there other areas of research you’re looking to explore, or points you’ve honed for extended analysis?
A: Yes, some of the biometrics we want to get into. For example, we’re finding children are prediabetic at a very young age in Texas, and around the country, and diabetes is a major public health issue right now, so we want to start getting into tracking some of these biometrics.
Another piece we want to get into… we want to check on teachers’ wellness, specifically with teachers on the program. We just finished a survey with about 700 teachers and found Brighter Bites was effective in improving their own eating habits, so we’re digging deeper into that as well.
Q: I wanted to talk with you more about the logistics side. How are you getting the food and distributing it? You have partnerships with food banks as well as with suppliers and retailers too? How does the system work?
LISA: Fresh fruits and vegetables are sourced from produce suppliers and retailers through donations and purchases, delivered to our partner foodbanks and distributors, and each week our team chooses 8 to 12 different types of produce from the huge warehouse coolers, and the food is specially tagged for Brighter Bites.
Pallets of bags and cases of fresh produce for Brighter Bites are loaded by food bank staff into trucks for delivery to different sites, such as a school gym or cafeteria. Then Brighter Bites staff, parents, and community volunteers unpack and divide the produce into bags. Also added into the bags are nutrition handbooks, tip sheets, and recipes that incorporate that week’s fresh produce.
In addition, educational materials are linked to children’s in-class nutrition lessons from CATCH and other evidence-based, coordinated school health programs we help implement.
In every city where we operate, except Austin where we just partner with for-profit suppliers, we have a food bank partner as well as a for-profit supplier.
Q: What cities do you cover now, and where are you headed next?
LISA: We’re at over 125 sites across Houston, Dallas, Austin, New York City, The Washington, D.C. area and Southwest Florida, with consistent growth since we started in 2012. In 2018/2019, we will launch in our seventh city and estimate serving nearly 24,000 individual families.
Q: How does that translate in number of produce servings?
LISA: Since 2012, Brighter Bites has provided families with more than 18 million pounds of produce, to more than 265,000 individuals (representing 53,000 cumulative families).
For instance, Sysco is a big supplier. Rich Dachman, as you know, is on our board, and one of our main advocates, and then in New York, we have D’Arrigo Bros. In Washington, DC, we have The Coastal Companies Foundation, in Florida, we have Lipman; in Dallas we have Taylor Farms.
In some cases, we have competitors all partnering together to make this happen.
We basically depend on the food banks as the main source of the produce. They’re the aggregators of the donated produce, and we partner in many other ways.
For-profit suppliers and farms donate to us as well to create unique items and variety in the bag. For example, we partner with Houston Foodbank, let’s say they provide five items that week, Sysco comes in and goes to Taylor Farms or Mann Packing or Church Brothers, and says, “Hi, I’m here to pick up for my restaurant customer a foodservice order, and I’m getting five pallets of snap peas this week. Can you give me an extra pallet for Brighter Bites?”
They’ll pay the freight to bring it back to Texas and you’ll get a donation for your produce. So that’s how we have everybody from suppliers to distributors to non-profits involved. Everybody’s working together to make this happen.
Q: How can people who are excited about this program get involved?
A: On the produce side, we have a sourcing manager Jennifer Boone (email@example.com), and she will be with us at the New York Produce Show. She is the one managing all the produce donations from the industry for us. That’s on the product side. And of course, we’re also accepting financial donations. But the real big goal of ours is to receive more product.
As I explained earlier, in every market we have a distributor that can pay the freight, and we’re looking for actual product from the farm, and we would love to partner with them.
The only way this program is successful is if we have product. What’s interesting to add is that it doesn’t have to be kohlrabi; it could be kale, spinach, mushrooms, berries, things we see as normal but may not be normal to the families we serve.
So we’re really grateful for any product we receive to create variety and interest, but the key to sustain the program long term is this industry’s direct involvement by giving us product.
Q: Are you building partnerships with retailers?
LISA: HEB is very, very supportive and engaged, and also Target and Walmart are very involved, and strong financial donors.
Q: One other question. When you’re doing your analysis of how much produce you’re providing, if it’s coming from food banks, do you consider the overlap that the food would be distributed through other means besides Brighter Bites...
LISA: The difference we say with food banks and Brighter Bites is that food banks distribute food as their mission and that’s awesome, but what we’re doing is taking the food they would distribute and, instead of just feeding, we’re feeding with impact, taking that same food with programming to create behavior change.
Q: As we conclude this fascinating preview, what are the key takeaways you’ll want attendees to glean from your presentation?
LISA: We want to be the produce industry’s best friend. We want to build demand because we know your products are the key to better health. We can’t build Brighter Bites without produce. Together we can create market sustainability. It’s a win-win.
Well, we can all use a best friend. In addition to what promises to be a fascinating presentation on Wednesday, for those interested and willing to volunteer, we are offering a great opportunity on Thursday.
We have a 35-seat bus leaving the Headquarters Hotel, the New York Hilton Midtown, and heading out to Jackson Heights, Queens, to give people an opportunity to experience being part of a bagging and prep crew getting produce ready for distribution to the schools and, ultimately, the homes.
The bus leaves at 7:15 AM and should return before noon. If you would like to be part of the experience, please email us here.
You can register for the whole event, including the Brighter Bites presentation, at this link.
If you need a hotel room, just let us know here.
Come be a part of the Brighter Bites program and help it spread across the land and come to The New York Produce Show And Conference where great ideas help you, your company and the industry SOAR.