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‘Nutrition-Education Doesn’t Work’ Says Associated Press Review Of Literature

Jim Prevor’s Perishable Pundit, July 6, 2007

When governments start spending money, the problem that often happens is they develop a kind of industry that is dependent on the same funds. The industry consists of government bureaucrats who give out the funds and private contractors who receive them, and they develop evaluation methods that are self-serving.

These self-serving evaluation methods provide a basis for perpetuating and expanding the programs that they happen to run and benefit from.

The Associated Press took it upon itself to do a review of the scientific literature examining 57 nutrition education programs and found only four that were showing any real success at changing the way children eat:

”Any person looking at the published literature about these programs would have to conclude that they are generally not working,” said Dr. Tom Baranowski, a pediatrics professor at Houston’s Baylor College of Medicine who studies behavioral nutrition.
Tons of sources should be studied before the process of writing a research paper.

Among the programs that have been disappointing are many near and dear to the produce industry’s heart:

  • Last year a major federal pilot program offering free fruits and vegetables to school children showed fifth graders became less willing to eat them than they had been at the start. Apparently they didn’t like the taste.
  • In Pennsylvania, researchers went so far as to give prizes to school children who ate fruits and vegetables. That worked while the prizes were offered, but when the researchers came back seven months later the kids had reverted to their original eating habits: soda and chips.
  • In studies where children tell researchers they are eating better or exercising more, there is usually no change in blood pressure, body size or cholesterol measures; they want to eat better, they might even think they are, but they’re not.

When it comes to analyzing why there are such difficulties, the article borders on being silly. In a piece focused on the need for research to quantify results, the writer speculates without citing any research that things such as poverty and advertising and a paucity of supermarkets in poor areas are big causes of the problem. But of course, our country was much poorer in the past and didn’t have the same childhood obesity problems, and there is no evidence that childhood health has improved in those nations that have banned snack food advertising aimed at children.

Some “experts” posit eccentric theories about taste buds, and the reporter presents it as if it is accepted scientific fact:

“If the mother is eating Cheetos and white bread, the fetus will be born with those taste buds. If the mother is eating carrots and oatmeal the child will be born with those taste buds,” said Dr. Robert Trevino of the Social and Health Research Center in San Antonio.

That we have more failures than successes in trying to solve such a difficult social problem as childhood obesity is not surprising. If it was easy to solve the problem, we would have solved it already.

What is disturbing is the kind of self-serving reasoning that has entered into the minds of bureaucrats and contractors. Take a look at how an important USDA professional thinks about spending taxpayers’ hard-earned money:

Kate Houston, deputy under secretary of the USDA’s Food, Nutrition and Consumer Services, oversees most federal funds, $696 million this year, spent on childhood nutrition education in this country. Funding has steadily increased in recent years, up from $535 million in 2003. Houston insists the programs are successful.

“I think the question here is how are we measuring success and there are certainly many ways in which you can do so and the ways in which we’ve been able to measure have shown success,” she said.

But isn’t the goal of these programs to change the way kids eat?

“Absolutely that’s the goal,” she said.

And they’re successfully reaching that goal?

“We’re finding success in things in which we have been able to measure, which are more related to knowledge and skill. It is more difficult for us to identify success in changing children’s eating patterns.”

When asked about the many studies that don’t show improvement, Houston asked for copies of the research. And she said the USDA doesn’t have the resources to undertake “long term, controlled, medical modeled studies” necessary to determine the impact of its programs.

At least she acknowledges the goal — changing consumption patterns. But how ridiculous is it for her to say that “…the USDA doesn’t have the resources to undertake “long term, controlled, medical modeled studies" necessary to determine the impact of its programs.”

She should be before Congress every week demanding that no program ever be done without a mechanism set up to determine if it is achieving its goal. If there is no more money available, better to do half as many programs and study them for efficacy than to do a bunch of random programs and spend billions and billions over the years with not the foggiest idea of whether the goal is being accomplished.

Some of the contractors have talked themselves into forgetting the goal of changing consumption patterns:

Their teacher, Jenkins, offers fact-filled and engaging nutrition lessons as part of a $7 million USDA program which reaches about 388,000 students a year in the Los Angeles Unified School District.

The most recent evaluation of the 8-year-old program was disheartening: no difference in the amount of fruits and vegetables eaten by kids participating in the program and those who weren’t. Teachers who spent more hours on nutrition education had no greater impact than those who didn’t. And parent behavior didn’t change either.

“It’s true, it didn’t change what they actually eat. But the program really made a difference in how kids were feeling about fruits and vegetables. They really had a more positive attitude toward fruits and vegetables,” said Dr. Mike Prelip, a UCLA researcher who headed up the evaluation.

Is it possible that Dr. Prelip thinks the taxpayers care about how children are “feeling” about fruits and vegetables? The children have a more ‘positive attitude’ towards fruit and vegetables? Who is this guy, the Dr. Norman Vincent Peale of produce? It would be nice to hear him say something scientific, such as that he has an ongoing study that he believes will show that thinking positively about produce at age 9 correlates to higher consumption at age 12.

This is a very serious problem for the produce industry. We cannot solely fund ourselves the scope of activities required to change eating habits in America, so we must depend on government, private foundations, etc.

Recently we have started getting some funding and support — but it will dry up like a shallow swimming hole in a long drought if people start to sense that we, as an industry, just want to sell a bunch of produce to government programs.

We have to be, like Caesar’s wife, above suspicion. We have to demand that all these efforts we favor be subjected to the most withering, scientific and exact study that can be done.

If one type of program is not showing to be successful, we change it and try again. We combine with other disciplines and include exercise and behavioral approaches.

The crucial point: every government agency, every congressperson, every private foundation must be convinced, through our actions, that we are a genuine partner in a search for ways to help solve societal problems such as childhood obesity.

Otherwise we will alienate those supporters willing to fund these programs, which will truly be killing the goose that lays the golden egg for this industry.

We mentioned this problem before in our piece, School Nutrition Success Cries for Research, in which we focused on a program that had won a Produce for Better Health Foundation’s National Excellence Award. We lauded the energetic program run by a school nurse in New Hampshire, but we decried the fact that in the absence of research as to its effectiveness, we had no way to use it as a pilot program to raise funds to roll it out across America. We suggested that “…we would like to see PBH add a criteria to its award program. We would like to see a requirement for a research component.”

Equally, when PMA launched its plan to do a cooperation with Scholastic (and we should note PMA was spending its own money, not taking government funds so it was free to do what it will), we also urged as follows:

“Now we have but one request:

Can we please use some of the money to do baseline and follow-up research on children both exposed to the Scholastic program and a control group not exposed to the materials? This way we can actually determine if the program is having an effect on consumption.”

And when we praised the Food Dudes program both here and here, it was because we saw at least an attempt being made to quantify the results.

Interesting enough, one of the best things about the Food Dudes program is that the programs sponsors explain it as a behavioral-based concept:

How can children be influenced to change their eating habits for the better?

The traditional approach has been to inform people through health education campaigns about what they should and should not eat in the hope that they will alter their eating habits accordingly. Unfortunately, the research evidence shows that this approach has very limited success.

In spite of the enormous quantity of information about the health-giving properties of fruit and vegetables that has been issued over recent years, children’s eating habits have remained largely unaltered. Clearly, children’s knowing what they should do does not mean that that is what they will do. What they need is not simply to be given information, but help to change their actual eating behaviour.

In the Associated Press article, some experts said doing more studies of nutrition education is pointless:

Doctors like Tom Robinson, who directs the Center for Healthy Weight at Lucile Packard Children’s Hospital at Stanford University, said those studies aren’t needed. The research has already shown they don’t work.

“I think the money could be better spent on programs that are more behaviorally oriented, as opposed to those that are educationally oriented, or studies that just describe the problem over and over again,” he said.

It seems giving the Food Dudes a scientifically monitored trial, with control groups, in a few U.S. schools would be a good place to start.

You can read the whole AP piece here.

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