Hanging on to the Internet to Improve Children’s Nutrition Consumption

Schools Play a Major Role in Helping Kids Decide Upon Nutrient-rich Food Choices

Who is ready for a pizza party at home? Irrespective of age (be it a toddler or an elderly person, adolescent or a middle-aged man) almost all of us raise our hands. Sophistication, advancement and modernisms are never curbed and we strive to achieve excellence and improvements when it is always for the better. Humans seem to have forgotten this concept when it comes to the field of nutrition. There have been aplenty new fruits and vegetables introduced, different cuisines and dishes tried and tested, ingredients revealed and healthy foods portrayed but individuals prefer eating tasty and processed treats. With decrease in health index of human beings there has been an inclination to eat more of nutrition-enhanced foods but still neither adults nor children have embarked on a nutritious journey to good health. The recommended five portions of fruits and vegetables consumption has never been met until now by a majority of the population while meat consumption exceeds dietary recommendations! Fats have been our favorite macronutrient with proteins following suit as they help us embark on our path to a muscular physique.

Nutrition, dietetics and health has become a major field these days with more and more people seeking the advice of registered dietitian nutritionists to improve their healthy intake and stay fit. Health programs that are conducted for children take place in various settings using various methodologies. But such programs are crucial as they form the foundation for strong eating habits as adults. The latest in trend is Social Marketing that is recommended by the World Health Organization to promote healthy eating patterns and lifestyle behaviors that’s good for the individuals. There are several reviews and programs suggesting that behavioral changes and eating behaviors (that included fruits, vegetables and whole grains consumption) improved greatly when Social Marketing strategies were implemented. There are increased insights revealing that web-based interventions are effective in changing behavior. Since long back we have noticed that our suggestions or recommendations go unnoticed with regards to anything be it studies, health or even general knowledge but the same gets high regards and is implemented when the knowledge is imparted by a professional who excels in the same field. Kids too regard their teachers as demi-Gods and there’s not a word that remains unfulfilled when it come from a teacher’s mouth.

Hence, nutritionists and dietitians are becoming an integral part of our lives as we live in a world that has forgotten to eat right. Rising obesity and overweight rates, widespread prevalence of health problems and diseases and the processed food culture have deviated our paths which now needs the intervention of an expert to take it right back to where it belonged- eating right. We have had several occasions where web-based interventions seem to be effective in changing behavior. You might meet the health expert in a face to face interview at the beginning but follow ups mostly happen via chats, messages or mails that help in reminding and encouraging individuals to bring in behavioral changes. We also have results showing that having something that’s beyond the web, such as messages or telephonic feedbacks do have a greater impact than email discussions and follow ups. Adults can take care of these follow up intervention methods but in the case of children it solely depends on the parent to decide how SMS or emails can improve their kid’s eating habits apart from web-based interventions.

A research study wanted to know whether providing additional support in the form of SMS or emails could improve a child’s eating behavior and lifestyle beyond web-based approaches. This study focused on Social Marketing nutrition program on kid’s food intake. The main focus was to know whether extra information and aids such as SMS follow ups would enhance behavioral changes of the kid instead of using only a web-based approach.

Looking Beyond Web-based Interventions for Improving a Child’s Nutrition Intake
The research took place in Switzerland, a country where only 55% girls and 40% boys ate fruits and vegetables daily. Data also shows that almost 40% of adults and more than 20% of children are either overweight or obese. A web-based social marketing program called ‘FAN’ was designed to encourage healthy food consumption and daily exercise performance among all people irrespective of their age group. Though parents used SMS, email and web services mostly on all days they were happier with the web-based intervention compared to the other two. The research team were focused on four different hypothesis: there would be an increase in healthy food consumption across age groups; there would be a decrease in unhealthy food consumption across age groups; email group would show greater improvement than web-only group and SMS group would show greater improvement than web-only group. Families were invited to participate and those who decided to participate had to complete a baseline (BL) survey. After this each of them were assigned to one of the three groups namely Web-only (group G1), web + email (group G2) or web + SMS (group G3). The study period was 8 weeks and during this period both the parents and kids received information on nutrition and physical activity behaviors. Content was decided based on the gender of the parent, number of children and the gender of each kid and also based on the behavior that was perceived as being difficult to perform.

Encouraging words sometimes work wonders and this study too implemented the same. Every Tuesday, the website updated its site with a new theme on nutrition such as “You are off to a good start and that is half the battle!”. During the fifth week another theme called “Lunch and snacks with imagination”. Apart from imparting knowledge about the need for a healthy nutrition the website also came up with innovative, healthy and easy tips and recipes for eating better and staying healthier. You also get to know about introducing new foods onto your table and make your meal as healthy as possible. Emails and SMS were used as means to remind parents in the G2 and G3 groups to visit the Website. The email contained the link to the website, a note on the theme of the week, an attractive image and links to different pages on the Website at the bottom. SMS also followed the same pattern: a link to the website and a motivational message beneath it such as “Are you left with little time to cook for your child’s lunch box but still would love to make your little one eat a healthy meal daily? Then it’s time to visit the FAN Website!

A total of 452 parents and 608 kids were involved in the study and they were allocated to three different groups: G1 (163 parents and 218 kids), G2 (144 parents and 196 kids) and G3 (145 parents and 194 kids). As web-based programs were already established to be effective, this group was set as the control group. Gender, height, weight and age of kids were collected at baseline (BL). All the kids noted all of the day’s consumption in a food diary. The study group identified 12 main food categories that included water, fruits, vegetables, starchy foods, meat, fish, eggs, dairy products, fats, fat meat and fat fish, sweets and soft drinks. Frequency of each food was noted and mean frequency was taken as mean of daily intake. Mean age of the kids was 8.5 years and almost 49.3% were boys. A total of 195 parents visited the website with 261 children: 72 parents and 95 children in G1, 56 parents and 78 kids in G2 and 67 parents with 88 kids in G3. It was 39%, 30% and 39% kids in G1, G2 and G3 who visited the website on their own. Results showed that:

1. Frequency of fruits consumption increased significantly in G1 from BL to follow up (FUP) while G2 and G3 did not differ much from G1 with respect to fruit consumption
2. Regular consumption of sweets decreased significantly by 0.11 in G1 while G2 and G3 did not differ much from G1 in terms of sweet consumption
3. There were no visible changes in vegetable consumption observed between any of the groups from BL to FUP. There was a slight change in G3 from BL to FUP (+0.08) compared to the change in G1(-0.04).
4. Almost 47% kids in G1, 43% in G2 and 41% in G3 did not complete the FUP or completed it for less than 4 days. These kids differed from those children with complete data only in terms of a higher intake of fruit and dairy at BL.

Thus, a social marketing program that’s web-based helps in improving the child’s consumption of water, fruit, soft drinks and sweets.

Canadian Study on Web-based Intervention
No country has been spared of the obesity epidemic and this includes Canada as well where obesity rates have doubled in the last 30 years with one in three kids and adolescents affected by it. Obesity during adolescence is extremely harmful as it leads to greater mental trauma, physical insecurity and low self-esteem. A Quebec health survey on youth showed that more than 50% of adolescents don’t consume the recommended Canada Food Guide servings for vegetables and fruits (V/F) and milk products (M/A). There have been several suggestions and school-based intervention programs which incorporate technology use has been widely suggested for improving V/F and M/A consumption and changing eating behavior of children.

The study consisted of 10 classes of grade secondary I and II (grades 7 and 8) from 3 different schools in Canada. They were segregated into intervention (n=6) and control (n=4) group. Every student was given login credentials to the website and during the entire six-week calendar tenure each of the participants was asked to record their consumption of V/F and M/A from Monday to Friday twice a week. There were two icons displayed every day representing V/F and M/A. The icons were an apple and a milk carton and by clicking on each of the icons the participant could add servings of each of the foods consumed during different meal timings. V/F and M/A were further split into different colors based on their nutrient density and this included green (veggies rich in folic acid such as broccoli), orange (V/F rich in beta-carotene such as carrots), purple (vegetables rich in potassium and folic acid such as red cabbage, yellow (fruits containing aplenty vitamin C such as oranges), red (fruits rich in potassium & vitamin C such as cranberry) and blue (M/A rich in calcium and vitamin D including milk, cheese and yogurt). The children were challenged to fulfill the average daily consumption of recommended servings of V/F (6 servings/day) and M/A (3 servings per day) based on Canadian food guidelines. Scores for the participants were given based on ‘quantity’ and ‘variety’. Quantity refers to fulfilling the recommended servings while variety included that consumption must be equally distributed into six categories of foods based on the colors. There were regulation periods assigned after every two weeks to help children overcome hurdles and set their goals in the right direction to fulfill requirements. Data was collected at the start and end of the study for a total of 282 participants (193 in the intervention group and 89 in the control group). There were 42 overweight and 25 obese students and results of the study showed that:

1. There were no changes in body weight observed between intervention and control group
2. There was no difference between the two groups on V/F and M/A consumption at baseline but at weeks 3, 5 and end of study the intervention group reported higher consumption of V/F and M/A compared to control group.
3. 10 weeks after intervention there was no significant difference in the consumption of V/F and M/A between the intervention and control group.
4. Consumption of V/F increased to 0.39 servings for the control group and 3.4 for the intervention group between pre-test and post-1. Kids in the intervention group consumed 6.4 servings of V/F while the control group consumed an average of 3.7 servings at the end of the intervention
5. Students in the intervention group consumed an average of 3.5 daily servings of milk and alternatives while control group consumed an average of 1.6 servings per day after the intervention

The study shows that introducing web-based nutrition programs help youth adopt healthy eating habits as adults too later in life.
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References
Does Additional Support Provided through e-mail or SMS in a Web-based Social Marketing Program Improve Children’s Food Consumption? https://nutritionj.biomedcentral.com/articles/10.1186/s12937-018-0334-1
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The Impact of an Innovative Web-based School Nutrition Intervention to Increase Fruits & Vegetables & Milk & Alternatives in Adolescents: A Clustered Randomized Trial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644089/