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Serving healthy foods with a smile may entice students to eat better

Labeling healthy foods with smiley faces and offering small prizes for buying nutritious items may be a low-cost way to get students to make healthy choices in the school lunch line, according to a study to be presented at the Pediatric Academic Societies (PAS) annual meeting in San Diego.

Making poor food choices in school cafeterias is a risk factor for childhood obesity. Therefore, efforts have focused on improving the quality of school lunches and enticing children to eat them.

One such effort was a two-phase intervention to improve healthful eating among kindergarten through sixth-grade students at an inner-city school in Cincinnati. The first phase consisted of placing green smiley face emoticons by the most nutritious foods in the school cafeteria, including fruits, vegetables, plain white fat-free milk and an entrée with whole grains. Three months later, researchers introduced the concept of a "Power Plate," which consisted of the four healthy foods. Children who selected a Power Plate could receive a small prize, such as a sticker, temporary tattoo or mini beach ball. Prizes were given out at various times during the intervention if researchers saw a student with the four healthy foods/beverage. Cash register receipts were used to measure differences in the purchase of healthy foods from baseline to the end of the five-month intervention.

Results showed plain milk purchases increased from 7.4 percent to 48 percent of total milk sales -- a 549 percent increase. Meanwhile, chocolate milk selection decreased from 86.5 percent to 44.6 percent of total milk sales. The total amount of milk purchased remained constant from baseline to the end of the study.

In addition, fruit selection increased by 20 percent from 1 to 1.2 items per student per day, and vegetable selection rose by 62 percent from 0.74 to 1.2 items per student per day. Power Plate selection increased 335 percent from baseline.

"It looks like we found a very promising, low-cost and effective way of improving the nutrition of elementary school children," said study author Robert Siegel, MD, FAAP, medical director of the Center for Better Health and Nutrition of the Heart Institute at Cincinnati Children's Hospital Medical Center. "This type of program may be a useful component in schools trying to improve the nutrition and health of their students."

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