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Following the latest report on the nation’s diet by NHS Digital, the Secretary of State for the
Department of Health and Social Care is concerned that fruit and vegetable consumption among
UK children is decreasing despite numerous public health campaigns and nutrition guidelines
being implemented. He is meeting the Secretary of State for the Department of Education to
discuss how the two departments can work together to improve current food policy and design new
intervention to increase fruit and vegetable consumption in children. He is thinking there should be
less focus on health messaging and more emphasis on socio-cultural perspective to target
children’s attention. He is seeking your input for his meeting to understand the socio-cultural
factors that influence fruit and vegetable consumption among children and policy implications on
this issue.
To: Matt Hancock, Secretary of State for Department of Health and Social care
Date: 3/01/2020
Subject: Socio-cultural factors influencing fruit and vegetable intake among children
1. Introduction
Healthy eating is promoted among children in the belief that positive eating behaviours that
are initiated in childhood, continue over the adolescence years and persist into adulthood
(Lytle et al., 2000). Thus, encouraging children to eat more fruits and vegetables (FV) from
the start could lead to long-term physiological benefits and contribute to healthy cognitive
development (Tandon et al., 2016). Evidence show that children generally do not see it as
their role to be interested in health (EPPI, 2003). Instead, they value eating as a social
occasion and actively seek ways to exercise their own food choices based on food culture
at home and peer influences in school (EPPI, 2003). In order to develop effective
attention.
2. Objectives
WHO (2018) recommends that people to eat at least five servings of FV which is
approximately 400g per day and many countries including the UK adopted this into
Recent health survey indicates that only 18% of children in the UK aged 5 to 15
Recent data also shows alarming numbers of obese and overweight children with
more than 1 in 5 children are overweight or obese when they begin school, and 1 in
3 children are overweight or obese by the time they leave primary school (Public
Poor diet and low levels of physical activity are the primary factors to excess weight
Diets high in fruit and vegetables (FV) are linked to various health benefits including
The Global Burden of Disease Study reported low FV intake is one of the top ten
The WHO estimated that 3.9 million deaths worldwide in 2017 were attributable to
inadequate FV consumption.
4. Timing
Immediate
5. Background:
The fundamental problem behind public health issue for children are the changes in
food habits that have developed mainly due to changes in lifestyle, food industry
advertising and globalisation of fast food over the last few decades.
The increase in families two working parents, pressure of work, time limitation has
Many children grow up with out the basic skills of cooking a healthy meal and eating
out may be the only option for feeding themselves, encouraging the consumption of
unhealthy food and snacks with unknown nutrient contents (James, 2002).
The consumption of snacks products high in fat, sugar and salt may be responsible
trade-off between time and being healthy. Children prefer snacks like chocolate bar
because these are instantly available, can be eaten immediately, do not require
As taste and quality is guaranteed they do not risk wasting money on bad quality or
socially acceptable food such as confectionary, crisps and flavoured drinks rather
Peer influences towards easting FV differ by gender because of the symbolic value
of eating FV with respect to image and gender identify (xxxx et al. xxxx)
A study in primary school in Scotland reported that school girls valued the social
aspects of snacks compared to boys (Ross, 1995). Husby et al. (2009) identified
that girls prefer to swap food with their friends, for example pizza for fruit.
But another study reports that boys don’t want to swap healthy food (Ross, 1995).
This supports the finding that gender is among strongest determinants of FV intake
Eating is a social behaviour; children establish eating habits and awareness of type
of food through observing their parents and family. Cox et al. (1998) studied
School Fruit Health (DOH) every school day for distributing the fruits in
(1999) 2011)
before school
Source: Compiled by authors from various sources (DOH,2011) and (EPPI, 2003)
Although, these programmes have been rolled out nationally to ensure that school children
are able to eat healthily, these interventions do not specifically target to increase FV
consumption to meet the ‘5 A Day’ nutritional guidelines.
7. Policy Recommendation and Considerations
Recommendation A:
Previous research confirms that schools are the most popular way of accessing
In many schools, vending machines are usually the only source of snacks during
lesson break and sport activities. Vending machines have been criticised for
Vending machines could be used to sell healthier options for e.g. fruits; apple,
If there are no facility for vending machines, fruit tuck shops can be set-up by
Considerations:
Since the majority of British Children do not eat school lunches, other
Although children like the taste of FV, they are unwilling to sacrifice time to
wash, dry, peel or cut fruits. This lack of facilitation has been identified as a key
pre-packaged snacks that were easy to carry and no preparation was required
e.g. fruit gets bruised in the bag compared to a packet of crisps (Krølner et al.,
2011).
will buy a range of healthier products from vending machines when available
even though they are the usual brand products (Harvey, 2004)
Vending machines containing soft drinks, confectionary and crisps should not be
A few schools in Europe have banned school snack bars from selling soft drinks,
chocolate bars and crisps and replacing them with healthy alternatives such a
One UK study examined the impact of a school fruit tuck shop scheme on the
diets of children aged 9-11 years, results suggest that where children are not
allowed to bring unhealthy snacks to school, their willingness to utilise the fruit
tuck shops and eats fruits as snacks in school is greatly enhanced (L Moore,
2008)
Schools can join FV weekly subscription plan with local producers to ensure
children get access to fresh, local and seasonal FV. School can work with local
Given exchanging food among peer is an important social event for children, the
provided by schools does not act as a replacement for that normally received at
home.
Recommendation B:
The parent newsletter message should aim to increase home availability and
Consideration
children’s health
behaviours last longer if interventions are aimed at family behaviour and eating
results show that the quantity of FV that parents themselves reported eating was
having materials sent to them directly (Contento & Michela, 1998; Foerster et
school health, food and nutrition initiatives with parents involved in planning
process
Parents who are not participating actively should be kept up-to date about
Implement both Option 1 and Option 2 together to increase availability and accessibility in
Considerations:
snack of FV.
Children prefer food that they are familiar with and their familiarity is created by
vegetable for 2 weeks continuously could increase children’s liking for that
vegetable.
Recommendation D:
Do nothing
Considerations:
children may not get easy access to FV and the lack of facilitation will remain as
nutrition guideline which may not be possible given not all parents are aware of
this guideline and the benefits of healthy eating starting from childhood
FV will not be a popular social snack and may be remain as gendered food
choice
The alarming obesity levels among UK children may continue to rise due to poor