Lucy Cooke

Modifying children's food preferences: the effects of exposure and reward on acceptance of an unfamiliar vegetable

Objective: The aim of this study was to evaluate two interventions (one reward-based and one exposure-based) for increasing childrens acceptance of an unfamiliar vegetable compared with a no-treatment control. It was predicted that the exposure condition would increase liking for, and consumption of, the vegetable relative to either the reward or control group.Design: Using a randomized controlled design, participants were assigned to one of two intervention groups (exposure or reward) or to a no-treatment control condition, for a 2 week period. Liking for, and consumption of, red pepper was assessed before and after the treatment period.Setting: The study was conducted in three primary schools in London.Subjects: Parental consent was obtained for 49 out of a possible 72 children.Interventions: Interventions comprised eight daily sessions during which participants in the exposure group were offered a taste of sweet red pepper and told that they could eat as much as they liked. Participants in the reward group were shown a sheet of cartoon stickers and told that they could choose one of them on condition that they ate at least one piece of the pepper.Results: The exposure-based intervention significantly increased both liking (P=0.006) and consumption (P=0.03) compared with the control group. The outcome of the reward intervention was intermediate and did not differ significantly from the exposure or control conditions.Conclusions: Repeated exposure to the taste of unfamiliar foods is a promising strategy for promoting liking of previously rejected foods in children.Sponsorship: This study was financed by Cancer Research UK.

Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children

OBJECTIVE To examine the contribution to fruit and vegetable eating in children of potential predictive variables within the domains of demographics, parental feeding practices and personality traits. DESIGN Cross-sectional survey. SETTING Questionnaires were distributed to parents through 22 London nursery schools. SUBJECTS Questionnaires were completed and returned by 564 parents or principal caregivers of 2-6-year-old children. RESULTS Significant predictors of childrens fruit and vegetable intake emerged from all three domains examined. Demographic variables associated with childs vegetable consumption were mothers education and childs age and gender. Only ethnicity was significantly associated with fruit consumption. Parental consumption, breast-feeding and early introduction to fruit and vegetables were related to intake of both. Family meal times were associated with higher intake of vegetables, but not of fruit. Two characteristics of children themselves (food neophobia and enjoyment of food) were strongly related to the consumption of fruit and vegetables. Subsequent multivariate analyses revealed that parental intake and child food neophobia independently predicted intake of both foods. In the presence of these, fruit consumption was affected by breast-feeding and early introduction to fruit, whereas vegetable consumption was related only to childs gender and enjoyment of food. CONCLUSIONS These findings may be used to inform future interventions aimed at increasing childrens consumption of fruit and vegetables. Parents should be made aware of the possible impact of their own behaviour on the eating habits of their children.

Age and gender differences in children's food preferences.

The present study was conducted to examine the developmental patterning of food preferences in a large sample of British schoolchildren and to investigate possible gender differences. Using a cross-sectional survey design, the study was carried out in three primary and three secondary schools in West London, UK. A total of 1291 children aged from 4 to 16 years completed a 115-item food preference questionnaire in class time, supervised by class teachers and assistants. Children indicated whether they had ever tried each item and, if so, how much they liked it. We observed age-related increases in the number of foods tried (P<0.001), liked (P<0.005) and disliked (P<0.05). Controlling for the number of foods tried rendered the increase in dislikes non-significant and reversed the age effect on the number liked. Girls liked fruit (P<0.05) and vegetables (P<0.001) more than boys did; boys liked fatty and sugary foods (P<0.005), meat (P<0.001), processed meat products (P<0.001) and eggs (P<0.05) more than girls did. Some age differences were apparent in liking for categories of food, although the effects were not linear. Across ages and genders, children rated fatty and sugary foods most highly, although ratings for fruit were also high. Childrens food preferences overall are not consistent with a healthy diet. Interventions should focus on increasing the familiarity, availability and accessibility of healthy foods and should be mindful of the need to target messages appropriately for boys who have less healthful food preferences than girls at all ages.

Genetic and environmental determinants of children's food preferences

Omnivores have the advantage of a variety of food options but face a challenge in identifying foods that are safe to eat. Not surprisingly, therefore, children show a relative aversion to new foods (neophobia) and a relative preference for familiar, bland, sweet foods. While this may in the past have promoted survival, in the modern food environment it could have an adverse effect on dietary quality. This review examines the evidence for genetic and environmental factors underlying individual differences in childrens food preferences and neophobia. Twin studies indicate that neophobia is a strongly heritable characteristic, while specific food preferences show some genetic influence and are also influenced by the family environment. The advantage of the malleability of human food preferences is that dislike of a food can be reduced or even reversed by a combination of modelling and taste exposure. The need for effective guidance for parents who may be seeking to improve the range or nutritional value of foods accepted by their children is highlighted.

Food neophobia and mealtime food consumption in 4-5 year old children.

BackgroundPrevious research has documented a negative association between maternal report of child food neophobia and reported frequency of consumption of fruit, vegetables, and meat. This study aimed to establish whether neophobia is associated with lower intake of these food types in naturalistic mealtime situations.MethodsOne hundred and nine parents of 4–5 year olds completed questionnaires which included a six-item version of the Child Food Neophobia Scale (CFNS). The children took part in a series of 3 test lunch meals at weekly intervals at school at which they were presented with: chicken, cheese, bread, cheese crackers, chocolate biscuits, grapes and tomatoes or carrot sticks. Food items served to each child were weighed before and after the meal to assess total intake of items in four categories: Fruit and vegetables, Protein foods, Starchy foods and Snack foods. Pearson Product Moment Correlations and independent t tests were performed to examine associations between scores on the CFNS and consumption during lunches.ResultsNeophobia was associated with lower consumption of fruit and vegetables, protein foods and total calories, but there was no association with intake of starch or snack foods.ConclusionThese results support previous research that has suggested that neophobia impacts differentially on consumption of different food types. Specifically it appears that children who score highly on the CFNS eat less fruit, vegetables and protein foods than their less neophobic peers. Attempts to increase intake of fruit, vegetables and protein might usefully incorporate strategies known to reduce the neophobic response.

Changing perceptions of weight in Great Britain: comparison of two population surveys

Objectives To examine changes in public perceptions of overweight in Great Britain over an eight year period. Design Comparison of data on self perceived weight from population surveys in 1999 and 2007. Setting Household surveys of two representative samples in Great Britain. Participants 853 men and 944 women in 1999, and 847 men and 989 women in 2007. Main outcome measures Participants were asked to report their weight and height and classify their body size on a scale from “very underweight” to “obese.” Results Self reported weights increased dramatically over time, but the weight at which people perceived themselves to be overweight also rose significantly. In 1999, 81% of overweight participants correctly identified themselves as overweight compared with 75% in 2007, demonstrating a decrease in sensitivity in the self diagnosis of overweight. Conclusions Despite media and health campaigns aiming to raise awareness of healthy weight, increasing numbers of overweight people fail to recognise that their weight is a cause for concern. This makes it less likely that they will see calls for weight control as personally relevant.

Eating for Pleasure or Profit The Effect of Incentives on Children’s Enjoyment of Vegetables

Parents commonly use rewards to encourage children to eat healthfully, but this practice remains controversial because rewards are suspected of undermining children’s intrinsic motivation. A cluster-randomized trial examined children’s acceptance of a disliked vegetable over 12 daily taste exposures. These exposures were paired with a tangible reward, a social reward, or no reward, and the findings were compared with the results from a no-treatment control condition. Liking and intake of the vegetable were assessed in a free-choice consumption task at preintervention, postintervention, 1 month after intervention, and 3 months after intervention. Liking increased more in the three intervention conditions than in the control condition, and there were no significant differences between the intervention conditions. These effects were maintained at follow-up. Children in both reward conditions increased consumption, and these effects were maintained for 3 months; however, the effects of exposure with no reward became nonsignificant by 3 months. These results indicate that external rewards do not necessarily produce negative effects and may be useful in promoting healthful eating.

Environmental and individual determinants of core and non-core food and drink intake in preschool-aged children in the United Kingdom

Background/Objectives:Strategies to achieve healthier diets for children are likely to benefit from an understanding of the determinants. We examined environmental and individual predictors of childrens intake of ‘core’ foods (fruit and vegetables) and ‘non-core’ foods (snacks and sweetened beverages). Predictors included parental intake, home availability, parental feeding styles (Encouragement and Monitoring) and childrens food preferences. Based on research with older children, we expected intake of both food types to be associated with maternal intake, core foods to be more associated with childrens preferences and non-core food intake more with the home environment.Subjects/Methods:Primary caregivers (n=434) of children (2–5 years) from preschools and Childrens Centres in London, UK, completed a self-report survey in 2008.Results:Multiple regression analyses indicated childrens fruit intake was associated with maternal fruit intake (B=0.29; P=0.000), childrens liking for fruit (B=0.81; P=0.000) and a Monitoring style of parental feeding (B=0.13; P=0.021). Childrens vegetable intake was similarly associated with maternal intake (B=0.39; P=0.000), childrens liking for vegetables (B=0.77; P=0.000), Encouragement (B=0.19; P=0.021) and Monitoring (B=0.11; P=0.029). Non-core snack intake was associated with maternal intake (B=0.25; P=0.029), Monitoring (B=−0.16; P=0.010), home availability (B=0.10; P=0.022) and television viewing (TV) (B=0.28; P=0.012). Non-core drink intake was associated with maternal intake (B=0.32; P=0.000) and TV (B=0.20; P=0.019).Conclusions:Results indicate commonalities and differences in the predictors of core and non-core food intake, with only maternal intake being important across all types. Effective interventions to improve young childrens diets may need to call on different strategies for different foods.

Increasing food acceptance in the home setting: a randomized controlled trial of parent-administered taste exposure with incentives

BACKGROUND The use of rewards to encourage children to eat healthily is controversial. However, researcher-led interventions have shown that incentives combined with taste exposure can increase both intake and liking. To date, this has not been tested in the home setting. OBJECTIVES The objectives were to test the hypothesis that parent-administered repeated taste exposures to an initially disliked vegetable combined with reward will increase childrens liking and intake and to compare the effects of tangible and social rewards. DESIGN In this randomized controlled trial, families with children aged 3-4 y (n = 173) were randomly assigned to exposure + tangible reward (sticker), exposure + social reward (praise), or no-treatment control conditions after a pretest assessment in which a target vegetable was selected for each child. In the intervention groups, parents offered their children 12 daily tastes of the vegetable, giving either praise or a sticker for tasting. No specific advice was given to the control group. Assessments of intake and liking of the target vegetable were conducted by researchers immediately after the intervention period and 1 and 3 mo later. RESULTS Children who received exposure + tangible rewards increased their intake (P = 0.001) and liking (P = 0.001) of their target vegetable significantly more than did children in the control group. Differences were maintained at the 3-mo follow-up (intake: P = 0.005; liking: P = 0.001). Increases in intake and liking in the exposure + social reward group were not significantly different from the control group. CONCLUSION The findings of this home-based study support parental use of tangible rewards with repeated taste exposures to improve childrens diets. This trial is registered as ISRCTN42922680.

Do social norms affect intended food choice

OBJECTIVE To evaluate the effect of social norms on intended fruit and vegetable intake. METHODS A two-stage design to i) compare the perceived importance of normative influences vs cost and health on dietary choices, and ii) test the prediction that providing information on social norms will increase intended fruit and vegetable consumption in an experimental study. Home-based interviews (N=1083; 46% men, 54% women) were carried out as part of the Office for National Statistics Omnibus Survey in November 2008. RESULTS The publics perception of the importance of social norms was lower (M=2.1) than the perceived importance of cost (M=2.7) or health (M=3.4) (all ps<0.001) on a scale from 1 (not at all important) to 4 (very important). In contrast, results from the experimental study showed that intentions to eat fruit and vegetables were positively influenced by normative information (p=0.011) in men but not by health or cost information; none of the interventions affected womens intentions. CONCLUSIONS People have little awareness of the influence of social norms but normative information can have a demonstrable impact on dietary intentions. Health promotion might profit from emphasising how many people are attempting to adopt healthy lifestyles rather than how many have poor diets.