By:Ayala Laufer-Cahana, M.D.
Would you like a green salad with that?
Imagine being asked that question at fast food restaurants -- the way you're reminded about fries and a drink. Would it increase vegetable consumption?
Eating more fruits and veggies is the most tried and true piece of nutrition advice ever to be given -- health experts agree on it, and it has been withstanding the test of time and further research for many decades. The World Heath Organization estimates that 1.7 million deaths could be prevented each year -- 14 percent of gastrointestinal tract cancer deaths, 11 percent of heart disease deaths, and 9 percent of stroke deaths -- if people ate enough (400 grams or about 14 ounces) of these plants. Yet despite the consensus, very few people actually eat the recommended amounts: In the U.S. only 6 percent reach the target for vegetables and only 8 percent the recommended target for fruit.
Governments, industry and non-profits have made an effort to get the word out.
A new article by Reetica Rekhy and Robyn McConchie, published online ahead of print in Appetite, looks at the major programs put in place in the past decade and measures their effectiveness. Let's join the authors for trip around the world. Making produce sexy
Australia's social campaign "Go for 2&5" was designed to increase awareness and get people eating two servings of fruits and five servings of veggies a day. The national "Go for 2&5" campaign ended in 2007 after running for about two years due to lack of funding. After three years, consumption increased on average by a modest 0.8 servings, and as of 2011-2012, only 5.6 percent of Australian adults get their 2&5.
In the United States, the "5 A Day for Better Health" ran from 1991-2006 and was replaced in 2007 by "Fruits & Veggies -- More Matters" after research showed that more indeed matters. The campaign was a joint venture of governmental agencies as well as non-profits such as the Cancer Society and the Diabetes Association, as well as growers, manufacturers, foodservice and consumers' groups. Surveys showed that consumption overall remained unchanged (at 1.8 cups a day), but did increase modestly for kids. Awareness of the campaign was a bright spot: 26 percent of people knew about the message by 2012.
Denmark launched "6 a Day" in 1999 as a public-private campaign that ran for five years. It both promoted and increased access to fruits and veggies in schools, cafeterias and food-service, and is one of the best known programs in the European Union. The number six was chosen because it's pronounced "sex" in Danish, and is therefore easier to recall, especially by men. And six, or sex, was indeed a magic word. Kids 4-10 increased fruit intake by about 30 percent, veggies by as much as 60 percent, and 11-75 year olds increased fruit by 40 percent and veggies by 75 percent! The Danes actually seem to consume their recommended daily intake.
In the United Kingdom a program called "Food Dudes," designed to increase fruit and veggie intake and to reduce the intake of unhealthy foods, was developed at Bangor University in 2009. The Food Dudes are heroes of healthy eating featured in an adventure series of DVDs, and they encourage repeat tasting of fruits and veggies and offer awards to kids who comply. Controlled trials have shown the program to increase fruit and veggie consumption by as much as 60-200 percent.
Reetica and McConchie admit that it is difficult to compare the programs, and there is limited data about their effectiveness, but overall, they can say that while the campaigns have been successful in raising awareness, fruits and veggie consumption usually increased just modestly. The Danish 6 a Day and the British Food Dudes show more promise in that respect. Campaigns in which government and non-profits collaborated with industry and retail tended to be more effective, and those with clear goals, clear messages, involvement of the entire family and an interactive nature also saw more success.
Proven ways to increase fruit and veggie intake
Awareness is just the prelude to behavior change, and much more needs to be done. The authors offer several strategies, shown to increase fruit and veggies intake.
• Automatically include fruits and veggies as a side dish: If consumers would rather have French fries they'll have to ask.
• Make fruits and veggies more visible: the highest visibility points in a retail space are well known (have you noticed how much you notice the display near the cash register?) and should be reserved for healthy foods.
• Offer fruits and veggies as snacks during the day and include them in all meals.
• Offer price discounts and bonus deals on fruits and veggies.
Use positive role models to promote fruits and veggies (that is the essence of the British Food Dudes program and what's behind celebrity endorsment of any product).
• Involve kids in growing and cooking fruits and veggies. The "seed to table" experience will grow their love and desire to try these plant foods -- and it's a lot of fun!
Finally, I'd like to add a few words about what's competing with fruits and veggies' share of stomach. Although the $3-5 million a year spent on Fruits and Veggies -- More Matters (according to personal communications with the study's authors) seem like a lot of money, the fast food industry spends more than $5 million every day on marketing unhealthy foods to kids. Even a crystal clear, music-to-the-ear message hardly registers with so much noise.