Presentation on

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• Presentation on
• March 26, 2003 by
• Morten Strunge Meyer
• Danish Cancer Society

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School Fruit and Vegetable Snack ProgramsThe
European Experience
Presentation on March 26, 2003 by Morten Strunge
Meyer Danish Cancer Society
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Agenda

• 3 recently publishedEuropean studies
• Quick round trip to 5European countries
• Why fruit snack programs in schools is a hot
  topic world wide
• Challenges for fruit snack programs in schools
  world wide

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Study 1 from UK

• Pre-war diet and health study
• 1937-39 in England Scotland
• 1352 working class families
• 4999 children
• Followed up with 87 of the cohort in July 2000
• Cancer and Mortality
• 7 day kitchen inventory supply
• (Maynard et al. 2003)

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UK Results
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UK Results
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Conclusion

• 60 years of follow-up wow!
• 30-40 reduced risk of cancer associated with
  eating fruit
• Also effect of fruit on mortality
• But no effect of vegetables
• Diet data not on individuals

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Study 2 from Germany

• Effect of cutting produce into bite-size pieces
• Only one month follow-up
• 92 kids in 4 classes
• Free apples, bananas and carrots
• 2 classes got whole pieces
• 2 classes got bite-size pieces
• (Bönnhoff et al. 9/2002)

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German Results
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German Results

• Normal intake 182 g
• Ad libitum whole pieces 80 g
• Bite-size cut pieces 73 g
• Perspectives
• Short period
• What do they eat at home?
• Is this study relevant for you?

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Study 3 from Denmark
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Methods
Intervention trial in 4 schools Total of 1800
kids 45 of 6-10 year olds subscribed parents
pay 240 dietary recalls before the
intervention And again after 5 weeks
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Results from Denmark
Important social break Variation and
quality Commercial 275 schools Only 10
subscribing
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Unofficial Results
Initially only 2 out of 41 schools accepted to
test School Fruit Schools initial concerns
Parents responsibility not ours
We have too much to do already
Worsen social inequalities
Difficult administration
Distribution and storage problems
Garbage all over
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European Roundtrip

• Denmark
• Norway
• The Netherlands
• France
• England

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Norway
Subscription programme in its 8th year Parents
pay 2,5 NKRGovernment pay 0,7 NKR a day Very
close to national coverage 30 - 35 participation
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Norway Lessons Learned

• Too many suppliersNeed more participants
• Short on funding now solved
• Recipe for a healthier Norway

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ProChildren Project

• Multi-center study funded by EU
• Determinants
• Intervention
• Preliminary resultsEnvironment is
  importantKids eat more when its free!

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The Netherlands
7th year now New 3-year programme introducing a
new word Gruiten Free for 70,000 kids age 412
in big cities 2 days a week 70 of schools
participate expected to increase
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The Netherlands

• 100 of kids participate
• Financed by governmentand industry
• Expecting parents and local authorities to take
  over after 3 years
• Will evaluate impact on total diet

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France

• Ongoing feasibility study on the use of vending
  machines for fruits and vegetables in high
  schools
• Possibly government-subsidized prices on a
  national scale

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England

• Part of the
• National Health plan
• Target All children age 4-6 will have one piece
  of fresh fruit each day in school by the end of
  2004

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Health and Social Reasons

• Average 2 portions per day
• 20 do not eat any fruit in a week
• Three out of five children eat no leafy green
  vegetables in a week
• Half of all children do not drink any fruit juice
  in a week
• Children in the lowest income groups are about
  50 less likely to eat fruit and vegetables

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Target by the End of 2004

• 2.2 million kids
• 16,000 schools
• 200 school days a year
• 500 million pieces of fruit a year

• Today 600,000 kids enrolled
• Positive impact on school life
• Calming effect
• Improved attention levels
• Support to teaching

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England Economy

• All costs paid by Department of Health, minister
  of public health

YVETTE COOPER
Price tag approximately 2 US per
inhabitant Politicians are committed
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English Challenges

• Very limited variety
• Distribution and administration done centrally
  big task

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Hot Topic World Wide Why?

• Non-communicable diseases
• Obesity-epidemic
• Popular and visible thing to do
• Easy and EFFECTIVE thing to do
• Traditional nutrition campaigns proven not
  effective
• AVAILABILITY and READY to EAT

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Workplace Fruit
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Methods

• 12 worksites
• 283 employees
• 2 dietary interviews
• Before and after 3 months
• 6 worksites started free fruit

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Results
96 make use of the offer daily or almost
daily 85 believe they now eat more Impossible
to stop
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Workplace Fruit

• Trendy lots of allies
• Attract and hold employees
• 40 workplace fruit providers
• Legitimacy in less well paid worksites

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Behaviour First
Traditionally we have tried to change knowledge
and attitudes to improve diets Company Fruit
proves that is a wrong strategy Changing
behaviour first is much more efficient and comes
before changing attitudes and values
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Problems
USA
Parent paid programmes do not reach poor
kids Expensive marketing Administrative
burden Distribution burden Need for more
variation Allowing for special taste/allergy needs
Keep fruit separate from lunch
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Thank you
www.6aday.com
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References

• M. Maynard et al.
• Fruit, vegetables, and antioxidants in childhood
  and risk of adult cancer the Boyd Orr cohort
• J Epidemiol Community Health 57 p218-225, 2003
• N. Bonnhoff et al.
• Increased fruit and vegetable consumption in
  elementry school children (in german)
• Ernahrungs-Umschau 49 p340-343, 2002
• Karen Eriksen et al.
• Effect of a fruit and vegetable subscription in
  Danish schools
• Public Health Nutrition 6 p57-63, 2003