A recipe for taste connoisseurs

Can schools teach children lessons in healthy eating? Helen Coulthard looks at the evidence…
With poor diet being cited by Public Health England as the leading cause of death in the UK, learning the skill of healthy eating could save your life.

As a society we have a lot of knowledge about what makes a good diet, and have consumption targets such as consuming five portions of fruits and vegetables each day. Most people are aware that consuming a good diet is associated with increased wellbeing in the short term, and the prevention of chronic illness in later life. Despite this knowledge, in 2016 Public Health England reported nearly one-third of all children aged 2-15 years in the UK were classified as being at risk of overweight or obesity. In addition, the incidence of type 2 diabetes in children is increasing each year.

These trends are set against a backdrop of the modern food environment: a challenging one, where processed and packaged foods are advertised, endorsed and valued. Psychologists such as Jane Wardle have called this the ‘obesogenic environment’, as it encourages consumption of readily available high calorie foods. Yet schools present a somewhat different environment: one increasingly akin to a bubble, where the images, messages and structure can be protected. Interventions can be controlled, implemented at low cost, and the participants are available and willing. This is in stark contrast to the world outside the gates, where takeaways and sweet shops cluster around schools, and parents are hard to recruit and retain.

So, can schools, who only feed children some of their meals, be a place where healthy eating skills can be taught?

The national curriculum
Healthy eating has been in the national curriculum for many years, with the inclusion of experiential learning through cooking across primary and secondary schools from 2014. The main aim of the national curriculum is to standardise knowledge and learning across the UK. Yet when I have talked to teachers about the challenges of delivering healthy eating in schools, and fulfilling the national curriculum on food education, the message is clear: Delivery is dependent on the school. With pressure to meet literacy and numeracy targets, aspects of the national curriculum relating to healthy eating can be sidelined and ignored.

In the UK, food-related teaching has centred on education about healthy eating targets. When I have carried out sessions with teenagers on their memories of lessons on healthy eating, the feedback they give is consistent. The educational messages taught such as the ‘healthy plate’, ‘five a day’ or oral health messages are remembered. However they all stated that these lessons had not influenced their eating behaviour. They found these classes uninspiring and boring. It is unlikely that these educational techniques will have any impact on the quality of our children’s diets, unless the way the information is taught is radically changed.

In experimental research Jane Wardle found that most children are motivated to eat according to taste not health. The health risks connected with eating poor quality food seem far away and abstract to younger children: consider yourself, Would you prefer to eat something that may prevent you getting ill in the future or something that tastes delicious? Yet the educational system, and many public health messages, are still organised on the belief that educating children about healthy diets is the key to behaviour change. Teaching does not take into account empirical knowledge of children’s representations of food and how that links to food choice.

The lunch environment
Outside the classroom, food is an inevitable part of the school day, with children eating a substantial proportion of their caloric intake in school hours. Nutritionally, this has improved in leaps and bounds over the last 20 years, partly due to healthy eating champions such as Jamie Oliver. Children are provided with the opportunity each day to eat a healthy hot lunch and an additional fruit snack, both of which are free in key stage 1 (under the age of 8 years). However, provision and consumption are two very distinct concepts, and a considerable amount of healthy nutritious food ends up in the bin rather than children’s tummies. In addition, many parents and children still opt for packed lunches, which tend to be less regulated and nutritionally poor.

Sadly, two rather important factors have traditionally been ignored in the school canteen; the eating environment and children’s eating behaviour. Moore and colleagues in Wales, found that there are many aspects of the canteen environment that are challenging. There is generally a conveyor-belt system of queueing for food which is served by a caterer, leaving the child no agency to determine what portion size they want. Then eating is linked to play; the faster you eat, the more time you get in the playground. In the UK, we have often been behind our European counterparts in how the lunch environment is structured. In France for example, the idea of pleasure-based and sociable eating is structured into the school day, with longer and less rushed mealtimes. Lunchtime supervisors are in a difficult position; they have pressure to get children to eat some food, otherwise teachers will have difficulty retaining their pupils’ attention in the afternoon. However they also have to get a large number of children fed in a short window of time. This can lead to a rushed environment of pressuring and prompting, which can reduce liking for food. There needs to be much more research about how lunchtime supervisors can be supported to create a pleasurable eating environment in the school canteen.  

Psychological interventions
Psychological healthy eating interventions have traditionally been based on the three ‘R’s of evidence-based behaviourist strategies; rewards, role modelling and repeated exposure. These tend to focus on immediate tasting as the goal of any session, with positive role modelling and the use of tangible or social rewards acting as taste facilitators.

The most successful and well-designed psychological intervention to date is the Food Dudes, created by Pauline Horne and the late Fergus Lowe at Bangor University. Based on a superhero narrative, the intervention involves a series of six-minute cartoons where characters model positive outcomes of healthy fruit and vegetable consumption. This is combined with tasting opportunities for target foods at snack and lunchtime, with associated tangible rewards for successful tasting. The Food Dudes had excellent reported outcomes of increased fruit and vegetable consumption both in school and at home.

As a consequence the Food Dudes was bought by many education authorities, including  those in Ireland, the UK, Italy and some US states.

But there are some problems with the Food Dudes as a healthy eating intervention. Firstly, it is expensive, with schools having to buy the intervention package, including materials and trained staff to deliver the intervention. In addition, although tangible rewards, such as giving cups and pens, can be a successful strategy for tasting, there is a fine line between pressurising and encouraging exposure events. Children may feel pressurised to force down foods they find distasteful in order to secure a prize, which goes against the principles of pleasure-based eating. This has led myself and other researchers to create interventions that have focused on interacting with healthy food without immediate pressure to taste.

There has been a recent shift in looking at sensory education and sensory play as strategies for increasing pleasure based eating. In France school interventions have focussed on sensory education or ‘classes de gout’ (taste lessons), first created by Puisais in 1995. These methods encourage children to explore the tastes, smells and textures of foods, becoming taste connoisseurs. In these interventions, the child becomes an agent in the process, an expert on foods. This fits in well with the attitude to food as one of pleasure, sensation and discovery.

Implicit within this approach is that healthy, fresh foods taste better than processed foods. We have been carrying out experiments and interventions using multisensory play with real fruits and vegetables, such as restaurant plating games, bingo and making pictures with food based on narratives such as The Hungry Caterpillar by Eric Carle. Sensory play games are fun and rewarding, especially for younger children. The crucial element is that these games allow children to explore, and become familiar with, healthy foods without pressure to try.

These games can be time consuming, and require preparation, so should be an occasional technique rather than a daily opportunity. However sensory learning can be achieved through more conventional experiential learning tasks such as cooking and gardening lessons, which both allow hands on interaction with foods without pressure to taste.

Can schools solve the problem?
It is clear that schools may have a role in transforming the lives of our children through changing their eating behaviour. Yet at a time when schools are increasingly judged by key performance indicators, is it unfair to burden teachers with the task of delivering public health interventions and having the responsibility of ensuring our children’s long-term health? Although schools are attractive as they have a controlled environment, they may also be ineffective, as they do not teach parents and children how to navigate and make choices in the obesogenic environment. Amanda Spielman, the head of Ofsted, has recently been very vocal that schools cannot be held responsible for child obesity, citing the food environment and parenting failure as crucial contributory factors. Teachers that I have spoken to often cite that some parents are difficult to engage with, and these are the parents whose children are most ‘at risk’ for obesity.

In my view, there has to be a unified approach that includes the environment, parenting and schools. What schools can do is try to move away from a knowledge-based approach to healthy eating, and instead adopt a whole school approach to experiential and sensory learning about healthy food. This approach has the potential to give children a love of healthy food, which will hopefully be sustained throughout their lifespan.

- Helen Coulthard is a Senior Lecturer at De Montfort University, Leicester
[email protected]

Note: This article is part of a special collection.

References

Coulthard, H., & Ahmed, S. (2017). Non-taste exposure techniques to increase fruit and vegetable (FV) acceptance in children: The effects of gamification and FV stimuli. Appetite, 107679. doi:10.1016/j.appet.2016.08.030

Coulthard, H., & Sealy, A. (2017). Play with your food! Sensory play is associated with tasting of fruits and vegetables in preschool children. Appetite, 11384-90. doi:10.1016/j.appet.2017.02.003

Lowe, C. F., Horne, P. J., Tapper, K., Bowdery, M., & Egerton, C. (2004). Effects of a peer modelling and rewards-based intervention to increase fruit and vegetable consumption in children. European Journal Of Clinical Nutrition, 58(3), 510-522.

Moore S. N., Murphy S., Tapper K., & Moore L. (2010). The social, physical and temporal characteristics of primary school dining halls and their implications for children’s eating behaviours. Health Education, 110, 399–411.

Reverdy, C., Chesnel, F., Schlich, P., Koster, E.P., Lange, C., 2008. Effect of sensory education on willingness to taste novel food in children. Appetite 51, 156_165.

Wardle, J., & Huon, G. (2000). An experimental investigation of the influence of health information on children's taste preferences. Health Education Research, 15(1), 39-44. 

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