, et al
Effects of choice architecture and chef-enhanced meals on the selection and consumption of healthier school foods: a randomized clinical trial
JAMA Pediatr
; doi:

Investigators from Harvard partnered with a nonprofit organization, “Project Bread,” to develop and conduct the Modifying Eating and Life-style at School (MEALS) study. For MEALS, investigators assessed the benefits of having meals prepared by a professional chef and/or a smart café intervention on food choices and consumption in schools. The smart café design incorporates choice architecture strategies: placing vegetable selections first, using signage to promote fruits and vegetables, and placing fruit in attractive containers. Third- to eighth-grade students from 14 elementary and middle schools where a high percentage of students received free or reduced-price lunch were enrolled in the study. After evaluation of baseline food selection and consumption practices, 4 schools were randomly assigned a chef to help redesign school meals while the other 10 schools were controls. After a 3-month period, the percentage of participating students at “chef-enhanced” schools selecting and consuming a vegetable and/or fruit was compared to that in participants at the control schools. Subsequently, 2 of the chef-enhanced schools and 4 non-chef schools were randomly assigned to the smart café intervention; the remaining 8 schools served as controls. The analyses were repeated 4 months later comparing selection and consumption among children in prolonged (7 months) chef-enhanced schools, those exposed to 4 months of smart café design, participants in chef-enhanced plus smart café design schools, and controls.

Among 2,638 students, baseline fruit selection at each school ranged from 46.9% to 79.1% among participants, and vegetable selection varied from 39.7% to 62%. After 3 months of chef-enhanced meals, vegetable selection was significantly greater in participating students compared to those in control schools (OR = 1.75), but there were no significant differences in fruit selection or any form of fruit consumption between groups. Fruit and vegetable selection were significantly greater among students exposed to 7 months of chef-enhanced meals than among controls (fruit OR = 3.08, vegetable OR = 2.54). Similarly, those in smart café schools had significantly greater fruit and vegetable selection than control students (OR = 1.45 and OR = 1.91, respectively), as did participants exposed to both chef-enhanced meals and smart café design (OR = 3.10 and OR = 7.38, respectively). Compared to control students, those in chef-enhanced schools for 7 months had significantly greater fruit consumption and those in chef-enhanced plus smart café design schools had significantly greater vegetable consumption.

The authors conclude that both collaborating with chefs and using choice architecture to increase the draw for students to choose a fruit or vegetable may be effective. The effect of chef-enhanced foods was only apparent after 7 months of repeated exposure.

Dr Schreiber has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of...

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