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Art on a Plate: A Pilot Evaluation of an International Initiative Designed to Promote Consumption of Fruits and Vegetables by Children

Open AccessPublished:April 29, 2019DOI:https://doi.org/10.1016/j.jneb.2019.03.009

      Abstract

      Objective

      To evaluate the 2016 International Chefs Day cooking workshops Art on a Plate.

      Design

      Nonexperimental pretest-posttest design

      Setting

      Art on a Plate workshops with children from 14 countries in Asia, America, and Europe.

      Participants

      A total of 433 workshop participants aged 4–14 years (mean age, 8.6 years).

      Intervention

      Instructed by a chef, children in the workshops created a self-chosen design on their plate with a spinach–fruit salad.

      Main Outcome Measures

      Before and after the workshop, a questionnaire assessing liking and willingness to eat or taste; hunger was assessed using the Teddy the Bear method and emotions were assessed using the Self-assessment Manikin. The event coordinator evaluated salad intake.

      Analysis

      Linear and generalized linear (logit) mixed models were used to test statistical differences before and after the workshop.

      Results

      The workshop resulted in a small increase in liking (n = 409; P = .02) and person control (n = 375; P < .001) and a decrease in hunger (n = 379; P < .001). A total of 30% of children increased their liking scores, 18% decreased them, and 52% did not change them. Significant associations of liking and change in liking with salad intake were in the expected direction.

      Conclusion and Implications

      This study showed the positive effect of a cooking workshop on children's salad liking across a selection of countries worldwide. Further research and novel methods are needed to evaluate the long-term effectiveness of cooking activities in real-life settings across countries.

      Key Words

      Introduction

      Although the promotion of healthy eating habits in children is considered to be highly important, school-based interventions, which often focus on increasing fruit and vegetable intake, have had minimal impact on vegetable intake.
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      Simultaneously, vegetable intake remains a parental concern.
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      “Just three more bites”: an observational analysis of parents’ socialization of children's eating at mealtime.
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      Strategies used by parents to influence their children's food preferences.
      The use of experiential learning strategies in school education programs is associated with the largest increases in fruit and vegetable consumption, preference, and nutritional knowledge outcomes.
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      Changing children's eating behaviour—A review of experimental research.
      • Hersch D
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      The impact of cooking classes on food-related preferences, attitudes, and behaviors of school-aged children: a systematic review of the evidence, 2003-2014.
      • Dudley DA
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      Teaching approaches and strategies that promote healthy eating in primary school children: a systematic review and meta-analysis.
      The mechanism behind the positive effects of participatory activities (eg, cooking foods) potentially relates to several factors, such as having choices,
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      increasing familiarity with foods,
      • Heath P
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      Increasing food familiarity without the tears: a role for visual exposure?.
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      The role of familiarity in dietary development.
      a higher degree of child control and a consequent level of intrinsic motivation and pride,
      • Rohlfs Dominguez P
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      • et al.
      Providing choice increases children's vegetable intake.
      • Dougherty K
      • Silver C.
      Chef-nutritionist teams spark enjoyment and learning in cooking education series for 8- to 12-year-olds.
      • Heim S
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      A garden pilot project enhances fruit and vegetable consumption among children.
      the higher value placed on self-created objects,
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      I cooked it myself: preparing food increases liking and consumption.
      and the positive context in which cooking activities take place.
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      Overcoming picky eating. Eating enjoyment as a central aspect of children's eating behaviors.
      • Galloway AT
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      “Finish your soup”: counterproductive effects of pressuring children to eat on intake and affect.
      In addition to intervention studies that often combined several elements such as education and gardening activities with cooking, 2 experimental studies assessed the immediate effect of cooking on subsequent intake. Results from these experimental studies showed increased vegetable intake
      • van der Horst K
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      Involving children in meal preparation: effects on food intake.
      and increased willingness to choose and taste unfamiliar foods with vegetables.
      • Allirot X
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      Involving children in cooking activities: a potential strategy for directing food choices toward novel foods containing vegetables.
      Observational studies showed that cooking activities were associated with diet quality and fruit and vegetable intake in children
      • Chu YL
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      Involvement in meal preparation at home is associated with better diet quality among Canadian children.
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      and adolescents.
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      Food preparation and purchasing roles among adolescents: associations with sociodemographic characteristics and diet quality.
      In addition to participatory activities, several factors such as role modeling,
      • Yee AZ
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      The influence of parental practices on child promotive and preventive food consumption behaviors: a systematic review and meta-analysis.
      availability (ie, whether the food is present),
      • Yee AZ
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      The influence of parental practices on child promotive and preventive food consumption behaviors: a systematic review and meta-analysis.
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      Relationship between the home environment and fruit and vegetable consumption in children aged 6-12 years: a systematic review.
      accessibility (eg, washed and cut into pieces),
      • Cullen KW
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      • Rittenberry L
      • de Moor C
      Availability, accessibility, and preferences for fruit, 100% fruit juice, and vegetables influence children's dietary behavior.
      and enhancing the visual appeal of foods were suggested as strategies for promoting fruit and vegetable intake in children.
      • van Kleef E
      • Vrijhof M
      • Polet IA
      • Vingerhoeds MH
      • de Wijk RA
      Nudging children towards whole wheat bread: a field experiment on the influence of fun bread roll shape on breakfast consumption.
      • Jansen E
      • Mulkens S
      • Jansen A
      How to promote fruit consumption in children: visual appeal versus restriction.
      An international cooking workshop was developed with the aim of creating a positive hands-on experience with fruits and vegetables for children. The workshops were organized during the International Chefs Day on October 20, 2016. International Chefs Day is celebrated by over 10 million chefs around the world. It is an event for chefs to engage with their communities, honor their profession, and share the pleasure of cooking. Nestlé Professional and the Nestlé Healthy Kids Program

      Nestlé. Nestlé Healthy Kids Programme.https://www.nestle.com/csv/global-initiatives/healthier-kids. Accessed February 25, 2019.

      initiated a yearly event in 2015 with cooking workshops for children together with professional chefs in over 60 countries. In 2016, the workshops were conducted in 62 countries, with approximately 2,000 chefs and 19,000 children participating in the cooking workshops.
      The workshops in 2016 were themed Art on a Plate and combined hands-on experience with other important determinants of fruit and vegetable intake, such as exposure, role modeling, and visual appeal. The objective of the current study was to assess the effectiveness of the workshops in achieving positive change in children's liking and willingness to consume the prepared fruits and vegetables. It was hypothesized that children's liking and willingness to consume the prepared fruits and vegetables would increase after completing the workshop.

      Methods

      Participants and Recruitment

      The 52 Nestlé Healthy Kids contact persons from countries that participated in the Art on a Plate event were asked to participate in the evaluation on a voluntary basis as well, which resulted in 17 countries contributing to the evaluation. All countries organized cooking workshops in 1 location, except Russia, where the 3 work- shops were organized in different locations. Each participating location conducted at least 1 workshop. The Healthy Kids contact persons invited children to participate most often through collaborations with schools. Parents provided written consent for a child to participate in the event and evaluation. The study was exempt from ethical approval because it did not include health measures or sensitive or harmful questions and data were collected anonymously.

      Commission cantonale d'éthique de la recherche sur l'être humain (Cantonal Commission on Ethics in Human Research) [in French].http://www.cer-vd.ch/soumission/premiers-pas.html#c752. Accessed March 18, 2019.

      Before the analyses were conducted, 3 countries were excluded from the study because the study protocol was not followed adequately, only part of the data was collected, or the pre- and post-questionnaires were not assigned a unique identifier and therefore could not be matched to the corresponding child. In total, 433 children from 14 countries and 16 different locations were included in the study. Table 1 lists the descriptive statistics of the participating countries and the total study sample.
      Table 1Countries and Children Participating in Art on a Plate Workshops
      Spinach IntakeOther Ingredient Intake
      CountrynGirls (%)Age, y (mean)Age, y (range)None (%)Taste (%)Eat (%)None (%)Taste (%)Eat (%)
      Argentina48509.49–1140332702080
      Austria8506.54–80010000100
      Brazil17417.77–8244729184735
      China
      China reported that children were asked to consume the salad to prevent food waste. Note: Instructed by a chef, children in the workshops created a self-chosen design on their plate with a spinach–fruit salad. All countries organized a cooking workshop in 1 location, except Russia, in which 3 workshops were organized in different locations.
      41658.27–100010000100
      India12508.66–148335884250
      Indonesia295910.69–125248014860
      México23657.77–85326402377
      Peru15475.05–57405303367
      Philippines51539.39–141637470496
      Poland10509.28–110604004060
      Portugal46436.84–9242748181567
      Slovak Republic22647.47–814275900100
      Switzerland55629.06–1211474282666
      Bryansk, Russia13699.59–107702300100
      Kineshma, Russia22417.97–80326801882
      Moscow, Russia21678.87–90485204357
      Total433558.44–1418334942373
      a China reported that children were asked to consume the salad to prevent food waste.Note: Instructed by a chef, children in the workshops created a self-chosen design on their plate with a spinach–fruit salad. All countries organized a cooking workshop in 1 location, except Russia, in which 3 workshops were organized in different locations.

      Study Protocol

      Countries participating in the evaluation were free to set up the Art on a Plate workshop content with the chefs following local wishes and needs. However, to have comparable workshops across the evaluating countries, the contact persons were provided with a study protocol and were asked to include 1 specific recipe for spinach and fruit salad in the workshop. Contact persons were briefed through a telephone conference regarding how to use the evaluation protocol and measurement instruments. Questionnaires were translated into the local language in the respective countries. Children participated in groups in a single cooking workshop of about 1 hour with chefs in which they created an attractive design with the ingredients based on a spinach and fruit salad recipe. Spinach was used as an ingredient for the salad in all of the countries. The other ingredients could remain unchanged or be adapted depending on the availability of each ingredient, local taste, and the ideas of the chefs. The children were asked to use spinach for the Art on a Plate design but were free to choose from other ingredients that were provided. After the workshop, the children had the opportunity to taste and eat the salad they created. In some countries, children could make a second recipe during the workshop; however, this was not part of the evaluation.

      Measurements

      A questionnaire was administered before and after the workshop and answered by the children. If needed, children were assisted by the local organization members. Willingness to taste and eat was assessed with the questions If for your next meal you were offered a Spinach and Fruit Salad, would you like to taste it? and Do you think you would eat it entirely? Both questions were measured on a yes/no answering scale. This was followed by a third question assessing liking of the entire meal/salad, How much would you like it? on a 5-point smiley scale. The Self-Assessment Manikin (SAM) was used to assess children's emotions.
      • Bradley MM
      • Lang PJ
      Measuring emotion: the Self-Assessment Manikin and the Semantic Differential.
      The SAM is a validated nonverbal pictorial assessment technique that directly measures the valence (pleasure), arousal, and dominance (control) associated with a person's affective reaction to a stimulus and is an easy method for quickly assessing reports of affective response in various contexts, including cooking.
      • van der Horst K
      • Ferrage A
      • Rytz A
      Involving children in meal preparation: effects on food intake.
      Children were asked to rate their current state on each of the 3 dimensions on a 9-point pictorial scale. The pleasure dimension ranged from a smiling happy figure to a frowning unhappy figure. The arousal dimension ranged from an excited wide-eyed figure to a relaxed sleepy figure. The dominance dimension represented changes in control with changes in the size of the SAM; a large figure indicated maximum control of the situation.
      • Bradley MM
      • Lang PJ
      Measuring emotion: the Self-Assessment Manikin and the Semantic Differential.
      Hunger and fullness were assessed with Teddy the Bear
      • Bennett C
      • Blissett J.
      Measuring hunger and satiety in primary school children: validation of a new picture rating scale.
      on a 5-point verbal pictorial scale that indicated the amount of food in the belly of a teddy bear; verbal indications ranged from I am really hungry! My belly feels very empty and is rumbling! to I am not hungry at all! My belly feels very full and I cannot eat any more food! The event organizers were asked to evaluate the salad intake based on 2 questions. The first question asked whether the child ate the spinach on the plate, according to the following answers: the child did not eat and taste the spinach, the child tasted only, or the child ate the spinach. The second question asked whether the child ate the other ingredients from the plate; the answer options were: the child did not eat and taste the other ingredients, the child tasted only, or the child ate the other ingredients.

      Statistical analysis

      The researchers conducted statistical analyses using Stata software (version 13.1, StataCorp LP, College Station, TX, 2013). Because there were only 2 measurements (pre and post workshop), all analyses included subjects who reported both pre- and post-measures. Linear and generalized linear (logit) mixed models were used to test statistical differences between before and after the workshop for willingness to taste and eat entirely, liking, emotions, and hunger. Models included a coefficient for time (post- minus pre-workshop), a fixed effect for gender, a random intercept for each subject (level 1), and a random intercept for each workshop location (level 2). Age was not included in the models owing to the high correlation with the workshop location. To examine whether the effect of the intervention on liking differed by initial liking, additional coefficients for initial liking (indicator variable) and the interaction between initial liking and time were included in the model. The overall interaction was significant; therefore, the change in liking across each level of initial liking was estimated using the post-estimation –lincom command and tested whether it was statistically different from 0. Mixed ordered logit models with coefficients for gender, initial liking (indicator variable), difference in liking (no difference, decrease, and increase), and a random intercept for each workshop location were used to examine the association of difference in liking after the workshop and intake of the salad reported as did not taste, tasted, and ate. Subjects from China were excluded from this particular analysis because they were encouraged to prevent food waste and eat all of the food. The researchers checked the proportional odds assumption for the ordered logit models using a Brant test without the random intercepts. In addition, the proportional odds assumption was checked using the model including the random intercepts by collapsing the intake variables into the logistic models of tasted and ate vs did not taste, and ate vs did not taste and tasted, and comparing the coefficients from the 2 logistic models. Associations of emotions and liking scores with intake were tested using models similar to those reported previously.

      Results

      In total, data from 433 children (55% of whom were girls) were included in the cooking workshop evaluation. Mean age of children was 8.4 years, but with a large variation ranging from 4 to 14 years (Table 1). The size of the event in the number of participants differed among countries; the smallest number of children was in Austria, and the largest in Switzerland.
      In total, 18% of children did not eat or taste the spinach, 33% tasted only, and 49% ate the spinach. The other ingredients (mainly fruit) were not eaten by 4% of the children, whereas 23% tasted only and 73% ate the other ingredients (Table 1).
      Overall the workshop showed a small but significant increase in the liking score (Δ = 0.14; P = .02), the emotion dominance (Δ = 0.39; P < .001), and a significant decrease in hunger (Δ = –0.82; P < .001) (Table 2). Willingness to eat and taste and other emotions did not significantly differ before and after the workshop.
      Table 2Differences in Key Outcomes Before and After Workshop
      OutcomesnaInitial ResponsePost-Workshop ResponseOdds Ratio (95% Confidence Interval) or Difference ± SEP
      Would you like to taste it (% yes)41089.590.11.08 (0.70–1.67).74
      Would you like to eat it entirely (% yes)40342.347.11.27 (0.91–1.78).15
      Liking (1–5) (mean)4094.064.200.14 ± 0.06.02
      Valence (pleasure) (1–9) (mean)3858.318.18–0.13 ± 0.07.07
      Arousal (1–9) (mean)3755.855.900.15 ± 0.14.73
      Dominance (control) (1–9) (mean)3756.777.160.39 ± 0.11<.001
      Hunger (1–5) (mean)3793.312.49–0.82 ± 0.08<.001
      an represents the sample with complete data for a measure before and after the workshop.
      Notes: Instructed by a chef, children in the workshops created a self-chosen design on their plate with a spinach–fruit salad. Differences between initial and post-workshop responses were estimated and tested for statistical significance using mixed models including a fixed effect for gender, a random intercept for each subject (level 1), and a random intercept for each workshop location (level 2).
      Comparison of values before and after the workshop showed that 30% of children increased their liking score, whereas 18% of children decreased their liking scores and the remaining 52% did not change the scores (Table 3). The changes in liking scores were significantly associated with post-cooking workshop intake (Table 4).
      Table 3Change in Liking After Workshop, by Initial Liking Score
      Change in Liking (Initial vs Post)
      DecreaseSameIncrease
      Initial Liking Scoren% Within Each Level of Initial LikingaChangeb ± SEPc
      123039611.8 ± 0.2<.001
      213815771.7 ± 0.3<.001
      3631619650.68 ± 0.13<.001
      41292333440.06 ± 0.09.50
      518118820–0.32 ± 0.08<.001
      Total409185230
      aDescriptive percentages of children decreasing, remaining the same, and increasing their liking by initial liking score; bPredicted change in liking score using linear combinations of the model coefficients. The estimate of change is calculated as post liking minus initial liking; cTests for whether change in liking score differed from 0.
      Notes: Instructed by a chef, children in the workshops created a self-chosen design on their plate with a spinach–fruit salad. A mixed model with covariates for gender, time (pre vs post workshop), initial liking score, time interacted with initial liking, and random coefficients for study location were used to examine whether the effect of the intervention on liking differed by the initial liking score.
      Table 4Associations of Change in Liking With Post-Workshop Intake of Spinach and Fruit Salad (n = 361)
      SpinachOther Ingredients
      VariablesOdds Ratio (95% Confidence Interval)POdds Ratio (95% Confidence Interval)P
      Sex (girl)1.1 (0.71 – 1.7).691.0 (0.59–1.7).99
      Initial liking score
       Dislike very much (1)ReferenceReference
       Dislike slightly (2)1.1 (0.28–4.2).910.2 (0.05 1.2).09
       Neither like nor dislike (3)2.1 (0.75–5.6).161.4 (0.42–4.6).58
       Like slightly (4)2.9 (1.1–7.5).032.5 (0.78 7.7).12
       Like very much (5)5.7 (2.1–15.8)<.0014.1 (1.2–13.5).02
      Difference in liking
       Same likingReferenceReference
       Like less than initial0.30 (0.16–0.56)<.0010.36 (0.18–0.72).004
       Like more than initial1.7 (0.92–3.1).092.8 (1.3–6.0).007
      Notes: Instructed by a chef, children in the workshops created a self-chosen design on their plate with a spinach–fruit salad. Mixed ordered logit models including gender as a fixed effect and workshop location as a random effect were conducted to estimate the association of difference in liking (pre vs post) with intake of spinach and other ingredients. Odds ratios are in favor of eating vs tasting/none or eating/tasting vs none. Subjects in the workshop in China were excluded from this particular analysis because they were asked to consume the salad to prevent food waste. Significant odds ratios are indicated in bold.
      The association between both increased and decreased liking scores and intake was in the expected direction compared with that for subjects who did not change their liking for the salad. A decrease in liking was significantly associated with a lower likelihood of being at a higher intake level of spinach (odds ratio [OR] = 0.30; 95% confidence interval [CI], 0.16–0.56) and other ingredients (OR = 0.36; 95% CI, 0.18–0.72). An increase in liking was significantly associated with a higher likelihood of being in a higher intake category of other ingredients (OR = 2.8; 95% CI, 1.3–6.0). Percentages of subjects by intake levels across change in liking were predicted at an initial liking of 3 to provide a context for the ORs from the ordered logit models in Table 4 (Figure).
      Figure
      FigurePost-workshop intake of spinach (A) and other ingredients (B) by change (pre vs post workshop) in liking scores (n = 361). Instructed by a chef, children in the workshops created a self-chosen design on their plate with a spinach–fruit salad. Percentages of change were predicted using coefficients from mixed ordered logit models with post-workshop intake categories as the outcome, change in liking as the primary exposure of interest, initial liking as a control variable (set at 3), gender as a covariate, and workshop location as a random effect.
      Initial (P = .001) and post (P = .001) liking scores were both significant and positively associated with spinach intake. Initial and post scores for valence (pleasure) were not associated with higher intake levels, higher initial arousal was significantly associated with lower intake levels of spinach (P = .04), and post-dominance (control) was significant and positively associated with post-liking scores (P = .003) but not with intake (data not presented).

      Discussion

      Cooking workshops provide an opportunity to promote fruit and vegetable intake in children. Results of this evaluation study showed that most of the children tasted or ate the spinach and fruit salad. The results are in line with former research showing that children who participated in cooking a meal increased their intake of a subsequent lunch meal and increased their willingness to choose and taste unfamiliar foods with vegetables.
      • van der Horst K
      • Ferrage A
      • Rytz A
      Involving children in meal preparation: effects on food intake.
      • Allirot X
      • da Quinta N
      • Chokupermal K
      • Urdaneta E
      Involving children in cooking activities: a potential strategy for directing food choices toward novel foods containing vegetables.
      The positive effects on liking may have resulted from various factors, 1 of which was the positive social context in which the workshops took place.
      • Marty L
      • Chambaron S
      • Nicklaus S
      • Monnery-Patris S
      Learned pleasure from eating: an opportunity to promote healthy eating in children?.
      Instead of a normal school day, children were participating in a cooking workshop with a real chef. In the development of food likes and dislikes, the context or atmosphere in which the food exposure takes place is mentioned as important.
      • Aldridge V
      • Dovey TM
      • Halford JCG
      The role of familiarity in dietary development.
      In cooking workshops, children are exposed to foods in a positive environment. Children reported that they enjoyed cooking and that cooking stimulated positive feelings such as ownership and pride.
      • Dougherty K
      • Silver C.
      Chef-nutritionist teams spark enjoyment and learning in cooking education series for 8- to 12-year-olds.
      • Heim S
      • Stang J
      • Ireland M
      A garden pilot project enhances fruit and vegetable consumption among children.
      In line with a previous study,
      • van der Horst K
      • Ferrage A
      • Rytz A
      Involving children in meal preparation: effects on food intake.
      the children reported an increased feeling of dominance after the cooking workshop. However, a positive effect on the emotion valence (pleasure) could not be confirmed. This could be because of the setting of a school outing with an already high level of valence before the workshop started.
      In addition to this positive environment, other factors might have contributed to the increase in liking of the salad. First, the pre-workshop questionnaire showed that the spinach and fruit salad were well-liked. Most children indicated a willingness to taste it and the sample of children had a high initial liking score on average. Although spinach is a vegetable that children often reject, the combination with fruits that are well-liked by children might add positive value to the dish. A former study showed that serving a moderately liked food mixed with a preferred one might support the acceptance of the moderately liked food.
      • Olsen A
      • Ritz C
      • Kramer L
      • Moller P
      Serving styles of raw snack vegetables: what do children want?.
      Other factors contributing to an increase in liking and likelihood of consumption were the enhanced visual appeal of foods through the Art on a Plate design
      • van Kleef E
      • Vrijhof M
      • Polet IA
      • Vingerhoeds MH
      • de Wijk RA
      Nudging children towards whole wheat bread: a field experiment on the influence of fun bread roll shape on breakfast consumption.
      • Jansen E
      • Mulkens S
      • Jansen A
      How to promote fruit consumption in children: visual appeal versus restriction.
      • Chung LMY
      • Fong SSM.
      Appearance alteration of fruits and vegetables to increase their appeal to and consumption by school-age children: a pilot study.
      and the role model function of a chef. Role modeling was mainly explored in the parent–child relationship and parental modeling was consistently shown to have significant and positive associations with children's fruit and vegetable intake.
      • Hass J
      • Hartmann M.
      What determines the fruit and vegetables intake of primary school children? An analysis of personal and social determinants.
      • Draxten M
      • Fulkerson JA
      • Friend S
      • Flattum CF
      • Schow R
      Parental role modeling of fruits and vegetables at meals and snacks is associated with children's adequate consumption.
      Because chefs are well-qualified to teach professional cooking skills and instill enthusiasm for cooking with fruits and vegetables, they can act as positive role models.
      Owing to the setting of the workshops as a natural event, several limitations apply to this study, such as the absence of a control group, the lack of a baseline intake measurement of the salad without a workshop, and the absence of a precise intake measurement in grams. Another limitation was that liking and willingness to taste and eat were measured for the full salad; separate measures for the fruit and spinach were not collected. Therefore, children might have answered the questions more positively thinking about the fruits, or potentially more negatively if focusing only on the spinach. In addition, the questionnaire was not pretested in the various countries. This might have led to improper interpretation owing to cultural differences, especially in countries where these questions had never before been applied. Moreover, this study assessed the effectiveness of 1 short event and the potential sustainability of the effects could not be explored. Changes in liking or consumption might only have been in the short term. If repeated regularly at home, fun derived from the novelty might diminish over time. However, alternating between strategies to keep healthy foods interesting and children engaged might be successful if they lead to regular offering and tasting of the foods. It was shown that repeated exposure increases intake over time.
      • Ahern SM
      • Caton SJ
      • Blundell-Birtill P
      • Hetherington MM
      The effects of repeated exposure and variety on vegetable intake in pre-school children.
      • Lakkakula A
      • Geaghan J
      • Zanovec M
      • Pierce S
      • Tuuri G
      Repeated taste exposure increases liking for vegetables by low-income elementary school children.
      The variability in ingredients and organization in the different locations could be seen as a limitation because it prevented standardization and resulted in less controlled implementation of the workshop. Nevertheless, it could also be considered a strength because the variability better reflects how the workshop would be implemented in a real-world setting across various countries. There is a need to evaluate the effectiveness of interventions and activities in real-life settings that can be extended and implemented in a variety of locations and countries. To date, the effect of cooking on children's behavior has been examined as part of multicomponent nutrition education interventions and has been studied with experimental designs and randomized trials. For activities and events that will take place naturally in real-world settings like these workshops, it is difficult to implement a reference standard of randomized controlled trials. Therefore, natural experiments or field studies evaluating the effectiveness of real-world changes or events can provide an alternative study design.

      Implications for Research and Practice

      This study showed the positive effect of a cooking workshop on children's liking across a selection of countries worldwide. Future studies measuring both pre- and post-workshop intake as well as absolute grams are needed to determine the effect of cooking workshops on fruit and vegetable intake. It remains important to evaluate the long-term effectiveness of interventions and activities in real-life settings that can be extended and implemented in a variety of locations and countries. Methods including study protocols, questionnaires, and data analyses need to be further developed to capture the effects of these events fully. Adapting children's food environment is increasingly seen as fundamental to helping children develop healthy eating habits. Improving the attractiveness of healthier options through visual appeal, modeling, and participation in meal preparation are promising strategies to support healthy eating patterns in children.

      Acknowledgments

      This study was funded by Nestec Ltd (Vevey, Switzerland).

      Conflict of Interest

      K.v.d.H. and K.C.M. were employed by Nestec Ltd during the time of the study. A.P.P. is currently employed with Nestec Ltd. X.A. declares that he has no relevant conflicts of interest.

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      Linked Article

      • Just One Bite?
        Journal of Nutrition Education and BehaviorVol. 53Issue 4
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          A familiar phrase for both nutritionists and parents who are trying to increase the willingness of young children to try novel food. It is not a new area of study. However, I was intrigued by a study published in JNEB in 2002,1 where the number of children willing to try a novel vegetable (kohlrabi) was so high (76%) in the positive treatment group (storybook reading with positive kohlrabi message) that the results and study were severely limited. The authors had pretested the scenario with a small sample in which less than half were willing to taste the vegetable.
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