Encouraging Healthy Eating in Children with the Food Dudes Programme

    Impact: Health/Quality of life

    Description of impact

    Impacts on eating habits of children and parents
    Internationally, over half a million children from diverse social, economic, and ethnic,
    backgrounds have taken part in Food Dudes since 2008, with full evaluation in 25%. As in our
    proof-of-principle research [3.2, 3.3, 3.4], the rollout Programme produced large and significant
    increases in fruit and vegetable consumption [5.1, 5.2, 5.6, 5.7]. Effects were even bigger in
    children who ate the least before the intervention, showing that inequalities in children’s diets were
    addressed [5.7].
    Twelve months after the Programme in the Ireland study [3.4], parents were still providing 93%
    more fruit and vegetables and children’s consumption had increased by 90%, relative to baseline,
    adding two child-sized portions of fruit and vegetables to their daily diets. Following this successful
    study, from October 2007 the Irish Government began a 7-year Food Dudes rollout to their primary
    schools: 419,000 children have participated so far, and independent evaluations report reliable
    increases in consumption following the Programme [5.1]. Impacts extend to the home. Parents report that their children asked them to buy more fruit and
    vegetables following the Programme; parents also increased their own daily intake of fruit and
    vegetables [3.2, 3.3, 3.4, 5.6, 5.7]. A 20% decrease in children’s consumption of calorie-dense
    snacks was also reported in UK regional rollouts [5.6, 5.7], and Italy trials [5.5]. Parents and
    teachers also reported this impact on their own diets [5.6, 5.7].
    Children with learning difficulties are particularly susceptible to poor dietary habits and obesity. In
    our 2012 Special Schools trial (N=248), fruit and vegetable consumption increased and unhealthy
    snack consumption decreased [5.6].
    Rollouts of the Food Dudes programme
    The Ireland national-rollout team serve as international ambassador and mentor for the
    Programme. In 2009/2010, Wolverhampton Primary Care Trust and Italian researchers visited Irish
    schools to observe the Programme’s impact on children’s fruit and vegetable consumption and to
    learn the logistics of large-scale implementation -- knowledge that was shared with other UK
    commissioners [5.6, 5.7].
    Recognising the potential impacts of increased fruit and vegetable consumption at the population
    level, the UK fruit and vegetable industry, including 7 major UK supermarkets, multinational
    companies [5.3], and government agencies, have provided funding and on-going (2008-present)
    support for the Programme.
    The Food Dudes in England Collaborative Group was formed in 2008. With representatives from
    the Bangor Food and Activity Research Unit, the School Food Trust, and the Horticultural
    Development Council, its objective is to promote rollout of the Programme in England. Our
    researchers have presented the Programme’s extensive evidence-base to Industry and
    Government departments in many other European countries, and in the US.
    Companies in Ireland have accrued substantial economic benefits over the roll-out duration.
    Increases in turnover are: Real Events Solutions [Programme delivery] = €6,366,648; Giraffe
    [Programme materials] = €5,307,215; Pallas Foods [Fruit and Vegetable supply] = €7,181,614;
    Video Company [Food Dudes DVDs] = €166,223; jobs created = 13 full-time and 40 part-time
    posts, maintained annually to deliver the rollout.
    The Irish Government has spent €19.3 million on their Food Dudes Programme, demonstrating a
    strong impact on national public policy and services [5.1]. Extensive take-up by UK NHS Trusts
    and Local Authorities (investments of £1.9m, £1m respectively) demonstrates a policy shift towards
    behaviour change interventions, away from health education approaches.
    The UK Conservative Party Policy Green Paper, “A Healthier Nation”, highlights Food Dudes as “a
    good example of how many of the characteristics of successful behaviour change programmes can
    be incorporated in a single highly specific initiative” [5.9]. DEFRA’s First Report from the Council of
    Food Policy Advisors (2009; p13) recommends that “If evaluation shows long term benefits, extend
    the ‘Food Dudes’ healthy eating programme for children”.
    Lowe and Horne were advisors in 2007 to the EU’s €90 million European School Fruit Scheme;
    Lowe subsequently became the current Deputy Chair of the Scheme’s Scientific Expert Panel. The
    Scheme now promotes take-up by Member States of recommended evidence-based interventions,
    including the Food Dudes. This provides an excellent opportunity to extend the Programme
    throughout Europe. Since 2008 the EU (DG AGRI and DG SANCO) features Food Dudes within
    their healthy eating policy.
    In 2012, responding to a rapid escalation in demand for the Programme, Lowe and Horne – in
    partnership with Bangor University – established Food Dudes Health Limited, a spinout company
    with a new corporate website. In doing so, 20 new jobs were created. This Social Enterprise has
    developed new Food Dudes programmes and, by attracting further research funding from a variety
    of sources, scaled-up their delivery to improve children’s health and wellbeing globally Media and Awards
    Food Dudes has attracted increasing media attention: ITV’s Tonight programme “Obesity the Time
    Bomb” (23/2/2012) received 30,000 more views than their average (17% of the viewing population
    watched). And a Guardian article (9/8/2010) argues for Food Dudes in every UK school.
    The Programme’s health impacts have been recognized by 8 prestigious awards, among them:
    Social Marketing Showcase Award (2009), UK Chief Medical Officer’s Gold Medal Award (2010),
    Society for the Advancement of Behavior Analysis (ABAI) Award for Translational Research (2012;
    5.10), and Local Authorities Research Intelligence Association (2013).

    Impact Summary for the General Public

    The Food Dudes scheme devised by the Bangor Food and Activity Research Unit has produced
    large and lasting increases in children’s consumption of fruit and vegetables. More than 500,000 4-
    to 11-year-old children have participated, in European countries and the US, with funding of more
    than £20m for research, evaluation, and rollout. Given the major public health challenge of
    increasing children’s consumption of fruit and vegetables (often their least-liked foods), in order to
    reduce potential risk of future obesity or illnesses including diabetes, cardiovascular disease and
    some cancers, our unique combination of behaviour change principles -- including Role Modelling,
    Rewards, and Repeated Tasting -- has achieved significant success.

    Description of the underpinning research

    School-based, health nutrition interventions that inform children why they should eat more fruit and
    vegetables have often failed to produce any lasting increases in consumption of these foods. To
    investigate whether a behaviour-change approach might be more successful, Professors Lowe and
    Horne (at Bangor since the 1980s) launched a strand of translational research, funded initially by
    the ESRC (Nation’s Diet Initiative) and Unilever, in the first half of the 1990s. Whereas the
    research literature on food preferences suggested that repeated tasting could increase children’s
    liking of some novel foods, there was no reliable means of establishing the crucial taste exposures
    to fruit and vegetables.
    Lowe and Horne first conducted a systematic investigation of the separate and combined effects of
    Rewards and Role Modelling on consumption of fruit and vegetables in 5-7-year-old “fussy eaters”
    at home. Role modelling was provided by a video, created by the Bangor team, showing four
    fictional child characters, the Food Dudes, happily eating fruit and vegetables, “the source of
    special energy they needed to defeat the forces of evil”. The combination of Rewards and Role
    Modelling produced large and lasting increases in children’s consumption of targeted fruit and
    vegetables, effects that generalised to other foods in those categories. Rewards alone had some
    effect, but mainly for fruit consumption; Role Modelling on its own had no effect. This research
    identified a unique and powerful synergy -- the combination of Rewards and Role Modelling had
    effects that far exceeded those of either variable on its own [3.1]. This is because Rewards “from
    the Food Dudes” signify to the children that they have achieved approval from, and membership of,
    a successful and inspirational group of peers. The symbolic context of the Rewards determines
    both their potency and durability as incentives for behaviour change. The Food Dudes intervention
    enables children to repeatedly taste novel foods, discover their intrinsically rewarding properties,
    and develop a lasting liking for them, thereby maintaining the change in eating behaviour over
    time.
    In the late 1990s, this new behavioural intervention was taken to scale over a series of studies, first
    with classes of 5-7 year olds in local primary schools. From 2000, with funding from Industry, a
    whole-school intervention was developed and trialled successfully in UK primary schools [3.2, 3.3].
    This “Full Force” Programme was then modified for countries such as Ireland, where schools do
    not provide food at lunchtime, and to influence parents to provide fruit and vegetables in their
    children’s lunchboxes. In autumn 2007, following a successful controlled trial [3.4], and a World
    Health Organisation Award (2006), the Irish Government decided to roll out the Programme to all
    primary schools in Ireland. UK regional rollouts followed in 2009, and trials are on-going in Italy
    [5.4] and the US [5.5].
    A range of new principles from cognitive psychology and behavioural economics have been
    incorporated into the research, and new programmes have been trialled that: (i) maintain the
    school healthy eating culture year-on-year, with an increased focus on catering (“Food Dudes
    Forever”); (ii) increase children’s fruit and vegetable consumption in Special Schools [5.6] and Nursery Schools [3.5]; and (iii) raise levels of physical activity [3.6].
    Impact statusClosed
    Impact date20072012
    Category of impactHealth/Quality of life
    Impact levelBenefit