“Rabbit food” or “green stuff’ - there is one thing that we all know – vegetables and fruit are an important part of a healthy diet. Unfortunately, Canadians aren’t getting enough. Especially youth. Only 27.5% of Canadian youth aged 12 – 17 years old eat vegetables and fruit five or more times a day. Ontario’s consumption statistic is even worse at only 23.6% (Statistics Canada, 2017). As a Dietitian, I promote eating vegetables and fruit daily. But why is adequate vegetable and fruit consumption important? An alarming stat from Health Canada reported that in 2017, almost 50% of deaths from cardiovascular disease were attributed to dietary risks such as inadequate vegetable and fruit (Health Canada, 2019).
There is no arguing that Canadian youth need to do better.
Most people may think that “kids will be kids” and inadequate intake is just a dislike for vegetables and fruit – but it goes deeper than that. Understanding the factors that influence vegetable and fruit intake is an important step to improving youth’s consumption of the green stuff. A social ecological model can help improve understanding of the multilevel and interactive effects of personal and environmental factors that shape vegetable and fruit consumption among youth in Ontario.
From the impact of climate change, the food industry and food insecurity - the factors that affect youth vegetable and fruit intake is a huge intertwined web and led me down a rabbit hole. As youth spend six hours a day at school and consume about 50% of their calories at school, I decided to focus my model on the school setting.
Imagine Ben - he is a 14-year-old that lives in Ontario. He is among the 76.4% of youth that do not eat enough vegetables and fruit. Being male, the likelihood of him eating vegetables and fruit is already lower than girls (Colapinto, 2018). As youth enter high school and increase in grades, their vegetable and fruit consumption decrease (Minaker, L., & Hammond, D., 2016). These are two individual influences on Ben’s vegetable and fruit consumption.
Ben lives in a family that struggles to make ends meet. They are living in poverty and are food insecure - an interpersonal risk factor for lower vegetable and fruit consumption (Kirkpatrick, S.I. & Tarasuk, V., 2008). His parents don't like to eat vegetables and fruit; therefore, Ben does not see his parent’s role modeling this behaviour – another interpersonal influence (Rasmussen et al, 2006).
Ben arrives at school hungry. Luckily, his school has a breakfast program which is part of the Ontario Student Nutrition Program. The breakfast program adheres to nutrition guidelines and provides free fruit and other healthy food. Research shows that organizational programming like the Ontario Student Nutrition Program that provides access to vegetables and fruit in a school setting improves vegetable and fruit intake (Heart and Stroke Foundation, 2003).
As lunch time comes, Ben is hungry. His school has a cafeteria which provides food in compliance to the Ontario School Food and Beverage Policy. This Policy has an aim to improve the food environment in Ontario Schools, however most students complain about the high prices of the food (Elliott, Raine & Vine 2014). There are many fast food outlets within walking distance of Ben's school, so he decides to head to one of those instead. He can buy a hamburger for only $2.00. Fast food outlets in the proximity of schools is related poor vegetable and fruit consumption (Heart and Stroke Foundation, 2013 & Davis & Carpenter 2009). This is a community factor that is influencing Ben’s food choices, and another strike for Ben.
Ben knows the importance of eating vegetables and fruit through learning about Canada's Food Guide, however he does not have the food skills to prepare them, another individual influence. Students used to learn these skills in home economics class in grade 7-8, however this program was cut many years ago. Ben heads home for the day and may or may not have some vegetables and fruit for dinner.
Although this picture shows some positive elements that foster vegetable and fruit consumption on many levels of a social ecological model such as dietary guidelines at a national level which influence organizational programming such as curriculum development; improved access at a school level through the Ontario Student Nutrition program; and a policy with the goal to improve the food environment in schools - there are many factors that could change Ben's story for the better.
Let’s dig a little deeper to understand the weaknesses and opportunities within the current school system.
In a 2017 Unicef report, Canada ranked 37th out of 41 countries on access to nutritious food for children. Being the only G7 country that does not have a national school nutrition program and rising food insecurity among children are two reasons for this poor score. Although Ontario does have a Student Nutrition Program that provides free meals and snacks that emphasizes vegetables and fruit for students, lack of federal funding makes it difficult for these programs to make ends meet. Because of this, only a small fraction of students have access to these programs.
Ontario also introduced a School Food and Beverage Policy with the goal to sell healthier items to students in 2011. This policy in theory fits into the social ecological model very well. However, since the inception of the policy, there have been many criticisms. Lack of monitoring has made it easy for schools to slack on the guidelines, and many students also complain about the high price of food (Elliott, Raine & Vine, 2014). As a result, many students are leaving school grounds to seek other food. Could a policy with good intentions have increased the likelihood of students leaving campus to go to nearby fast food outlets and thus, made students diets worse?
What could help with both problems within the Province? A National School Food Program that provides subsidized or free meals to students. Research shows that students that participate in school food programs consume more vegetables and fruit (The Coalition for Healthy School Food, 2018). A Universal National School Nutrition Program could also alleviate food costs for a family aid with reducing food insecurity. The federal government is currently working on the first Food Policy for Canada, an important step in Canadian history. Food Security is one focus, and I hope to see the birth of a National School Food Program as a result.
The Coalition for Healthy School Food encourages anyone who agrees to sign a petition to the House of Commons to help #nourishkidsnow.
Secondly, on the organizational level of the social ecological model, programming that emphasizes food skills and hands on experiences such as school or community gardens have been shown to improve vegetable and fruit consumption (WHO, 2014). To help give students the opportunities for these needed food skills, schools must get more creative to provide students with these opportunities with other programs such as the Good Food Machine that is taking some Toronto schools by storm.
On the community level of the social ecological model, municipalities can also play a large role in improving the food environment. Municipal zoning bylaws that restrict fast food outlets close to schools is a strategy that could be very beneficial for our youth, taking away the temptation to venture outside of school grounds to seek other food. Several Health Units in Ontario are currently collecting data on the purchasing behaviours of students and GIS mapping of schools, however no municipalities have taken the leap yet. Quebec has seen some successes with zoning bylaws and a few cities in the Unities States have also jumped on this bandwagon.
Let's start Ben’s story again.
Ben arrives at school to eat breakfast. His school has a program that provides free breakfast to all students funded by the national school nutrition program based on a national food policy for Canada. At lunch, Ben does not leave the school as fast food outlets are not close to his school thanks to a zoning policy at the municipal level. Instead, Ben takes advantage of the vegetables and fruit available at his school’s cafeteria as he qualifies for reduced prices due to the federally funded school nutrition program. Ben health class cares for and uses the produce from the school garden in programming that teaches him food skills. Ben is confident in preparing vegetables and fruit with his improved food skills and is more likely to eat them at home. Ben's parents are also involved in the school garden and bring some produce home which makes access easier and improves the likelihood for Ben’s parents to role model eating vegetables and fruit at home. As a result of federal food policy, a national school food program, community zoning to reduce unhealthy food in proximity to schools and a supportive school environment which includes policy, school programming, access to vegetables and fruit and connections home, Ben is more likely to have the knowledge, skills and opportunities to improve his consumption.
Changing the story is a task that takes commitment on all levels of a social ecological model – but it’s worth it. I hope to see some of these changes in the future, for all our children’s sake.
References
Colapinto, C.K., Graham. J., & St-Pierre, S. (2018). Trends and correlates of frequency of fruit and vegetable consumption, 2007 to 2014. Statistics Canada, Health Reports, Vol. 29, no. 1, pp. 9-14. Retrieved from: https://www150.statcan.gc.ca/n1/en/pub/82-003x/2018001/article/54901-eng.pdf?st=jx5hK5vC
Center for Disease Control and Prevention. (2018). Healthy Schools – School Nutrition. Retrieved from: https://www.cdc.gov/healthyschools/nutrition/schoolnutrition.htm
Davis, B., & Carpenter, C. (2009). Proximity of fast-food restaurants to schools and adolescent obesity. American journal of public health, 99(3), 505-10. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661452/
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