The document summarizes a pilot program in Israel that provided fresh vegetables and fruits to elementary school pupils with the goal of encouraging their consumption. The program involved delivering free produce to schools twice a week for consumption during recess. Evaluations found an increase in pupils', parents', and headmasters' reports of vegetable and fruit consumption as well as a decrease in consumption of snacks. The program was deemed successful although improvements like increased parental involvement were suggested.

1. Encouraging Consumption of Fresh
Vegetables and Fruit Among Elementary
School Pupils
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
Presentation at
WealthR Academic Workshop,
December 9, 2013
Yael Kachel,Tsipi Fridkin
Research, Economy and Strategy
Division
Ministry of Agriculture and Rural
Development
1

2. Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
2
Background
• Overweight and obesity on the increase in
Israel:
Ynet 3/12/2013: One out of three children – overweight
The State Comptroller (2011): 61% of population in Israel
overweight (68% in the US), 13.6% of them obese,
children: 26% overweight (35% in the US)
• Lifestyle changes: decreased physical activity,
convenience food
• Decreasing fruit and vegetable consumption
Negative impact on health !

3. Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
3
Source: OECD, 2012 (Z. Stahl, Ministry of Health, 2012)

4. Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
4
Source: own calculations based on CBS data,
2012 – preliminary data
Israel - Per Capita Supply of Fresh Fruit and Vegetables

5. Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
5
Can schools make a difference to children’s fruit and
vegetable consumption ?
De Sa, Lock (Eur. J. Publ. Health 2008): Review – In 70% out of 30 studies
fruit and vegetable consumption increased as a result of school
interventions, some evidence of positive long-term impact on consumption.
Horne et al. (Eur. J. Clinical Nutrition 2009): Food Dudes intervention
significantly increased fruit and vegetable consumption, positive long-term
impact.
Ransley (Public Health Nutrition 2010): Provision of free fruit in England
increases children’s intake of fruit and vegetables but not sustained beyond
the intervention.
Delgado-Noguera et al. (Preventive Medicine 2011): Meta-analysis of 19
trials: computer-based interventions were effective in increasing fruit and
vegetable consumption, free provision of fruit/vegetables not effective (2
studies).
Positive impact depends on the details of the program

6. Encouraging vegetable and fruit consumption
of pupils through
exposure to a variety of fresh vegetables and
fruits at school and
joint consumption in the classroom
The Goal of the
School Fruit and Vegetable Program:
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
6
Part of the National Program for an Active and Healthy Lifestyle

7. Principles of the School Fruit and Vegetable Program
1. Free delivery - participation of all children in school
2. Consumption in the classroom during recess - creating shared
consumption experience
3. Repeated exposure to a variety of vegetables and fruits -
repeated exposure necessary to adopt new flavors
4. Educational accompanying measures
5. Parental involvement - necessary to change pupils habits
6. Evaluation - pupils habits before and after intervention
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
7

8. Pilot program:
Key figures for 2013
 5,000 pupils
 2 local authorities: Jewish and
Arab (Holon and Tura’n)
 9 schools
 0.5 million NIS funding by the
Ministry of Agriculture
 Target group: school children
aged 6-12
 Full cooperation of the
Agriculture, Education and
Health Ministries, the Plant
Board and the local authorities
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division 8

9. - From February 2013 to the end of the school year
- Two servings of vegetables/fruit per week
- Consumption during the breakfast break, in the presence of a teacher
- Schools supported the program by educational activities offered by the
Ministry of Education
- Schools appointed a responsible teacher and cooperated with program
evaluation (questionnaires for students, teachers and parents)
Operation of the Pilot Program in 2013
Evaluation of two kinds of packaging/preparation:
• Phase 1: whole fruit / vegetables, bulk packaging
• Phase 2: fresh-cut, individually packed portions (60-80 gram)
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
9

10. School in Tur'an, 27/02/13
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division 11
Individual portion

11. Educational measures:
Vegetables and fruits in the mirror of:
Art Reading comprehension
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division 12

12. Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
13
Results – Questionnaire Pupils
Did you eat yesterday …. ?
% of pupils eating the food at least once, n = 1318 (Holon), 722 (Tura’n)
Holon Tura'n
before after before after
Fresh fruit 71.2% 73.8% 78.6% 84.8%
Fresh veg./salad 73.9% 75.2% 78.3% 75.0%
Cooked veg./soup 46.1% 39.3% 62.6% 50.2%
Sweet snacks 72.3% 67.1% 86.0% 78.6%
Salty snacks 52.8% 51.5% 76.4% 71.3%
Bold: differences are significant at the 5% level
* Probably a decline in soup consumption explained by different seasons (first
questionnaire at the start of the project in winter, second questionnaire in May)
? *

13. Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
14
Results – Questionnaire Parents
Increase in ….
% of parents answering the questionnaire, n = 277 (Holon), 180 (Tura’n)
Remaining answers: mainly “no change”

14. Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
15
Results – Interviews Headmasters
 Key factors for success: individual packaging,
punctual delivery
 Variety important, including vegetables and fruit
consumed less frequently
 Importance of interaction and discussion in classroom,
encourages kids to taste new fruits and vegetables
 Important project for educating children and parents to
change consumption habits

15.  Positive feedback of pupils, teachers and
parents
 Results indicate positive impact on
consumption habits
 Possible improvements (preliminary):
more parental involvement,
integration with other educational measures
Summary and Conclusions:
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
16

16. • Should schools be selected based on socio –
economic criteria ?
• Cost efficiency of intervention:
Can alternative programs with lower costs achieve
similar results ?
Can local food supply chains decrease costs ?
On expense of variety ?
Questions for discussion:
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
17

17. Thank you
for your
attention !
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
18