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10 November 2016

Rewards For Health: How Incentives Stimulate Healthy Eating Habits in Children

Keywords: food, fruit, health, intervention, vegetables, North America, experiment, food intake, kids,

Researchers of a Journal of Health Economics study wondered whether incentives can stimulate healthy eating behaviors in elementary school children. They found that children eat more fruits or vegetables during lunch at school when they receive small incentives for consuming these healthy foods. Interestingly, incentives seem to have long-term effects: the increased consumption of fruits or vegetables by children was observed even two months after they had received the incentives.

Take aways

  • Small incentives for consuming fruits and vegetables at school lunches increase children’s (6-12 y/o) fruit or vegetable intake, both on the short and the longer term. 
  • Thus, the stimulating effect of incentives persists even when the incentives are removed. 
  • For healthcare and intervention developers, it’s useful to know that incentives can form healthy eating habits in children. 

Study information

  • The question?

    Are incentives successful in stimulating children’s fruit and vegetable consumption? 

  • Who?

    40 elementary schools involving 8000 students in grades 1 to 6 (approximately 6 to-12 year-olds; 51% were boys). 

  • Where?

    Utah, United States

  • How?

    Each participating school enrolled in a 18-month intervention program that consisted out of a baseline measure (2 weeks), an incentive period (3-5 weeks; schools were randomly assigned to have the reward period for either 3 weeks or 5 weeks), and a follow-up measure (1 and 2 months after the incentive period). During all measurement periods, the number of servings of fruits and vegetables children took and actually consumed were recorded. This was done by research assistants who observed each child’s lunch tray at the beginning and at the end of the lunch (before it was thrown away in the trash can). Children were given two or three lunch choices and were allowed to choose as many additional items as they want from a selection of fruits, vegetables and other side dishes. Children who ate at least one serving of fruits or vegetables received a special coin with a picture of an apple and a carrot on it. The coins were worth $0.25 and could be spent at the school store, school carnival, or book fair. 

Facts and findings

  • Compared to the baseline measure, both interventions (3-week & 5-week incentive period) increased the amount of children who ate at least one serving of fruits or vegetables during school lunch, see Figure 1
  • As shown in the figure, when the incentive period ended, the amount of children who ate at least one serving of fruits or vegetables decreased, but remained higher than it was prior to the incentive period. 
  • This emphasizes that increases in healthy eating due to rewards persisted, even when incentives were removed. 
  • The researchers gave three possible reasons for this finding: (1) children became that much used to eating fruits and vegetables during lunch that it resulted in an automatic behavior pattern (i.e., habit formation), or (2) children developed a new taste or a change in taste (when exposure was limited) by consuming the fruits and vegetables which resulted in more positive tastes and evaluations, or (3) eating fruits and vegetables became more popular (due to the incentive) which changed the social norm.
  • Critical note: Children’s fruit and vegetable consumption was only observed during school lunches, not outside of school. It is therefore unknown what kind of effect the intervention has outside their school lives.