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
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Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
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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 !

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

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

Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
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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

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
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Part of the National Program for an Active and Healthy Lifestyle

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

Educational measures:
Vegetables and fruits in the mirror of:
Art Reading comprehension
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Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
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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)
? *

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

Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
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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

 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
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• 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
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Thank you
for your
attention !
Ministry of Agriculture and Rural Development – Research, Economy and Strategy Division
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