The magical fruit

Spanish Ministry for Health announced a government plan to reduce the “epidemic of obesity.” Health Minister, Bernat Soria, introduced a plan to give free fruit to school children as part of the European School Fruit Scheme. Italian Minister, Luca Zaia, followed suit. In fact, this week, the European Commission endorsed the implementation policies for the European School Fruit Scheme by the Member States, opening the door for this obesity initiative to be funded across Europe beginning in September. Member States are signing up.

If the School Fruit Scheme sounds familiar, that’s because Europe and the United States have already tried these massive and expensive programs… and they’ve failed. But when it comes to public health policies: politics and lobbying trump scientific evidence every time.

Last fall, the Agriculture Council of the European Commission accepted the proposal for the political management strategy of a European-wide scheme to provide “free” fruits and vegetables to school children. According to its press release, government will pay for the produce and its distribution, totaling €90 million [about $128 million U.S. dollars] every year. Like all government money, it comes with strings attached. To receive this money, Member States that adopt the scheme must match those funds someway. The European Commission also authorized that, besides providing fruits and vegetables to a target group of schoolchildren, “the scheme will require participating Member States to set up strategies including educational and awareness-raising initiatives.”

The School Fruit Scheme is one of the EU’s key public health initiatives said to fight obesity and promote healthy lifestyles. This program is primarily founded on claims of an epidemic of childhood obesity afflicting more than 5 million children, with the numbers of ‘obese’ children to grow by 400,000 every year. According to the EU: “Experts agree that a healthy diet can play an integral role in reducing obesity rates, and cutting the risk of serious health problems — such as cardiovascular disease and diabetes 2 — in later life. Key to this is the consumption of sufficient amounts of fruit and vegetables.”

As we’ve seen, of course, none of these claims for produce hold up in sound medical research. While they may sound intuitively correct after years of hearing them repeated, no special diet or eating lots of fruits and vegetables has been shown to reduce obesity in children or to prevent heart disease, cancer or diabetes.

The adoption of the School Fruit Scheme followed reforms of the Common Market Organisation for fruits and vegetables proposed in 2007 by a group of stakeholder consultants (Inter-Service Group) to increase the market for produce. They stressed drawing attention to obesity and the role that agricultural policy could play to combat obesity.

In light of the dramatic increase in obesity amongst schoolchildren, which has been highlighted in the recently published Commission White Paper… the Council invites the Commission to come forward with a proposal for a school fruit scheme as soon as possible based on an impact assessment of the benefits, practicability and administrative costs involved."

“People who eat a lot of fruit and vegetables in childhood remain good consumers,” said the EU. Understandably, a range of produce interests have lobbied for the School Fruit Scheme.

To design the best-practice management policies and promote the School Fruit Scheme, the EU held a major conference last December in Brussels and invited the key stakeholders and promoters to speak. The speakers told of the successes of the School Fruit Scheme and programs in the UK and United States.

Fresh Fruit and Vegetable Program. Vice President of the United Fresh Produce Association, registered dietitian Lorelei DiSogra, told the EU that the fresh fruit and vegetable snack program is the “largest school-based environmental change program in the USA.” The 2002 Farm Bill provided $6 million to pilot test the feasibility of a Fresh Fruit and Vegetable Program in four states in 2002-03 school year, DiSogra told the audience. The program’s 2003 report to Congress called it “A Big Success!” As a result, the program has been expanded, with $65 million earmarked for this school year and $101 million for next year, she said.

Not explained was the definition of “success.” The stated goal of the program is to increase the availability and accessibility of fresh fruits and vegetables in schools. The 2008 Farm Bill was an “opportunity to align our national agricultural policy with public health policy,” she said, which will require strong political will and relentless public marketing of its benefits at national education, public health and agricultural venues. The program is designed to “grow produce sales, creating new markets for all sectors of the produce industry [and] creating new customers.”

Success was determined by how much produce the schools purchased, not how much children ate. Success was also measured by the feasibility and logistics of running such a program and opinion polls of parents and schools — an evaluation of the process — not sustained changes in children’s eating behaviors, any demonstration of improved immediate or long-term health, or any evaluation of risks and potential harm of teaching young children that being healthy means eating means low-calorie, high-fibre fruits and vegetables. By measures that matter to consumers, whose money is being spent on it, in fact, the program has been a bust.

The public heard that among the program’s benefits, students eat more produce “almost immediately” — but failed to mention that the report didn't show that. Even the 5-A Day for Better Health Program, after 15 years and limitless marketing and skyrocketing federal funding, the Centers for Disease Control and Prevention’s own data found the entire campaign has been a dismal failure.

Hungry for Success. Remember the Hungry for Success program to encourage Scottish children to eat “healthy” and increase their fruits and vegetable? It was a government program to address a purported rapidly rising epidemic of childhood obesity (an “epidemic” the evidence showed didn’t really exist). Despite years of nonstop messaging and giving children free fruit in school, the report concluded “there is no evidence as yet that it directly impacts the total fruit consumption of primary school children.”

Grab 5!. From 2001 to 2002, Sustain, the sustainable agriculture lobby for local organic produce, conducted a pilot project to promote fruit and vegetable consumption among 7-11 year olds, with a focus on low-income families. Its Grab 5! project was tested in nine primary schools in Lambeth, Leeds and Plymouth. Grab 5! taught youngsters that healthy eating meant salad and vegetables “with lots of fibre” and more fruits and vegetables. The program created health zones in the schools and focused educational messaging on healthy lifestyles. The Grab 5! evaluation report said the program was a success.

But “Success” primarily evaluated the process and levels of participation. After the program, when questioned, there was no significant change in the number of young children “knowledgeable” about healthy foods or who had “healthier” food preferences, such as for salad. “Before the project started, most children already knew that they should eat five pieces of fruit and vegetables per day,” the report said. At the end of the year, children self-reported eating 0.5 pieces more of produce overall, but no greater variety and no more salad, with the only statistically significant increases in consumption reported in four of nine schools. The authors reported that the vegetable (?) most eaten by UK children (14%) was still baked beans. The pilot project wasn’t able to demonstrate changes were maintained beyond the first school year. In fact, it reported that the children in follow-up focus groups said that the constant messages of healthy eating were at “almost every assembly” and “we just ignore it after awhile.”

There was no attempt to evaluate the extent of the potential harms in teaching children nutritional and health concepts beyond their intellectual readiness; teaching youngster to read labels and count grams of fat, sugar and salt and avoid chemical names; of efforts to increase fruits and vegetables by creating peer pressure; telling young children to do more exercise and eat less of other foods; or any analysis of the program’s effects on children’s health. According to the evaluation, schools carefully chose activities most likely to demonstrate success and no school coordinator reported any unsuccessful activity. Yet, the evaluation report said that “children in all [focus] groups gave unprompted examples” of what they saw with classmates eating excessive amounts of fruits and vegetables after a “healthy eating” activity, such as: “One boy eats 15 fruits a day.” And another child admitting: “My mum told me I was eating too much fruit and told me to cut back.”

School Fruit and Vegetable Scheme. Remember the national School Fruit and Vegetable Scheme, undertaken to distribute free produce to more than two million children in 18,000 British schools? It was designed to create lifelong healthy eating habits in the pupils and cost $284.24 million just during its first two years. Studies of its effectiveness reported success, with the children consuming about 2/3 of an apple more… at first. By 7 months, the changes had waned to 0.2 serving difference and disappeared entirely in year two.

In other words, even giving children free produce didn’t change their diets or prove effective in instilling longer-term changes in their eating. The researchers concluded:

The findings of this evaluation showed that a short term increase in fruit intake can be achieved in young children who remain in the scheme; however, further interventions may be needed to prevent the waning of this effect….

The findings …cast doubt on the effectiveness of the SFVS to sustain long term increased fruit and vegetable intake in children.

So, what did the government agency recommend after finding it didn’t work?

Expand it.

© 2009 Sandy Szwarc