The

Effect of Cooking on
Dietary Quality







By
Alyssa Borba










A Senior Project submitted
In partial fulfillment of the requirements for the degree of
Bachelor of Science in Nutrition




Food Science and Nutrition Department
California Polytechnic State University
San Luis Obispo, CA

December 2014

Abstract
A greater dependency on convenience foods and fast food has caused the quality of many
Americans diets to deteriorate, along with their health. Although more research is
needed, cooking at home and cooking skills interventions have been linked to improved
dietary quality. Studies of various designs, populations, and interventions were assessed
to determine the impact of cooking on dietary quality. Findings from cross-sectional
studies showed that participation in food-related behaviors was associated with an
increased likelihood of consuming more servings of fruits and vegetables per day and
meeting Healthy People 2010 dietary guidelines, and eating breakfast and dinner at home
was associated with a lower risk of obesity, consumption of lower total calories,
percentage of calories from fat and saturated fat, and higher consumption of protein,
carbohydrates, and fiber. A longitudinal cohort that followed teenagers over a period of
10 years found that involvement in food preparation in emerging adulthood was
associated with better diet quality five years later, including higher intakes of fruit,
vegetables, dark green and orange vegetables, less sugar sweetened beverages and less
fast food consumption. The studies that involved cooking interventions found an
increase in cooking confidence, increased fruit and vegetable preference and
consumption, and increased self-efficacy. Although significant direct causation between
cooking at home and dietary quality is lacking, there continues to be strong associations
between cooking involvement and eating at home and improved dietary quality. More
research and development of cooking interventions would be a beneficial step in
improving the diets of many Americans.

Introduction
The American diet has become increasingly dependent on fast food, restaurants,
and convenience foods. As a result, most American do not adhere to the dietary
guidelines set by the United States Department of Agriculture (USDA) for a healthful and
balanced diet. According to the USDA and U.S. Department of Health and Human
Services ([HHS], 2010), Americans consume excess sodium, solid fats, added sugar, and
refined grains. Although most Americans consume over their recommended calorie
intake in a day, they do not meet the recommendations for fruits, vegetables, whole
grains, fat-free and low-fat dairy, seafood, and oils (USDA & HHS, 2010). These poor
food choices have contributed to a severe increase in the rate of overweight and obese
Americans, with over two-thirds of the population categorized as overweight and over
one-third considered obese. This can increase the risk of certain chronic diseases like
cardiovascular disease, type II diabetes, and some cancers.
An instrumental factor in the poor diets of many Americans is the increase of
meals eaten away from home, especially fast food. The USDA Economic Research
Service (2013) estimates that food prepared away from home accounts for 32% of
Americans caloric intake, which has nearly doubled in the last three decades.
Restaurants and fast food establishments often serve food in oversized portions, packed
with added fats and added sugars, and lacking much nutritional value (Todd & Morrison,
2014). With this increase in frequency of consuming meals away from home, has come a
parallel increase in the rates of obesity and chronic disease. Even so, Americans have
become excessively dependent on these fast and convenient options and have lost any
connection or relationship with the food they consume.
The fast-paced lifestyle of Americans today has driven them to rely on processed,
already prepared foods that do not require any time or preparation of their own. The
deteriorating health of the U.S. population points to a crucial need to change these current
dietary habits. This paper will explore ways to improve the American diet including
smaller portions, having a greater understanding and connection with food consumed,
and relying less on convenience and fast foods. The purpose of this paper is to examine
the impact of cooking at home on dietary quality. It will discuss the role of cooking at
home and how it can impact diet through more involvement in and connection with food
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consumed, more control over the ingredients used, and a more balanced intake of
nutrients.
The American Diet
A century ago, the only food Americans consumed was local, real, whole food,
there was no fast food chains, packaged snack food, or frozen foods (Hyman, 2011).
Over time, Americans began working longer hours, more women have entered the work
field, and smaller households have become increasingly common, which has caused
people to turn to options that are faster, cheaper, and easier (Euromonitor International,
2012). Increased reliance on fast and convenient options has caused a huge disconnect
with thequantity and quality of food that is actually being consumed. Consumption of
excess calories continues to rise and the number of meals prepared at home continues to
decrease (Lin & Morrison, 2012). This continues to pose serious health consequences on
the American population.
In the fast-paced lifestyle Americans lead today, eating food away from home has
become increasingly popular. Convenient options like fast food, sit-down restaurants,
and packaged foods have become a staple in the diets of many Americans. These options
are often packed with fat, sodium and calories, and lacking much nutritional benefit.
Figure 1. below exhibits the standard American diet. According to the USDA, the
average diet includes only 12% of calories from plant-based sources like fruits,
vegetables, whole grains, and legumes.

Figure 1: Composition of the Standard American Diet, according to the USDA

From Cote (2012)
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The next 25% of calories come from animal-based foods, and the majority of the
American diet is composed of processed foods like oils, fats, fast food, refined grains,
and sweets (Cote, 2012). This imbalance of nutrients has led to serious health
consequences.
Dietary Guidelines
The USDA Dietary Guidelines for Americans (DGA) are formulated in order to
help people maintain a healthy weight, reduce the risk of obesity and chronic diseases,
and promote overall health and wellbeing (USDA, 2010). The guidelines are intended
for Americans aged two and older to help them choose a healthy, nutritionally balanced
diet. However, the average American diet has strayed incredibly far from these healthy
recommendations. Almost the entire U.S. population does not consume enough fruits,
vegetables, whole grains, and dairy, while most people over consume solid fats, added
sugars, and alcoholic beverages (Krebs-Smith, Guenther, Subar, Kirkpatrick & Dodd,
2010).
As the incidence of eating away from home increases, so does the caloric intake
of most Americans. The USDA reports that the average American consumes almost
2,600 calories a day, which is nearly 500 more than they did 40 years ago (Ferman,
2014). This drastic caloric increase has resulted in an imbalance in consumption and
expenditure, leading to weight gain and an increased prevalence of obesity. Compared
with home foods, foods consumed away from home are denser in total fat, saturated fat,
sodium, and cholesterol, all nutrients that are already over-consumed by most Americans
(Lin & Morrison, 2012). Restaurants and fast food establishments tend to serve oversized
portions of unhealthy foods, contributing to Americans over consumption of calories and
under consumption of healthy nutrients found in foods like fruits, vegetables, and whole
grains.
Eating Out
These drastic disparities in the American diet can be attributed to the growing
prevalence of consuming food away from home, especially fast food. Fast food has
become a much more integral part of the American diet than it has before. In 1970, there
were 30,000 fast food restaurants and 30 years later in 2001, there were 222,000 and that
number has continued to rise (Therien, 2013). This growing trend in eating out has lead
3

to many health consequences. According to the USDA Agriculture Research Service,

about 34% of the average Americans energy intake comes from foods and beverages
consumed away from home (USDA, 2010). In addition, American household are
spending more and more on eating out rather than on groceries to cook at home, about
42% of household food budgets go to eating away from home (Lin & Morrison, 2012).
As fast food establishments become increasingly common, and eating out becomes more
and more popular, Americans continue to consume too many calories and not enough
nutrients.
Restaurant food is just as big a concern as fast food in this drastic increase in the
prevalence of obesity. On average, a single meal at a sit-down restaurant can contain
56% of your daily calories, 151% of your daily sodium, 83% of your saturated fat, and
60% of your daily cholesterol (Fontenot, 2013). Shockingly, this is the damage that just
one meal eaten away from home can do. Unfortunately, many Americans eat multiple
meals away from home a day, in fact, nearly half of all food expenditures are spent eating
out (Larson, Story & Nelson, 2008). Often, poor dietary choices are a result of
consumers being unaware and not having the nutritional information they need to help
them make healthy choices.
The more frequently Americans eat out, the more they become accustomed to
these large servings and nutrient poor foods. These meals consumed away from home
tend to be very energy-dense and poor in dietary quality, which contributes to higher
body weight and adverse health outcomes (Kant, Whitney & Graubard, 2014). Research
has shown that even eating just one meal away from home each week can result in two
extra pounds a year (Todd, Mancino & Lin, 2010). Currently, the average American eats
out almost five times a week (Lin & Morrison, 2012), which has contributed to weight
gain and poor health outcomes.
Health of the U.S. Population
Diet and nutrition are essential to overall wellbeing. However, Americans have
become exceedingly disconnected with the foods they consume and the quantities they
consume them in. The U.S. Department of Health determined that the combination of
poor diet and lack of exercise causes 310,000-580,000 deaths a year (McGinnis & Foege,
2004). Increased dependency on energy-dense and nutrient-poor dietary choices served
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at fast food chains and restaurants have contributed to a staggering increase in the rates of
overweight and obese Americans. Over the past 30 years, obesity rates have more than
doubled in both adults and children (World Health Organization, 2014). Currently, over
two-thirds of the American population is overweight, and about one third is obese. With
this rise in obesity, has come an increased risk and incidence of chronic diseases.
According to the USDA Dietary Guidelines, poor diet contributes to major causes
of morbidity and mortality including cardiovascular disease, hypertension, type II
diabetes, osteoporosis, and some types of cancer (2010). As seen in Table 1., inadequate
diet is a factor in many of the major health problems and causes of mortality facing the
American population. About 37% of Americans have cardiovascular disease and 34%
have hypertension (USDA, 2010), and up to one third of cancers are related to diet
(Szabo, 2004). The quality of food Americans consume is an essential way to fuel their
bodies for optimal health. By improving dietary quality, Americans can reduce their risk
of these chronic diseases and lead healthier, longer lives.
Table 1. Leading Cause of Death (Diet and inactivity are leading factors for caused of
death shown in bold)
1. Heart Disease
2. Cancer
3. Stroke
4. Chronic Obstructive Pulmonary Disease
5. Accidents
6. Diabetes
7. Pneumonia and Influenza
8. Alzheimers Disease
9. Nephritis
10. Septicemia
11. Suicide
12. Chronic Liver Disease/Cirrhosis
13. High Blood Pressure
14. Pneumonitis
15. Homicide

709,894
551,833
166,028
123,550
93,592
68,662
67,024
49,044
37,672
31,613
28,332
26,219
17,964
16,659
16,137

From Hoyert, Kung, Smith (2005)

Ways to Improve the American Diet

Up until about 100 years ago, growing food to provide for your own family was
something almost all Americans did (Lieberman, 2011). Americans went from being
involved in every step of food production, from farming their own vegetable to milking
cows to roasting chickens, to putting all of their trust in strangers and being completely in
the dark about what they are consuming, The busy lifestyle that most people lead today
has caused a complete disconnection with the foods they consume. In order to improve
their dietary quality, Americans must increase their understanding and awareness of the
foods they consume.
Relying Less on Convenient Options
Choosing the convenient option of eating out, whether it be fast food, sit-down
restaurants, frozen dinners, etc, has contributed to the poor dietary quality of most
Americans. In the U.S., adults have decreased consumption of food at home and reduced
time spent on preparing and cooking food (Smith, Ng & Popkin, 2013). It is essential
that Americans stop choosing the convenient option and start becoming more involved in,
or at least aware of, their food preparation. By using the dietary guidelines and cooking
more meals at home, Americans can learn more about proper servings sizes and foods to
increase and reduce in their diet.
According to the MyPlate website created by the USDA, when they do eat away
from home, it is important for Americans to think about what and how much they are
eating and drinking, as well as how the meal was prepared (USDA, 2011). It is important
to ask the server how the food is cooked and what ingredients are added to ensure that
they are not additional added fats and sugars. As a society, Americans need to start
asking questions about where their food comes from and what is being done to it before it
reaches their plate (Lieberman, 2011). Instead of aimlessly eating whatever quality and
quantity of food is served to them, Americans need to reconnect with their food source
and reestablish the role of food to their health and wellbeing.
One of the biggest concerns with eating out frequently is the oversized portions
that are served and consumed. In the past few years, the amount of restaurants that offer
supersize options on their menu has drastically increased, and even other food items,
like snack foods, have increased in weight (French, Story & Jeffrey, 2001). These large
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portions have caused Americans to lose awareness in appropriate servings and how many
they are actually consuming in one sitting. Large portions have become associated with
value for your money, and as a result, have become something most Americans desire
or even expect when eating out.
Studies have shown that people eat more when they are confronted with larger
portion sizes (Rolls, Morris, & Roe, 2002; Diliberti et al., 2004). A study conducted by
Rolls, Morris, & Roe (2002) examined whether portion sizes affect energy intake
compared how adults responded to meals when presented with four different serving
sizes. They found that participants consumed 30% more calories when served the largest
portion compared to the smallest, and that participants served all different sizes reported
the same levels of hunger and fullness (Rolls, Morris & Roe, 2002). Americans have lost
their natural cues of hunger and satiety, and have become accustomed to eating whatever
is put in front of them. Learning what appropriate serving sizes look like in each food
group and trying to consume foods in these quantities can significantly improve the
American diet.
Choosing the Right Foods
The current diet of most Americans is far from healthful and nutritious. As seen
in Figure 2. below, the typical American diet is incredibly flawed and conflicts with
almost all of the recommendations put forth by the USDA. The average American
consumes well below the recommendations for whole grains, vegetables, fruits, dairy,
seafood, and oils, in many cases under half of the recommended goal. Possibly even
more concerning is the extreme overconsumption of several items like saturated fat,
sodium, refined grains, solid fats and added sugars, and meat, poultry, and eggs. The
typical American consumes 200% of their recommended goal for refined grains and
280% of their recommendation for calories from solid fats and added sugars. This
extreme imbalance of not enough healthy nutrients and too many detrimental nutrients
has posed many consequences on the health of the U.S. population.

Figure 2: Comparison of a typical American diet to recommended intake levels or limits

of the Dietary Guideline for Americans 2010. From USDA (2010)
Whether eating out or cooking at home, Americans can make healthier choices
that can improve their dietary quality. According to the USDA Dietary Guidelines,
Americans should increase their consumption of vegetables, fruit, whole grains, fat-free
and low-fat dairy, and a variety of lean proteins (USDA, 2010). While eating out, this
can be done by reading menus carefully, asking about the foods and how they were
prepared, asking for substitutions, and opting for choices like grilled chicken instead of
beef and whole grain bread instead of sourdough. When eating at home, people should
aim to make half of their plate fruits and vegetables and incorporate a variety of lean
proteins like salmon, chicken, turkey, eggs, etc.
Foods or nutrients to avoid or limit while eating out or at home include salt,
saturated fat, cholesterol, trans fat, added sugars, refined grains, and alcohol (USDA,
2010). To accomplish this, one can make substitutions like water or low-fat dairy instead
of sugary drinks and use cooking methods that reduce added fats like baking, broiling,
and roasting. According to the USDA, no more than 15% of your dietary intake should
come from empty calories; however, empty calories currently make up about 35% of the
average American diet (USDA, 2010). Reading nutrient labels when grocery shopping or
eating out is essential to avoid consuming too much of these over consumed nutrients,
especially salt and cholesterol.
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Developing a Healthy Relationship with Food

In order to develop a better understanding and relationship with the food they
consume, Americans should think about food as a way to fuel their bodies and better their
nutrition. Like any relationship, a healthy relationship with food takes time and effort
(Erickson, 2014). It is important to be conscious of the quality of food consumed and
what a healthy serving size looks like in each food group. Rather than convenience, it is
important to put health and nutrition first when it comes to making food choices.
Americans should aim for a balanced and varied diet that incorporates many different
fruits and vegetables and limits processed food. It is important not to fear foods or
restrict foods, but instead eat less nutritious foods in moderation and less frequently
(Erickson, 2014).
Cooking at Home
Americans now spend more time watching cooking on the Food Network than
actually preparing their own meals (Hyman, 2011). This is unfortunate because eating at
home can provide much more control over the nutrients and portions consumed. Instead
of relinquishing control of calories and nutrients over to restaurant owners and fast food
establishments, cooking at home gives the consumer control over the ingredients used.
As a result, foods prepared at home tend to have much better nutritional content than
foods eaten away from home (Guthrie, Lin, Okrent & Volpe, 2013).
Experimenting and creating with food at home can help incorporate a variety of
foods to ensure the consumption of essential nutrients and to achieve a healthy, balanced
diet. In a study examining the influences on dietary behavior in children, it was found
that the availability, accessibility, and exposure to a range of fruits and vegetable in the
home was correlated with increased consumption (Hearn et. al., 1998). By having
healthy options at home, and exposing children to a variety of nutritious foods early on,
better dietary habits can be formed both in and out of the home.
The Effect of Cooking at Home on Dietary Quality
In order to maintain healthy bodies, people must give them the right nutrientsreal, local, fresh, and unprocessed (Hyman, 2011). Cooking at home allows the
consumer to choose healthier options and to increase the consumption of healthy
9

nutrients like fruits and vegetables and decrease the consumption of added fats, sugars,
and sodium. Without being limited to the options of a restaurant or fast food
establishment, the consumer can make healthier food choices by substituting whole
grains for refined grains, leans meat and poultry for red meat, and choose low or nonfat
diary.
More Control
Nutrition is essential to good health, so food preparation and cooking skills can
have an impact on diet and wellbeing. Cooking at home gives the consumer more control
and flexibility over the choice and variety of ingredients used. Using fresh produce not
only tastes better, but also contains higher amounts of vitamins and nutrients (Miller,
2014). Cooking food at home, rather than eating out, gives the consumer complete
control over the proportions of foods and the way the way the food is prepared. Cooking
your own food allows you to prepare it in a way that will not deplete nutrients or add
excess fats, sugars, and salt (GRACE Communication Foundation, 2014). Instead of
consuming added chemicals and preservatives of processed foods that the average
American has become accustomed to, Americans can retrain their palates to prefer the
taste of fresh foods and season their meals according to their individual preferences at
home. Foods prepared at home tends to be more nutritious than that prepared away from
home, and healthier dietary variety can be achieved by people who regularly cook from
fresh or raw ingredients (Caraher, 1999). Having more control over the nutritional
content of the foods they consume, can help more Americans meet public health
guidelines.
Cooking at home gives the consumer complete control over the portion sizes they
consume, which is essential to a balanced diet. It is essential that consumers take back
control of their own diet and rely less on convenience and take out foods that provide
oversized portions and little nutritional value. Many restaurant items are served in
portions twice or several times as large as the standard serving size set forth by the
USDA (Jacobson & Hurley, 2002), which is especially concerning because people tend to
consume more food and more calories when presented with larger portions (Rolls, 2003).
Cooking at home can be an essential way to control how much food is prepared and

10

consumed, in order to more closely address personal healthy and adhere to the USDA
dietary recommendations.
More Balanced
Cooking competence, both knowledge and skills, is vital to have because it affects
self-reliability, nutritional knowledge, dietary behavior and quality, and personal health
(Ternier, 2010). If equipped with the proper knowledge and skills, the consumer can rely
less on convenience, packaged, frozen, or fast food items, and can take back control of
the foods they consume. Cooking competence can enable the consumer to prepare and
incorporate vital foods for a healthy diet, broaden their food selection, and contribute to
higher consumption of healthier foods like fruits, vegetables, and grains (Levy & Auld,
2014).
The increase in consumption of away-from-home foods has significantly
impacted the diets of most Americans. Eating out often leads to consumption of excess
calories and fat- 96% of restaurant meals exceed USDA recommendations for fat, salt,
and overall calories (Wu & Sturm, 2013). By cooking more meals at home, the consumer
can make better dietary choices based on individual health and preference. Instead of
being limited to the options set by a menu or drive-through, cooking at home allows
endless options of various foods and preparation methods that can contribute to a healthy,
balanced diet.
Connection with Food Consumed
Eating away from home relinquishes control of the quality and quantity of food
consumed to restaurant owners and chefs. Research suggests that increases in portion
size, calorie density, and variety of available foods are all associated with increased
caloric intake (Wansink, 2014), which has become a fundamental issue in the average
American diet. Instead of trusting strangers with their dietary quality and eating
whatever is put in front of them, Americans need to become more aware and involved in
their food preparation and consumption. It is vital for American to regain a relationship
with food and relearn the appropriate portions of food. Cooking at home and getting the
family involved can build healthy habits that with last a lifetime and increase awareness
of how good healthy, fresh food can taste.

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Clinical Trials and Studies on the Impact of Cooking on Dietary Quality

A study by Monsivais et al. (2014) examined the association between the amount
time spent on food preparation activities (preparing, cooking, and cleaning up meals at
home) and food consumption, food spending, and restaurant use. This was a crosssectional study, including 1,319 adults, who were the main food providers in their
households. The population was composed mostly of women (67.4%), with a mean age
of 54 years old. Data was collected through weekly surveys and food frequency
questionnaires. Results showed that 16% of participants spent less than one hour a day
on food preparation, 43% spent one to two hours a day on food preparation, and 41%
spent more than two hours a day. Fruit and vegetable consumption was positively
associated with food-related time use, those who spent the most time cooking consumed
fruit 8.4 times per week and vegetables 13.6 times per week compared with fruit 6.1
times per week and vegetables 10.6 times per week in the lowest time use group. Weekly
food spending for meals and beverages away from home was inversely related with time
spent on food activities.
The percentage of each time-use group visiting full-service restaurants did not
differ among groups, but visits to quick service (fast food restaurants) was 43% in the
lowest time-use group compared to 30% in the highest time-use group. Those in the
lowest time use group were 1.8 times more likely to visit quick-service restaurant
compared to those in the highest time-use group. The study concluded that healthier food
consumption patterns (consuming more fruits and vegetables, spending less on food away
from home, eating at fast food restaurant less frequently) were significantly associated
with more time spent preparing, cooking, and cleaning up from meals.
A limitation of the study is that it was cross-sectional, which does not allow for
causality- it is unclear whether time spent on preparing food enables healthier eating
habits or whether individuals who consume healthier diets also enjoy spending time
cooking. Another limitation was that the independent variable and all three dependent
variables were self-reported, which can lead to error and bias. Dietary quality was only
assessed through the intake of only a few food groups and only frequency, not quantity of
intake was examined. However, the study included a relatively large population sample

12

and an innovative linkage of food intake, food spending, restaurant usage, and time spent
on food preparation.
Another study, by Laska et al. (2012), examined whether involvement in food
preparation tracks over time and is associated with better dietary quality. This was a
longitudinal cohort study with participants sampled from Minnesota public secondary
schools, which explored associations over 10 years between home food preparation,
dietary quality, and meal patterning. The sample for this study included 565 males and
756 females between 15 and 16 years old. Student completed online surveys and
biometric measurements at the start of the study, five years later, and 10 years later when
they were in their mid-to-late twenties.
Results of the study showed that emerging adult food preparation predicted better
dietary quality five years later in the mid-to-late twenties, including higher intakes of
fruit, vegetables, dark green/orange vegetables, and less sugar sweetened beverage and
fast food consumption. Associations between adolescent food preparation and later
dietary quality did not show significant results. The study showed that food preparation
behaviors track over time, and involvement in food preparation during early adulthood
significantly predicted both liking to cook and more frequent preparation of meals with
vegetables five years later for males and females in their mid-to-late twenties (p<0.001),
as well as more frequent breakfast and lunch consumption and less frequent fast food
intake among males and females in their mid-to-late twenties (p<0.05).
Males and females with higher food preparation scores in emerging adulthood
tended to consume more fruit, vegetables, and dark-green and orange vegetables in their
mid-to-late twenties, as well as fewer sugar sweetened beverages (p0.01), and females
also consumed more whole grain and lower saturated fat consumption five years later
(p<0.01). However, involvement in food preparation and purchasing during adolescence
was associated with a lower consumption of vegetables in males and whole grains in
females among those in their mid-to-late twenties.
Although the study controlled for parental employment in examining adolescent
food preparation, they did not control for other characteristics like family structure and
number of adults living in the household. These factors have an influence on the
relationship between food preparation and dietary intake. Another limitation of this study
13

is a lack of consistent measures of food preparation across all three time points.
Measurement among emerging adults included several behavioral dimensions, while only
one survey question was used to determine adolescent involvement in food preparation.
The studys limited ability to determine adolescent food preparation could have made it
less likely to detect an association if one did exist. However, this study was the first of its
kind to look at longitudinal associations between home food preparation and dietary
outcomes over the period of time from adolescence to young adulthood. It used data from
a large, diverse cohort of participants, which makes it more relevant to the general
population and followed participants over a 10-year period.
Another study by Wrieden et al., aimed to examine the impact of communitybased food skills interventions on cooking confidence, food preparation methods, and
dietary choices. This was an exploratory trial, examining 113 participants in eight urban
communities who were divided into control and intervention groups. The program
entailed 10 weekly, two-hour sessions, including practical and educational elements.
Measurements were taken at baseline, right after the implementation, and six months
later. Only 29 intervention and 21 control subjects finished analysis from baseline to right
after intervention, and only 24 intervention and 17 control were able to be analyzed from
baseline to six months later. Evaluation and data collection was performed through
interview questionnaires, cooking skills questionnaires, food diaries, and food frequency
questionnaires.
Results determined that fruit intake increased between baseline and after
implementation. Between baseline and six months later, there was a significant increase
in intervention subject who reported confidence in following a recipe. However, food
frequency questionnaires across time points did not show significant differences, any
small change in dietary habits found were not maintained after implementation was
completed. Weaknesses of this study were that the population sample was all of low
socioeconomic status, where confidence, a dependent variable in the study, is generally
low. The study did not yield significant results regarding the impact of the cooking
intervention on dietary quality. The intervention duration may have been too short and
the process was too demanding in this population to have enough subjects complete the
process. However, the small dietary improvements found set the stage for further
14

research to determine whether food skills interventions can contribute to improvement in

dietary quality.
This trial, performed by Wrieden et al. (2007), was very different from the other
two studies because it was an exploratory trial that included intervention to a population
sample compared to a control group, while the other two studies were observational. The
sample size was much smaller for the exploratory trial and no significant findings were
realized. Similar to the study by Laska et al, the trial followed the same group of people
over a period of time, in this case six months, to track food behavior and dietary changes
as a result of the intervention.
A study by Crawford et al. examined associations between various food-related
behaviors and fruit and vegetable intake (2007). It was a cross-sectional survey, in which
subjects were randomly selected from electoral roll in 45 Melbourne suburbs of different
socioeconomic statuses. The study population included 1136 women, aged 18 to 65
years old.
Fruit and vegetable intakes were assessed through questionnaires and 24-hour
recalls. Results of the questionnaires were distributed on a five-item scale. Meal
behaviors and eating behaviors were assessed through 10-item questionnaires and
answers were categorized on a scale from never to six or seven times a week or more, or
never to always.
Results of the study found that women who participated in food-related behaviors
(grocery shopping, planning meals, trying new recipes, etc.) more often, were more likely
to consume two or more servings of fruit a day than those who never or rarely
participated in these activities. Women who prepared meals at home most often were 1.4
times more likely to consume two or more servings of fruit compared to women who ate
meals at home four or five times a week at most. The likelihood of meeting fruit intake
recommendations was lower in women who ate meals from a fast food restaurant,
cafeteria, or the freezer section of a supermarket. Involvement in and enjoyment of foodrelated activities was also associated with a higher probability of consuming two or more
servings of vegetables compared to those who rarely or never participated in these
activities. Women who ate meals at home the most frequently were twice as likely to

15

consume two or more servings of vegetables than those who ate meals at home four or
five times a week at most.
The cross-sectional design of this study means that it cannot determine a causal
relationship between these food behaviors and fruit and vegetable intake, only an
association between the two. However, the study used a large, diverse sample of women
from a broad range of socioeconomic backgrounds and adjusted for potential
confounders, which ensures that the results are significant and transferable to the general
population.
This study provides insight into specific food-related behaviors and their
association with fruit and vegetable intake- key indicators of a healthy diet. The results
found similar associations with increased fruit and vegetable consumption and
involvement in food-related behaviors. This is particularly interesting because fruit often
requires little or no culinary preparation and is usually consumed as a snack rather than
part of a meal. Vegetables, however, often require more preparation and time, and are
usually consumed as part of a meal. This can suggest that these food-related behaviors
relate to over all healthier food choices and nutrition.
Larson et al. (2006) performed a cross-sectional study that examined food
preparation and purchasing roles in adolescents and their effect on dietary quality. The
study population consisted of students from middle school and high school in
Minneapolis. Their dietary intake was assessed weekly through food frequency
questionnaires and a Project EAT survey on frequency of involvement in preparing and
shopping for food over the previous week.
Results showed that individuals who were more involved in food purchases and
preparation or who cook more often were more likely to meet dietary guidelines set by
Healthy People 2010. Participants with high meal preparation involvement scores
consumed the recommended five servings a day of fruit and vegetables (31%)
significantly more often than those who consumed more convenience food products
(3%). Frequency of food preparation was associated with higher intakes of fruits,
vegetables, fiber, folate, and vitamin A. Food preparation was also associated with lower
intakes of fat (P<0.01), lower intakes of carbonated beverages among female adolescents
(P<0.01), and lower intakes of fried foods in male adolescents (P<0.01).
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This study shows that involvement in purchasing and preparing food has positive
effects on dietary quality, increasing healthy nutrients and decreasing unhealthy foods.
Involvement in food preparation processes can give people a healthier relationship and
awareness of the foods they consume.
A study by Brown and Herman (2005), performed through the Oklahoma
Cooperative Extension examined the effect of cooking classes on fruit and vegetable
intake in youth and adults. The program focused on fruits and vegetables and used
cooking classes to teach basic fruit and vegetable preparation skills and nutrition related
to produce. The classes covered various fruit and vegetable preparation methods like
baking, pressure cooking, grilling, steaming, etc. as well as how to incorporate fruits and
vegetables into different foods like smoothies, salads, snacks, soups, etc. Participants
were allowed to taste the products prepared during each class. The program was
implemented in 28 counties by County Extension educators who were trained in how to
conduct and evaluate the program. Each program consisted of eight classes, delivered
over a period of about two months.
The program had 602 participants who completed the evaluation, 229 youth and
373 adults. The average age of youth participants was 12 and the average age of adult
participants was 57. The study found a significant increase in the number of fruit and
vegetable servings consumed for both youth and adults. Average fruit consumption
increases from 1.1 to 2.3servings a day for youth (P< .0001) and 1.5 to 2.1 servings a day
for adults. Results showed a 39% increase in the number of youth and a 17% increase in
the number of adults who consumed the recommended two fruit servings a day. The
average number of vegetable servings increased from 1.4 to 2.4 servings for youth (P<
.0001) and 2.1 to 2.7 servings a day for adults. There was a 25% increase in the number
of youth and 18% in the number of adults who consumed the recommended vegetable
servings a day. Additionally, 69% of youth and 48% of adults reported eating a new fruit
or vegetable, and 67% of youth and 47% of adults reported preparing fruits or vegetables
in a new way.
Although the study population was relatively small, participants had a large range
of ages and the study was performed in 28 different counties, giving a better range of
demographics and socioeconomic status. The content of the cooking class was relatively
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consistent in each county, and incorporated frequent participation by subjects over a

period of two months. The cooking lessons showed a positive effect on fruit and
vegetable consumption, and should be considered as method to improve dietary
nutritional quality.
A study by Yunsheng et al (2003). examined the association between eating
patterns, including eating meals away from home, and obesity. The study included 499
subjects, ranging from 20 to 70 years old. Data, including three 24-hour dietary recalls
and body weight measurements, was collected at five equally spaced time points over a
one-year span.
The study found that eating breakfast away from home more often was associated
with an increased risk of obesity. Compared to subjects who ate breakfast away from
home less frequently, those eating breakfast away from home more frequently had more
than twice the risk of obesity. Similarly, those who ate dinner away from home more
frequently had twice the risk of obesity as those who rarely consumed dinner away from
home. However, eating lunch away from home was found to have a lower risk of
obesity, 30-60% lower risk than those who ate lunch out less frequently. Breakfasts and
dinners eaten away from home were significantly higher in total calories, percentage of
calories from total fat, and percentage of calories from saturated fat, and a lower
percentage of calories from protein, carbohydrate, and fiber than breakfasts and dinners
eaten at home. Lunches eaten away from home were significantly higher in total calories
and percentage of calories from total fat, and lower in percentage of calories from protein
than lunches eaten at home.
To assess eating patterns, the study used 15 24-hour recalls to reduce withinperson variation and minimize error. The dietary recalls were unannounced to avoid
error in recall like omission and/or inclusion, long-term averaging, and bias. The study
also performed several physical activity recalls and anthropometric measurements to
control for the effect of physical activity when examining the association between eating
patterns and body weight.
The study population, however, may not be representative of the US population
because it was made up mostly on white, middle-class people who were members of a
health maintenance organization and who had to be highly motivated to participate and
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finish the studys long and tedious protocol. There is also inconsistency with the effect of
eating lunch away from home, and eating breakfast and dinner away from home. This
could be a result of people packing their own lunch to eat at work, which the study did
not account for.
A randomized, controlled intervention utilizing Cooking with Kids, an
experimental school-based education program, aimed to assess the impact of this program
on fruit and vegetable preference, food and cooking attitudes, and self-efficacy
(Cunningham-Sabo & Lohse, 2013). The study was conducted with 257 students in 12
classes in four public schools. The intervention entailed a one-hour introductory lesson,
three two-hour cooking classes, and three one-hour fruit and vegetable tasting sessions.
These sessions were led by trained food educators, occurred during school hours, and
lasted throughout one semester.
Results of the intervention showed an increase in vegetable preference, food and
cooking attitudes, and self-efficacy in students who participated in the Cooking with Kids
program. The benefits were especially significant in boys without previous cooking
experience.
These studies incorporated various methods and designs, and examined the
impact of cooking on a range of different populations. Table 3. below summarizes the
different study characteristics such as design, study population, and intervention methods,
as well as describes the main outcomes each study focused on and their key results.

Summary and Future Research Needs
Of the studies discussed, four were cross-sectional analyses, which assessed
eating patterns through dietary recalls, food surveys, and food frequency questionnaires.
These studies examined the association between food preparation and behaviors and
outcomes like food consumption, fruit and vegetable intake, diet quality, restaurant use,
and obesity. The study populations ranged from 499 to 1710 participants. Three of the
studies included both men and women and one study examined only women. Foodrelated time use was positively associated with fruit and vegetable consumption
(Monsivais et al., 2014), and participation in food-related behaviors was associated with
increased likelihood of consuming more servings of fruits and vegetables per day
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