Continuing professional development

Strategies to encourage healthy eating

among children and young adults
PHC854 Ruxton C, Derbyshire E (2014) Strategies to encourage healthy eating among children
and young adults. Primary Health Care. 24, 5, 33-41. Date of submission: November 25 2013.
Date of acceptance: January 27 2014.

Abstract
There is a need for children and young people to improve their diets to meet recommended targets for fat, sugar,
fibre, vitamins and minerals. Yet, efforts to promote healthy eating in research studies or in national campaigns
have been unsuccessful or resulted in small changes to behaviour. The available evidence, albeit limited, suggests
that the most effective healthy eating strategies involve techniques such as providing personalised information and
incentives, supporting behavioural change, encouraging self-efficacy, where patients take control over their health,
and using social media and technology to deliver messages. Nurses have an important role in supporting dietary
improvement in children and young people, particularly to increase intakes of nutrients known to support growth
and development, such as iron, calcium, vitamin D and long-chain omega-3 fatty acids. Advice should include
both food consumption and appropriate use of dietary supplements as the latter can help bridge the gap between
recommendations and current low intakes of certain nutrients.

Aims and intended learning outcomes

After reading this article and completing the time out
activities you should be able to:
Have a working knowledge of dietary intakes of
UK children and young adults, including the gaps
between intakes and recommendations.
Discuss what dietary messages need to be
imparted to children and young people to promote
healthy eating.
Appreciate the range of methods used to promote
healthy eating as well as whether or not they can be
used in clinical practice.
Describe which strategies are more effective than
others, and apply this knowledge to your own
work setting.
This article explores why it is important to encourage
healthy eating among children and young adults, how
nutrition affects growth and development, and assesses
which healthy eating strategies may be effective.

Introduction
Children and young adults often have poor eating
habits, making them vulnerable to nutritional
inadequacies. Children, as well as adults, require
sufficient energy and nutrients to sustain normal
PRIMARY HEALTH CARE

physical and metabolic functions, and to support growth

and development.
Children grow rapidly in the first year of life,
acquiring substantial mental and physical skills,
before settling into a phase of more steady growth.
However, in the adolescent years, this changes again
when they have a further growth spurt, transforming
the child into a young adult with new physical, mental
and emotional capabilities. Even in young adults, the
body undergoes some refinement, particularly to bone
mass, which steadily increases into their mid-twenties
(Ruxton and Derbyshire 2013).
Nutritional inadequacy during the early years
can have a negative effect on short- and long-term
health and wellbeing. Table 1 (page 34) provides
an overview of important nutrients for growth and
development, indicating the possible consequences
of dietary inadequacy.
While there is abundant evidence on the ill effects
of nutritional deficiency in developing countries, where
food insecurity is widespread, there are fewer studies
on how poor diets affect children and young adults from
wealthier nations (Tomkins 2000). One US study found
an association between low iron status in non-anaemic
female students and suboptimal performance in

Carrie Ruxton is lead

consultant and dietitian at
Nutrition Communications
Emma Derbyshire is senior
lecturer in nutrition, school
of healthcare science,
Manchester Metropolitan
University
Correspondence:
carrie@nutrition-communications.
com

Keywords
Alcohol, children, diet,
healthy eating, minerals,
supplements, vitamins,
young adults
This article has been subject
to double-blind review and
checked using antiplagiarism
software. For related articles
visit our online archive and
search using the keywords
Conflict of interest
The authors of this article
received funding from
the Health Supplements
Information Service, which
is supported by a restricted
educational grant from the
Proprietary Association of
Great Britain. The content
reflects the opinions of
the authors
Author guidelines
phc.rcnpublishing.co.uk

June 2014 | Volume 24 | Number 5 33

Continuing professional development

Table 1 Important nutrients for growth and development
Purpose

Possible consequences
of inadequacy

Carbohydrate,
fat, protein

Energy for growth.

Protein essential building
block for body tissues

Stunting, poor bone health

Long-chain omega-3
fatty acids

Brain and retina structure

Lower cognitive function

and IQ, poor visual acuity

Iron

Red blood cells,

immune function

Iron deficiency anaemia,

fatigue, increased
risk of infection

Zinc

Nervous system,
immune function

Lower cognitive function,

increased risk of infection

Selenium,
iodine, folate

Brain development

Lower cognitive function

Vitamin A

Eye and skin health

Poor eyesight, dry

skin, low immunity

Vitamin C

Cell repair, immune

function, collagen formation

Poor wound healing,

increased risk of infection

Vitamin D, calcium

Bone health

Low bone mass leading

to rickets, increased risk of
fracture or osteomalacia

1
Time out

Nutrient

Apart from growth and development, reasons for

promoting healthy eating in children and young adults
include establishing a pattern of good dietary habits,
preventing obesity, lowering the long-term risk of chronic
multifactorial conditions, such as heart disease and
cancer, which may take several decades to develop, and
ensuring that girls are sufficiently healthy to sustain a
normal pregnancy should conception occur (Ruxton and
Derbyshire 2011), especially as around 45,000 teenage
pregnancies occur in the UK annually (Family Planning
Association 2010).
Now do time out 1.

Apply your experience

Write a case study outlining dietary issues
in a child you have met and how these might
be addressed.

Diets of children and young people

The National Diet and Nutrition Survey (NDNS) is the
most reliable source of information on UK diets. Originally
the survey was conducted every ten years on specific
age groups, but more recently it has evolved into an
annual rolling programme, based on a representative UK
population, and includes blood sampling that enables
estimates of nutrient status.
This section presents data on the diets of four to ten
year olds and 11 to 18 year olds, using the figures from
the NDNS published in 2012 covering three years of
the rolling programme (Bates et al 2012) as well as
data on the diets of 19 to 24 year olds using the 2003
NDNS (Henderson et al 2003). This has been done
because the 2012 NDNS gives combined data on adults
aged between 19 and 64 years old only.
Table 2 presents average intakes of fruit, vegetables,
sugar, salt, saturated fat and fibre in relation to current

(Adapted from Prentice et al 2006, Georgieff 2007, European Commission 2013)

problem-solving tests, indicating a negative effect of low

body iron on cognitive function (Blanton et al 2013).
Poor vitamin D status in childhood has also been
associated with greater risk of tuberculosis, attention
deficit hyperactivity disorder and insulin resistance
(Battersby et al 2012, Boucher-Berry et al 2012,
Koovsk et al 2012).
Table 2 Intakes compared with dietary reference values
SFA*
(as % total
energy)

NMES
(as % total
energy)

Salt (g)

Fibre (g)

Age (years)

Fruit and vegetable

portions
(% meeting target)

4-10

Data unavailable

13.3

14.3

4.2

11.3

11-18

2.9 (9%)

12.5

15.2

5.0

11.8

19-24

1.5 (0)

13.2

15.8

6.2

11.4

Target

5-a-day

10

10

* SFA = saturated fatty acids

34 June 2014 | Volume 24 | Number 5

3-5g for 4-10 year olds;

6g for >10 year olds

18

NMES = non-milk extrinsic sugars, for example mainly added sugars

PRIMARY HEALTH CARE

Table 3 Proportion of children and young adults with micronutrient intakes below lower reference nutrient intakes
4-10 years

11-18 years

19-24 years

Male

Female

Male

Female

Vitamin A

12

14

16

15

Vitamin B2

20

13

Vitamin C

Iron

45

40

Calcium

18

Magnesium

15

50

17

22

Potassium

31

18

30

Zinc

19

Selenium

12

44

Iodine

20

12

UK dietary targets. Each of the age groups failed to meet

the dietary targets, particularly for fibre and sugars.
Intakes of fruit and vegetables (FV) were particularly
low in young adults at just under two portions a day,
although this is likely to be a slight underestimate,
because the 2003 NDNS did not count FV added to
composite dishes such as stews or pies.
Using the same data sources, Table 3 looks at the
proportion of children and young adults with inadequate
vitamin and mineral intakes. The Lower Reference
Nutrient Intake (LRNI) is a level of intake that would be
expected to meet the needs of just 2.5% of the population
(DH 1991). Thus, a significant risk of deficiency is
indicated if more than 2.5% have intakes below the LRNI.
Table 3 shows that younger children were more
likely to have adequate vitamin and mineral intakes
than teenagers and young adults; in contrast, girls and
women were more likely to have intakes below the LRNI,
especially for calcium, magnesium, iron and selenium.
In the case of iron, 40-45% of females had inadequate
intakes compared with 3-4% of males, and this was
reflected in worse iron status as estimated by measures
of haemoglobin and ferritin (Bates et al 2012).
Now time out 2.

Time out

Nutrition policy
Check if your local area has a nutrition
policy for children, for example in nurseries
or schools, and tell a colleague about
the key points.

PRIMARY HEALTH CARE

Two important nutrients for growth and development,

vitamin D and long-chain omega-3 fatty acids, do not
have LRNIs, but there is, nevertheless, evidence that
intakes may be too low. In the past, it was assumed that
sufficient amounts of vitamin D would be synthesised by
the UK population in response to sunlight, but this has
been challenged by evidence showing that vitamin D
deficiency affects 20-40% of adults, teenagers and older
people (Bates et al 1999, 2012). The findings have led
to a re-evaluation of vitamin D recommendations.
Daily intakes of long-chain omega-3 fatty acids,
found in oily fish and fish oil supplements, have been
estimated from the most recent NDNS at 113-124mg
in children and around 300mg in adults (Gibbs 2013,
personal communication), while the UK target is 450mg
(Scientific Advisory Committee on Nutrition/Committee
on Toxicity 2004).
These low intakes of micronutrients and fibre, and
high intakes of saturated fat, sugar and salt are probably
due to dietary trends, such as skipping breakfast, high
intake of sugar-sweetened soft drinks that contribute
16-30% of daily sugar intakes low oily fish and
FV consumption, low red meat consumption in girls
and women, and high intakes of snack foods, such
as biscuits, cakes, savoury snacks, chocolate and
confectionery that account for around 25% of children
and young peoples daily energy intakes (Ruxton 2013).
A low uptake of dietary supplements may also explain
poor intakes of certain nutrients because only around
one quarter of children and young adults take any type of
dietary supplements (Bates et al 2012).
Alcohol consumption is a worry in adolescents and
young adults because alcoholic drinks are nutrient
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Table 4 Examples of healthy eating trials conducted on children and young adults
Study

Sample size and age group

Methods/intervention

Key findings

Clustered RCT*. A SMART lunch box

intervention programme consisted of providing
food boxes, bag and supporting materials

Children in the intervention group had lunches that

provided higher levels of vitamin A and folate; 11% more
children were provided with vegetables and salad in their
packed lunch, and 13% fewer children were given crisps

School meal/lunchbox studies

Evans et al 2010a

Data collected from children

aged eight and nine years old
at baseline, n =1,291

Improving fruit and vegetable intakes

Glasson et al
2012

Parents with children of

primary school age, n = 292

Six-week RCT. The intervention

group attended a fruit and veg sense
session, and received newsletters
two and five weeks after attending

FV intake increased significantly in the

intervention group by 0.62 servings compared
with 0.11 in the control group ( p = 0.001)

Panunzio et al
2011

32 schools involved;
schoolteachers, n = 96 and
schoolchildren, n = 813

School-based RCT. Teachers assigned

to two different nutrition education
interventions:
Attending a nutritionist-led training course
Performing a self-training course

Intakes of FV rose by 45% and 39% in children taught

by teachers from group 1. Intakes of FV went up by 21%
and 19% in children taught by teachers from group 2

Clarke et al 2009

Eight schools involved; pupils

aged between 4.5 and 12
years, n =477

Three-week intervention. The

intervention included free FV (80g
portions), a peer-modelling video and
a series of small rewards, followed by
a four- to six-week maintenance phase
during which free FV continued

Children in years 1 and 2 consumed FV at school more

often after the intervention compared with the baseline,
and ate a greater number of portions each time. There
were no significant differences in home consumption

Nitzke et al 2007

Young people aged between

18 and 24 years, n=2,024

Twelve-month randomised treatment-control

study. Participants received mailed
materials and educational calls.
Controls received a mailed pamphlet

Participants in the experimental group had higher

FV intakes than the controls ( p < 0.05), and were
more likely to maintain these habits for longer

Improving fibre intakes

Sullivan et al
2012

Children aged between

two and 14 years, n=43

Twelve-month RCT. Children with

constipation randomised to a behavioural
tool group aimed at increasing fibre
intakes, or a control group

The behavioural intervention tool significantly increased

fibre intakes of children with constipation at three months,
compared with standard dietary treatment ( p = 0.005)

Rees et al 2010

Children, aged between

12 and 16 years, n=823

Clustered RCT. Randomised by school

class to receive a tailored, intervention
or a generic leaflet aimed at improving
FV and wholegrain intakes

The tailored intervention leaflet significantly boosted

brown bread intake from 0.39 to 0.51 servings a day

poor, while representing a significant source of calories.

The NDNS found that 15% of 11 to 18 year olds had
consumed alcohol during the dietary assessment and,
overall, alcohol provided about 6% of total daily energy
intake in adolescents and adults. Specifically, in 19 to 34
year olds, 44% of men and 37% of women exceeded 21
units a week, with alcohol providing 9% of daily energy for
men and 6% for women. There is also evidence that 24%
of UK teenagers combine high caffeine, sugar-sweetened
energy drinks with alcohol (Zucconi et al 2013).
Thus, based on the evidence for dietary intakes,
legitimate targets for health promotion include advising
a reduction in the consumption of saturated fat, sugar,
36 June 2014 | Volume 24 | Number 5

salt and alcohol, as well as promoting FV, oily fish,

fibre-rich foods and sources of important micronutrients,
such as vitamin A, vitamin D, calcium, iron, potassium
and magnesium. Public Health Englands Eatwell
plate, which shows the food proportions necessary for
a balanced diet, Eatwell week and the DHs 5-A-Day
campaign are good sources of information about what a
healthy, balanced diet should look like in practice (NHS
Choices 2013a, 2013b, Food Standards Agency 2011).
While healthy eating principles should underpin
dietary promotion, advice about taking vitamin and
mineral supplements, including a daily multivitamin, can
be useful, particularly for groups with high requirements,
PRIMARY HEALTH CARE

Study

Sample size and age group

Methods/intervention

Key findings

Young women, n = 210

Six-month, three-arm RCT.

Randomised to swap calorific beverages
with either water or DBs

The DB group had lower energy intake from all beverages

than water group at month three ( p < 0.05). The group
drinking water had a greater drop in grain intake at month
three and a greater rise in FV intake at month six ( p < 0.05);
those on DBs saw a greater decline in their dessert intake
than the water group at month six ( p < 0.05)

Toumbourou et al
2013

Secondary schoolchildren
in year seven (mean age
12.3 years), n = 24

RCT, 24 schools followed the intervention

(social relationship curriculum for
children, education for parents with
aim to reduce alcohol misuse), while
12 schools were used as controls

Intervention students showed significant reductions

in any lifetime use of alcohol, and reduced
progression to frequent and heavy use

Gmel et al 2012

Secondary school students,

aged between 16 and
18 years, n = 668

Quasi-randomised controlled trial. A

brief group alcohol intervention provided
to reduce the frequency of heavy drinking
occasions, maximum number of drinks on an
occasion, and overall weekly consumption

Borderline significant beneficial effects ( p<0.10)

on heavy drinking occasions and alcohol volume
were found six months later for the medium-risk
group only, but not for the high-risk group

Improving beverage habits

Piernas et al
2013

Alcohol reduction

Improving overall dietary habits

Shahril et al 2012

University students, n=417

Clustered RCT. Intervention group received a

ten-week nutrition intervention (a conventional
lecture, brochures, and text messages).
Control group did not receive any intervention

Diet improved significantly in intervention group,

for example there was an increase in energy intake,
carbohydrate, calcium, vitamin C and thiamine, fruits and
100% fruit juice, fish, eggs, milk, and dairy products.
Intakes of processed food dropped significantly

Siega-Riz et al
2011

Students, n=3,908

Two-year cluster-randomised study.

The effects of the HEALTHY intervention
(Siega-Riz et al 2011) determined by
measuring dietary intakes in sixth- and
later in eighth-grade students

Average daily fruit intake 10% higher at the end of the

study in intervention schools than in control schools
( p=0.0016). Water intake was 58mL higher in the
intervention schools than in the controls ( p=0.008)

Paineau et al
2010

Parents and children,

n=2,026

Eight-month RCT looking at the

effects of family dietary coaching

Mean number of servings a day improved significantly for

7% of targeted food categories in children. Mean serving size
was modified for 12% of targeted food categories in children

* RCT: randomised controlled trial

FV = fruit and vegetable

such as young children, pregnant and lactating women,

and older people. Vitamin and mineral supplements are
also good for people with low micronutrient intakes,
such as teenage girls, fussy eaters or those who have

Time out

Healthy v typical diet

Search online for the Eatwell week (www.
eatwelleveryday.org) and compare this with
your typical diet. What are the differences?

PRIMARY HEALTH CARE

DBs = diet beverages

restricted diets, including vegans and people who

avoid oily fish.
Now do time out 3.

Evidence from healthy eating trials

Table 4 provides evidence from international studies
that have attempted to improve dietary intakes
in children and young adults.
Of the studies identified, educational sessions,
teacher training and the distribution of newsletters
and brochures appear to be the most successful
and commonly used interventions. Providing free FV
has improved school pupils micronutrient intakes
June 2014 | Volume 24 | Number 5 37

Continuing professional development

38 June 2014 | Volume 24 | Number 5

Healthy Options Consciously Everyday) study randomised

young people to swap calorie-containing beverages for
water or diet beverages. Young people drinking diet
beverages had significantly lower energy intakes than
the water group, while FV intakes significantly improved
in the water group (Piernas et al 2013). Overall, these
findings show that changing beverage habits may also
lead to alterations in dietary habits, but more work is
needed to confirm this.
The HEALTHY study mentioned earlier also found
that changing the food and beverage options available in
schools led to significant improvements in water intakes,
increasing them by about 56mL compared with intakes
in control schools (Siega-Riz et al 2011).
Two trials looked into how alcohol intakes could be
reduced in young people. An Australian study focusing
on parent education and student awareness about the
effects of alcohol misuse found that these approaches
helped to reduce students alcohol use. They were also
less likely to use alcohol frequently or progress to heavy
use (Toumbourou et al 2013). However, a Swiss
study found that an alcohol intervention conducted on
16 to 18 year olds was ineffective, possibly because
heavier drinkers may have needed a more intensive
programme (Gmel et al 2012).
Other studies have offered more general advice
to children and young people. For example,
Paineau et al (2010) found that small dietary changes
such as changing serving sizes, cooking methods or
substituting foods worked best, and participants were
more likely to improve nutrition choices. A ten-week
multi-intervention programme comprising lectures,
brochures and text messages to students significantly
improved their dietary intakes and boosted energy
levels, as well as their daily intakes of carbohydrate,
calcium, vitamin C, thiamine, fruit, fish, eggs and
milk. Correspondingly, it resulted in a reduction in their
intakes of processed foods compared with a control
group (Shahril et al 2012).
Overall, these findings suggest that, while most
dietary interventions have had a degree of success,
the level of change is generally small. In addition, few
studies have shown sustained effects, indicating that
many interventions provide short-term benefits only.
Now do time out 4.

4
Time out

(Clarke et al 2009), but not total daily intakes

(Schagen et al 2005), and supplying children with
food boxes and bags led to children having lunches
that were more in line with UK government standards
(Evans et al 2010).
Most interventions have focused on ways to
improve FV intakes in children and young people.
In Australia, the fruit and vegetable sense session
an educational scheme targeted at parents led to
significant improvements in childrens FV intakes,
which increased by about 0.62 servings (Glasson et al
2012). Young economically disadvantaged Americans
aged 18-24, provided with educational materials and
supported by telephone follow up, also had improved
FV intakes (Nitzke et al 2007). Average intakes following
intervention were 4.9 servings a day, compared with
4.6 servings a day in the control group.
The American HEALTHY study (Siega-Riz et al
2011) also investigated the effects of making simple
changes in the school cafeteria, snack bars, school
stores and vending machines. These changes led
to daily fruit intakes increasing by an average of 10%,
compared with intakes in control schools. An Italian
study tested the effects of education programmes
delivered to teachers; compared with baseline, FV
intakes were 45% higher in schools where teachers had
attended a course led by a nutritionist and 38% higher
when teachers participated in self-training programmes
(Panunzio et al 2011).
Two recent studies looked at ways to improve fibre
and wholegrain intakes in children and young people.
Constipation occurs in 5-30% of children (National
Institute for Health and Care Excellence 2010) and
may be partially attributed to low fibre intakes (Stewart
and Schroeder 2013). One behavioural intervention
combining a self-monitoring and reward system helped
to improve significantly fibre intakes in children with
functional constipation after three months, but these
effects were not sustained at six or 12 months, indicating
that it may be difficult for children to maintain high fibre
diets (Sullivan et al 2012).
A study in eight UK schools in low income and/
or ethnically diverse areas asked girls aged 12-16
years to complete a computerised test. They were then
randomised to receive a tailored intervention leaflet or
a generic leaflet with a view to improving wholegrain
intakes. Girls receiving the intervention ate about 0.35
more servings of brown bread weekly than the control
group compared with baseline, indicating that the
tailored leaflet was more effective (Rees et al 2010).
That said, the effects of this intervention were rather
small, indicating that more could be done to improve
dietary intakes in teenage girls.
Three major studies have looked at ways to modify
beverage habits in young people. The CHOICE (Choose

Communication tools
Locate a healthy eating policy or leaflet from
your area, perhaps aimed at patients or staff.
How do the messages and communication
tools used compare with the evidence from
healthy eating studies?

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PRIMARY HEALTH CARE

5
Time out

A number of healthy eating campaigns have been

established with a view to improving dietary behaviours
and reducing the risk of obesity among young people.
Some have been more successful than others. For
example, the UK School Fruit and Vegetable Scheme
(SFVS), which still runs today, is a Department
for Education programme introduced in 2004 that
entitles every child between the ages of four and
six to a piece of fruit or vegetable each school day
(NHS Supply Chain 2013).
The efficacy of the SFVS was evaluated by
Schagen et al (2005) who found a non-significant
improvement in FV intakes in the intervention group
(3.65 daily FV portions) compared with the control group
(3.28 FV portions), although it was noted that home
FV intakes appeared to drop when free FV was offered
at school. A similar European Union-wide programme,
known as the School Fruit Scheme, has also now
been established to provide sustainable FV to schools
(European Commission 2009).
The Childrens Food Trust (2013a) has developed
a number of policies with a view to improving childrens
health. These include banning savoury snacks high in
salt and fat, such as crisps, and allowing only nuts,
seeds and FV with no added salt, fat or sugar. A similar
policy has also been applied to drinks, with only water,
low-fat milk, fruit juice or combinations of these allowed
(Childrens Food Trust 2013b), although the efficacy of
these policies is yet to be reported.
Certain celebrity campaigns, such as Jamie Olivers
school meals, have influenced government policy
and may provide benefits. An independent study of
11-year-old pupils eating Jamie Olivers school meals
showed that their performance improved by 8% in
science and 6% in English, while absenteeism due to ill
health fell by 15% (Waite 2009).
The Food Dudes healthy eating programme is an
example of an earlier motivational campaign aimed
at improving FV intakes in children aged 2-7 years.
Children were provided with a video of the Food Dudes
telling them that if they ate more FV, they could join the
Dudes struggle to save the health of the children of the
world and defeat the evil General Junk. Non-food treats,
such as stickers, badges and pencils, were awarded to
children who consumed sufficient quantities of targeted
foods. By the end of the intervention (two to three weeks
later) children were eating 100% of their fruit and 83%
of their vegetables, and intakes remained relatively
high even six months later (Horne et al 2004). Ireland
adopted the Food Dudes programme in 2007.
The governments UK-wide Healthy Start scheme
is available for pregnant teenagers and for women
with children under the age of four who also receive
income support or child tax credits (Healthy Start

2013). The scheme provides free vouchers that can

be spent each week on milk, fresh and frozen FV and
infant formula milk. Free vitamins are also provided,
but problems relating to their supply and distribution
have resulted in just 10% of eligible individuals receiving
supplements (DH 2013).
Other campaigns have been developed with a view
to lowering alcohol intakes among young people in
the UK. The Drink Aware initiative has developed
information resources for parents on how to talk to their
children about alcohol (Drink Aware 2013), while the
Youth Alcohol Advertising Council (YAAC) comprises a
group of young people from across England and Wales
that meets to review alcohol advertising against a set of
principles within the rules that regulate content in the
Advertising Standards Code (YAAC 2013). However,
while these both have important potential health
implications, their effects remain to be tested.
Now do time outs 5 and 6,

6
Time out

Healthy eating campaigns in the UK

Healthy Start
Investigate the uptake of the Healthy Start
scheme in your area and comment on
the findings.
Are the right people getting help?
What are the barriers to uptake?

Dietary advice
Outline the dietary advice, including
information on food and supplements,
that you would give a 19-year-old
woman with poor eating habits and
a fish allergy.

Discussion
It is clear from dietary surveys that children and young
people in the UK have a need for dietary interventions
to reduce intakes of less desirable nutrients, such as
saturated fat, sugar, salt and alcohol, and to increase
intakes of beneficial nutrients, particularly vitamin D,
minerals, fibre and long-chain omega-3 fatty acids.
FV intakes also need to be boosted to meet the 5-A-Day
target, although some improvements have been seen
in recent years.
While there are several policies aimed at improving
childrens diets, typically involving controls on school
food, delivery of information or provision of free FV,
there is little evidence that these are effective in the
long term or that they influence what children eat when
they are not at school. This is frustrating, although small
June 2014 | Volume 24 | Number 5 39

Continuing professional development

improvements are nevertheless desirable, even if such
initiatives only affect what children eat at school. At
present, there are no large campaigns to target obesity
prevention in children, although many parts of the UK
now have obesity strategies.
Looking specifically at FV, it was disappointing that
the SFVS scheme had a non-significant effect on overall
FV intakes given the likely cost of implementation
(Schagen et al 2005). However, the Food Dudes
programme (Lowe et al 2004), which combined better
availability of FV with non-food incentives, has shown
significant improvements in FV intakes over a number
of studies, including research in socially disadvantaged
areas. This provides some hope and may represent
a pattern of intervention that could be applied to other
areas, for example increasing intakes of mineral-rich
foods, boosting fibre consumption or limiting
alcohol intake.
While diet remains the cornerstone of advice, vitamin
and mineral supplements have a role in helping children

and young people to meet recommendations for vitamins,

minerals and long-chain omega-3 fatty acids intakes.
Supplements can be recommended when dietary change
is slow, but vitamin and mineral requirements are high,
for instance during teenage pregnancy, in a childs early
years, or when children and young people avoid valuable
nutrient sources such as oily fish, dairy foods or meat.
The government has acknowledged the value of
supplements for certain groups, for example folic acid
for pregnant women, vitamin D for young children, older
people, lactating women, people who are housebound
or individuals who cover their skin for cultural reasons
(DH 2012). The CMOs recent annual report proposed
that, because targeted approaches such as Healthy Start,
had not worked, all children under five years should
receive free vitamin supplements (DH 2013).
Nurses have an important role to play in encouraging
healthy eating in children and young people, such as
providing personalised information and incentives,
supporting behavioural change, encouraging self-efficacy,

References
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40 June 2014 | Volume 24 | Number 5

Childrens Food Trust (2013b) Healthier

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PRIMARY HEALTH CARE

Conclusion
Children in the UK remain in need of healthy eating
advice to shift their diets towards national targets.
Intakes of saturated fat, sugar and salt are persistently
high, while intakes of fruit, vegetables, fibre and certain
nutrients for growth, such as iron and vitamin D, are
lower than recommended.
Most healthy eating campaigns have focused on
fruit consumption, with little effect. The evidence from

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PRIMARY HEALTH CARE

intervention studies highlights that several aspects

can improve compliance with healthy eating advice,
for example school settings, telephone support,
incentives, personalised advice and practical solutions
to dietary choices. Other ideas, such as social media,
apps, music and role models could also be explored
in future studies.

Practice profile

Time out

where patients take control over their health, and using

social media and technology to deliver messages. Some
techniques may require additional training.
Encouraging healthy eating can be difficult and the
evidence for efficacy is sparse. More published studies
are required, but in the meantime health professionals
should continue to support positive dietary change in
children and young people. This can include providing
advice about foods, as well as supplements to bridge the
gap between intakes and recommendations.

Now that you have finished the article, you

might like to write a practice profile of
between 750 and 1,000 words.
Go to the Primary Health Care website
at phc.rcnpublishing.co.uk and follow
the link to the continuing professional
development pages to find out how to make
a submission.

primary schoolchildrens fruit and vegetables

intake: a randomized controlled trial. Annali
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June 2014 | Volume 24 | Number 5 41

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