Food Dudes': Increasing Children's Fruit and Vegetable Consumption

 
Food Dudes': Increasing Children's Fruit and Vegetable Consumption
CASES                                                        PUBLIC HEALTH
                                                 COMMUNICATION & MARKETING
                                                                              in

                                                                                                 Volume III, Summer 2009

     ‘Food Dudes’: Increasing Children’s Fruit
           and Vegetable Consumption

                        C. Fergus Lowe, PhD and Pauline J Horne, PhD
                         Food and Activity Research Unit, Bangor University, Wales

                  Corresponding Author:
                  Professor Fergus Lowe, The Bangor Food and Activity Research Unit (BFARU),
                  Adeilad Brigantia, Bangor University, Gwynedd LL57 2AS, UK. Email: c.f.lowe@
                  bangor.ac.uk

    Suggested Citation: Lowe, Fergus and Horne, Pauline. Food Dudes: Increasing children’s fruit and vegetable
    consumption. Cases in Public Health Communication & Marketing. 2009; 3:161-185.
    Available from: www.casesjournal.org/volume3

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Food Dudes': Increasing Children's Fruit and Vegetable Consumption
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Abstract
      The UK has one of the lowest fruit and vegetable intakes in Europe,
      and Britain now has one of the worst heart disease records in the
      world. Other diet-related health problems such as obesity are also
      on the increase. Children, in particular, are reluctant to eat fruit
      and vegetables, and it is the aim of the present Government to in-
      crease children’s consumption of these foods.

      The Food Dudes Program is an initiative to encourage and main-
      tain healthy eating habits in children. It is a school-based interven-
      tion designed for use in primary schools that:

      •   Encourages children to eat fruit and vegetables at school and at
          home
      •   Helps children develop a liking for fruit and vegetables
      •   Encourages children to become proud to think of themselves as
          healthy eaters
      •   Changes the ‘culture’ of schools to strongly support healthy eat-
          ing

      The Program has two main phases:

      Phase 1 (16 days): Children are read a letter and/or watch a
      specially designed DVD episode starring the “Food Dudes”, who
      provide influential role-models to imitate. Children are then given
      a portion of fruit and vegetable and those who eat both are given
      a small reward (e.g. juggling balls, pedometers). This encourages
      repeat tasting so that children begin to like these foods.

      Phase 2: Ongoing but less intensive support for eating of fruit and
      vegetables, using Classroom Wall Charts to record consumption
      levels which earn further rewards and Food Dudes certificates.

      Full evaluations demonstrate large and long-lasting increases in
      fruit and vegetable consumption in children from 2 to 11 years of
      age. The greatest increases are shown by those children who were,
      at the start, the poorest eaters of fruit and vegetables. Increases
      extend across a wide range of fruit and vegetable varieties.

      Based on these successes, Food Dudes is being rolled out in Eng-
      land, Ireland, Sicily and California.

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Project Overview
The Food Dudes Healthy Eating Pro-                 that they are able to develop a liking for
gramme is a school-based intervention, de-         these foods. Small rewards are given each
signed to increase consumption of fruit and        time the child tries fruits and vegetables,
vegetables among children 4 – 11 years old.        and in the process children come to re-cat-
                                                   egorize themselves as ‘fruit and vegetable
The program works by encouraging children          eaters’1.
to taste fruit and vegetables repeatedly, so

Figure 1. Food Dudes website visual

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Food Dudes': Increasing Children's Fruit and Vegetable Consumption
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There are two main phases to the program:           with a Food Dudes Home Pack, which en-
                                                    courages them to eat more fruit and vegeta-
Phase 1 (16 days)                                   bles at home by involving their parents and
Each day, children are read a letter and/           self-monitoring.
or watch a specially designed DVD episode
starring the “Food Dudes”. These Food               Phase 2
Dudes provide influential role-models for           The program continues to support suc-
children to imitate. Children are then given        cessful eating of fruit and vegetables, but
a portion of fruit and vegetable, and those         with less intensity than during Phase 1.
who eat both are given a small reward (e.g.         Classroom Wall Charts are used to record
juggling balls, pedometers). The rewards            consumption levels of these foods, and as
are used at the beginning of the Program            the children achieve more advanced goals,
to encourage children to repeatedly taste           they earn further rewards and Food Dudes
fruits and vegetables so that they begin to         certificates.
like these foods. Children are also provided

Budget
Ireland: 28 million euros (over 7 years) ($36       Wolverhampton: £575,000 (over 3 years)
million US)                                         ($805,000 US)

Results Overview2
Full evaluations are available, demonstrat-         •   Long lasting changes to dietary patterns
ing significant behavior changes, including:            and fruit and vegetable consumption.
• Large and long-lasting increases in fruit         •   Increases extend across a wide range of
   and vegetable consumption in children                fruit and vegetable varieties.
   from 2 to 11 years of age.                       •   The Program works for all children aged
• The greatest increases in consumption                 2-11 years old.
   are shown by those children who are, at          •   Effects are highly reliable, regardless of
   the start, the poorest eaters of fruit and           school location and social deprivation.
   vegetables.

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Background and Context
There is strong evidence that eating a diet                 to taste fruit and vegetables repeatedly, so
rich in fresh fruit and vegetables is vital for             that they are able to discover the intrinsi-
health and well-being 3. However, in spite of               cally rewarding properties of these foods
health messages, the UK has one of the low-                 and to develop a liking for them. In the
est fruit and vegetable intakes in Europe 4.                process, children come to view themselves
                                                            as ‘fruit and vegetable eaters’7.
The recommended ‘5 A DAY’ guidelines in
the UK advise eating at least 5 portions                    The Food Dudes Healthy Eating Program
(totaling approximately 400g) of fruit and                  has now attracted a great deal of interest
vegetables a day. However, current British                  from overseas and government agencies.
consumption levels are estimated to average
only 245g per person per day and, in some                   2005: The Irish Government, with support
age and social groupings, the real figure is                from the European Union and Industry,
substantially lower i.                                      launched a pilot program in 150 primary
                                                            schools across Ireland (view the Irish ‘Food
Diet-related health problems are on the in-                 Dudes’ website at: www.fooddudes.ie).
crease and current predictions indicate that
by 2010 over a quarter of all adults will be                2006: In recognition of its success after one
clinically obese5. Research suggests that                   year, the program was awarded a World
children’s food consumption patterns are es-                Health Organization Best Practice Award.
tablished early in life 6. It is therefore clear            It was chosen to receive this prestigious
that, to improve a nation’s long term health,               award from among 202 applications from 35
work has to start with children.                            countries.

The Food Dudes Healthy Eating Pro-                          2007: Based on the pilot’s success, the Irish
gramme, originated in 1992 by the Food                      Government made the Food Dudes Program
and Activity Research Unit at Bangor                        available to every primary school in Ire-
University in Wales, incorporates known                     land. It is being introduced to the country’s
psychological principles to help change chil-               3,300 primary schools over 7 years, on a
dren’s eating habits.                                       budget of 28 million euro ($36 million US).

The program works by encouraging children                   2009 and beyond: England begins a roll-

i The English government’s 5 A DAY program aims to increase fruit and vegetable consumption by: raising aware-
ness of the health benefits; improving access to fruit and vegetables through targeted action. The 5 A DAY pro-
gram has five strands which are underpinned by an evaluation and monitoring program: National School Fruit
Scheme; Local 5 A DAY initiatives; National/local partners - Government Health Consumer Groups; Communica-
tions program including 5 A DAY logo; Work with industry - producers, caterers, retailers. Available at: http://
www.dh.gov.uk/en/Publichealth/Healthimprovement/FiveADay/FiveADaygeneralinformation/DH_4069924.

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out in selected regions. Wolverhampton City                 and other organizations. DoH will be con-
Primary Care Trust (PCT)ii and The Wor-                     ducting formal evaluation of the roll-out.
shipful Company of Fruiterersiii are sup-
porting the first major roll-out of the Food                Trials of the program in Italy (view the
Dudes program in England. In the course                     Italian ‘Food Dudes’ website at: http://www.
of a three-year project, the program will be                fooddudes.it/doceboCms) and California also
extended to 20,000 primary school children                  began in 2009.
in Wolverhampton as part of the Primary
Care Trust’s strategy to improve chil-                      The Food Dudes Program is a key feature of
dren’s health. The total budget is £575,000                 an exciting new European Union initiative
($805,000 US). The program will also be                     launched in 2009, in which 90 million euros
introduced in London in 2009. This is sup-                  ($116 million US) will be provided annually
ported by the Government’s School Food                      to promote the eating of fruit and vegeta-
Trustiv, the Department of Health (DoH)                     bles in the 27 member states.

ii Primary Care Trusts (PCTs) work with local authorities and other agencies providing health and social care lo-
cally to ensure that communities’ health needs are met. PCTs are now at the centre of the NHS and control 80% of
the NHS budget. There are currently 152 PCTs in England.
iii The Worshipful Company of Fruiterers is one of the Livery Companies of the City of London. Originally and
presently concerned with the fruit trade, it is a notable charitable institution.
iv The School Food Trust was established by the Department for Education and Skills in September 2005. Its remit
is to transform school food and food skills, promote the education and health of children and young people, and
improve the quality of food in schools. Available at: http://www.schoolfoodtrust.org.uk/index.asp.

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The Social Marketing Benchmark Criteria
Benchmark 1: Customer Orientation
 Maintains a strong focus on the customer, seeking to understand as much as possible about
 the presenting issue and the target audience by using a mix of quantitative and qualitative
 research.

The Food Dudes Program began with be-                     from 2-7 years old in homes, schools and
havioral psychology – a deep understanding                nurseries.
of how children learn; how they emulate
role models; how they respond to incentives;              The program template included two key ele-
and how they acquire early taste patterns.                ments: video adventures that featured the
                                                          Food Dude hero figures; and small rewards
Original Research                                         to encourage children to taste the new
The Bangor Food and Activity Research                     foods.
Unit (BFARU), under the direction of Pro-
fessor Fergus Lowe and Dr Pauline Horne,                  All studies confirmed that the program
pursued extensive research to identify the                brought about significant long-term increas-
key psychological factors influencing chil-               es in children’s consumption of fruit and
dren’s food choices. The fact that children               vegetables. For instance, in one of the home-
do not eat fruit and vegetables is clearly an             based studies with ‘fussy eaters’ (aged 5-6
issue that relates to learning and cultural               years), children’s consumption of targeted
phenomena. By examining psychological                     fruit rose from 4% to 100%, and of targeted
principles associated with learning develop-              vegetables from 1% to 83%. Targeted fruit
ment, ‘Food Dudes’ researchers were able to               consumption was still at 100%, and vegeta-
create a pilot project that incorporated the              ble consumption at 58%, when the children
key principles of social learning and applied             were observed again 6 months later 9.
them to the issue of taste acquisition8.
                                                          The Food Dudes Healthy Eating
Based on this academic research, a pilot                  Program: pre-testing and
intervention was designed and tested on a                 development
small scale. This trial was funded by the                 Following these initial successes, the
Economic and Social Research Councilv and                 BFARU developed a stand-alone package
the multinational company Unilever. The                   to enable primary schools to implement
study involved more than 450 children aged                the program across all age groups. In all

v The Economic and Social Research Council (ESRC) is the UK’s leading research and training agency addressing
economic and social concerns. Available at: http://www.esrc.ac.uk/ESRCInfoCentre/index.aspx.

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schools, children were presented with fruit         consumption10.
and vegetables at lunchtime and fruit and/
or vegetables at ‘snack-time’ (immediately          All new procedures and materials, includ-
prior to morning break). The Food Dudes             ing videos and educational materials, were
Program was then introduced in a number             pre-tested with children in primary schools
of schools selected to receive the interven-        in Harwell (Oxfordshire, England), Bangor
tion. Following introduction of the interven-       (Gwynedd, Wales), Salford (Greater Man-
tion, all of these schools recorded signifi-        chester, England), Brixton and Stockwell
cant increases in pupils’ fruit and vegetable       (London, England).

Benchmark 2: Insight
 Uses the research phase to identify ‘actionable insights’: key pieces of understanding that un-
 derpin program development.

A range of insights identified by behavioral        model is part of a group; and if there is a
psychology research were used in the devel-         clear reward or benefit in being like the
opment of the Food Dudes Program.                   role model. This understanding was used in
                                                    developing the Food Dude super heroes12.
The first insight was that children are mo-
tivated by praise, recognition, and re-             Behavioral psychology accepts that lan-
wards. This was borne out by the evidence           guage locks in specific behaviors, through
that when rewards were omitted from the             the process of categorization. For example,
Food Dudes intervention its effectiveness           if a parents say repeatedly of their child,
was almost completely eliminated11.                 ‘Jenny hates tomatoes’, Jenny, indeed, will
                                                    come to categorize herself as a tomato-hat-
Positive role models were also identi-              er, saying of herself, ‘I hate tomatoes’. The
fied as having a powerful influence over            Food Dudes Programme works on the prem-
children’s learning and value systems. It           ise that you can change this learned concep-
was established that a child’s likelihood of        tualization if you encourage a child to try
imitating behavior is increased if the role         new foods, and to re-categorize himself as
model is older than the child; if the role          a ‘fruit and vegetable liker’13.

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            Figure 2. A Food Dude enjoying fruit

Benchmark 3: Behavioral Goals
 The focus is on changing people’s actual behavior. Baselines are identified and there are
 clear behavioral goals which are specific, measurable and time-bound.

The Food Dudes Program has a primary               In all schools, baselines are collected prior
behavioral goal that accords with the UK           to the intervention, and the program is
Government’s 5 A DAY guidelines to in-             fully evaluated in terms of actual changed
crease fruit and vegetable consumption             behavior (see ‘Evaluation & Results’). Con-
among primary-aged children. In addition,          sumption data are also collected from con-
it aims to maintain this behavior change in        trol schools to demonstrate the impact of
children’s eating habits over the long-term,       straight-forward fruit and vegetable provi-
and to encourage parents and teachers to           sion without the ‘Food Dudes’ package of
support children’s acceptance of fruit and         promotion and support.
vegetables and their move towards healthier
eating choices.

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Benchmark 4: Segmentation
  Avoids a ‘one size fits all’ approach. Instead identifies audience ‘segments’ with common
  characteristics (e.g., socioeconomic, geographic, demographic, attitudinal, behavioral), and
  then tailors interventions appropriately.

The Food Dudes Program is two-tiered,               Secondary Target Audience:
working not just to influence children’s            • Teachers – a crucial target audience,
healthy food choices, but also to equip                as they are responsible for the effective
teachers, parents and caregivers with the              delivery of ‘Food Dudes’
necessary resources for supporting this             • Parents, caregivers and relatives
change. It thus has two discrete target audi-
ences:                                              (see ‘Methods Mix’ for details of how inter-
                                                    ventions are tailored to each audience)
Primary Target Audience:
• Primary school children aged 4-11

Benchmark 5: Exchange
  Considers both the benefits and the costs of adopting a new behavior, aiming to maximize
  the benefits and minimize the costs, so creating an attractive exchange.

The Food Dudes exchange element works on            to less nutritious, heavily marketed alterna-
two levels:                                         tives that are high in sugars and fats.

For children                                        The Food Dudes Program aims to overcome
Eating a diet rich in fruit and vegetables          these barriers by creating a positive en-
has many health benefits including: re-             vironment (at home and school), in which
ducing the risk of coronary heart disease;          children are encouraged to try new foods
protecting against cancers; providing a good        and develop a taste for them.
source of energy and nutrition; protecting
against asthma; keeping skin, teeth and             In addition, it offers specific benefits that
hair healthy14.                                     give children clear incentives to adopt the
                                                    program: Viewing the adventures of the
However, there are a range of barriers that         Food Dudes on DVD is a fun experience for
traditionally prevent children from attain-         them to share with friends; the small Food
ing their recommended five portions a day.          Dudes prizes they win reward their healthy
These include: lack of support for healthy          eating and make participation in the pro-
eating at home or in schools; lack of positive      gram appealing; as they come to see them-
role models; negative role models15; and the        selves as ‘fruit and vegetable eaters’ they
low profile of fruit and vegetables, compared       come to take pride in their new identity;

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they gain kudos and self-confidence from            addition, 99% of parents and 99% of teach-
being able to succeed on the program.               ers thought that the health of children in
                                                    Ireland would benefit from the introduction
Problems sometimes found with rewards               of the Food Dudes Program in all primary
schemes16 are avoided in the Food Dudes             schools17.
program. Initially rewards are used to en-
courage children to taste new foods. Chil-          The home pack also encourages changes at
dren’s liking for the foods increases each          home, including changes to parents’ own
time they taste them and it is their enjoy-         diets: 88% of parents reported consuming
ment of the taste of the foods that main-           one or more portions of fruit and vegetables
tains consumption in the longer-term when           themselves on a daily basis as a result of
the tangible rewards are phased out.                the Program18.

For parents and teachers                            As an added incentive for schools, the pro-
Among some school teachers there may be             gram offers a fun experience for the whole
initial resistance to the ‘Food Dudes’, since       school to become involved in, supporting
delivery requires commitment of additional          the idea of ‘health-promoting schools’ and
time and energy, particularly over the first        strengthening the school community by in-
16 days (i.e., 20 minutes per day).                 volving parents, caregivers and volunteers.
                                                    It also has the potential to offer behav-
However, the benefits of the Program speak          ioral improvements among children: 31%
for themselves, and evaluation demonstrates         of teachers felt that children’s classroom
that teachers and parents come to support it        behavior had improved since the introduc-
strongly because the children are perceived         tion of the program19.
to enjoy it and because it works. During
evaluation of the Ireland program, 96% of           (See ‘Evaluation and Results’ for full de-
parents and 99.1% of teachers reported that         tails)
children were enjoying participating. In

Benchmark 6: Competition
 Aims to understand what competes for people’s time, attention, and inclination to change,
 and to work with or learn from the competition.

‘Food Dudes’ developers recognize that              during children’s TV viewing times. Three-
brand allegiance is a strong driver of be-          quarters of such food advertisements pro-
havior. Heavily branded ‘junk foods’ are all        mote high-calorie, low-nutrient foods20. The
around, and children are inevitably attract-        Food Dudes Program thus had to create a
ed by what they appear to offer. In industri-       product that could compete with the high
alized countries, food advertising accounts         sugar, fat and salt foods that are so heavily
for around half of all advertising broadcast        marketed to children.

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            Figure 3. The Food Dudes heroes

This meant evolving a strong brand pres-          and the video creates a fun identity for the
ence that would become as recognizable as         program, which children can engage with,
the cartoon figures and imagery used to           remember, and ask for.
market mainstream food products to chil-
dren. ‘Food Dudes’ now offers children an         Furthermore, ‘Food Dudes’ recognizes
alternative brand - a fruit and vegetables        that peer pressure is a strong influence
brand - whose appeal is carefully built           in schools. However, rather than trying to
through the design and promotion of its           circumvent this fact, the program uses peer
product range. The ‘Food Dudes’ superhero         pressure in its favour – turning it around
cartoon characters represent this brand,          to get the whole school (and especially older

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children) on board, and making it ‘cool’ to         and Vegetable program, which is part of the
eat fruit and vegetables.                           UK Government’s 5 A DAY program to in-
                                                    crease fruit and vegetable consumption. Un-
Initial results show that, by developing chil-      der the program, all 4-6 year old children
dren’s taste for fruit and vegetables, their        in Local Education Authority-maintained
learned preference for sugary, sweet snacks         infant, primary and special schools are
can also be overcome. In pilot trials in pri-       entitled to a free piece of fruit or serving of
mary schools, fruit consumption of 5-6 year         vegetable each school day 23.
olds more than doubled from 28% to 59%
over six months, while vegetable consump-           In order not to duplicate with this ‘competi-
tion increased from 8% to 32%21. This was           tor’, ‘Food Dudes’ is working closely with
true even when popular sweet and savoury            the Department of Health to ensure close
snacks were presented alongside the fruit           coordination is achieved. In particular, the
and vegetables22, demonstrating the abil-           new roll-out in Wolverhampton is being
ity of fruit and vegetables to hold their own       evaluated by the Department of Health. In
against strong food competitors, if positive        fact both programs are entirely complemen-
taste patterns can be established.                  tary. While the School Fruit and Vegetable
                                                    Scheme is concerned with the supply of
A further source of ‘good’ competition is rep-      fruit and vegetables, the focus of the Food
resented by the other initiatives also aiming       Dudes Program is to increase demand,
to increase fruit and vegetable consumption         which, of course, enhances the effectiveness
among children. The main example of such            of supply-based programs.
is the Department of Health’s School Fruit

Benchmark 7: Methods Mix
 Uses a mix of methods to prompt and facilitate behavior change, including education, sup-
 port, control and design techniques. Does not rely solely on raising awareness.

‘Food Dudes’ has a strong methods mix,              Phase 1 (16 days)
including ‘Food Dudes’ DVDs, letters, re-           Phase 1 is the initial 16-day intervention
wards, and Home Packs - each described              phase, during which children are intro-
below. The program runs in three phases as          duced to the Food Dudes who, via DVD
follows:                                            adventures, letters and rewards, encourage
                                                    them to eat fruit and vegetables.
Preparation
Baseline behavioral measurements are tak-           This introduction provides opportunities for
en for the first one to four days (optional).       children to sample fruit and vegetables, and, in
During this phase, children’s consumption           the process, to develop a liking for them. Phase
of fruit and vegetables is measured before          1 procedures can either take place during the
the ‘Food Dudes’ Program is introduced.             school’s snack time or lunch time break.

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Every day during this phase, children are            Phase 2
read a letter and/or watch a specially designed      Phase 2 is the ‘maintenance’ phase of the
DVD episode (lasting 6 minutes) starring the         program, in which the school supports the
Food Dudes. The Food Dudes are young su-             children’s increased consumption of fruit
perheroes who are involved in saving the ‘Life       and vegetables through, for example, the
Force’ from the ‘Junk Punks’, who plot to            use of class wall charts, certificates and a
take away the energy of the world by depriv-         small number of other rewards.
ing it of fruit and vegetables. The children
watch the Dudes getting the better of the            This phase lasts for up to a year and the
Punks in a series of video adventures. They          aim is for the school to move towards a self-
see the Dudes eating and enjoying a range            sustaining system of intrinsically reward-
of fruit and vegetables while praising their         ing fruit and vegetable consumption, which
health-giving properties and taste, and the          will ensure that a culture of healthy eating
children see that these eating choices are part      is maintained over time.
and parcel of the Dudes’ winning strategy.
                                                     In Phase 2 the program continues to support
The short letters that accompany these DVDs          successful eating of fruit and vegetables,
are read out by teachers to their class and          but with less intensity than during Phase
they provide a key means of communication            1. Classroom wall charts are used to record
between the Food Dudes and the children.             consumption levels of these foods and, as
They also provide important information              the children achieve more advanced goals,
about prizes and the benefits of eating a            they earn further rewards and Food Dudes’
healthy diet, as well as giving encouragement        certificates.
and praise for the children’s eating efforts.
                                                     Phase 3
The purpose of the ‘Food Dudes’ hero fig-            By the end of Phase 2, schools will have devel-
ures is to provide influential role-models for       oped, as an ongoing Phase 3, their own systems
children to imitate. At the same time, chil-         for supporting healthy eating. This Phase is
dren are also given small rewards if they            also very important. It operates to involve the
succeed in eating the pieces of fruit and            new intake of children each year, to introduce
vegetable they are given. Acting together,           them to the Food Dudes, and to recruit them to
the Food Dudes and their rewards provide             the healthy eating culture of the school.
the children with the incentives to follow
the Food Dudes’ healthy eating advice and
                                                     Education Support Materials
this, in turn, ensures that they get enough
                                                     The enthusiasm generated by the Food
repeated tastes of the foods to begin liking
                                                     Dudes Program provides an excellent ve-
them for their own intrinsic qualities.
                                                     hicle for achieving educational goals across
                                                     the curriculum. Education Support Materi-
Children are also provided with a ‘Food
                                                     als have been designed around the ‘Food
Dudes’ Home Pack, to encourage them
                                                     Dudes’ theme. Each pack contains sugges-
to eat more fruit and vegetables at home
                                                     tions and worksheets covering English,
through the involvement of parents and a
                                                     Mathematics and Science and Technology.
system of self-monitoring.
                                                     These materials are not essential to the
                                                     program, but can be helpful to teachers.

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Benchmark 8: Theory
 Uses behavioral theories to understand human behavior, and to develop programs around
 this understanding.

The Food Dudes Healthy Eating Pro-                  involves eating a piece of fruit or vegetable,
gramme is based on a comprehensive theo-            and the consequence is the receipt of a tan-
retical foundation. For a full review of the        gible reward or verbal encouragement.
social and cultural learning theory that
underpins it, see Lowe, C.F., Dowey, A.J &          Using rewards and praise in this way, the
Horne, P.J. (1998) Changing what children           Food Dudes Program positively reinforces
eat. In A. Murcott (Ed.) The Nation’s Diet:         the operant behavior. As a consequence, the
The Social Science of Food Choice. London.          children are encouraged to taste different
Longman, pp. 57-80.                                 fruits and vegetables over and over again.

In brief, two fundamental theories were             Taste Acquisition Theory25
used in development of the program:                 This theory, supported by a wide-ranging
                                                    body of evidence, suggests that repeatedly
Reinforcement Theory24                              tasting particular foods leads to an ac-
Reinforcement Theory focuses on the pro-            quired taste for them.
cess of shaping behavior by manipulating
the consequences of that behavior. Rewards          The Food Dudes Healthy Eating Pro-
can be used to ‘reinforce’ desired behavior         gramme facilitates a process of repeat tast-
(i.e., increase the probability of its occur-       ings that enables children to discover the
ring again). Any behavior that produces a           intrinsically rewarding properties of fruits
consequence is called operant behavior, be-         and vegetables. In other words, the children
cause the individual operates on his or her         grow to like these foods for their own par-
environment.                                        ticular flavours, textures and other sensual
                                                    properties, rather than for any other exter-
Reinforcement theory concentrates on the            nal rewards. At this point the program’s
relationship between the operant behavior           outcomes become long term and sustainable:
and the associated consequences. In the             children have learned to enjoy fruit and
case of ‘Food Dudes’, the operant behavior          vegetables for their own sake.

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Figure 4. Food Dudes reinforcement theory model

Evaluation and Results
The Food Dudes Healthy Eating Pro-                           Robust evaluation has always been an
gramme has been developed and extensively                    integral part of the program. Much of the
tested with thousands of children aged 2-11                  research carried out by the Bangor Food
in home, nursery and primary school con-                     and Activity Research Unit (BFARU) used
texts in England (Oxford, Manchester and                     observational measures of each child’s indi-
London), Wales and Ireland, and it has been                  vidual consumption of fruit and vegetables
shown, in every such study, to be highly                     before, during and after the program had
successful in encouraging children to eat                    been introduced. This was time-consuming,
fruit and vegetables26.                                      but yielded an objective, quantitative mea-
                                                             sure of the Program’s effectiveness.
In taking the program forward in Wolver-
hampton, England, the Department of                          Simpler measures suitable for a large num-
Health has also agreed with the School                       ber of schools have now been developed for
Food Trustvi to undertake and fund a full                    roll-out alongside the program. These take
evaluation of the impact of the project on                   the form of questionnaires or food diaries.
the diets of the children who participate. An                In addition, BFARU are developing a 1-day
intensive evaluation, comparing different                    diary (the “DIET-24: 24hour dietary intake
methodologies, will also be conducted in the                 evaluation tool”) that may be used in large-
Bedford schools.                                             scale evaluations of the Food Dudes Pro-

vi The School Food Trust was established by the Department for Education and Skills in September 2005. Its re-
mit is to transform school food and food skills, promote the education and health of children and young people, and
improve the quality of food in schools. Available at: http://www.schoolfoodtrust.org.uk/index.asp.

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gram to assess food intake both by children          class in every school for this purpose.
and parents.
                                                     The in-school co-ordinator is then asked to
BFARU has also developed short question-             collate the results from all classes onto the
naires for parents, teachers and in-school           Whole School Record Card, which, when
co-ordinators to assess the perceived im-            completed, is returned to the Food Dudes
pact of the Program. Formative evaluation,           Project Managers. This information enables
through interviews or focus groups, is an-           the Project Managers to determine the over-
other means of determining the acceptabil-           all effects of the program in each school,
ity of the Program to its target audience.           and it provides useful material in support of
                                                     the evaluation.
As the program is rolled out, Food Dudes
Project Managers monitor progress in each            Baseline measures of fruit and vegetable
school to ensure that class teachers are             consumption should be taken for a four-day
adhering to procedures. Teachers or other            period just prior to the start of Phase 1.
school staff (e.g. teaching assistants) are          These same measurements should be taken
asked to record the number of children in            again at the end of Phase 1 and at a follow-
their classes eating fruit and vegetables be-        up period, into Phase 2 and beyond, in order
fore the Program, and during Phases 1 and            to assess immediate and longer-term effects
2. A Class Record Card is provided for each          of the Food Dudes Program.

Results
Evaluation to date indicates that the Food               eating just 4% of the fruit they were
Dudes Healthy Eating Programme brings                    given prior to the Food Dudes interven-
about substantial increases in pupils’ con-              tion to eating 68% after it. Four months
sumption of fruit and vegetables.                        later (at follow-up) these children were
                                                         still eating twelve times the fruit they
Key evaluation findings from three major                 ate originally, and four times the quan-
evaluations27 include:                                   tity of vegetables. The poorest eaters in
                                                         the Control school, however, continued
•   Large and long-lasting increases in fruit            to show no interest in eating fruit and
    and vegetable consumption in children                vegetables in spite of having them read-
    from 2 to 11 years of age28.                         ily available.
•   The greatest increases in consumption            •   Long lasting changes to dietary patterns
    are shown by those children who are, at              and fruit and vegetable consumption30.
    the start, the poorest eaters of fruit and           In one Irish study, in the school that
    vegetables29. In the London pilot, for               had the Food Dudes program, parents
    instance, the poorest eaters in the Food             provided and children ate far more
    Dudes (Intervention) school went from                fruit and vegetables than they had done

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      previously, even 12 months after the                 of vegetables in lunchboxes
      intervention, whereas children in the            •   91% of teachers reported that children
      control school continued to eat very little          were eating one or more portions of
      of these foods.                                      lunchbox fruit (78% in the case of veg-
•     Increases extend across a wide range                 etables)
      of fruit and vegetable varieties31. In all       •   31% teachers felt that children’s class-
      studies, consumption of all 8 fruits and             room behavior had improved since the
      vegetables increased significantly after             introduction of the Program
      the Food Dudes intervention. The eight           •   99% of teachers thought that the health
      food types were: clementines; pears; ba-             of children in Ireland would benefit from
      nanas; apples; broccoli; peas; sweetcorn;            the introduction of the Food Dudes Pro-
      and green beans.                                     gram into all primary schools35
•     The program works for all children aged
      2-11 years old32. Food Dudes increases           Analysis of the parents’ questionnaires
      fruit and vegetable consumption in chil-         showed
      dren aged 4-11years, but has also been           • 96% of parents reported that children
      shown to increase consumption in chil-              were enjoying participating in the Food
      dren as young as 2-4years old.                      Dudes Program
•     Effects are highly reliable, regardless of       • 90% of parents reported putting one or
      school location and social deprivation33.           more portions of fruit in their children’s
                                                          lunchboxes, while 70% reported putting
Results from Year One of the Irish rollout                one or more portions of vegetables in the
(implemented in 46 schools, September 2005                lunchboxes
- June 2006), were obtained via question-              • 91% of parents reported that children
naires to parents and teachers in partici-                were eating one or more portions of
pating schools. These questionnaires were                 lunchbox fruit (81% in the case of veg-
analyzed independently by University Col-                 etables)
lege Dublin. Questionnaires were returned              • 94% reported that children were eating
from 44 of the 46 schools; from 3,833 (51%)               one or more portions of fruit and vegeta-
parents; and from 218 (73%) teachers34.                   bles at home because of the Food Dudes
                                                          Program
These results confirmed those obtained                 • 85% of parents reported that their chil-
from earlier studies as follows:                          dren had asked them to buy more fruit
                                                          and vegetables as a result of the Food
                                                          Dudes Program
Analysis of the teacher questionnaires                 • 88% of parents reported consuming one
showed                                                    or more portions of fruit and vegetables
• 99.1% of teachers reported that children                themselves on a daily basis as a result of
   were enjoying participating in the Food                the Program
   Dudes Program                                       • 99% of parents thought that the health
• 92% of teachers reported that parents                   of children in Ireland would benefit from
   were putting one or more portions of                   the introduction of the Program into all
   fruit in their children’s lunchboxes,                  primary schools36
   while 77% reported one or more portions

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Roll Out
Based on these successes, Food Dudes is be-        ly by the DoH. A similar project has begun
ing rolled out in Europe and beyond. In Ire-       in Bedfordshire, with nine schools partici-
land the program is being introduced into          pating so far and, again, evaluation data
all primary schools. To-date 1103 schools          are being analysed. The project has also
and 162,000 children have participated.            been launched in Sicily this year, with six
In England, the program is going into all          schools participating so far. Initial results
primary schools in Wolverhampton over the          are being analysed. A pilot project is under-
next 3 years, beginning this January. So           way in California (a collaboration between
far twelve schools have been involved and          researchers at UC Davis and California
the evaluation findings are being analyzed.        State University, Stanislaus).
This project will also be evaluated separate-

Lessons Learned
Results indicate that this is a program that       cal activity in primary school children. This
can now be introduced into all primary             project has been funded by the Wales Office
schools internationally, to produce large and      of Research and Development for Health
long-lasting changes in the diets of children      and Social Care.
in both school and home contexts.
                                                   A lunch–based version of the Food Dudes
The Food Dudes Healthy Eating Pro-                 Programme has been recommended for the
gramme has wide-ranging impacts on the             future since it was found to be:
diets of boys and girls alike across the
economic spectrum, including those who,            •   The most effective strategy in increas-
for reasons related to family income, suffer           ing children’s consumption of fruit and
social exclusion from improvements in the              vegetables
nation’s conditions of life. The program has       •   More cost effective
an important role to play in redressing one        •   Easier for staff to implement
of the prime sources of health inequality in
contemporary society.                              It is crucial to ensure that sufficient fund-
                                                   ing is in place before embarking on any
The Fit Food Dudes Programme: Initial              plans to implement the Program. The key
research findings suggest that an inter-           costs associated with setting up and run-
vention modeled closely on the Food Dudes          ning the ‘Food Dudes’ program are as fol-
Programme is effective in increasing physi-        lows:

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Food Dudes materials: (i.e., DVDs, re-             fruit and a portion of vegetables at school.
wards, letters, parents pack, wall charts)         In some countries, these foods may already
for Phases 1 and 2. All materials need to          be available to children in school as part
be printed and delivered to schools in a           of national provision programs. In these
ready-to-use format.                               cases, the Food Dudes Program may be
                                                   used to complement these existing programs
Project management: there needs to be              by boosting consumption of the foods and
funding for designated Food Dudes Project          reinforcing the healthy eating ethos within
Managers based in host countries who will          schools. In countries where fruit and veg-
facilitate and ensure correct implementation       etables are not provided to all children, a
of the Program in those countries’ schools.        merit of the Food Dudes Program is that
                                                   the foods need only be provided for 16-20
Fruit and vegetable provision: on each             days.
of the 16 days of Phase 1, as well as on all
days during baseline (at least 4 days), all        Training and support: from the Bangor
children need to be provided with a piece of       Food and Activity Research Unit.

180
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References
1. Horne, P.J., Lowe, C.F., Fleming, P.F.J. & Dowey, A.J. (1995). An effective procedure for
changing food preferences in 5-7 year-old children. Proceedings of the Nutrition Society, 54,
441-452. Horne, P.J., Lowe, C.F., Bowdery, M.A. & Egerton, C. (1998). The Way to Healthy
Eating For Children. British Food Journal, 100, 133-140. Lowe, C.F., Dowey, A.J & Horne, P.J.
(1998). Changing what children eat. In A. Murcott (Ed.) The Nation’s Diet: The Social Science
of Food Choice. London. Longman, pp. 57-80.

2. Lowe, C. F., Horne, P. J., Tapper, K., Bowdery, M., & Egerton, C. (2004). Effects of a peer
modelling and rewards-based intervention to increase fruit and vegetable consumption in
children. European Journal of Clinical Nutrition, 58, 510-522. Horne, P. J., Tapper, K., Lowe,
C. F., Hardman, C. A., Jackson, M. C., & Woolner, J. (2004). Increasing children’s fruit and
vegetable consumption: A peer-modelling and rewards-based intervention. European Journal
of Clinical Nutrition, 58, 1649-1660. Horne, P.J., Hardman, C.A., Lowe, C.F., Tapper, K., Le
Noury, J., Madden, P., Patel, P. & Doody, M. (2008). Increasing parental provision and chil-
dren’s consumption of lunchbox fruit and vegetables in Ireland: the Food Dudes intervention.
European Journal of Clinical Nutrition advance online publication, 21 May 2008; doi: 10.1038/
ejcn.2008.34.

3. Sharp, I. ‘At Least Five a Day: strategies to increase vegetable and fruit consumption’. Lon-
don: National Heart Forum, 1997.

4. Ministry of Agriculture, Fisheries and Food. National Food Survey: 1996. London: Her Maj-
esty’s Stationary Office, 1997.

5. Health Survey for England (2005) Latest trend data. Available at: http://www.ic.nhs.uk/
pubs/hseupdate05/commentary/file. Accessed 12 May 2009.

6. Gifft, H., Washbon, M. and Harrison, G. Nutrition, Behavior and Change. New Jersey:
Prentice-Hall, 1972.

7. Horne, P.J., Lowe, C.F., Fleming, P.F.J. & Dowey, A.J. (1995). An effective procedure for
changing food preferences in 5-7 year-old children. Proceedings of the Nutrition Society, 54,
441-452. Horne, P.J., Lowe, C.F., Bowdery, M.A. & Egerton, C. (1998). The Way to Healthy
Eating For Children. British Food Journal, 100, 133-140. Lowe, C.F., Dowey, A.J & Horne, P.J.
(1998). Changing what children eat. In A. Murcott (Ed.) The Nation’s Diet: The Social Science
of Food Choice. London. Longman, pp. 57-80.

8. Lowe, C.F., Dowey, A. and Horne, P.J. (1998). Changing what children eat, in Murcott, A.
(ed.), The Nation’s Diet: The Social Science of Food Choice. Addison Wesley Longman, London,
pp. 57–80.

                                                                                              181
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9. Horne, P.J., Lowe, C.F., Fleming, P.F.J. & Dowey, A.J. (1995). An effective procedure for
changing food preferences in 5-7 year-old children. Proceedings of the Nutrition Society, 54,
441-452. Horne, P.J., Lowe, C.F., Bowdery, M.A. & Egerton, C. (1998). The Way to Healthy
Eating For Children. British Food Journal, 100, 133-140. Lowe, C.F., Dowey, A.J & Horne, P.J.
(1998). Changing what children eat. In A. Murcott (Ed.) The Nation’s Diet: The Social Science
of Food Choice. London. Longman, pp. 57-80.

10. Horne, P. J., Tapper, K., Lowe, C. F., Hardman, C. A., Jackson, M. C., & Woolner, J. (2004).
Increasing children’s fruit and vegetable consumption: A peer- modelling and rewards-based
intervention. European Journal of Clinical Nutrition, 58, 1649-1660.

11. Dowey, A.J. (1996). Psychological determinants of children’s food preferences. Unpublished
Doctoral Dissertation, University of Wales, Bangor.

12. Lowe, C. F., Horne, P. J., Tapper, K., Bowdery, M., & Egerton, C. (2004). Effects of a peer-
modelling and rewards-based intervention to increase fruit and vegetable consumption in chil-
dren. European Journal of Clinical Nutrition, 58, 510-522.

13. Lowe, C.F., Dowey, A.J & Horne, P.J. (1998). Changing what children eat. In A. Murcott
(Ed.) The Nation’s Diet: The Social Science of Food Choice. London. Longman, pp. 57-80.

14. Sharp, I. ‘At Least Five a Day: strategies to increase vegetable and fruit consumption’.
London: National Heart Forum, 1997. World Health Organization (1990), Diet, Nutrition and
the Prevention of Chronic Diseases. Technical Report Series: 797. Geneva: World Health Orga-
nization. Department of Health (1994), Nutritional Aspects of Cardiovascular Disease. Report
of the Cardiovascular Review Group, Committee on Medical Aspects of Food Policy. Report on
Health and Social Subjects 46. London: HMSO.

15. Greenhalgh, J., Dowey, A.J., Horne, P.J., Lowe, C.F., Griffiths, J.H., Whitaker,C.J. Posi-
tive- and negative peer modelling effects on young children’s consumption of novel blue foods.
Appetite (2009), doi: 10.1016/j.appet.2009.02.016.

16. Horne, P.J., Lowe, C.F., Fleming, P.F.J. & Dowey, A.J. (1995). An effective procedure for
changing food preferences in 5-7 year-old children. Proceedings of the Nutrition Society, 54,
441-452.

17. ‘Food Dudes Program in Ireland’, Paper presented by Michael Maloney at 5th International
Symposium of the International Fruit and Vegetable Alliance, October 2006.

18. ‘Food Dudes Program in Ireland’, Paper presented by Michael Maloney at 5th International
Symposium of the International Fruit and Vegetable Alliance, October 2006

19. Available at http://www.fooddudes.ie/html/research.html. Accessed 12 May 2009.

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20. Survey data from ‘A Spoonful of Sugar: Television food advertising aimed at children, an
international comparative survey’. Consumers International Program for Developed Economies,
1996.

21. Lowe, C.F., Horne, P.J., Bowdery, M.A., Egerton, C., & Tapper, K. (2001). Increasing con-
sumption of fruit and vegetables in children. In J.S.A. Edwards & M.M. Hewedi (Eds), Culi-
nary Arts and Sciences III, Global and National Perspectives. Poole: Bournemouth University,
363-371.

22. Lowe, C.F., Horne, P.J., Bowdery, M.A., Egerton, C., & Tapper, K. (2001). Increasing con-
sumption of fruit and vegetables in children. In J.S.A. Edwards & M.M. Hewedi (Eds), Culi-
nary Arts and Sciences III, Global and National Perspectives. Poole: Bournemouth University,
363-371.

23. Available at: http://www.5aday.nhs.uk/sfvs/default.aspx. Accessed 12 May 2009.

24. Keller, F.S. (1969). Learning: Reinforcement Theory. New York, NY: Random House Inc.
Mayer, Richard E. (2003). Learning and instruction. Upper Saddle River, NJ: Merrill Prentice
Hall. Skinner, B.F. (1969). Contingencies of Reinforcement: A Theoretical Analysis. Englewood
Cliffs, NJ: Prentice-Hall.

25. See Pliner, P (1982). The Effects of Mere Exposure on Liking for Edible Substances. Ap-
petite. 3:283-90. Also see Zajonc, R. B. (1968) Attitudinal Effects of Mere Exposure. Journal of
Personality and Social Psychology, 9, 1-27.

26. Lowe, C.F., Horne, P.J., Tapper, K., Jackson, M., Hardman, C.A., Woolner, J., Bowdery,
M.A., & Egerton, C. (2002). Changing the nation’s diet: A program to increase children’s con-
sumption of fruit and vegetables. End of project report. University of Wales, Bangor. Lowe,
C.F., Horne, P.J., Bowdery, M.A., Egerton, C., & Tapper, K. (2001). Increasing children’s con-
sumption of fruit and vegetables. Public Health Nutrition 4, 2(A), 387. Lowe, C.F., Horne, P.J.,
Bowdery, M.A., Egerton, C., & Tapper, K. (2001). Increasing consumption of fruit and veg-
etables in children. In J.S.A. Edwards & M.M. Hewedi (Eds), Culinary Arts and Sciences III,
Global and National Perspectives. Poole: Bournemouth University, 363-371.

27. Lowe, C.F., Horne, P.J., Tapper, K., Jackson, M., Hardman, C.A., Woolner, J., Bowdery,
M.A., & Egerton, C. (2002). Changing the nation’s diet: A program to increase children’s con-
sumption of fruit and vegetables. End of project report. University of Wales, Bangor. Lowe,
C.F., Horne, P.J., Bowdery, M.A., Egerton, C., & Tapper, K. (2001). Increasing children’s con-
sumption of fruit and vegetables. Public Health Nutrition 4, 2(A), 387. Lowe, C.F., Horne, P.J.,
Bowdery, M.A., Egerton, C., & Tapper, K. (2001). Increasing consumption of fruit and veg-
etables in children. In J.S.A. Edwards & M.M. Hewedi (Eds), Culinary Arts and Sciences III,
Global and National Perspectives. Poole: Bournemouth University, 363-371.

28. Large increases in consumption: Horne, P. J., Tapper, K., Lowe, C. F., Hardman, C. A.,

                                                                                              183
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Jackson, M. C., & Woolner, J. (2004). Increasing children’s fruit and vegetable consumption: A
peer- modelling and rewards-based intervention. European Journal of Clinical Nutrition, 58,
1649-1660

29. Greatest increases in poorest eaters: Horne, P. J., Tapper, K., Lowe, C. F., Hardman, C. A.,
Jackson, M. C., & Woolner, J. (2004). Increasing children’s fruit and vegetable consumption: A
peer- modelling and rewards-based intervention. European Journal of Clinical Nutrition, 58,
1649-1660

30. Long-lasting increases in consumption: Horne et al. (2008) European Journal of Clinical
Nutrition. Advance online publication, 21 May 2008; doi:10.1038/sj.ejcn.2008.34.

31. Increases across a wide range of fruit and veg: Lowe, C. F., Horne, P. J., Tapper, K.,
Bowdery, M., & Egerton, C. (2004). Effects of a peer modelling and rewards-based intervention
to increase fruit and vegetable consumption in children. European Journal of Clinical Nutri-
tion, 58, 510-522.

32. All children aged 2-11yrs: Tapper, K., Horne, P.J. & Lowe, C.F. (2003). The Food Dudes to
the rescue! The Psychologist 16(1),18-21.

33. Available at http://www.fooddudes.co.uk/evidence/. Accessed 12 May 2009.

34. ‘Food Dudes Program in Ireland’, Paper presented by Michael Maloney at 5th International
Symposium of the International Fruit and Vegetable Alliance, October 2006.

35. ‘Food Dudes Program in Ireland’, Paper presented by Michael Maloney at 5th International
Symposium of the International Fruit and Vegetable Alliance, October 2006.

36. ‘Food Dudes Program in Ireland’, Paper presented by Michael Maloney at 5th International
Symposium of the International Fruit and Vegetable Alliance, October 2006.

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Author Information
     Dr Pauline J Horne (BSc, MPhil Biochem, BA, PhD Psychol)
     Pauline Horne is Reader in Psychology at Bangor University.
     Her research in the areas of children’s learning and the psychol-
     ogy of food choice is published in leading international journals
     and books. With her colleague, Professor Fergus Lowe, she has
     developed an intervention – known as The Food Dudes - that brings
     about large scale and long lasting increases in children’s consump-
     tion of fruit and vegetables. Its success in combating obesity has
     been recognised by awards from the World Health Organisation and
     the Caroline Walker Trust. The Program is currently being intro-
     duced into all primary schools in Ireland and selected regions of
     England. It is also being piloted in a number of other countries.

     Professor C. Fergus Lowe (BA, PhD, CPsychol, FBPsS)
     Fergus Lowe is Professor of Psychology and Deputy Vice-Chancellor
     at Bangor University. His research in the areas of children’s learn-
     ing and the psychology of food choice is published in leading inter-
     national journals and books. With his colleague, Dr Pauline Horne,
     he has developed an intervention – known as The Food Dudes - that
     brings about large scale and long lasting increases in children’s con-
     sumption of fruit and vegetables. Its success in combating obesity
     has been recognised by awards from the World Health Organisation
     and the Caroline Walker Trust. The Program is currently being
     introduced into all primary schools in Ireland and selected regions
     of England. It is also being piloted in a number of other countries.

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