Small Prizes and a "Smile" Increase Young Students' Choice of Healthy Food Options at School

Sunday, April 26, 2015

How do you get students to select a healthier school lunch that doesn’t contribute to obesity? Give them prizes and a “smile” to encourage them to choose a healthy food option.

A Cincinnati Children’s Hospital Medical Center initiative resulted in an increase of more than 300 percent in selection of the healthy option when students in grades one through six were given small prizes for selecting it.

“Poor food selection in school cafeterias is a risk factor for childhood obesity,” says Robert Siegel, MD, medical director of the Center for Better Health and Nutrition at Cincinnati Children’s. “The food industry has used prizes to encourage purchasing packaged meals. We wanted to find out whether prizes could also be awarded to improve child health.”

In collaboration with the Cincinnati Public Schools, Dr. Siegel and his colleagues involved 297 children at a single inner-city school. The project involved two interventions which were introduced sequentially over a three-month period.

In the first intervention, they placed green smiley-face emoticons by the most nutritious foods in the school cafeteria. These foods included fruits, vegetables, white fat-free milk, and an entrée with whole grains. In the second intervention, children were offered prizes such as pencils, erasers and stickers for selecting a healthy “Power Plate.” This option had at least four U.S. Department of Agriculture recommended components: entrée, fruit, vegetable and low-fat milk.

After three months, plain milk purchases increased 549 percent, from 7.4 percent of total milk sales to 48 percent. Chocolate milk selection decreased from 86.5 percent to 44.6 percent of total milk sales. Fruit selection increased by 20 percent, and vegetable selection by 62 percent.

There was a 335 percent increase in selection of the Power Plate.

“We suggest schools can use the Power Plate to improve food selection as it is low cost and effective,” says Dr. Siegel. “Stickers and washable “tattoos” are about three cents each.”

The researchers did not study whether the students consumed the meals, and they did not extend the study to determine whether prizes are effective long term.

Dr. Siegel will present results of the initiative at 3:45 Pacific time Sunday, April 26, at the annual meeting of the Pediatric Academic Societies in San Diego. Read his blog post about the study.

About Cincinnati Children’s

Cincinnati Children’s Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S. News & World Report’s 2014 Best Children’s Hospitals. It is also ranked in the top 10 for all 10 pediatric specialties. Cincinnati Children’s, a non-profit organization, is one of the top three recipients of pediatric research grants from the National Institutes of Health, and a research and teaching affiliate of the University of Cincinnati College of Medicine. The medical center is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Additional information can be found at Connect on the Cincinnati Children’s blog, via Facebook and on Twitter.

Contact Information

Jim Feuer, 513-636-4656,