Remington, A., Añez, E., Croker, H., Wardle, J., & Cooke, L. (2011). Increasing food acceptance in the home setting: a randomized controlled trial of parent-administered taste exposure with incentives. American Journal of Clinical Nutrition, Vol 95, pp72-77
Use of rewards to promote healthy eating in children is commonplace but remains controversial because rewards are suspected of undermining intrinsic motivation.
A cluster-randomized trial with 422 4-6 year olds assessed the short and longer-term impact on acceptance of a disliked vegetable of systematic taste exposure (12 daily ‘tiny tastes’) paired with either tangible reward (stickers), social reward (praise) or no reward, compared with a no-treatment control condition. Liking and intake in a free-choice consumption task were assessed pre- and post-intervention and at 1 and 3 month’s follow-up.
All three exposure conditions increased liking more than the control condition, with no differences between conditions. Effects were maintained at follow-up. Both reward conditions increased consumption, with effects maintained for 3 months, but the effects of exposure alone were non-significant by 3 months.
These results indicate that external rewards do not necessarily undermine intrinsic motivation and may be useful in promoting healthy eating.
Cooke, L. J., Chambers, L. C., Añez, E. V., Croker, H. A., Boniface, D., Yeomans, M. R ., & Wardle, J. (2011). Eating for pleasure or profit: the effect of incentives on children's enjoyment of vegetables Psychological Science, Vol 22, pp190-196
The use of rewards to encourage children to eat healthily is controversial. However, researcher-led interventions have shown that incentives combined with taste exposure can increase both intake and liking. To date, this has not been tested in the home setting. The aim of the study was to test the hypothesis that parent-administered repeated taste exposures to an initially-disliked vegetable combined with reward will increase children’s liking and intake, and to compare the effects of tangible and social rewards.
This was a randomised controlled trial, in which families with children age 3-4yrs (n=173) were randomly assigned to exposure + tangible reward (sticker), exposure + social reward (praise), or no-treatment control conditions, after a pre-test assessment where a target vegetable was selected for each child. In the intervention groups, parents offered their child 12 daily tastes of the vegetable, giving either praise or a sticker for tasting. No specific advice was given to the control group. Assessments of intake and liking of the target vegetable were conducted by researchers immediately after the intervention period, and 1 and 3 months later.
Children receiving exposure + tangible rewards increased their intake and liking of their target vegetable significantly more than children in the control group. Differences were maintained at 3-month follow-up. Increases in intake and liking in the exposure + social reward group were not statistically significantly different from the control group.
The findings of this home-based study support parental use of tangible rewards with repeated taste exposures to improve children’s diets.
Fildes, A., van Jaarsveld, C. H. M., Wardle, J. and Cooke, L. J. (2013) A randomized controlled trial of parent-administered exposure to increase children’s vegetable acceptance. Journal of the Academy of Nutrition & Dietetics (in press)
Repeated taste exposure, in combination with small rewards, has been shown to increase children’s acceptance of disliked foods. However, previous studies have used direct contact with researchers or professionals for the implementation of the repeated exposure procedure. If mailed taste exposure instructions to parents produced comparable outcomes, this could be a cost-effective and easily disseminable strategy to promote healthier diets in children.
This randomized controlled study aimed to test the efficacy and acceptability of mailed materials giving instructions on taste exposure as a means of increasing acceptance of vegetables in pre-school children. Participants were families of three year-old twins from the Gemini cohort who took part between March 2011 and April 2012. Families were randomized to a mailed intervention or a no treatment control condition. The intervention involved offering each child 14 daily tastes of a disliked (target) vegetable with a small reward (a sticker) if the child complied. Outcomes were the child’s intake of the target vegetable (number of pieces) and parent reports of the child’s liking at two baseline (T1, T2) and one post-intervention behavioral assessment (T3).
Record sheets with intake and liking data from T1, T2 and T3 were returned for 472 children, of which 442 were complete (94%). Over the intervention period (T2 to T3) intake and liking of the target vegetable increased significantly more in the intervention group than the control group. Acceptability of the procedure was very high among parents who completed the protocol.
Mailed instructions for taste exposure were effective in increasing children’s acceptance of an initially disliked vegetable. These results support the value of parent-administered exposure to increase children’s vegetable acceptance, and suggest that it can be carried out without direct health professional contact.