The Modifying Eating and Lifestyles at School Study (MEALS)

The Modifying Eating and Lifestyles at School (MEALS) Study

The purpose of this study is to examine the impact of introducing healthier, chef-enhanced foods and/or environmental modifications (choice architecture) on selection and consumption of school foods among elementary and middle school students.

Study Overview

• Status: Completed
• Conditions: Food Habits; Meals
• Intervention / Treatment: Other: Chef-enhanced meals; Behavioral: choice architecture

Detailed Description

Project Modifying Eating and Lifestyles at School (MEALS) was a school-based study developed by the nonprofit organization Project Bread (www.ProjectBread.org) and the Harvard School of Public Health. Project Bread hired a professional chef to work with several schools in a low-income, urban school district in Massachusetts to enhance the palatability and nutrient profile of the school meals. Four schools were randomly assigned to receive the professional chef. Additionally, two schools in that district and four schools in a second school district were randomly assigned to receive a behavioral psychology intervention to influence the selection and consumption of the healthier foods offered. Selection and consumption were assessed at baseline, up to 3 months post-implementation (short-term implementation for chef-enhanced meals), up to 4 months post-implementation (long-term implementation for behavioral psychology) and/or up to 7 months post-implementation (long-term implementation for chef-enhanced meals).

Primary Aim 1: to examine the impact of introducing healthier, chef-enhanced foods with increased palatability on selection and consumption among elementary and middle school students. It is hypothesized that there will be an increase in the selection and consumption of entrees, fruits, and vegetables in schools where healthier, chef-enhanced foods are served.

Aim 2: to examine the impact of physical modifications to the placement and displays of foods in the cafeteria on selection/consumption among elementary and middle school students. It is hypothesized that there will be an increase in selection and consumption of entrees, milk, fruits, and vegetables when modifications are made.

• Study Type: Interventional
• Enrollment (Actual): 6873
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Students in grades 1-8 attending a participating school and receiving a school meal on a study day

Exclusion Criteria:

• Bringing a lunch from home on a study day or not eating lunch in the cafeteria on a study day

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: control; Students received standard meals in a standard cafeteria environment
Experimental: Chef; Students were exposed to chef-enhanced meals	Other: Chef-enhanced meals; meals prepared by a professional chef with enhanced palatability
Experimental: choice architecture; Students were exposed to modifications to the physical environment in the cafeteria to "nudge" students towards healthier choices	Behavioral: choice architecture; Place vegetables at the beginning of the lunch line.; Place fruits in attractive bowls or trays lined with appealing fabric, and place other fruit options next to the cash registers.; Promote fruits and vegetables with prominently displayed signage and images.; Place white milk selection in front of sugar-sweetened milk (e.g. chocolate milk) or at eye-level.; Other Names: Smart Cafe
Experimental: Chef and choice architecture; Students were exposed to both chef-enhanced meals and modifications to the physical environment in the cafeteria to "nudge" students towards healthier choices	Other: Chef-enhanced meals; meals prepared by a professional chef with enhanced palatability; Behavioral: choice architecture; Place vegetables at the beginning of the lunch line.; Place fruits in attractive bowls or trays lined with appealing fabric, and place other fruit options next to the cash registers.; Promote fruits and vegetables with prominently displayed signage and images.; Place white milk selection in front of sugar-sweetened milk (e.g. chocolate milk) or at eye-level.; Other Names: Smart Cafe

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in the selection of meal components (Selection of entrees, milk, fruits, and vegetables)	Selection of entrees, milk, fruits, and vegetables	baseline, up to 3 months post-implementation, and up to 7 months post-implementation
Change in the consumption of meal components (consumption of entrees, milk, fruits, and vegetables)	consumption of entrees, milk, fruits, and vegetables	baseline, up to 3 months post-implementation, and up to 7 months post-implementation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to eat (Estimated amount of time spent eating foods)	Estimated amount of time spent eating foods	up to 24 months
Hunger (Self-reported hunger at the end of the meal)	Self-reported hunger at the end of the meal	up to 12 months

Collaborators and Investigators

• Sponsor: Harvard School of Public Health (HSPH)

Publications and helpful links

General Publications

• Cohen JF, Richardson SA, Cluggish SA, Parker E, Catalano PJ, Rimm EB. Effects of choice architecture and chef-enhanced meals on the selection and consumption of healthier school foods: a randomized clinical trial. JAMA Pediatr. 2015 May;169(5):431-7. doi: 10.1001/jamapediatrics.2014.3805. Erratum In: JAMA Pediatr. 2015 Aug;169(8):791.

Study record dates

Study Major Dates

• Study Start: September 1, 2011
• Primary Completion (Actual): June 1, 2012
• Study Completion (Actual): June 1, 2014

Study Registration Dates

• First Submitted: November 18, 2014
• First Submitted That Met QC Criteria: December 3, 2014
• First Posted (Estimated): December 5, 2014

Study Record Updates

• Last Update Posted (Actual): January 26, 2024
• Last Update Submitted That Met QC Criteria: January 24, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: 21198-103