The Future of Nutrition Education:
Using Evidence-Based Approaches and Social Media Style Engagement
Tasha Cahill
Department of Nutrition & Dietetics, University of North Dakota
N&D 997 Independent Study
Instructor Dr. Anne Bodensteiner
Background
According to the U.S. Department of Agricultures (USDA), 41% of families with children receive the Supplemental Nutrition Assistance Program (SNAP, aka “Food Stamps”) in 2018 (U.S. Department of Agriculture (USDA), n.d.b). The USDA has a list of foods commonly purchased by SNAP households and compares those with non-SNAP households. The second most common expenditure in SNAP households is sweetened beverages, while the same rank in non-SNAP households is vegetables (which place third for SNAP households) (USDA, n.d.a). This means that a large portion of children in the U.S. live in households with more spending toward sweetened beverages than vegetables. Fruit placed fourth in non-SNAP households and eighth in SNAP households (USDA, n.d.a). It is reasonable to assume that children in SNAP households are less exposed to fruits and vegetables and more exposed to sugary drinks than their non-SNAP peers.
One major concern in childhood nutrition is sugar intake. The USDA recommends that up to 10% of calories in the daily diet can be from added sugar, this is equal to 50g for a 2,000 kcal diet (U.S. Food and Drug Administration, n.d.). Meanwhile, the American Heart Association (AHA) recommends no more than 25g of added sugar for women and children, and 36g for men (American Heart Association, 2023). The AHA does not recommend added sugar based on total caloric intake; however, compared to the USDA recommendation it would be about 5% of total daily calories. In 2018, NHANES reported that children ages 6-11 years consumed an average of 68g of added sugar per day (Park, et al., 2023). This is more sugar than recommended by the FDA and AHA.
Parents are aware that their children are consuming too much sugar and trying to limit this consumption according to the International Food Information Council (2021, p. 32). Although the same study found that most parents still give their children regular servings of juice and other daily sweets (International Food Information Council, 2021, p. 5). Parents might be the “gate keepers” for their children’s nutrition (Dixon et al., 2020, p. 2); except, three fifths of children impact the purchasing decisions of their parents (Giraffe Insights, 2023, p23). Furthermore, children with parents who are restrictive of their sugar intake are more likely to indulge in sugary treats outside of the home (Norman et al., 2018, p. 442). Finding the right balance of sugar intake in the home might be a good approach to reduce sugar intake and help children develop a sense of moderation. However, such approaches would be limited in their effectiveness because children have some decision-making power over the foods they eat in and out of the home.
Children are exposed to food marketing through many venues such as their peers, on television, and social media. They are especially affected by advertisements on social media because the popularity of influencers increases the child’s desire to imitate their actions (Coates et al., 2019, p.2). Children are not aware of when they are being advertised to (Smith et al., 2019) and do not have the cognitive abilities to understand the effects of advertising (Dixon et al., 2020). In fact, higher reasoning needed to decern advertising doesn’t develop until late adolescence (URMC, 2022). Children are sensitive to marketing of all types and are not able to decern the presence or effects of such.
Social media has become more popular and used by children throughout the years. Currently, TikTok and YouTube are the most popular media for children ages 2-12 years (Giraffe Insights, 2023, p. 10). Short-form videos are increasingly popular with children as TikTok viewership has increased from 107 daily minutes in 2022 to 112 daily minutes in 2023 for children ages 4-18 years (Perez, 2024). Nine out of ten children watch YouTube, and half of those watch YouTube Shorts (videos limited to 60 seconds) (Giraffe Insights, 2023, p. 12). Children are now watching and engaging with short-form videos on social media at an all-time high.
Other trends for childhood wellness that have increased profoundly include the rates of eating disorders (ED) and disordered eating (DE). Rates of eating disorders have increased significantly from 3.4% of the total population in 2000 to 7.8% in 2018 (Center for Women’s Health, 2024). The cause of eating disorders is “complex interaction of genetic, biological, behavioral, psychological, and social factors” that often develops in a person’s teen years, but also can develop in childhood (U.S. Department of Health and Human Services, 2024). Some researchers have suggested that social media plays a role in the increased rates of ED and DE because it exposes children to these topics (Center for Women’s Health, 2024). The development of ED and DE in younger ages is a serious issue that can have lifelong effects for a growing body.
Children need to be educated in a way that embraces the marketing they are exposed to and focus on foundational knowledge and personal choices. Exposure to marketing is not going to fade from childhood experiences, therefore, preparing children to make informed decisions is a quality approach to overcoming the obstacles media places on childhood nutrition. Programs that are sensitive to the cognitive abilities of the targeted age groups—using language and concepts are relatable and easily understood—can increase the knowledge base of the students, further empowering their decisions. Children have decision making power when it comes to food choices. With a good knowledge foundation and empowered choices, children can start building positive habits for their future.
Good nutrition is necessary for all growing minds and bodies. It is essential to set early, positive habits for children to learn to manage food choices as adults (Rasheed, 2023). Educating children about nutrition is one way to support early decision making. The right nutrition education program can also guide children to develop a healthy relationship with food.
This project is focused on a new approach to nutrition education for elementary school aged children: six to twelve years old. By using evidence-based practices in nutrition education and combining it with current trends in social media, this project aims to engage and educate students through effectively entertaining curriculum.
New Approach to Nutrition Education
In 2023 a review of systematic reviews found five elements for an effective nutrition education intervention: the use of experiential learning, integration of cross-curriculum, parental involvement, driven by theory, and incorporation of other approaches when appropriate (Cahill, 2023). This research described subcategories of effective programs as well, which included the effects of environment, games, and program duration (Cahill, 2023). The result of this research is highly informative for the design of this project.
When discussing theory, the 2023 research demonstrated that Social Cognitive Theory (SCT) has proven to be the most effective foundation for a successful nutrition intervention (Cahill). SCT focuses on behavior being the result of personal beliefs with self-efficacy being a major part of the individual’s motivation (Contento & Koch, 2021, p. 138). In this theory, the person’s perception of their abilities will greatly influence whether they choose to take a specific action. When applied to education environments, students who have practiced a skill are more likely to apply that skill outside of the lesson. This is why experiential learning is important for the effectiveness of a nutrition education program: it supports self-efficacy.
The other main element of this program is the use of cross-curriculum. When children use other, known concepts in the application of new knowledge, they build stronger relationships between both topics. This also helps increase understanding of both the new knowledge and the pre-existing knowledge. The use of cross-curriculum is an important element for all early learning as it increases global learning and understanding.
This program uses the “4-E’s: Elicit, Explain, Expand, Exit” education plan (Contento & Koch, 2021, p. 331) and centers on social media style videos for the intervention. Each lesson begins by eliciting known information, attitudes, and feelings about the topic by the students. The social media style video is then played to explain the new information. After the video lesson is presented, the students are then asked to reflect on the new information and apply it using other known skills (expand). The end of the lesson (exit) involves further reflection and planning. This education plan is recommended for its wide application and usefulness through multiple types of media and learning styles (Contento & Koch, 2021, p. 331).
The social media style videos are short-form (less than a minute) and presented in the style of the most popular social media platforms: Tiktok and Youtube Shorts. The videos are displayed in a 16:9 ratio with a portrait orientation. The composition is informed by popular videos on each social media platform, mimicking the styles of some current trends. The content is intended to engage younger views while providing age-appropriate and accurate information.
Furthermore, the content is sensitive to the young child’s relationship with food. This focus is paramount in helping to reduce the onset of ED and DE. Nutrition education programs hold a responsibility to help students develop positive associations with food and body weight. To do this, a program can use a “health promotion approach, focusing on building self-esteem, positive body image, and a balanced approach to nutrition and physical activity” (National Eating Disorders Collaboration, n.d.). Positive nutrition education programs will reduce stigmatization of foods, educate, and demonstrate moderation.
The first curriculum for this project is focused on the reduction of sugar intake. The plan is to educate children on reading the nutrition facts label for added sugar, know the recommended amount, understand the effects of sugar in the body, and practice moderation. These large concepts have been broken down into small pieces and simplified where necessary to become approachable for the early learner. By empowering the decisions of the students through education and application, this curriculum can help reduce the daily sugar intake of students.
Conclusion
The majority of children in the US are less exposed to regular consumption of fruits and vegetables, while being more exposed to regular sugary beverages. High sugar intake is a concern for children, and their parents are aware of it. However, parents can only control what their children eat to a certain extent. Beyond parental control, children have decision making power over the foods they consume. Children are also widely exposed to marketing efforts, which they are unable to discern and decipher.
Social media holds a large portion of the media market for children, with short form video platforms recently becoming the most popular format. Children are heavily influenced by what they see on social media, especially by the actions of popular influencers. Social media may also play a role in the increasing rates of ED and DE. These video platforms have a profound grasp on the attention of young viewers.
This project intends to take the power of social media style short-form videos to create an engaging delivery of nutritional information. When combined with lesson plans that use the evidence-based approaches of experiential learning and cross-curriculum and driven by SCT with a focus on self-efficacy, the program will have a higher rate of effectiveness. Sensitivity toward nurturing healthy relationships with food will assist in the prevention of ED and DE. This project will begin with focusing on reducing sugar intake for students as the most immediate issue. The results will be a novel approach to nutrition education that is focused on the real desires and needs of the students.
References
American Heart Association. (2023, May 10). Added sugars. www.heart.org. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars
Cahill, T. (2023). What Are the Best Practices in Nutrition Education for Elementary Students? A Review of Reviews [Unpublished manuscript]. University of North Dakota.
Center for Women’s Health. (2024). Center for Women’s Health. Oregon Health & Science University. https://www.ohsu.edu/womens-health/why-are-eating-disorders-rise#:~:text=However%2C%20data%20shows%20eating%20disorders,7.8%25%20of%20all%20people).
Centers for Disease Control and Prevention. (2021, November 28). Get the facts: Added sugars. https://www.cdc.gov/nutrition/data-statistics/added-sugars.html
Coates, A. E., Hardman, C. A., Halford, J. C., Christiansen, P., & Boyland, E. J. (2019). The effect of influencer marketing of food and a “protective” advertising disclosure on children’s Food Intake. Pediatric Obesity, 14(10). https://doi.org/10.1111/ijpo.12540
Contento, I. R., & Koch, P. A. (2021). Nutrition education: Linking research, theory, and Practice. Jones & Bartlett Learning.
Dixon, H., Scully, M., Gascoyne, C., & Wakefield, M. (2020). Can counter-advertising diminish persuasive effects of conventional and pseudo-healthy unhealthy food product advertising on parents?: An experimental study. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09881-1
Giraffe Insights Ltd. (2023). Park; Precise Advertiser Report, kids, USA Q2 2023. Precise.TV. https://content.precise.tv/en-us/en-us/park_usa_q2_2023_report_landing_page
International Food Information Council. (2021). Foodinsight. Foodinsight.org. https://foodinsight.org/wp-content/uploads/2021/03/IFIC-Parents-Caregivers-Survey.March-2021.pdf
National Eating Disorders Collaboration. (n.d.). Prevention Programs https://nedc.com.au/eating-disorders/preventing-eating-disorders/prevention-programs#:~:text=Research%20has%20shown%20that%20the,to%20nutrition%20and%20physical%20activity
Norman, J., Kelly, B., McMahon, A.-T., Boyland, E., Baur, L. A., Chapman, K., King, L., Hughes, C., & Bauman, A. (2018). Children’s self-regulation of eating provides no defense against television and online food marketing. Appetite, 125, 438–444. https://doi.org/10.1016/j.appet.2018.02.026
Park, S., Zhao, L., Lee, S. H., Hamner, H. C., Moore, L. V., Galuska, D. A., & Blanck, H. M. (2023). Children and adolescents in the United States with usual high added sugars intake: Characteristics, eating occasions, and top sources, 2015–2018. Nutrients, 15(2), 274. https://doi.org/10.3390/nu15020274
Perez, S. (2024, January 25). Kids spent 60% more time on TikTok than YouTube last year, 20% tried OpenAI’s chatgpt. TechCrunch. https://techcrunch.com/2024/01/25/kids-spent-60-more-time-on-tiktok-than-youtube-last-year-20-tried-openais-chatgpt/
Rasheed, M. (2023). Promoting nutritional education in primary school children. British Journal of Nursing, 32(8), 14–18. https://doi.org/10.12968/bjon.2023.32.8.s14
Smith, R., Kelly, B., Yeatman, H., Moore, C., Baur, L., King, L., Boyland, E., Chapman, K., Hughes, C., & Bauman, A. (2020). Advertising placement in digital game design influences children’s choices of advertised snacks: A randomized trial. Journal of the Academy of Nutrition and Dietetics, 120(3), 404–413. https://doi.org/10.1016/j.jand.2019.07.017
U.S. Department of Agriculture. (n.d.a). Foods typically purchased by Supplemental Nutrition Assistance Program (SNAP) households. Food and Nutrition Service U.S. Department of Agriculture. https://www.fns.usda.gov/snap/foods-typically-purchased-supplemental-nutrition-assistance-program-snap-households
U.S. Department of Agriculture. (n.d.b). Percentage of participating snap households with children (FY 2018). Food and Nutrition Service U.S. Department of Agriculture. https://www.fns.usda.gov/SNAP-State-characteristics
U.S. Department of Health and Human Services. (2024). Eating disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/eating-disorders#:~:text=Eating%20disorders%20frequently%20appear%20during,%2C%20psychological%2C%20and%20social%20factors.
U.S. Food and Drug Administration. (n.d.). Added sugars on the nutrition facts label. https://www.fda.gov/food/nutrition-facts-label/added-sugars-nutrition-facts-label
URMC. (2022). Cognitive development in the Teen Years. Cognitive Development in Adolescence – Health Encyclopedia – University of Rochester Medical Center. Retrieved July 8, 2022, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P01594
