Improving Diet and Health for Low Income Rural American Children

aileenmeyers's picture

Counter to the 2010 Dietary Guidelines for Americans recommendations, children across the United States are eating more sugars and fats and less fresh fruits and vegetables. In low income rural communities there is a disproportionate number of high risk overweight and obese children.  This gives rise for concern as obesity leads to diseases such as hypertension and diabetes. In a recent study published in the Journal of the Academy of Nutrition and Dietetics, researchers found that children who were part of the study consumed significantly more fruits and vegetables.


A team of investigators conducted a two year intervention study called CHANGE to prevent unhealthy weight gain in low income, rural areas. CHANGE stands for Creating Healthy, Active and Nurturing Growing-Up Environments and the mantra of the group is to “Eat smart. Play Hard.”  The research team wanted to see that students exposed to the study would improve the quality of their diet due to the healthier environment.  Lead author Juliana F. W. Cohen explained that their goal was to examine the differences in fruit, vegetable, legume, whole-grain and low-fat dairy consumption among the students who were exposed to the CHANGE intervention and the students in control schools.  

They believed that students exposed to the study would improve their diet and physical fitness quality due to their exposure to healthier food environments. There were eight rural communities between 2007 and 2009 that participated in the program.  Two communities from each of the following four states participated: California, Kentucky, Mississippi, and South Carolina.  Children grades 1 through 6 participated and the average age of the 1230 participating students was about 8.6.  85-95% of the students were nonwhite.

Primary objectives for the study were to improve the diets, physical activity levels, and weight status of rural children.  For each state, two communities were randomly assigned to either an intervention or control group.  The intervention model was based on the goals of the Shape Up Somerville model. 

At baseline, the students at the CHANGE schools ate similar amounts of fruits, vegetables, dairy, potatoes, saturated fats, and sugars as students in the control group.  The students at the CHANGE schools also consumed significantly more legumes than the control group.

Shape Up Somerville Model

In the Shape up Somerville model, intervention groups were given daily access to healthier school foods.  They also had a weekly educational curriculum that reinforced healthy living goals such as: at least five servings of fruit and vegetables, no more than two hours of television or screen time; and at least one hour of physical activity.

Shape up Somerville was a successful three year environmental intervention program that completely revamped the community and school system to help promote healthy living.  School food service promoted fresh fruits and vegetables and made them available everyday for breakfast and lunch.  Lesson plans, that focused on increasing fruit, vegetable, whole grain, and low fat dairy consumption; decreasing snacks high in saturated fat and sugar; increasing physical activity; and limiting sedentary time, were implemented into a new classroom based health curriculum called The HEAT Club (Health Eating and Active Time). Through the example of this program, researchers hypothesized that nutrition for rural low income families was possible by implementing the intervention program.


After one year, students enrolled in the CHANGE study intervention schools consumed significantly more vegetables and combined fruits and vegetables when compared to the students in the control schools.  Students at the intervention schools also reduced their average daily dietary glycemic index.  No significant differences were seen in the students’ consumption of whole grains, legumes, dairy, potatoes/potato products, saturated fat, added sugars, or dietary fiber consumption.

Researchers conclude that the CHANGE study enhanced the fruit and vegetable dietary intake for rural students.  They believe that similar interventions in rural America can prove to be promising to support vegetable consumption and healthy living.


Journal of the Academy of Nutrition and Dietetics



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