July
2007
Fruits
& Veggies—More Matters: Bringing New Life to an Old
Nutrition Message
By Dina Aronson, MS, RD
Today’s Dietitian
Vol. 9 No. 7 P. 30
Step aside, 5-A-Day. A fresh initiative
is here and primed to conquer Americans’ inadequate fruit
and vegetable consumption.
In March, the Produce for Better Health Foundation
(PBH) and the Centers for Disease
Control and Prevention (CDC)
launched a new health initiative called Fruits & Veggies—More
Matters™. The program has created waves on the Web and
will soon find its way onto packaging and into stores—at
least 21,000 supermarkets and 170 companies are already licensed
to participate.1
According to Elizabeth Pivonka, PhD, RD, president and CEO of
PBH, the plan is for Fruits & Veggies—More Matters
to eventually replace the familiar, 15-year-old 5-A-Day For
Better Health Program, which will be phased out by the end of
2008. However, the mission remains the same: get Americans to
eat more fruits and vegetables. The new Fruits & Veggies—More
Matters brand was also developed to be consistent with the latest
Dietary Guidelines for Americans, which recommends various numbers
of servings of fruits and vegetables depending on an individual’s
calorie needs—ranging from four to 13 servings (or 2 to
61/2 cups) per day.
The main catalyst for the transition was a growing
collection of scientific data showing that for optimal health,
five to nine servings of fruits and vegetables (the number recommended
by the 5-A-Day initiative) is simply too few.2
5-A-Day: Lessons Learned
The 5-A-Day for Better Health Program, which began in 1991,
is the nation’s largest public-private nutrition education
initiative. A collaborative effort of many groups, including
government agencies, private companies, state coordinators,
and educators, its main goal was to increase fruit and vegetable
consumption to at least 5 servings per day for 75% of Americans
by 2010. The program reached far and wide to improve public
awareness. Media campaigns, community-level interventions, point-of-purchase
programs, and industry partnerships worked to get the message
out. How effective have these efforts been?
Despite available data on consumption patterns
and knowledge surveys, it is difficult to evaluate whether the
5-A-Day Program—or any mass media-based nutrition campaign—has
affected population-level dietary patterns. The reasons are
that first, there are no groups unexposed to the 5-A-Day campaign
that can be used as a comparison to those exposed; second, there
are many other national and local programs to improve dietary
patterns, a large proportion of which also include a focus on
increasing vegetable and fruit consumption; and third, low-intensity,
public health-oriented dietary intervention programs yield relatively
small changes in dietary patterns that may take many years to
detect.3
Even after spending roughly $50 million (combined
5-A-Day partners in-kind) per year in marketing efforts to get
people to “strive for five,” research revealed that
fruit and vegetable consumption rates did not budge, according
to Pivonka. But the efforts were not for naught. Fifty million
dollars may seem like a lot of money and marketing, but not
compared to the $6.8 billion spent annually on commercial advertising
efforts for food, candy, and beverages.4 Hopefully, Fruits &
Veggies—More Matters can do more to battle this competitive
force.
Studies evaluating Americans’ fruit and
vegetable consumption over the past two decades consistently
show that most Americans fall short of the 5-A-Day goal (which
is supposed to be the minimum number of servings per day; 5-A-Day
is really 5-to-9-A-Day). A recent article in the American
Journal of Preventive Medicine assessed adult trends in
fruit and vegetable consumption between 1988 and 2002.5 Its
findings were not encouraging: approximately 89% of Americans
failed to meet the USDA’s Dietary Guidelines during that
time. Furthermore, there was no change in fruit consumption
over these years, and vegetable intake actually decreased.
The authors offer three possible reasons for
these findings. First, personal and cultural food preferences
create a stubborn barrier to change. Second, environmental barriers
such as easier accessibility to low-nutrient-density foods and
cost issues deter people from eating more fruits and vegetables.
David Katz, MD, MPH, FACPM, FACP, director of the Prevention
Research Center at Yale University School of Medicine, explains
this concept well: “Compared to many processed foods,
fresh produce is less available, less convenient, less economical,
and less reliable. Cheese doodles always taste the same, but
peaches, for instance, do not.” Third, the authors cite
possible confusion over how to put the recommendations into
practice.
More Barriers to Consider
Many clients comprehend that more fruits and vegetables are
better (and survey data back this up), and many can afford to
eat what and how they want.6,7 So why aren’t they opting
for the side salad over the pasta or fresh fruit over cake?
It seems that instant gratification often takes precedence over
health concerns. Moreover, despite a plethora of undeniable
evidence, perhaps the benefit is still unclear on a personal
level, as illustrated by justifications such as, “My grandfather
never touched a vegetable and lived to be 105,” or, “Something
is going to get me anyway, so I might as well enjoy this pie
now while I can.” These are glaring statements backed
by powerful emotion. A successful public health initiative needs
to address these conceptual barriers.
Another barrier, Katz says, may be the low-carb
and low-glycemic diet trends, which have misled many people
into thinking that eating fruit may actually be harmful. “Vegetables
and fruits are, in fact, the most nutritious of all foods, and
if more of us ate more of them, the public health benefits would
be considerable. To get there from here will require a systematic
effort to identify and dismantle every barrier. If we know and
understand these barriers, then we can formulate counseling
strategies to address them,” he says. Fruits & Veggies—More
Matters seeks to address these challenges with its primary strategy
of disseminating simple, positive, appealing messages.
Overview of Fruits & Veggies—More Matters
As most dietitians know, only approximately 10% of Americans
consume the level of fruits and vegetables recommended by the
Dietary Guidelines. The mission of Fruits & Veggies—More
Matters is to change people’s behavior over the long term
and improve the health status of the nation. This, of course,
was also the mission of 5-A-Day, but the new initiative seeks
to address underlying weaknesses of 5-A-Day and redirect education
efforts more effectively. Some key differences are that Fruits
& Veggies—More Matters does the following:
• targets the mom, who is still the primary
healthcare and food gatekeeper for the family;
• features a Web site that is more interactive,
encouraging users to share information;
• offers practical and specific advice
regarding meal planning, shopping, and tips;
• is less prescriptive and more descriptive;
• more clearly applies to a wider range
of foods, such as those based on fruits or vegetables like tomato
sauce and 100% fruit juice; and
• relays a message that is more emotionally
based than fact-based.
According to Pivonka, Fruits & Veggies—More
Matters was developed with moms in mind since they are still
the primary healthcare and food gatekeepers for the family.
Most moms already believe that eating more fruits and vegetables
is important; they just need help turning this knowledge into
behavior. Simple tips and suggestions are what they need. However,
study surveys revealed that mothers didn’t want to be
preached to or scared into eating more fruits and vegetables,
nor did they want to be made to feel guilty about what they
did or did not do. So the Fruits & Veggies—More Matters
message “serves as a gentle reminder that taps into mom’s
sense of responsibility to do her job as a mom,” explains
Pivonka.
The attractive, interactive, and easy-to-navigate
Fruits & Veggies—More Matters Web site—www.fruitsandveggiesmorematters.org—provides
recipes, tips, serving ideas, and shopping advice. It includes
a “mom2mom” area with polls, a message board, and
an opportunity to submit a question to an expert. While the
site was developed with Generation X moms (aged 29 to 41) as
the primary target, the site is appropriate for all users. It
features activities and tips for getting children involved (including
downloads such as coloring sheets) and allows visitors to submit
their own ideas, which may then be published on the site. Visitors
can sign up for a free e-mail newsletter, which is a way to
keep the message fresh for consumers, especially those who might
forget to revisit the site.
Fruits & Veggies—More Matters’s
Web site, as well as its programs and educational materials,
focuses on practical and specific advice regarding meal planning,
shopping, and tips. The goal is to help consumers turn health
knowledge into healthy behaviors for themselves and their families.
In addition to practical information on items like picking the
best produce and meal planning guidelines, the program provides
useful, specific messages designed to promote a higher consumption
of fruits and vegetables. “Ask for more vegetable toppings
(like mushrooms, peppers, and onions) and less cheese on your
pizza” (an Eating Out tip) and “The prebagged salad
greens have been carefully washed before packaging; it is safe
to eat them out of the bag” (a Shopping tip) are targeted,
helpful messages that appeal directly to the consumer.
While the 5-A-Day program tended to focus on
numbers, the new initiative focuses on “more.” For
years, the numbers 5 or 5-to-9 stuck in people’s heads,
and the good intention may have backfired for people for whom
this seemed like too much food. Also, the “how-to”
factor may not have been prominent enough.
Fruits & Veggies—More Matters is less
about quantity and more about how to incorporate fruits and
vegetables in today’s busy lifestyles, shifting simple
awareness to awareness plus utility. The initiative does not
describe in terms of portions but in cups; this is not only
consistent with the 2005 Dietary Guidelines but may also be
an easier concept for people to grasp. The 5-A-Day program defined
a portion or serving as one medium-sized fruit; 1/2 cup raw,
cooked, frozen, or canned fruits (in 100% juice) or vegetables;
3/4 cup 100% fruit or vegetable juice; 1/2 cup cooked, canned,
or frozen legumes (beans and peas); 1 cup raw, leafy vegetables;
and 1/4 cup dried fruit. For Fruits & Veggies—More
Matters, 1 cup of raw or cooked vegetables or 100% vegetable
juice, or 2 cups of raw leafy greens can be considered 1 cup
from the vegetable group. One cup of fruit or 100% fruit juice
or 1/2 cup of dried fruit can be considered 1 cup from the fruit
group.
The Web site and its education materials provide
easy-to-understand, attractive visuals describing what constitutes
a cup of each fruit and vegetable; for example, eight large
strawberries equals 1 cup, as do five broccoli florets or one
large banana. It is possible that implementing this change will
increase understanding and compliance.
What about a goal number of cups per day? Translating
this information will always be a challenge because needs differ
according to gender, age, and activity level. And while the
initiative focuses on fruits and vegetables, at some point we
need to separate them to encourage variety. Fruits & Veggies—More
Matters uses CDC guidelines and features simple charts that
show goal numbers of cups for men, women, girls, and boys (each
has a separate chart), with numbers differing by age and activity
level. Cups of fruits and cups of vegetables are listed separately.
For example, a moderately active 35-year-old woman should aim
for 2 cups of fruits and 21/2 cups of vegetables per day, while
a very active 7-year-old boy should strive for 11/2 cups of
fruits and 2 cups of vegetables.8
Pivonka says that according to studies, 5-A-Day
did promote foods like salsa and dried fruit, but the message
did not get across clearly. Fruits & Veggies—More
Matters emphasizes these foods clearly as examples of fruits
and vegetables people should be consuming. This is why the phrase
“all product forms count—fresh, frozen, dried, canned,
and 100% juice” is a major part of the initiative. This
component may, at least in part, address Katz’s point
that people tend to prefer packaged food over fresh produce
for its consistency and lower price tag.
According to Pivonka, the most important change
has been creating a message with an “emotional”
base. While 5-A-Day is rather factual or intellectual in nature,
Fruits & Veggies—More Matters imparts a more emotional
connection for people. Based on Pivonka’s research, an
emotionally based message that focuses on a mother’s feelings
of responsibility for taking care of her family is more likely
to influence her to include more fruits and vegetables in her
family’s meals and snacks. The Fruits & Veggies—More
Matters health initiative is meant to do just that, not just
in the form of the Fruits & Veggies—More Matters graphic,
but in how photos are used on the Web site and education materials
and in the words chosen (and not chosen) for key message points
and simple tips. PBH is treating this new health initiative
like a “brand” as opposed to simply a “logo,”
and this brand, says Pivonka, “is passionate, vital, optimistic,
and straight-talking.”
It is interesting to note that while the initiative
was developed with moms as the core target, it was further tested
with more than 1,000 consumers: men and women between the ages
of 21 and 65, low and middle income, with oversampling for African
Americans and Hispanics, and it tested very well with all of
these groups.9,10
Much has happened in the few months since the
debut. It appears that marketing plans for the initiative are
more pervasive. Already you’ll find the attention-grabbing
logo on Web sites such as General Mills (on the Green Giant
page) and Stop and Shop (www.stopandshop.com). You will soon
see the logo on food packages, in stores, and on nutrition education
materials used by public and private programs. September’s
5-A-Day Month will now be the Fruits & Veggies—More
Matters Month, so get ready to help spread the message.
Considerations
Despite comprehensive testing of this program and its messages,
only time will tell how effective this initiative will be for
long-term behavior change. And it will not be maximally effective
without the influence of health educators. It is the responsibility
of dietitians to reinforce the message by disseminating factually
correct, customized/client-specific information on increasing
fruit and vegetable intake. Fortunately, the Fruits & Veggies—More
Matters program provides health educators with myriad resources
to assist in effective nutrition education (see accompanying
resources).
Just providing our clients with handouts has
never been, and never will be, enough. We can do our part not
only by offering clear, consistent messages but also by explaining
how the benefits apply to each of our clients and by addressing
specific issues expressed by our clients. For example, the message
about “all forms [of fruits and vegetables] are included”
may lead a client to believe that grape juice is as good as
broccoli for weight loss. We must explain the basis for this
message and its application to personal health goals.
We are fortunate to have the high-quality information
and materials available to us from the Fruits & Veggies—More
Matters initiative (some free of charge and some for purchase).
PBH encourages us to spread the new message far and wide, and
these resources aid our efforts in helping people achieve optimal
health.
— Dina Aronson, MS, RD, is a nutrition
consultant, a freelance writer, and a speaker specializing in
dietetics-related technology and vegetarian nutrition.
Resources
Brand guidelines for health educators using
Fruits & Veggies—More Matters
Fruit
and vegetable consumption data and statistics.
Fruits & Veggies—More
Matters Web site by the Produce for Better Health Foundation.
Fruits & Veggies—More
Matters Web site by the CDC.
Informative series of research
briefs on understanding food and vegetable choices.
Tools for health professionals to spread the
Fruit & Veggies—More Matters message.
References
1. Produce for Better Health Foundation. “Fruits &
Veggies—More Matters, the Next Generation ‘5 A Day’.”
March 19, 2007. Available here.
2. USDA, U.S. Department of Health and Human
Services. 2005 Dietary Guidelines Advisory Committee Report
— “Selected Food Groups.” Available here.
3. National Cancer Institute’s Cancer
Control and Population Sciences. “5 A Day for Better Health
Program Evaluation Report: Message Environment.” Available
here.
4. “50th Annual 100 Leading National Advertisers.”
Advertising Age. June 27, 2005.
5. Casagrande SS, Wang Y, Anderson C, et al.
Have Americans increased their fruit and vegetable intake? The
trends between 1988 and 2002. Am J Prev Med. 2007;32(4):257-263.
6. Potter JD, Finnegan JR, Guinard J-X, et al.
5 A Day for Better Health Program Evaluation Report (NIH Publication
No. 01-4904). Bethesda, Md.: National Institutes of Health,
National Cancer Institute; 2000. Available here.
7. Stables GD, Subar AF, Patterson BH, et al.
Changes in vegetable and fruit consumption and awareness among
U.S. adults: Results of the 1991 and 1997 5 A Day for Better
Health Program surveys. J Am Diet Assoc. 2002;102(6):809-817.
8. Fruits & Veggies—More Matters.
Available here.
9. Pivonka E, Hoy K, Boyce B. Development of
the Fruits & Veggies—More Matters brand: The next
stage of increasing fruit and vegetable consumption. FASEB
J. 2007;21:671.12.
10. Hoy K, Pivonka E, Boyce B. Fruits &
Veggies—More Matters: Development of a relevant brand
identity. FASEB J. 2007;21:671.13.
