Improving fruit/vegetable behaviors as a social determinant of health among children: A systematic review

Abstract

The national school lunch program (NSLP) supports nutrition, a social determinant of health, by improving children’s access to healthy meals, yet many still fall short of recommended fruit and vegetable (F/V) intake. This systematic review examines 21 school-based interventions (2018-2025) in NSLP-participating schools aimed at improving F/V behaviors (i.e., consumption, selection, and waste). Using behavioral economics and Kahneman’s system 1 (intuition-based) and system 2 (knowledge-based) thinking systems to organize results, 18 interventions (86%) improved at least one F/V behavior. System 1 interventions (n = 12) were most effective, improving all F/V behaviors regardless of setting or duration. System 2 interventions (n = 4) had mixed results, with one worsening F/V behavior. Mixed interventions (n = 5) showed variable outcomes. System 1 interventions that improve appeal of F/V and cafeteria food environments can improve F/V behaviors in children. These interventions did not require classroom time, large investments from school districts, and may save money and reduce waste.