Originally printed in the March 2019 issue of Produce Business.
By Shreela Sharma
Read Jim Prevor’s Commentary below
Since starting in Houston in 2012 and by partnering with local food banks, for-profit food distribution companies such as Sysco and growers nationwide, Brighter Bites has distributed more than 20 million pounds of fresh, donated produce as well as hands-on, evidence-based nutrition education to a cumulative 53,000-plus families across Texas (Houston, Austin, Dallas), New York City, Washington DC and Southwest Florida.
Brighter Bites is now a 501c3 non-profit organization with programming efforts spanning the six regions. What is particularly compelling about Brighter Bites is the ongoing partnership with academic institutions. For example, the UTHealth (University of Texas Health Center at Houston) School of Public Health has been a partner since inception of the program, leading operationalization of the framework of the program, and conducting research and evaluation.
A non-randomized controlled trial of Brighter Bites in Houston across 760 first-grade children and their parents in six intervention and six comparison schools conducted in 2013-2015 demonstrated statistically significant increases in child and parent intake of fruits and vegetables, and decreased intake of added sugars among children. Moreover, there were significant improvements in the home nutrition environment, including a two-fold increase in frequency of cooking using basic ingredients, utilizing nutrition fact labels in making grocery purchasing decisions, and eating more meals together as a family with increased fruits and vegetables available at those meals.
Subsequently, we conducted a two-year, follow-up study in 2017 among those children and parents in the intervention schools to determine the long-term maintenance effects of the program. Results show that even at two-year post-intervention follow-up, there is a sustained increase in vegetable intake among children and their parents, with a concurrent sustained decrease of added sugars, sugary beverages and eating out at restaurants. Given an average family size of five in our study sample, this corresponds to 19 additional servings of fruits and vegetables per week consumed by families exposed to Brighter Bites. These results speak to the long-term impact of Brighter Bites on creating consumers of fruits and vegetables and demand for produce that currently doesn’t exist.
Results from the parent surveys across the three years demonstrate that more than 85 percent of parents reported using all or most of the fruits and vegetables provided, and more than 83 percent reported the fruits and vegetables to be effective in improving their child’s intake.
Brighter Bites also has institutionalized a robust, ongoing process and outcome evaluation efforts using a real-time, cloud-based monitoring platform and visualization dashboard to track program implementation efforts. A case study assessing the reach of Brighter Bites across three school years in Houston (2012-2016), showed that, across the three years, on average, families consistently received 53.6 to 61.3 servings of 8 to 12 different types of fruits and vegetables each week. More than 90 percent of the produce distributed was donated produce that was procured from production and retail sources locally and nationwide. Cost of the produce decreased with increasing number of families served, starting with $2.67 in the 2013–2014 school year to $2.29 in the 2015–2016 school year.
Results from the parent surveys across the three years demonstrate that more than 85 percent of parents reported using all or most of the fruits and vegetables provided, and more than 83 percent reported the fruits and vegetables to be effective in improving their child’s intake, thus demonstrating consistency and replication of findings. Qualitative data from parent focus groups support these findings. Parents reported Brighter Bites allowed them to become familiar with new types of produce and use healthier recipes without the fear of waste, and importantly, it afforded them an opportunity to introduce their children to new flavors and make eating fruits and vegetables normative. And, more recently, in the 2017-2018 school year, 69 percent of the teachers (n=593) across all six cities reported that Brighter Bites has significantly increased parental engagement at their schools.
To meet the need that exists in every community nationwide, Brighter Bites continues to grow rapidly, with 24,000 families enrolled across 92 sites in the six regions in the current 2018-2019 school year. By combining nutrition education with food provision, Brighter Bites demystifies produce for the families so they can shop, cook and eat healthier.
The maximum capacity of the surplus produce in the United States is more than sufficient to meet the needs of the program and scale up. Also, the partnerships with local food banks, food distributors, food retailers and growers are in place for successful sourcing and distribution of the produce, as evidenced by the rapid replication of Brighter Bites across six regions in the United States.
The purpose of Brighter Bites is to expand, not limit or redistribute, availability of fruits and vegetables. Finally, it meets children and families where they already are (i.e., schools, preschools), going the last mile to put the produce into the hands of families that need it the most. By linking food growers, distributors, food banks, schools and families, and having strong partnerships with academic institutions, Brighter Bites is feeding with impact and creating communities of health through fresh food.
Shreela Sharma is associate professor of epidemiology, University of Texas Health Science Center at Houston (UTHealth) School of Public Health and co-founder, Brighter Bites. For more information, turn to page 112.
Measuring Effectiveness Is Key
By Jim Prevor
My desk functions as a clearance portal for research done around the world on produce consumption. And I have to say that, for the most part, the world is filled with earnest people, who want to do good, who want to help others get healthier, want children to do better in school, want all good things for the world. I have read countless reports on countless initiatives, each one of which claimed not only to have increased produce consumption, but also claimed numerous secondary benefits such as children doing better in school.
It is absolutely inspiring to read of the people launching and sustaining these programs. It is also enormously frustrating. Why? What the industry actually needs is not anecdotes that claim to increase fruit and vegetable consumption or that claim doing so has had benefits; what the industry needs is research sufficiently rigorous that it will attract financial support from non-produce entities. In other words, we need resources that will come from foundations, insurance companies and the government if we are to roll things out across the country, maybe even around the world.
You don’t attract that kind of support because a teacher institutes a program in her school and claims it is a big success. You need control groups, you need testing done on multiple sites, you need evaluations of total consumption, not just at a school, and you need third-party evaluators who are impartial.
The Brighter Bites program is exceptional in many ways. A lot of programs focus solely on giving away free produce at school. The Brighter Bites initiative relies on integrating produce distribution and education within the home.
In fact, the produce giveaway is used as a kind of bait because parents can’t get this produce, about $35 a week’s worth, unless a parent walks into the school.
What really differentiates the program, though, is the commitment to research. Brighter Bites held its board meeting at The New York Produce Show and Conference and, in conjunction with that, Professor Shreela Sharma and Brighter Bites founder and board chair, Lisa Helfman, presented at the conference. We did a preview article on the PerishablePundit.com, a sister publication to Produce Business, and the key to the research, and the program, was expressed this way:
Q: Can you elaborate on why you thought it was important to have the research element?
LISA: There were two reasons: One, because I was doing this in my spare time, and I had no benefit to gain personally. I wasn’t going to be paid for this; I was doing this because I believed in the mission of creating health for people through fresh food, produce specifically, and if it wasn’t working, then why would we do this?
The Brighter Bites program is exceptional in many ways. A lot of programs focus solely on giving away free produce at school. The Brighter Bites initiative relies on integrating produce distribution and education within the home. … What really differentiates the program, though, is the commitment to research.
This is about how eating produce impacts societal health, and I wanted to know this model was effective and the strategy was working. Then, if it was working and we got to the point where we are today, I wanted to show our partners and donors with evidence we were making an impact and give them tangible results, because I don’t think we should move forward unless we can show value.
Shreela is a nationally recognized epidemiologist in childhood obesity at one of the largest research medical facilities in the country (University of Texas, Health Science Center at Houston). I was introduced to her as one of the best and brightest in the field. Shreela told me at the time the Institute of Medicine had recently announced if we want to curb childhood obesity and work on prevention, we not only need to teach kids literacy, we also need to combine with food access, so she was excited about the program.
No one was doing food delivery, and that’s what we realized six years into this program. We are one of the only non-profits that get the product into the home, and it goes the last mile, we like to say. That’s not only trying to change the children’s behavior but also the parents, who are the buyers of the product and the influencers.
We believe the kids cross-pollinate with the parents and cross influence their behavior, and that’s why it becomes sustainable longer term. Shreela can show this more through her data, but that’s the secret sauce of our program, attaching it to the whole family, and those holding the money to purchase the produce.
Of course, as Lao Tzu wrote, “The journey of a thousand miles begins with a single step.” There is much still to do. We have to ascertain the staying power of these interventions. Do college students who started the program in kindergarten eat differently than students who did not? We have to see if these dietary changes translate into better health. We have to study whether the parents who engage are different from those who won’t — and how are they different. Can they be reached effectively?
But, this program is unique and important. The industry would do well to engage and make it its own.