Research Article

Calorie Labeling in a Rural Middle School Influences Food Selection: Findings from Community-Based Participatory Research

Table 3

Five significant themes.

ThemesQuotations

Theme 1: Students want nutrition information and felt it was a school’s duty to help them achieve and maintain a healthy weight.
Students want schools to provide nutrition information to help them make healthier food choices and achieve a healthy weight.
Students wanted the school to
(i) provide the calorie labels at point of purchase,
(ii) provide more opportunities for activity,
(iii) discuss nutrition more in the classroom
(iv) only give healthy choices at lunch,
(v) announce what the healthy cafeteria options are everyday
“They ’re {labels} good and I think they should start showing them more often”
“I think they should put those little signs back up”
More “variety of fruit and vegetables” “selections of healthy food”, “food with less fat” and “with lower calories”
“Give extra time at recess. Cause they talked about an hour of exercise that you need every day in health class”
“offer sweet things less frequently”
Students recognized that the school was trying to take measures to combat obesity. “with labels they’re {school}, at least, attempting to do something about it”
“My teacher mentioned the labels once and that's when I went looking for them”
Many students want classroom based nutritional education alongside menu labeling in the cafeteria.“I think they should have an assembly and talk to everybody about labels”

Theme 2: Student understanding of nutrition and use of nutritional information were related to home environment.
Students with parents who discussed nutrition at home and used nutritional labels were more likely to
(i) notice and use the lunchroom labels,
(ii) use nutritional labels on prepackaged food,
(iii) have a greater overall awareness about nutrition and healthy eating,
(iv) place greater importance on nutrition in general
“Sometimes my dad just tells me we gotta eat healthy”
“she {mother} likes it when things have labels so that she can make a choice”
“I'd go home and talk to my parents and tell them what we had at school and we would talk about it”
“We look up to see how much sugar it has for fun. We just start guessing, then someone gets it right”
“My mom, my sisters and me. We look at the nutrition label thing”
Students who did not discuss nutrition at home
(i) had poor nutritional knowledge,
(ii) were less likely to use the calorie labels,
(iii) were to assess the schools obesity problem
Q. “how is it that you make decisions about what you're gonna eat?” A. “My dad, he usually just says he eats what he wants”
“We just, kind of, eat whatever there is”
“We don't talk about nutrition”
Q. “Do you think there’s a lot or a little problem with overweight at the school?”… A. “Not that much.”
Some students used their knowledge of the school calorie labels back in their home.“I use it, like, when I prepare some foods at home”

Theme 3: Taste preference, nutrition, and being a healthy weight are important to most of the students.
Taste, nutrition, and appearance are the most important factors for students when choosing food.
Taste was the most significant factor for students
Nutritious food needs to taste and look good in order for the students to eat it.
Some students highly prioritized taste over nutritional content of food
“Taste and portion size and to see how healthy it is for me. Those are the 3 most important things.”
“If it don't taste and look good, I'm not gonna eat it”
“I don’t really care how high the calories are as long as it tastes good”

Theme 4: Most but not all students admitted to noticing and using the calorie labels to make healthier food choices.
The students who claimed to use the labels all used them to make healthier lower calorie food choices.
Reasons given for menu labeling use include
(i) helping to make lower calorie food choices,
(ii) helping when comparing the calorie content of food,
(iii) being easier to make healthier food choices,
(iv) giving an idea of calories consumed at lunch each day,
(v) helping when choosing smaller potions,
(vi) reminding them to think of nutrition when choosing a food
“now I get something that doesn’t have as much calories”
“I didn’t get the stuff I used to get…I ate more fruit”
“I tried to grab low calorie, healthy foods and not grab junk food”
“I had a piece of paper with me the second day to see how many calories I had during lunch”
“I took a smaller plate of chips”
“helped me choose the right food to eat”
“It helps you think about nutrition”

Theme 5: The calorie labels and nutritionally related topics in general were not discussed among students.
Most students did not discuss the presence of the labels in the cafeteria with their peers.
Initial interest shown by students prompted some discussion.
“I have never heard a classmate of mine say anything”
“At first everyone said what's up with the food calories”
“We did talk about it for a little bit, but then we would just focus on the food”