Does giving gifts to Kids to Eat Healthy right? What the Research Says:

Your child agrees to eat some broccoli in return for a sticker.  He knows if he gets enough stickers he can pick out a toy.  Will he keep eating broccoli when the rewards stop?  New research says, well, maybe.

Studying the effects of non-food rewards on healthy food acceptance in kids is hot right now.  Doesn’t this go against everything we know (and I teach!) about rewarding kids for eating?  Let’s first look at the research.

Research

In a 2011 study in Appetite,  Lucy Cooke and colleagues reviewed the evidence regarding rewards and food acceptance in children. The first studies, starting in the 1980′s, revealed a backfiring effect, with rewards causing decreased liking and intake using relatively palatable foods like fruit-based drinks.  When food was used as the reward, it did not increase liking for the target food but it did for the reward food.

More recent research indicates that non-food rewards

 (it is generally accepted that food should not be used as the reward) can lead to increased intake of less palatable foods like vegetables. Some of the most promising studies utilize repeated exposure and small tastings in younger children. For example, one study divided 4 to 6 year olds into separate groups, with one group receiving exposure with a tangible reward (like a sticker) another group receiving exposure with a verbal reward and another group receiving exposure without a reward.  Each group was exposed to a target vegetable for 12 days.  After intervention, liking increased in all 3 groups but intake only increased in the reward groups, which was maintained 3 months after the study. Two other studies in which parents administer these experiments at home show similar results.

What about older children?  Researchers from Brigham Young University and Cornell used money to incentive kids to eat fruits and vegetables, resulting in significantly increased intake (80%).  But when the monetary reward went away, consumption returned to the prior level.  Studies using rewards as part of the UK’s Food Dude program at schools reveal increases healthy food intake as well.  But when researchers examined how this translates to eating at home, they found that while intake was higher at 3 months, by one year the effect was no longer seen.

Rewards and Motivation

What does research say about the use of rewards to change other desired behaviors (like studying/good behavior to improve academics)?  First off, this is a controversial area, with some experts supporting the use of rewards with others strongly opposing it. All agree that rewards change behavior over the short term but what gets muddy is the effect on intrinsic motivation (desire to do the task for its own sake) which helps the desired behavior stick.

Research does show that rewards can undermine intrinsic motivation.  For example, when people feel like they are being controlled, rewards decrease autonomy and competence.  Some come to value the reward more than the activity itself, so when the reward goes away so does the behavior.  But in other cases, especially when there is low intrinsic motivation to begin with, rewards can create interest and change behavior.  And while some experts say controlling rewards can “crowd out” intrinsic motivation, rewards viewed as supportive may “crowd in” intrinsic motivation. Below is a summary of instances where rewards are more likely to work and not work:

Likely to be ineffective:

-already motivated or interested in task

-use of vague performance objectives

-rewards become expected and are promised ahead of time

-rewards feel controlling

-over-reliance on rewards to change behavior

May help:

-activities where there is little interest

-use specific performance objectives

-rewards are given after desired behavior

-rewards feel supportive

-judiciously using rewards

Relating it back to food

Based on the research, anyone considering — or currently using — rewards to encourage kids’ healthy eating need to weigh the pros and cons.  Will it undermine a child’s internal motivation to make good choices now or in the future?  Or will it give the child the (friendly) push she needs?

In one of her Family Meals Focus Newsletter, Ellyn Satter adds her perspective:

Getting children to eat certain foods isn’t the point of sDOR. Instead, it is raising children to be Eating Competent with respect to their eating attitudes and behaviors.¹² To be Eating Competent throughout life with respect to food acceptance depends on a sense of self-direction with respect to choosing what to eat and a sense of agency with respect to exploring unfamiliar food and learning to eat it. Children raised according to sDOR have these positive inclinations; those raised using controlling feeding methods do not. 

For those of us who follow the trust model of feeding, rewards go against the very thing we are trying to instill in children.  Because as Satter points out, supporting a child’s internal motivation to eat is more important than focusing on outcomes (eating the food). This is done with exposure (which, by the way, increases liking), joyful meals, modeling, structure, making food taste good and not interfering during mealtime. Will adding rewards really hurt all the work parents do to build eating competence in children?  Maybe or maybe not, but for some of us (me included) the risk is not worth it.

But like everything in parenting, individuals need to decide for themselves.

Do you use rewards to encourage your child to eat healthy?

References

Cooke et al. Facilitating or undermining? The effect of reward on food acceptance: a narrative review. Appetite, 57, 493-497.

Fides A, van Jaarsveld CH, Wardle J, Cooke L. Parent-administered exposure to increase children’s vegetable acceptance: a randomized control trial. J Acad Nutr Diet; 2013 September 24 [epub ahead of print]

David Just, Joseph Price. Using incentives to encourage healthy eating in children. The Journal of Human Resources, December 2013

Upton D, Upton P, Taylor C. Increasing children’s lunchtime consumption of fruit and vegetables: an evaluation of the food dudes programme. Public Health Nutr; 2013 June 16 (60: 1066-72.

Deci EL, Koestner R, Ryan RM. A meta-analytic review of experiments examining the effect of extrinsic rewards on intrinsic motivation. Psychol Bull; 1999:125(6):627-68.

Cameron J, Banko KM, Peirce WD. Pervasive Negative effects of rewards on intrinsic motivation: the myth continues. The Behavior Analyst. 2001;24, 1-44.

Ledford GE, Gerhart B. Negative Effects of Extrinsic Rewards on Intrinsic Motivation: More Smoke than Fire. World at Work Quarterly 2013.

Kohn A. The Risk of Rewards. ERIC Digets 1994.