Researcher in Profile: Sarah Gripshover on Children’s Understanding of Nutrition

By Chia-wa Yeh, Head Teacher and Research Coordinator

What might be an effective way to help children learn about nutrition? Is it possible to teach young children biological concepts about food and nutrition? If so, does it make a difference in children’s food choices? Sarah Gripshover, a 4th-year graduate student in psychology at Stanford University, and her advisor, professor Ellen Markman, PhD, have been investigating this topic at Bing Nursery School over the past three years.

Slim with short hair, bright eyes and abundant energy, Gripshover grew up in Chicago. Both her parents and younger brother are social workers. Gripshover graduated from the University of Chicago with a major in linguistics. She worked as an assistant on a longitudinal research project on language acquisition for three years after graduation. She then decided to pursue a graduate degree in developmental psychology and came to Stanford.

Most broadly, Gripshover is interested in how belief systems guide behavior and how belief systems change over time. Many health interventions avoid merely equipping people with knowledge, reasoning that “knowing what to do” doesn’t necessarily motivate people to actually do it. However, Gripshover is keen on figuring out when and how knowledge can be motivating. There is evidence to suggest that having a coherent, compelling conceptual framework for understanding why and how particular behaviors are beneficial is more effective than just telling people—especially children—what to do without any explanation. Her research program is designed to uncover effective ways of presenting health messages to children in a clear and developmentally appropriate way to make those messages comprehensible and compelling.

Gripshover found Markman’s research on nutrition, which has a strong applied component, an excellent match for her, as she is interested in pragmatic aspects of social science. At Bing, the researchers’ goal is to design an intervention that influences children’s developing biological concepts, which will help them understand nutrition and thereby make sound food choices. The target age of the participants are 4- and 5-year-olds.

First-year project: using linguistic framing

Consider the following two sentences: Milk gives you strong bones and Your body uses milk to make strong bones. The first statement frames milk as the causal agent whereas the latter frames the body as having an active part in the process. Gripshover argued that sentences like Milk gives you strong bones can be misleading because food is an inert substance. Rather, our bodies extract nutrients through the process of digestion to make the body grow. She hypothesized that a conceptual intervention framing the body as the causal agent would improve children’s understanding. For example, saying “Your body uses healthy food to grow” rather than “Healthy food helps you grow.”

The intervention was presented in picture book format with two picture books differing only in whether food or the body was framed as the causal agent. The books are designed to teach children concepts related to nutrition such as the presence of tiny invisible nutrients within food, the ability of the body to take nutrients out of food and the importance of eating many different kinds of food.

Gripshover and her research assistants read the books to children in game rooms (research rooms) and invited them to teach a puppet about food in a subsequent session. For one of the tasks, researchers invited children to pack a healthy lunch for a puppet by presenting them with a plate with one kind of food, say, a picture with celery. They then showed children another picture of celery, a picture of carrots and a picture of cheese and asked the children to choose one more item for the puppet’s plate.

Results indicated that children in the intervention framing the body as the causal agent indeed achieved a greater understanding of the importance of dietary variety than children in the intervention framing food as the causal agent.

Second-year project: story books and snack observations

In Gripshover’s second year, she and Markman designed a series of five short picture books featuring language framing the body as the causal agent and sought to determine whether the intervention’s effect can last over a longer period of time than one single session, as was the case for the previous study.

Their hypothesis was that presenting children with a coherent, developmentally appropriate conceptual framework for understanding the relationship between food and the body (as they did with picture books) will help children understand the need for variety and balance in their diet that goes beyond overly-simplistic “healthy vs. unhealthy” food categories.

Each of the five picture books focused on one of the concepts featured in the books used the previous year. These books provided rich elaboration of each concept and reinforced the concepts in the other books. For example, one book capitalized on the fact that children have experience understanding the importance of variety in domains other than nutrition. It is easy for young children to see why it might not be okay to make a tricycle out of just lots of handlebars and nothing else, even though handlebars are a good thing to have on a tricycle. Just as a tricycle has many different parts that work together so we can ride it, our bodies need many different kinds of foods with unique combinations of nutrients so that we can be healthy. No one food, however healthy, is enough to make our whole body healthy.

As part of Gripshover’s study, Bing teachers read these picture books aloud at snack time. There were three phases to the study: The researchers observed the children’s snack intake in the autumn quarter, read the intervention books to them in the winter quarter, and observed their snack intake again, as well as their conceptual understanding, in the spring quarter. To measure snack intake, children were presented with familiar and unfamiliar vegetables, cheese, fruit and whole-grain crackers during snack time and observed by researchers. To measure conceptual understanding, children were invited into the game room to help teach a puppet about food.

Results indicated that children were able to attain a sophisticated understanding of food, digestion and invisible nutrients, and this understanding helped them to grasp that different kinds of foods make unique contributions to the body—this is why dietary balance and variety is needed. Observations of children during snack time revealed that children who listened to these storybooks also ate more vegetables during snack time compared to children who did not listen to them.

Third-year project

How does the researchers’ conceptual intervention compare with a more traditional intervention to encourage healthy eating in children recommended by the United States Department of Agriculture? Gripshover and Markman launched the next phase of their study to find out.

The same procedures—reading at snack time and later snack observations—were implemented for two groups of roughly 120 children. One group heard stories providing a conceptual framework whereas the other group heard fun, child-friendly stories recommended by the USDA incorporating messages such as “eat more fruits and vegetables.” The children participated in the game rooms, teaching a puppet all about food as in the previous year.

Preliminary results revealed that children in all classrooms increased their vegetable intake from fall to spring quarter. However, children who heard a coherent, developmentally appropriate explanation for why their body needs a wide variety of healthy foods increased their vegetable intake by a significantly greater margin than children in the USDA intervention condition. This shows that the improvement in the intervention condition cannot be attributed solely to other factors such as talking about healthy foods with teachers and peers in a positive, supportive social context. Together, both studies suggest that appealing to children’s natural curiosity about how the world works by providing a coherent explanation is a promising new approach to nutrition education.

What is Gripshover’s own attitude towards food? She enjoys cooking and loves to eat. It is worth spending extra time to make the food tasty, she said, and she enjoys experimenting with whatever ingredients she has at hand. What are her favorite ingredients? Garlic, onion and butter. Her belief? Everything in moderation—just as one of her picture books conveys.

Next Steps

Gripshover and Markman plan to use their materials with a wider range of populations, including children from more diverse socioeconomic backgrounds. The researchers would also like to extend these materials to children in kindergarten and first grade.

The researchers are also interested in investigating whether their conceptual materials can boost the effect of other interventions, such as those used by the USDA. There is much innovative research being conducted on the effect of intervention such as making healthier foods the default at school lunch time, and “sneaking” physical activity into children’s daily lives (e.g., in the form of a fun dance). Gripshover and Markman wonder: Would having a conceptual understanding of nutrition help children buy into the health behaviors promoted by these interventions? Does a conceptual understanding lead to a greater feeling of self-efficacy in children who understand both why and how to eat a wide variety of healthy foods?

Finally, the researchers would like to know if this kind of conceptually based intervention could be tailored to other health goals, such as helping children with allergies understand why and how to avoid trace amounts of allergens.