Increasing vegetable consumption out-of-home: VeggiEAT and Veg + projects

Adequate vegetable consumption is fundamental to a healthy, balanced diet; however, global compliance with recommendations to increase consumption is poor. There is a growing interest in the sustainability of current dietary patterns in light of expected climate change and an expanding global population where part of the response is increasing vegetable intake. Two international projects, VeggiEAT and Veg + , explored the determinants of vegetable liking and consumption in different age groups and countries and the effect of a nudging strategy on vegetable consumption in an out-of-home setting. The projects found that the importance given by consumers to natural or healthy ingredients, social norms, female gender and positive attitudes towards nudging all inﬂuenced vegetable consumption. Some sensory factors, such as bitterness and sourness, had a negative loading, while others, such as sweetness, had a positive effect on liking for vegetables. ‘Dish of the day’, as a nudging strategy in a workplace canteen setting, increased vegetable dish selection for some of the sample (adolescent females) but not for males or older people. Globally, there is a strong need to promote the consumption of vegetables as a public health issue but also to improve their availability and uptake, especially within out-of-home foodservice.


Introduction
Population health and the state of the planet rely on a food system that respects planetary boundaries and prioritises societal health. It is easy to make an ethical and moral case for more sustainable diets given that food lies at the intersection of some of the world's greatest environmental and societal challenges (Hughes & Hughes 2016). The Food and Agriculture Organization (FAO 2016) identifies lifestyle, symbolised by eating out, as an important aspect that must be considered for improving sustainability for all. In general, consumption of plant-based foods, even from the most inefficient agricultural practices, is less environmentally damaging than the most efficient animalbased food production (Poore & Nemecek 2018;Bowles et al. 2019;Chai et al. 2019). Notwithstanding, vegetables are one of the most difficult categories of food to introduce into menu planning, especially out of home, since they are not as well liked as other ingredients (Morizet 2012). Hence, the aim of the VeggiEAT and Veg+ projects was to develop an evidence base for predictive modelling of vegetable intake that takes into account individual characteristics (acceptability, intake level, age group) as well as environmental cues such as choice architecture (nudging). This paper provides an overview of background knowledge and the objectives of two related projects examining the factors associated with increased vegetable consumption. The synthesis of results from both projects provides a comprehensive summary of current knowledge on promoting out-of-home vegetable consumption.
The projects, co-ordinated by Bournemouth University, arose because the foodservice industry provides 40% of food consumed outside the home in the UK, equating to £60 billion in revenue in 2019 (Defra 2019), and unlike the food manufacturing industry has been slow to respond to the emerging agenda of health and sustainability (Hughes & Hughes 2016). The availability of a larger variety of vegetables in foodservice has been shown to positively affect consumption, while little variety has been reported as an obstacle (Ensaff et al. 2015). Other factors such as age and liking of vegetables also mediate the effect of offering a choice (de Wild et al. 2015). Previous consumer studies have given some indication of attitude to and preference for vegetable intake but there has been limited attention given to contextual factors such as sensory variation which would aid industry response (Feeney et al. 2014). Most research on barriers and facilitators has been conducted at the level of general vegetable consumption and not at the commodity/meal level that would acknowledge the use of vegetables as ingredients (Cox & Poelman 2015). Food consumer behaviour is highly complex with many external and internal influences on perception, attitude and action. The product attributes, the individual characteristics of the consumer and the eating environment all play a key role in food-related decisions.
The VeggiEAT and Veg+ projects aimed to increase knowledge about attitudes to vegetables specifically across the lifespan. While the health benefits of high fruit and vegetable consumption are well known and considerable work has attempted to improve intakes of both, increasing evidence also recognises a distinction between fruit and vegetables, both in their impacts on health and in their consumption patterns . Although research demonstrates health benefits from a high consumption specifically of vegetables, intakes remain low, and barriers to increasing this are prevalent, making intervention difficult (Rodrigues et al. 2019).
A systematic review of interventions aimed at increasing intake of vegetables as a distinct food group identified 77 studies, detailing 140 interventions, of which 133 (81%) were conducted in children . They comprised interventions aiming to use or change hedonic factors, such as taste, liking and familiarity (n = 72), use or change environmental factors (n = 39), use or change cognitive factors (n = 19), or a combination of strategies (n = 10). Increased vegetable acceptance, selection and/or consumption were reported to some degree in 116 (83%) interventions, but the majority of effects were small and inconsistent in conclusion. From this systematic review, it appears that success is currently found from environmental, educational and multi-component interventions, but the authors concluded that publication bias was likely, and the long-term effects and cost-effectiveness were rarely considered. A focus on long-term benefits and sustained behaviour change is required.
The term 'vegetables' covers a heterogeneous group of foods, especially across cultures and geographical locales. For instance, legumes (dried beans and peas), which are not by botanical definition vegetables, are often included for calculating vegetable intake, although this definition is not consistent with the culinary parlance which classifies plant-based ingredients on the basis of taste (see Rodrigues et al. 2019 for further discussion). The FAO provides aggregated data at national level: it demonstrates that vegetable supply (excluding potatoes and pulses) in Europe has increased over the last 40 years (FAO 2020). However, in Northern Europe (e.g. Finland 84 kg/person/ year) it is lower than in Southern Europe (Greece 150 kg/person/year). Often statistics for fruit and vegetable intake are combined, which distorts the true picture of vegetable consumption, especially for children. There is a tendency within this population to eat more fruit than vegetables, with this slowly reversing as individuals grow older (FSA 2014). It has been shown, for example, that 79% of primary schoolchildren (5-10 years old) eat less than 3.5 portions of vegetables a day rising to 96% among secondary schoolaged children (11-15 years old) (Food Foundation 2020). Factors influencing vegetable intake are numerous and linked to each other in complex ways that are not yet fully understood. Features of the physical, social and cultural environment as well as personal aspects, such as taste, preference and neophobia all play a part (Bevan et al. 2016). As a consequence, changing vegetable consumption patterns remains a challenge, particularly at population level.
The main goal of the VeggiEAT project was to increase knowledge and understanding of the determinants of vegetable acceptability (liking), and consumption/intake; through investigation of the sensory characteristics and aspects of the eating environment and taking a lifespan approach (adolescents aged 10-19 years and older people aged ≥ 65 years). This was achieved by three overlapping research areas: product and sensory analysis, recipe development and consumer behaviour. The project was led by the Foodservice and Applied Nutrition Research Group and colleagues at Bournemouth University (UK) and involved a consortium of academics from the University of Copenhagen (DK) and the University of Florence (IT), and industry representatives from the Institute Paul Bocuse (FR) and Bonduelle (FR). The research was multidisciplinary, encompassing marketing, consumer studies, nutrition, public health, psychology, sociology, foodservice and culinary expertise.

Sensory characteristics
The sensory characteristics of different vegetables were evaluated across all participating countries (DK, FR, IT and UK) and were subsequently used to develop guidelines for recipe development. A positive relationship between stated liking and familiarity was found. Irrespective of the country, one group of highly liked vegetables (carrots, tomatoes, green salad) was identified, characterised by innately liked tastes (sweet, umami), delicate flavour and bright appealing colour. A second group of highly disliked vegetables consisted of cauliflower and broccoli, characterised by disliked sensations such as bitter taste and less preferred flavours. Internal preference maps from actual liking scores indicated that the generally disliked tastes (bitter, sour) were clearly correlated with a negative hedonic response. The hedonic valence of a generally wellaccepted taste such as salty and texture descriptors depended on the type of vegetable. Internal preference maps from actual liking data indicate that flavour and appearance descriptors of the distinct sensory properties of each type of vegetable positively affected liking, while the intensity of unusual flavours was related to sample disliking (our research is fully described in Dinnella et al. 2016;Cliceri et al. 2017 andAppleton et al. 2019). Both older people and adolescents also sorted vegetable (pea and sweetcorn) samples in relation to the sensory properties that were relevant for their hedonic judgement about each product. Appearance seemed to be less relevant for older people who tended to focus their attention more on texture and hedonic terms. The within-product approach used in this study highlighted that independent from familiarity and stated liking, the main drivers of actual liking and disliking were the same across countries and ages; sweetness, in opposition to bitterness and sourness.

Product development and field testing
One of the aims of the VeggiEAT project was to move from 'product' to 'recipe' with the goal of developing innovative dishes that are accepted by consumers. Development criteria taken into consideration included aspects of nutritional profile, cost and scalable food service. Eleven dishes were developed by culinary masters students at the Institute Paul Bocuse in France which, on piloting with an expert panel, were reduced to three (sweetcorn soup, pea tart and a vegetable burger mix). These dishes were evaluated in the four countries (DK, FR, IT and UK) by both adolescents and older people. The vegetable burger mix fully reflected global nutritional guidelines and since it was also the one most preferred by consumers, this was the dish taken through to the field-testing stage in a self-serve workplace canteen. In addition, the most appropriate nudge for vegetable dish selection was identified from a pilot study and the cue of 'Dish of the day' selected. This default option strategy relies on the premise that people tend to prefer the status quo and was successful in increasing choices for the vegetarian offer in a Living Lab context (Saulais et al. 2019).
A natural field experiment (n = 380 adolescents and n = 345 older people) was implemented in the four countries to study the conditions under which this type of nudge would contribute to increasing the probability of choosing a vegetable-rich dish. The experimental design comprised two conditions: neutral and nudge (Dish of the day). The VeggiEAT dish consisted of the vegetable burger mix, shaped into 'balls'; the alternative dishes were traditional meatballs (made with beef) or fish balls (made with minced white fish). All the dishes were served with rice or pasta, salad and tomato sauce, as was most acceptable to consumers of each age and in each of the European countries. Concurrently, a questionnaire was administered that comprised sociodemographic characteristics; food-related lifestyle (adherence to Mediterranean Diet, Food Frequency Questionnaire, Food Neophobia); personal values (Human Values Scale, self-efficacy, social norms and self-estimated health); and attitudes towards nudging. Binary logistic regression analyses were used to assess associations between choice of dish (dependent variable: plant-based and animal-based dish) and all other variables.
We found that 'Dish of the day' as a nudging strategy increased vegetable dish selection for some of the sample (adolescent females) but not for males or older people (Saulais et al. 2019). Choice of a vegetablebased dish among adolescents was predicted by natural dimension (higher importance given to natural ingredients, avoidance of artificial ones and absence of additives), social norms, female gender and positive attitudes towards nudging interventions Dos Santos et al. 2020). Among older participants, women were also more likely to be nudged to choose the plant-based dish (Zhou et al. 2019).
Analysis of the questionnaire responses showed that consuming a higher quantity of vegetables was associated with older age, higher affluence score and greater liking for vegetables, and a lower importance of familiarity. Greater vegetable variety was associated with a higher liking and importance of health benefits, and a lower importance of familiarity. These findings demonstrate a role for liking and a lower concern for eating familiar foods for older people for vegetable consumption, and a particular role for concern for health benefits (Appleton et al. 2017).
The implementation of nudges in real-life operations is still challenging. On the one hand, nudging appeared to be unsuccessful among adolescents and elderly in promoting the plant-based alternatives when presented with very similar options (Dos Santos et al. 2020; Zhou et al. 2019), while on the other hand, it was effective when the choice was made among unfamiliar dishes (Saulais et al. 2019). From this research, it appears that strategies to increase vegetable consumption should focus on promoting the health benefits of vegetables and enhancing the positive sensory and natural aspects of vegetables , while nudging appears to be context-specific and successful results in one setting do not necessarily translate into other contexts. Clearly, further study is required to test these hypotheses and therefore a second project, Veg+, was conducted.
The Veg+ project extended the work of the Veg-giEAT project by considering aspects of vegetable consumption from farm to fork in a young adult population in Brazil. All factors that influence vegetable consumption in young adults were evaluated; from vegetable supply by farms through fostering markets for locally produced goods to consumption. There are five million 'family farms' in Brazil which employ three quarters of the farm labour force and are responsible for one third of agricultural income; however, 87.5% Brazilians aged 16 to 24 years do not meet the intake recommendation of two portions of vegetables per day (Centre for Disease Control & Prevention 2017). The development of 'direct from farm' purchase policies in Brazil began in 2003 as part of the Zero Hunger Programme. Until then, food supplies were based on economic criteria that made the participation of family farmers difficult. After the implementation of the Food Purchase Programme, public procurement strategies were developed for family farmers (Brazil 2003). This programme has led to a reduced ecological footprint and a more engaged civil society in schools but is yet to reach university canteens (World Food Programme 2020). The Veg+ project involved collaboration between Bournemouth University and the Federal University of Santa Catarina, Brazil.

Background
The first stage of the project was to conduct a scoping review of existing literature examining the factors that affect vegetable consumption among college students globally (Rodrigues et al. 2019). Two empirical studies followed. Study 1 focussed on vegetable supply and evaluated local farmers' potential for vegetable production within a short food supply chain using semi-structured interviews (Table 1)

Vegetable supply and consumption
The literature analysis identified a purchasing potential for vegetables, particularly in a university setting (Martinelli et al. 2015). For example, the restaurant of the Federal University of Santa Catarina serves approximately 9000 meals per day. Thus, it would require more than 55 tons of vegetables per month, representing a yearly investment of 900 thousand dollars. However, due to the high volume of meals produced and the restaurant structure, all vegetables require some degree of pre-processing, such as washing, peeling and cutting. This can limit the access of family farmers since they have neither the manpower nor mechanised processes to do this, but could also represent an opportunity for them in relation to income. The results also showed the potential of the restaurant for the promotion of sustainable and local production systems.
The key themes arising from the semi-structured interviews in Study 1 were grouped into benefits and difficulties for procurement from local farmers ( Table 2) and suggested that local purchasing could improve the quality of canteen meals by increasing the diversity of fresh vegetables offered. Respondents also highlighted that a closer relationship between consumption and production would help preserve traditional food habits. Even so, with Brazil's political and economic status favouring lowest cost options, there is a sensitivity regarding public sector procurement which may hinder purchase from family farmers.
Inclusion criteria for Study 2 on vegetable consumption included students aged 18 years or older, and a sample size of n = 525 was achieved. The online questionnaire was available from November 2018 to April 2019 and consisted of questions on food-related lifestyle, for example: (1) availability and accessibility of vegetables; (2) cooking behaviour at home; (3) cooking behaviour away from home and personal attitude towards vegetables; (4) self-efficacy for using vegetables and seasonings; (5) self-efficacy on consumption of fresh vegetables; and (6) motives underlying the selection of food. Analysis of the survey was done by principal component analysis. This showed that vegetable consumption in young Brazilian adults was influenced by health, sensory and naturalness dimensions. The initial model contained eight predictor latent variables for the vegetable consumption outcome. Iterative evaluation and revision was undertaken until the measurement model met the criteria of acceptability. While health, naturalness and sensory showed similar strengths, the first two were positive and the last negative. The higher the participant  Increasing vegetable consumption out of home weighting for vegetable 'Healthiness' and 'Naturalness', the higher consumption was likely to be, whereas 'Sensory' factors had a negative influence. This may be supported by a notion of extreme taste, unpleasantness of texture and smell which can be associated with some vegetables, as was also found in the VeggiEAT project. The other potential predictor variables, weight control, price, familiarity, convenience, use of condiments and cooking behaviour, did not have a significant impact on vegetable consumption in this population group.

Discussion
It is accepted that there is insufficient vegetable consumption globally from young to old and that there is a disease burden associated with this low intake. There is also a paucity of data on the inclusion of vegetables as part of a composite meal. While there have been studies of perceptions of freshness, psychosocial, environmental and life course factors influencing fruit consumption, there are very little comparable data on vegetables and this constitutes an under researched area (Bray & Hartwell 2017). Vegetable consumption in adolescents is reported to be low, at least in part, due to unappealing sensory properties, such as bitter tastes. However, not all vegetables have unappealing sensory properties, and strategies to improve vegetable consumption may benefit from wider consideration. Repeated exposure has been advocated to increase vegetable liking and consumption, as has the use of rewards but effect sizes are small, although limited evidence suggests potential long-term benefits (Appleton et al. 2018). Both the VeggiEAT and Veg+ projects improved understanding of factors associated with the regular consumption and liking of vegetables with more appealing and less appealing sensory properties. The scoping review, carried out as part of the Veg+ project (Rodrigues et al. 2019), summarises worldwide data regarding vegetable consumption from almost 70 000 college students. The findings demonstrate that the majority of young adults do not consume vegetables as frequently as recommended by the Centre for Disease Control and Prevention (2017), nor in sufficient quantities to satisfy other relevant guidelines. No consumption patterns according to country or region were apparent although being female was the more frequent predictor associated with a higher intake. Other factors such as normal weight, living in the family home, importance given to healthy eating, higher socio-economic level and more openness to new experiences (i.e. reduced neophobia, greater nutrition knowledge, being more active and drinking less alcohol) were all associated with a higher intake of vegetables. Availability appears to be a key proximal determinant of consumption, especially when the figure for fruit is also added. Among older people, a systematic review of behavioural interventions showed that effective dietary education, meal service provision and food-based dietary interventions (e.g. improving diet quality) increase older people's consumption of fruit and vegetables while also improving their physical health and nutrition status (Zhou et al. 2018).
Where sensory and naturalness elements are found to positively influence the consumption of vegetables among young adults, small-scale family farmers through their diversified production and ability to supply a variety of fresh produce may offer a solution for improved menu quality in some contexts. While this provides numerous advantages including reducing food transportation, reducing pesticide use and supporting the local farming economy, key barriers exist in the abilities of small-scale family farms to provide a continuous supply of produce. Further, food service operators require processed produce such as prewashed and sorted commodities which is challenging for local farmers to deliver. Taken together, these findings present new insights not previously reported in the literature.
There is a continuing need for research that identifies specific ways for improving vegetable consumption and translating this into new product development and new markets. From an operational perspective, processed vegetables, including canned and frozen varieties, provide a convenient way to help promote intake as they have a longer shelf life than their fresh counterparts, are available out of season, can take advantage of surplus or over production, can have cost advantages and are easy to use in commercial meal preparation and dish development. This latter aspect enables them to be incorporated into production schedules where labour is limited or unskilled or equipment is not available. Notwithstanding, consumers tend to have a more positive attitude towards fresh vegetables rather than canned or frozen (Perez-Cueto et al. 2017).
Food choices in adolescence usually track into adulthood and are determinants of health outcome later in life. Adolescents who eat more protein from plant origin are less likely to be obese or overweight (Lin et al. 2015). Even so, efforts to promote vegetable consumption (as a marker for healthy eating) have been implemented with limited success (Perez-Cueto et al. 2012). Nudging is attracting considerable interest due to its understanding and application of heuristic biases among consumers. While a study to test and compare three nudges in promoting vegetable consumption using priming (creating a leafy environment with green plants and an odour of herbs), default (pre-portioned salad in a bowl containing 200 g of vegetables) and perceived variety (a premixed salad subsequently divided into each of its components) showed that the default design successfully increased the energy intake from vegetables among study participants (124 kcal vs. 90 kcal in control, P < 0.01) (Friis et al. 2017), a default nudge towards a vegetable-based 'Dish of the Day' was not successful in increasing its uptake in the VeggiEAT study in either male adolescents or older adults from four European countries Dos Santos et al. 2020).
The two research programmes (VeggiEAT and Veg+) provide an interesting snapshot of vegetable consumption across the lifespan where it is evident that there are common factors of sensory, health and naturalness dimensions.

Conclusion
Globally, there is a strong need to promote the consumption of vegetables as a public health issue but also to improve sustainability and food service operations. Sustainable considerations include not only planetary but personal health and the livelihood of small-scale family farmers globally. Both VeggiEAT and Veg+ found that sensory characteristics such as bitterness and sourness have a negative influence on acceptance and consumption of vegetables, while sweetness encourages consumption. Additionally, personal views on health and the perception of naturalness act on likely vegetable consumption. The synergistic approach of both Veg-giEAT and Veg+ projects to explore factors affecting vegetable consumption across the whole food chain will aid the transition from theoretical understanding to practical application. The geographical areas chosen for fieldwork provide insight from a spread of countries and cultures. As such, they present a comprehensive test bed for consumer study and evaluation of factors associated with increased vegetable intake from farm to fork.