Success story: One university's attempt to improve the health culture on campus

George Fox University implements Nutrition Matters program to weave nutrition importance throughout campus culture 

George Fox University wants to be known as the healthiest campus in the U.S. Part of that process includes changing the campus culture to support the role of nutrition in lifelong health.

George Fox is a tight-knit campus community just outside of Portland in Oregon's growing wine country. The university's promise to students, that they will "be known" is taken seriously. The 4,000 plus students aren't just anonymous faces floating through their time on campus –the university works to create a supportive environment where students can learn to be their best selves.

That promise is evident as Fred Gregory, special assistant to the president, walks across campus on a rainy morning; students smile and say hello as he passes, he asks them about their classes, last weekend's game or their current internship. He pops his head into a classroom and says hello. It's clear his behavior isn't seen as unusual. With a student to faculty ratio of 14:1, professors get to know their students and both faculty and staff are an integral part of campus life.

An idea takes root
Gregory is describing an aha moment when friend, colleague and fellow George Fox alumnus Kent Thornburg, Ph.D. gave the commencement speech a few years back. Thornburg is the director of the OHSU Moore Institute for Nutrition & Wellness and internationally known for his work on the developmental origins of health and disease (DOHaD). Specifically his work focuses on the role early life nutrition plays in setting the course for lifelong chronic disease risk and how this risk is passed on to future generations. Gregory saw the potential in using the George Fox campus as an incubator of sorts to implement many of Thornburg's ideas.

During the college years young adults become more independent, move out of the family home and establish habits that last throughout their lives. This time offers a unique opportunity to influence eating, cooking and exercise habits that can impact the students' own lifelong health as well as that of their future families and the people they may touch through their professional careers.

Gregory thought George Fox offered an ideal setting for developing a culture that would help support the creation of positive health habits. "It was just a good fit with our core values," said Gregory. "We're already an alcohol and tobacco-free campus. We want students to be healthy. What else can we do during their time here to help them be the best they can be?"

Gregory brought the idea to key leaders at the university, including the president, provost and dean of the College of Behavioral and Health Sciences. Together they developed an idea to infuse the importance of nutrition and physical activity throughout the campus culture. They decided to start with overhauling the curriculum of the lifelong fitness class required of all incoming freshmen, which focused on exercise, with a little nutrition mixed in. The required class provided an easy method of reaching all incoming students with the nutrition message.

Gregory approached another George Fox graduate, Lori Sobelson, director of corporate outreach for Bob's Red Mill about funding the program. What resulted is the Nutrition Matters program now in its third year. The program aims to shape the campus culture to initiate sustained positive health behaviors and include a science-based nutrition curriculum for all students.

A program develops
The first year of the program focused on individual knowledge and behavior change. This included implementing standardized nutrition curriculum in conjunction with the OHSU Moore Institute for the lifelong fitness class. Along with the focus on nutrition, students were required to use a fitness tracker and report on daily step counts.

As part of the Nutrition Matters grant, the university purchased a BOD POD to measure body composition. Students in the class were asked to do a health assessment and body composition measurement at the beginning and end of the semester. These assessments screened for potential problems like over-exercising or eating disorders and offered private counseling services. While required for students in the lifelong fitness class, the BOD POD is available to all students, faculty and staff.

To reinforce the nutrition message and spread it beyond entering freshmen, the university began working with its campus food service provider, Bon Appetit, to overhaul the food offerings on campus.

Going beyond the classroom
"It was a really good fit for us because we'd been working for a long time to promote scratch cooking and move away from processed foods," said Denny Lawrence, Bon Appetit manager.

The university was in the process of constructing a central dining area. The new Canyon Commons is nothing like the cafeterias most of us imagine from college campuses. Gone are the mystery meat burgers and fries, the soggy unrecognizable vegetables. The bright, spacious area has a full salad bar overflowing with fresh local produce and whole grain salads. There's a station with hummus, pita triangles and fresh sliced veggies, another with bowls of fresh whole fruit and another with stir fry's, baked chicken, bowls of brown rice and quinoa.

"We go through about 75 pounds of quinoa a week," said Lawrence

That's not to say all the usual college fare is missing. But, Lawrence said, while "we still have chicken finger night we now also offer baked and gluten free versions."

Staff work with Bon Appetit to reinforce lessons learned as part of the Nutrition Matters curriculum. Digital signage in the Campus Commons highlights nutrition messages and offers nutrition information for products served, including calorie counts.

With the increased focus on nutrition, Lawrence was able to implement other measures as well, including ditching the ubiquitous cafeteria trays. The move may seem simple, but it forced students to be more thoughtful in their initial food selections, and as an added bonus reduced food waste by almost 25 percent. The nutrition-focus seems to have affected drink choices as well. Since the changes, the consumption of sugar-sweetened soft drinks has gone down by half.

The dedication of George Fox leadership to see this program succeed has allowed it to evolve naturally. The second year of the program added cooking demonstrations open to all students, where basic kitchen skills and easy, healthy recipes were taught.

Jim Foster, dean of the College of Behavioral and Health Sciences said that since freshmen are required to live in the dorms, "we realized they didn't have any place to cook." Dorms are equipped with kitchens, but lacking in some of the equipment, like Vitamix blenders, that were used in the cooking demos. "So, we created a checkout program for cooking equipment," Foster said. This allows students to try the recipes they've learned on their own.

Student internship positions were created to help students interested in pursuing health professional careers implement pieces of the program. One position works with Bon Appetit on message and menu creation, another works with the Office of Student Life to develop campus events tied-in with the program. Another helps organize the cooking demonstrations.

For Nutrition Matters' final year of funding, the university is developing science-based nutrition curriculum in conjunction with the OHSU Moore Institute for its health majors, including biology, nursing, allied health, athletic training and health and human performance. Nutrition curriculum has traditionally been lacking in many of these programs. The hope is that these students will continue to spread the message about the importance of nutrition through their professional careers.

Promising results
So far the results are positive. Responses to the surveys taken at the beginning and end of the lifelong fitness class have shown a steady improvement in the effectiveness of the curriculum to alter behavior and increase knowledge of the role of nutrition in lifelong health. A survey of students six months following completion of the class found 70 percent were continuing to maintain the suggested minimum requirement for physical activity, significantly higher than a national sampling of college students that found only 48.7 percent meeting the goal.

There have also been multiple ripple effects of the program too according to Gregory. The School of Education included curriculum on how to teach nutrition to kids for new teachers to take out to classrooms around the state. The School of Physical Therapy hosted a Health and Wellness Week that included information about nutrition and exercise. Data from the Nutrition Matters program has been made available to students to develop research projects and one has been presented at a national meeting.

A new group of students enters each year and the Nutrition Matters messages must continue to resonate throughout the broader campus culture. However, by the end of the next school year, all students on campus will have completed the lifelong fitness class. The changes to the cafeteria will no longer be novel. Soon, students in health majors will assume nutrition has always been an essential part of their curriculum.

The university hopes this program helps to make George Fox a model for what can be done on college campuses. The institution has built it into the ongoing academics and culture of the university in a way that they won't need external funding to keep it going. The goal is ultimately to make all of the resources from the Nutrition Matters program available for use by other institutions so the cultural shift seen on the George Fox campus can extend to other universities until it is the norm.

When the George Fox administration embarked on this journey, they knew that they were trying to change a culture, in this case a food culture which is deeply embedded into all of our lives. They also understood that they were building gradual change that they might not see the ultimate effects of during their lifetimes. But they knew it was worth it. Worth it for the health of their students, and worth it for the lives these students would ultimately touch through their personal and professional lives.  After all, isn't college ultimately about providing knowledge and hope for a better future?