School food policy at primary and secondary schools in Belgium-Flanders: does it influence young people's food habits?

Robust implementation of school food policy is needed to improve nutritional outcomes of children in European and Western Pacific countries: A systematic review

OBJECTIVE

The present systematic review explored compliance status with school food policies in Europe and the Western Pacific regions, challenges and facilitators of policy compliance, and its impact on children's diets and nutrient intakes.

RESEARCH METHODS

An electronic search for full-text research articles published between January 2009 and July 2023 was conducted in Science Direct and PubMed scientific databases.

RESULTS

A total of 659 titles and abstracts were screened, and final data was extracted from 34 included studies. Results showed low compliance with the school food policy in Europe and the Western Pacific regions. The European schools chad better compliance than the Western Pacific, and supportive interventions improved policy adherence. Impact assessment studies reported that the implementation of the school food policy increased fruit and vegetable consumption, thus increasing nutrient intakes (vitamin A, vitamin D, iron, calcium, folate, and dietary fibers). However, its impact on the availability and consumption of foods high in fat, sugar, and salt (HFSS) was less conclusive. The effects of the policy on the school food environment indicated no significant improvement.

CONCLUSION

Results highlighted the need for additional support and surveillance at the school level to ensure adequate policy compliance.

Teacher Training and Engagement in Health Promotion Mediates Health Behavior Outcomes

School-based health promotion interventions have been shown to lead to measurable changes in the nutrition and physical activity behaviors. This study examines whether the impact of an intervention program on students’ healthy eating and physical activity was mediated by teacher training and engagement in health promotion. The trial was conducted in three phases: needs assessment of the baseline survey of teachers, mothers’ and children; intervention among seven randomly selected schools that included teacher training in healthy eating and physical activity; and a post-intervention evaluation survey. The SPSS PROCESS for Hayes (Model8) was used to determine moderation and mediation effects. The difference in difference (DID) was calculated for the three main outcomes of the study: eating breakfast daily (DID = 17.5%, p < 0.001); consuming the recommended servings of F&V (DID = 29.4%, p < 0.001); and being physically active for at least 5 days/week (DID = 45.2%, p < 0.001). Schoolchildren’s eating breakfast daily was mediated by their teachers’ training in nutrition (β = 0.424, p = 0.002), teachers’ engagement (β = 0.167, p = 0.036), and mothers preparing breakfast (β = 1.309, p < 0.001). Schoolchildren’s consumption of F&V was mediated by teachers’ engagement (β = 0.427, p = 0.001) and knowing the recommended F&V servings (β = 0.485, p < 0.001). Schoolchildren’s physical activity was mediated by their teachers’ training in physical activity (β = 0.420, p = 0.020) and teachers’ engagement (β = 0.655, p < 0.001). Health behavior changes in the school setting including improvements in eating breakfast, consuming the recommended F&V and physical activity was mediated by teacher training and engagement. Effective teacher training leading to teacher engagement is warranted in the design of health-promotion interventions in the school setting.

Impacts of School Nutrition Interventions on the Nutritional Status of School-Aged Children in Asia: A Systematic Review and Meta-Analysis

This review aims to describe school nutrition interventions implemented in Asia and quantify their effects on school-aged children’s nutritional status. We searched Web of Science, Embase, Ovid MEDLINE, Global Health, Econlit, APA PsycInfo, and Social Policy and Practice for English articles published from January 2000 to January 2021. We quantified the pooled effects of the interventions on the changes in body mass index (BMI) and body mass index z score (BAZ), overall and by type of intervention. In total, 28 articles were included for this review, of which 20 articles were multi-component interventions. Twenty-seven articles were childhood obesity studies and were included for meta-analysis. Overall, school nutrition interventions reduced school-aged children’s BMI and BAZ. Multi-component interventions reduced the children’s BMI and BAZ, whereas physical activity interventions reduced only BMI and nutrition education did not change BMI or BAZ. Overweight/obesity reduction interventions provided a larger effect than prevention interventions. Parental involvement and a healthy food provision did not strengthen school nutrition interventions, which may be due to an inadequate degree of implementation. These results suggested that school nutrition interventions should employ a holistic multi-component approach and ensure adequate stakeholder engagement as well as implementation to maximise the effects.

School Food Policies Related to Soft Drink and Fruit Juice Consumption as a Function of Education Type in Flanders, Belgium

Recent data on erosive tooth wear (ETW) in Belgium have associated a vocational/technical type of education with ETW risk. Since the role of schools is essential to the promotion of healthy diets, this study aimed to investigate school food policies (SFP) related to soft drink and fruit juice consumption and to detect differences among schools in Flanders, Belgium (BE-F). An online questionnaire related to the control of acidic beverages and promotion of healthy drinking habits was sent to all Flemish secondary schools. For analysis, schools (n = 275) were grouped by type of education (vocational secondary education (VSE) and general secondary education (GSE)), and by socioeconomic status. Multiple factor analyses (MFA) were performed to identify schools with a similar SFP profile. Additionally, descriptive analyses were performed to determine other associations. Overall, 44% of schools in BE-F claimed to have written SFP related to the consumption of soft drinks. SFP expressly prohibiting or limiting acidic beverages were significantly more frequent in GSE schools (p < 0.05), where a higher economic status was present. This study shows that a considerable group of schools in BE-F have no or incomplete rules concerning acidic beverage consumption. Such rules differ between types of education, with VSE schools reporting less control regarding the consumption of drinks.

The Influence of Behavioural and Sociodemographic Risk Indicators on Erosive Tooth Wear in Flemish Adolescents, Belgium

Although Belgium has recently been ranked as the second highest consumer of soft drinks in Europe, no data on erosive tooth wear (ETW) are currently available. Therefore, the aim of this cross-sectional study was to determine the prevalence and associated risk indicators of ETW in adolescents residing in the region of Flanders, Belgium. Convenience sampling was used to recruit participants from different types of Belgian schools: general and vocational/technical education. Three calibrated dentists performed the dental examinations and a self-reported questionnaire was applied to evaluate risk indicators related with ETW. ETW was classified using the Basic Erosive Wear Examination (BEWE) index, and the overall prevalence was calculated using BEWE sum >0. The Kruskal-Wallis test, the Mann-Whitney U test, and logistic regression analysis were performed to evaluate frequencies and risk associations. From a total of 613 recruited adolescents (mean age: 15.1 years, SD: 0.8), 48.6% presented at least one affected tooth surface by ETW (BEWE sum >0), 14.4% (n = 88) scored BEWE sum >2, and the highest score obtained was BEWE sum = 8. Two predictive variables were found to have an association with ETW: vocational/technical type of education (OR: 1.49; 95% CI: 1.03-2.13) and frequent consumption of soft drinks (OR: 2.08; 95% CI: 1.38-3.14). In conclusion, ETW is a common condition presented with low severity among Flemish adolescents. Additionally, the frequent consumption of soft drinks and being part of a vocational/technical education appear to be risk indicators for ETW in this population. The latter indicates the need for specific orientated oral health promotion programmes for the prevention of ETW in Flemish adolescents.

Food environment and policies in private schools in Kolkata, India

School food policies and services have the potential to influence the food practices and eating behaviours of adolescents which in turn may affect their lifestyles and health in adulthood. The aim of this qualitative investigation was to describe the opinions of adolescents, their parents, nutrition educators and school principals about the prevailing food environment and canteen policies in Indian schools. Fifteen adolescents aged 14-15 years, 15 parents, 12 teachers and 10 principals from 10 private schools in Kolkata, India participated in semi-structured interviews. The interview questions were primarily based on the existing literature related to school food environments and policies. Audio recordings were transcribed verbatim and assessed thematically. Throughout the 52 interviews, a number of inadequacies of the school food environment and policies were revealed. These included the absence of written food policies, the widespread supply of unhealthy foods, inadequate provision of healthy foods, misleading messages about food communicated by school authorities, lack of cleanliness in the school canteen and the high cost of canteen food. Current school food environments do not appear to promote healthy eating among adolescents. Therefore, it is important to upgrade the quality of food services in Indian schools through adoption of healthy eating policies.

Effects of family affluence on the health behaviors of Korean adolescents

AIM

To examine the effect of the level of family affluence on the health-related behaviors of South Korean adolescents.

METHODS

A stratified, random cluster sampling of 400 middle schools and 400 high schools in Korea lead to the selection of 72,435 middle school and high school students. A logistic regression analysis was carried out to examine the impact of family affluence on the health-related behaviors of Korean adolescents.

RESULTS

The risk of alcohol intake was 0.824 and 0.809 times lower in those adolescents with low and moderate family affluence, respectively, compared to those with a high level of family affluence. The risk of current smoking was 0.896 times lower in the adolescents with moderate family affluence, compared to those with a high level of family affluence. The risk of not exercising was 1.286 and 1.425 times higher in those adolescents who were associated with moderate and low family affluence, respectively, compared to those with a high level of family affluence. The risk of skipping breakfast was 1.433 times higher in the adolescents with low family affluence, compared to those with high family affluence. The risk for consuming no fruit was 1.890 times higher in the adolescents with low family affluence, compared to those with a high level of family affluence.

CONCLUSION

A high level of family affluence had a greater negative impact on alcohol intake and smoking and a greater positive impact on exercise and dietary behaviors, as compared to low and moderate family affluence among Korean adolescents.

The provision of healthy food in a school tuck shop: does it influence primary-school students' perceptions, attitudes and behaviours towards healthy eating?

OBJECTIVE

To investigate students' tuck shop buying behaviour, choices of lunchbox items and healthy eating perceptions and attitudes at a school with a nutritionally regulated tuck shop and a school with a conventional tuck shop.

DESIGN

Mixed-methods research comprising a cross-sectional survey and focus groups.

SETTING

Bloemfontein, South Africa.

SUBJECTS

Randomly selected grade 2 to 7 students from a school with a nutritionally regulated tuck shop (school A; n 116) and a school with a conventional tuck shop (school B; n 141) completed a self-administered questionnaire about perceptions, attitudes, buying behaviours and lunchbox content. Six students per grade (n 72) in each school took part in focus group discussions to further explore concepts pertaining to healthy eating.

RESULTS

In school A, older students had a negative attitude towards their 'healthy' tuck shop, while younger students were more positive. School B students were positive towards their conventional tuck shop. In both schools students wanted their tuck shop to allow them to choose from healthy and unhealthy items. School A students mostly bought slushies, iced lollies and baked samoosas, while school B students mostly bought sweets and crisps. The lunchboxes of school A students contained significantly (P<0·05) more healthy items but also significantly more unhealthy items.

CONCLUSIONS

A single intervention such as having a nutritionally regulated tuck shop at a primary school cannot advance the healthy school food environment in its totality. A multi-pronged approach is recommended and awareness must be created among all role players, including parents who are responsible for preparing lunchboxes.

Correlates of fruit, vegetable, soft drink, and snack intake among adolescents: the ESSENS study

Background

Identifying modifiable correlates of dietary behaviors is of utmost importance for the promotion of healthy dietary behaviors.

Objective

This study explores individual, home, and school/neighborhood environmental correlates of dietary behaviors (intake of fruits, vegetables, soft drinks, and unhealthy snacks) among adolescents.

Methods

In total, 742 adolescents with a mean age of 13.6 (SD=0.3) were included in this cross-sectional study conducted in 11 secondary schools located in the eastern part of Norway. A web-based questionnaire was used to collect data. Univariable and multivariable linear regression analyses were used to explore factors associated with the dietary behaviors included.

Results

A higher frequency of food/drink purchase in the school canteen was related to a higher consumption of soft drinks and snacks. A higher frequency of food/drink purchase in shops around schools during break or recess was related to a higher consumption of snacks. A higher frequency of food/drink purchase in shops around the neighborhood on the way to and from school was related to a higher consumption of soft drinks. Perceived parental modeling and perceived accessibility at home were found to be positively associated with all dietary behaviors. Perceived parental rules were inversely associated with soft drink and snack consumption; self-efficacy related to healthy eating was positively associated with fruit and vegetable consumption. Other included school and neighborhood environmental correlates were not associated with the dietary behaviors.

Conclusions

There is a need to address the food purchasing behavior of the adolescents using different approaches. The findings also highlight the important role of parents and the home environment for healthy and unhealthy dietary behaviors of adolescents.

Change of School in Early Adolescence and Adverse Obesity-Related Dietary Behavior: A Longitudinal Cohort Study, Victoria, Australia, 2013-2014

Introduction

Environments that facilitate energy-dense, nutrient-poor diets are associated with childhood obesity. We examined the effect of a change of school environment on the prevalence of obesity and related dietary behavior in early adolescence.

Methods

Fifteen schools in Victoria, Australia, were recruited at random from the bottom 2 strata of a 5-level socioeconomic scale. In 9 schools, students in grade 6 primary school transitioned to different schools for grade 7 secondary school, whereas in 6 schools, students remained in the same school from grade 6 to grade 7. Time 1 measures were collected from students (N = 245) in grade 6 (aged 11–13 y). Time 2 data were collected from 243 (99%) of the original cohort in grade 7. Data collected were dietary recall self-reported by students via questionnaire, measured height and weight of students, and aspects of the school food environment via school staff survey. Comparative and mixed model regression analyses were conducted.

Results

Of 243 students, 63% (n = 152) changed schools from time 1 to time 2, with no significant difference in weight status. Students who changed schools reported an increase in purchases of after-school snack food, greater sweetened beverage intake, fewer fruit-and-vegetable classroom breaks, and less encouragement for healthy eating compared with students who remained in the same school. School staff surveys showed that more primary than secondary schools had written healthy canteen policies and fewer days of canteen or food services operation.

Conclusion

A change of school environment has negative effects on children’s obesity-related dietary behavior. Consistent policy is needed across school types to support healthy eating in school environments.

Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood

Clinical manifestations of cardiometabolic risk (CMR) may be set early in childhood due to unfavorable behaviors or lifestyle patterns related to diet and physical activity. Several factors may determine the adoption of such lifestyle-related behaviors, which researchers have tried to cluster under certain frameworks or models. In this context, the framework developed and proposed by this review gathers all the present knowledge regarding these determining factors to date and groups them into three main categories related to personal characteristics and the social and physical environment. Based on the proposed framework, a large variety of personal, social and physical environmental factors can positively or negatively influence CMR-related behaviors (either directly or indirectly via their interrelations), thus leading to decreased or increased risk, respectively. This framework could be of great value to public health policy makers and legislators for designing and implementing interventional programs tailored to the needs of susceptible population groups who are most in need for such initiatives. Targeting the correlates as potential determinants of CMR-related behaviors, and not just on the behaviors themselves, has been shown previously to be the most effective approach for tackling health issues related to CMR starting from early life stages.

Health promotion in primary and secondary schools in Denmark: time trends and associations with schools' and students' characteristics

Background

Schools are important arenas for interventions among children as health promoting initiatives in childhood is expected to have substantial influence on health and well-being in adulthood. In countries with compulsory school attention, all children could potentially benefit from health promotion at the school level regardless of socioeconomic status or other background factors. The first aim was to elucidate time trends in the number and types of school health promoting activities by describing the number and type of health promoting activities in primary and secondary schools in Denmark. The second aim was to investigate which characteristics of schools and students that are associated with participation in many (≥3) versus few (0–2) health promoting activities during the preceding 2–3 years.

Methods

We used cross-sectional data from the 2006- and 2010-survey of the Health Behaviour in School-aged Children study. The headmasters answered questions about the school’s participation in health promoting activities and about school size, proportion of ethnic minorities, school facilities available for health promoting activities, competing problems and resources at the school and in the neighborhood. Students provided information about their health-related behavior and exposure to bullying which was aggregated to the school level. A total of 74 schools were available for analyses in 2006 and 69 in 2010. We used chi-square test, t-test, and binary logistic regression to analyze time trends and differences between schools engaging in many versus few health promoting activities.

Results

The percentage of schools participating in ≥3 health promoting activities was 63% in 2006 and 61% in 2010. Also the mean number of health promoting activities was similar (3.14 vs. 3.07). The activities most frequently targeted physical activity (73% and 85%) and bullying (78% and 67%). Schools’ participation in anti-smoking activities was significantly higher in 2006 compared with 2010 (46% vs. 29%). None of the investigated variables were associated with schools’ participation in health promoting activities.

Conclusion

In a Danish context, schools’ participation in health promotion was rather stable from 2006 to 2010 and unrelated to the measured characteristics of the schools and their students.

Food for thought: analysing the internal and external school food environment

Purpose

– Availability and access to food is a determinant of obesity. The purpose of this paper is to examine food availability within and outside of post-primary schools in Ireland.

Design/methodology/approach

– Data on the internal school food environment were collected from 63 post-primary schools using questionnaires. The external school food environment for these 63 schools was assessed by mapping food businesses within 1 km of schools, using a Geographic Information System (GIS). Food businesses were categorised based on type of food sold.

Findings

– A total of 68.3 per cent of schools had a canteen, 52.5 per cent had a small food shop and 37.1 per cent had a vending machine. A total of 32.7 per cent of schools reported selling chips (French fries) in their canteen while 44.2 per cent of schools reported selling energy-dense nutrient-poor foods in their school shop. Of the schools surveyed, there was an average of 3.89 coffee shops and sandwich bars, 3.65 full service restaurants, 2.60 Asian and other “ethnic” restaurants, 4.03 fast food restaurants, 1.95 supermarkets, 6.71 local shops and 0.73 fruit and vegetable retailers within a 1 km radius of the post-primary schools. Findings are presented by geography (urban/rural), disadvantage (Delivering Equality of Opportunity in School (DEIS)/non DEIS), gender (girls/boys/mixed) and food policy in place at the school (yes/no).

Practical implications

– These data will facilitate schools working on the framework for Health Promoting Schools in Ireland.

Social implications

– This work can contribute to current discussions on restricting accessibility to certain foods and food premises for school children.

Originality/value

– The study explores the internal and external school food environment. GIS have been used to link the external food environment to specific schools thus allowing a comprehensive analysis of the schools’ food environment. To the authors knowledge, this is the first time that both environments are explored simultaneously.

The relationship between school lunch attendance and the food intakes of French schoolchildren aged 3-17 years

OBJECTIVE

Recently, school meal composition regulations have been implemented in France in order to improve the nutritional status of children. The present study investigated the link between school lunch attendance and the food intakes of schoolchildren aged 3-17 years.

DESIGN

Second French cross-sectional dietary survey (2006-2007). Eating frequencies were assessed for twenty-four food groups with a 7 d food record. Eating locations were recorded for main meals. Food group intakes at weekday lunches were compared for the school canteen and for other locations. The children's overall dietary intake was compared based on school lunch attendance.

SETTING

Mainland France.

SUBJECTS

Schoolchildren aged 3-17 years (n 1068).

RESULTS

Lunchtime food intake differed between the school canteen and other locations. Some intakes at school canteens were more in accordance with the regulations (more fruit and vegetables, fish and dairy products, and less sandwiches, soft drinks, chocolate and confectionery), whereas others highlighted needs for improvement (more sweet biscuits and pastries, ice cream and dairy desserts, pizzas and salty pastries). Many of these differences were also observed in the children's overall diet: children regularly attending school lunches ate more mashed fruit, fish and sweet biscuits or pastries, and less sandwiches and soft drinks. The link between school lunch attendance and overall diet was less pronounced in secondary-school children.

CONCLUSIONS

School canteen attendance is associated with both potentially beneficial and deleterious differences in the lunchtime and overall diets of French children. These findings are important to consider when setting national regulations for school meal composition.

WHO European Childhood Obesity Surveillance Initiative: School nutrition environment and body mass index in primary schools

BACKGROUND

Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention.

OBJECTIVE

To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries.

METHODS

Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children's weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children's BMI/A Z-scores was calculated.

RESULTS

Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%-95% of schools) and school nutrition environment scores (range: 0.30-0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20-1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed.

CONCLUSIONS

Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the "unhealthy" school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.

The school nutrition environment and its association with soft drink intakes in seven countries across Europe--the ENERGY project

The school is an important setting for promoting healthy eating especially at the transition from childhood to adolescence. This study contributes to the literature by describing practices within physical, political and sociocultural aspects of the school nutrition environment in seven countries across Europe based on questionnaires to the school management, and exploring their associations with soft drink consumption reported on questionnaires by 10-12 year olds. Several of the commonly self-reported practices could be supportive of a healthy diet (time to eat, access to water, restriction on marketing), but some practices were underutilized (i.e. discussion with stakeholders, healthy foods at events). Only a few associations of practices with the pupils׳ soft drink consumption were found.

Do attitudes, intentions and actions of school food coordinators regarding public organic food procurement policy improve the eating environment at school? Results from the iPOPY study

OBJECTIVE

The present study investigates whether public organic food procurement policies have the potential to induce changes in the school food service environment.

DESIGN

A comparative cross-national survey was conducted in public primary and/or secondary schools in Finland, Germany and Italy. The school food coordinators completed a web-based questionnaire on their attitudes, intentions and actions towards organic school food provision.

SETTING

In Germany, 122 out of 2050 schools in the state of Hesse responded. In Finland, 250 out of 998 schools across the country responded. In Italy, 215 out of 940 schools from eight provinces responded.

SUBJECTS

School food coordinators in the sample of schools in the three countries.

RESULTS

The German and Finnish school food coordinators separately most agreed with the promotion of healthy eating habits (P < 0·001) and organic food (P < 0·001) by schools. The Finnish schools were most likely to adopt a food and nutrition policy (P < 0·001), a health-promoting school policy according to WHO principles (P < 0·001), to have a playground (P < 0·001), to involve physical activity themes in teaching (P = 0·012) and to have a canteen (P < 0·001). The Italian schools were most likely to involve the food and nutrition policy in pedagogical activities (P = 0·004), to serve nutritional school meals (P < 0·001) and to recommend children to eat healthily (P < 0·001). In the three countries, the non-organic schools were less likely to adopt a food and nutrition policy (P < 0·001), a WHO health-promoting policy (P < 0·001) and have a canteen (P = 0·017) than the organic schools.

CONCLUSIONS

The study suggests that there is a gap in the effects of public organic food procurement policy on building a healthier school food environment.

Children's food intake: a comparison of children's and parents' reports

PURPOSE

In longitudinal studies, parents are the most accurate source of information on young children's dietary intake; for older children, questioning children themselves may be more appropriate. However, if parental reports for young children and self-reports of older children are to be used in the same analyses, the measures must be comparable.

METHODS

During school hours, fourth and sixth graders in 14 Flemish (Belgium) primary schools completed an online 15-item food frequency questionnaire with a retest questionnaire one to two weeks later; parents completed a paper-and-pencil or online questionnaire. Test-retest data were available for 286 children; children's tests could be matched to parents' reports for 275 children.

RESULTS

On average, test-retest correlations were 0.68 (grade 4: 0.63; grade 6: 0.71) and correlations between children's and parents' reports were 0.44 (grade 4: 0.39; grade 6: 0.49). No systematic differences were found between the test and retest. Comparison of children's and parents' reports resulted in significant differences for six of the 15 items.

CONCLUSIONS

Low consensus between parents' and children's reports for several items may impede comparisons at a group level. Additionally, the results indicate more optimal dietary assessment in sixth graders.

The association between organic school food policy and school food environment: results from an observational study in Danish schools

AIMS

School food in many countries has become the object of change and innovation processes, not only in relation to policies for healthier eating but also in relation to policies for more sustainable food consumption and procurement. The purpose of this study was to examine the possible influence that organic food sourcing policies in Danish school meal systems may have on the development of healthier school food environments.

METHODS

The study was a cross-sectional analysis undertaken among 179 school food coordinators (SFCs) through a web-based questionnaire (WBQ) in a sample of Danish public primary schools. The 'organic' schools were compared to 'non-organic' schools. The questionnaire explored the attitudes, intentions/policies and actions in relation to organic and healthy foods served in the schools.

RESULTS

Data indicates that 20 'organic' schools were associated with the indicators of healthier school environments, including adopting a Food and Nutrition Policy (FNP) in the school (p = .032), recommending children to eat healthily (p = .004).

CONCLUSIONS

The study suggests that organic food policies in schools may have potential to support a healthier school food environment.

Changes in school environment, awareness and actions regarding overweight prevention among Dutch secondary schools between 2006-2007 and 2010-2011

Background

Schools can be an important setting for the prevention of overweight. This nation-wide survey investigated changes in the obesogenity of the school environment, the awareness of schools regarding overweight, school health policy, and actions taken by schools to prevent overweight.

Methods

In 2006/2007 and 2010/2011, questionnaires were sent to all Dutch secondary schools, (n = 1250 and n = 1145, response rate 44% and 33% respectively, repeated data for 187 schools).

Results

The percentage of schools with vending machines for soft drinks (~90%) and sweets (~80%) remained fairly stable, whereas slightly more schools indicated to have a canteen (87%-91%). The food supply was reported to be healthier in 2010/2011 compared to 2006/2007. Canteens and/or vending machines offered more often fresh fruits (+8%), sandwiches (+11%), water (+11%) and salad (+7%) and less often sugar sweetened soft drinks (−10%). However, unfavorable changes such as an increase in the supply of pizza slices (+13%) and milk and yoghurt drinks with added sugar (+12%) were also reported. Between 2006/2007 and 2010/2011, the presence of water coolers increased (12% versus 33%) as well as facilities for physical activity (67% versus 77%). However, more schools had vending places of unhealthy foods in the vicinity (73% versus 85%). Compared to 2006/2007, a higher percentage of schools indicated that they have taken actions to stimulate healthy eating behavior (72% versus 80%) or to prevent overweight (34% versus 52%) in 2010/2011. Less schools indicated that they expect to pay more attention to overweight prevention in the near future (56% versus 43%), but none of them expected to pay less attention.

Conclusions

Several aspects of the school environment changed in a positive way. However, schools should be encouraged to contribute to the prevention of overweight, or to continue to do so.

School food research: building the evidence base for policy

Objective

Following an international workshop on developing the evidence base for policy relating to school food held in London, UK, in January 2012, the objectives of the present paper were (i) to outline a rationale for school food research, monitoring and evaluation in relation to policy and (ii) to identify ways forward for future working.

Design

The authors analysed presentations, summaries of evidence, and notes from discussions held at the international workshop in London in 2012 to distil common themes and make recommendations for the development of coherent research programmes relating to food and nutrition in schools.

Setting

International, with an emphasis on middle- and high-income countries.

Results

Overviews of existing school food and nutrition programmes from the UK, Hungary, Sweden, the USA, Australia, Brazil, China, Mexico and other countries were presented, along with information on monitoring, evaluation and other research to demonstrate the impact of school feeding on health, attainment, food sourcing, procurement and finances, in the context of interactions between the evidence base and policy decisions. This provided the material which, together with summaries and notes of discussions, was used to develop recommendations for the development and dissemination of robust approaches to sustainable and effective school food and nutrition programmes in middle- and high-income countries, including policy guidelines, standards, cost-effectiveness measures and the terms of political engagement.

Conclusions

School food and nutrition can provide a cohesive core for health, education and agricultural improvement provided: (i) policy is appropriately framed and includes robust monitoring and evaluation; and (ii) all stakeholders are adequately engaged in the process. International exchange of information will be used to develop a comprehensive guide to the assessment of the impact of school food and nutrition policy and supporting infrastructure.

School food policy at Dutch primary schools: room for improvement? Cross-sectional findings from the INPACT study

Background

Schools can play an important role in the prevention of obesity, e.g. by providing an environment that stimulates healthy eating habits and by developing a food policy to provide such an environment. The effectiveness of a school food policy is affected by the content of the policy, its implementation and its support by parents, teachers and principals. The aim of this study is to detect opportunities to improve the school food policy and/or implementation at Dutch primary schools. Therefore, this study explores the school food policy and investigates schools’ (teachers and principals) and parents’ opinion on the school food policy.

Methods

Data on the schools’ perspective of the food policy was collected from principals and teachers by means of semi-structured interviews. In total 74 principals and 72 teachers from 83 Dutch primary schools were interviewed. Data on parental perceptions about the school food policy were based on a cross-sectional survey among 1,429 parents from the same schools.

Results

Most principals (87.1%) reported that their school had a written food policy; however in most cases the rules were not clearly defined. Most of the principals (87.8%) believed that their school paid sufficient attention to nutrition and health. Teachers and principals felt that parents were primarily responsible to encourage healthy eating habits among children, while 49.8% of the parents believed that it is also a responsibility of the school to foster healthy eating habits among children. Most parents reported that they appreciated the school food policy and comply with the food rules. Parents’ opinion on the enforcement of the school food policy varied: 28.1% believed that the school should enforce the policy more strongly, 32.1% was satisfied, and 39.8% had no opinion on this topic.

Conclusion

Dutch primary schools could play a more important role in fostering healthy eating habits among children. The school food policy could be improved by clearly formulating food rules, simplifying supervision of the food rules, and defining how to enforce the food rules. In addition, the school food policy will only influence children’s dietary behaviour if both the school and the parents support the policy.

Lunch habits of German children and adolescents: composition and dietary quality

BACKGROUND/AIMS

Data from the ongoing, open-cohort Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were used to describe warm family lunch meals and the association of the lunch composition with total diet quality.

METHODS

2,095 three-day weighed dietary records, collected between 2004 and 2009, from a 4- to 18-year-old DONALD study subgroup were used.

RESULTS

Warm lunch (eating occasions between 11.30 a.m. and 2.29 p.m. including at least one course that is typically consumed warm) was eaten on 68.8% of all record days. Meat lunch (>50%) was predominant, followed by vegetarian (25%), fish (13%) and sweet lunch meals (3%). The prevalence of desserts at lunch was high and beverages were drunk at 80% of lunch meals. A meat lunch was associated with a higher protein (+1.4% energy intake, %E) and fat intake (+1.7%E) than a sweet lunch; also densities of vitamin A, folate and iron were higher. A dessert at lunch decreased protein intake slightly (-0.2%E), but increased carbohydrate (+0.7%E) and added sugar intake (+1.4%E) as well as density of calcium (+18 mg/MJ).

CONCLUSION

Our study proves the impact of lunch on daily dietary quality and yields valuable insights on the development of food and meal-based dietary guidelines.

A healthy trend: less food used in fundraising and as rewards and incentives in Minnesota middle and high schools

OBJECTIVE

To assess change in the 4-year prevalence (2006-2009) of the use of food in school fundraising and as rewards and incentives for students, following implementation of federal legislation in the USA in 2006.

DESIGN

Serial cross-sectional design using trend analysis to assess school-level data collected over four consecutive years from 2006/2007 to 2009/2010.

SETTING

Minneapolis/St. Paul, MN.

SUBJECTS

Convenience sample of middle and high schools participating in two longitudinal, aetiological studies that examined youth, their environment and obesity-related factors.

RESULTS

A significant and sustained decrease was demonstrated in the use of low-nutrient, energy-dense foods in school fundraising activities and the use of food and food coupons as rewards and incentives by teachers and school staff.

CONCLUSIONS

Results support the utility of policy and legislative action as a tool for creating healthy, sustainable environmental change.

Does the school food environment influence the dietary behaviours of Norwegian 11-year-olds? The HEIA study

AIMS

The aim of the study is to investigate the influence of the school food environment on the dietary behaviours of 11-year-old Norwegian children in elementary schools.

METHODS

Baseline data from a school-based intervention study: the Health In Adolescents study was used. A total of 1425 11-year-old children from 35 schools from the eastern part of Norway were included. School administrators provided information on the physical, political, and sociocultural school food environment and students reported their intake of fruits, vegetables, sugar-sweetened beverages (SSB), and snacks. Multilevel modelling was used to assess the school-level variance in dietary behaviours and to investigate the association of school food environmental factors with these dietary behaviours.

RESULTS

After adjustment for student characteristics, the school level accounted for a small proportion (1.1%-3.0%) of the variance in the dietary behaviours investigated. None of the investigated school food environmental factors were found to be related to the children's reported intake of fruits, vegetables, snacks or SSB.

CONCLUSIONS

Most of the variance in the dietary behaviours investigated was at the personal level. Thus in this sample, the investigated school-level factors do not appear to exert a strong influence on the dietary behaviours of children. Longitudinal studies using validated measures of the school food environment are needed.

Family- and school-based correlates of energy balance-related behaviours in 10-12-year-old children: a systematic review within the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project

OBJECTIVE

To identify family- and school-based correlates of specific energy balance-related behaviours (physical activity, sedentary behaviour, breakfast consumption, soft drink consumption) among 10-12-year-olds, using the EnRG framework (Environmental Research framework for weight Gain prevention).

DESIGN

A literature review to identify observational studies exploring at least one family- or school-based correlate of the specific behaviours, resulting in seventy-six articles.

SETTING

Eighteen studies were conducted in Europe, forty-one studies in North America and seventeen studies in Australasia.

SUBJECTS

Healthy children aged 10-12 years.

RESULTS

Parental and maternal physical activity, doing physical activities with parents and parental logistic support were identified as the most important, positive correlates of physical activity. Parental rules was the most important correlate of sedentary behaviour and was inversely related to it. School socio-economic status was positively related to physical activity and inversely related to sedentary behaviour. The available studies suggested a positive relationship between soft drink availability at home and consumption. Soft drink availability and consumption at school were the most important school-based correlates of soft drink consumption. A permissive parenting style was related to more soft drink consumption and less breakfast consumption.

CONCLUSIONS

An important role has been awarded to parents, suggesting parents should be involved in obesity prevention programmes. Despite the opportunities a school can offer, little research has been done to identify school-environmental correlates of energy balance-related behaviours in this age group. Obesity prevention programmes can focus on the most important correlates to maximize the effectiveness of the programme. Future research should aim at longitudinal studies.

Developing school nutrition policies: enabling and barrier factors

PURPOSE

The study was conducted to identify the enabling and barrier factors in the development of nutrition policies in Prince Edward Island elementary and consolidated schools.

METHODS

A document review and in-depth interviews were conducted with key stakeholders (n=12).

RESULTS

Principals were identified as important champions for change. Working group members created an interface between the school world and the nutrition world, and drew upon common philosophical ground to work together to lead the change process. Successfully navigating the process of policy development required building a case for change, testing policies in the real world, integrating healthy eating within school life, offering support to schools, engaging participants, and acknowledging the need to weigh the costs and benefits of the change. At times, external pressures on schools and available foods varied in the extent to which they enabled or challenged policy development. Finally, resource limitations, competing issues, and the use of unhealthy food as rewards were identified as the primary barriers.

CONCLUSIONS

The use of a consultative approach that engages key stakeholders early in the process is critical to the successful development of school nutrition policies. This approach also may be an important predictor of the long-term success of such initiatives.

School meals in French secondary state schools: Do national recommendations lead to healthier nutrition on offer?

To improve the dietary offering in schools, the French authorities published recommendations on nutrition in 1999, which were then revised in 2007. The aim of the present study was to assess the nutritional offering in secondary school meals and the extent to which the recommendations promote balanced nutritional offerings. In 2005, a national survey was conducted on a representative sample of secondary schools, either administrated by the Ministry of Education (ES) or the Ministry of Agriculture (AS). Information on school-catering organisation and twenty consecutive meals was collected from each of the 707 secondary schools surveyed. Nutritional composition was estimated according to the French food composition database. Univariate and multivariate analyses were used to investigate the impact of food-group frequency guidelines (FFG) on nutritional offering. It was found that 15 and 26 % of ES and AS schools, respectively, had high compliance with the FFG, at lunch. Macronutrient content was unbalanced in ES school lunches in which 42·8 % lipids, 21·5 % proteins and 35·7 % carbohydrates contributed to the energy. Nevertheless, proper offerings in Fe, Ca and vitamin C content were observed. In addition, a lower offering in lipids and a higher offering in proteins, Ca, vitamin C and Fe were found when the FFG were applied (P < 0·001). Similar results were found for AS schools. This paper confirms the effectiveness of FFG in providing nutritionally balanced school meals. However, others measures such as nutrition promotion and actions to improve children's food habits have to be introduced to make the recommendations more effective and easier to understand.

Vegetable and fruit breaks in Australian primary schools: prevalence, attitudes, barriers and implementation strategies

School-based vegetable and fruit programs can increase student consumption of vegetables and fruit and have been recommended for adoption by Australian schools since 2005. An understanding of the prevalence and predictors of and the barriers to the adoption of school-based vegetable and fruit programs is necessary to maximize their adoption by schools and ensure that the health benefits of such programs to children are realized. The aim of this study was to determine Australian primary school Principals' attitudes and barriers to the implementation of vegetable and fruit breaks; the prevalence of vegetable and fruit breaks in schools and the implementation strategies used and associated with their recommended adoption (daily in at least 80% of classes). A random sample of 384 school Principals completed a 20-min telephone interview. While Principals were highly supportive of vegetable and fruit breaks, only 44% were implementing these to a recommended level. When controlling for all school characteristics, recommended vegetable and fruit break adoption was 1.9 and 2.2 times greater, respectively, in schools that had parent communication strategies and teachers trained. A substantial opportunity exists to enhance the health of children through the adoption of vegetable and fruit breaks in schools.

A review of the literature on policies directed at the youth consumption of sugar sweetened beverages

Sugar sweetened beverages (SSB) constitute a large percentage of energy consumed by youth. This paper reviews the literature on school nutrition policies and price interventions directed at youth SSB consumption. In addition to considering the direct effect of policies on SSB consumption, we provide an overview of the literature on how SSB consumption affects total energy intake (TEI) and BMI, as well as on how TEI affects BMI. By considering each of these links, we attempted to gauge the effect of policies directed at SSB consumption, as well as highlight areas that merit future research. We found that school nutrition and price policies reduce SSB consumption and that reduced SSB consumption is associated with a reduction in energy intake that can influence BMI. Policies directed at SSB consumption can play an important role in reducing youth overweight and obesity.

Policy options to support healthy eating in schools

OBJECTIVES

School nutrition policies offer a promising avenue by which to promote healthy eating and reduce the risk of chronic disease. This article reviews policy components that could support healthy eating, examines their evidence base and suggests directions for future research.

METHOD

Information was drawn from research and other literature written in English between 1994 and 2008. Guided by recommendations from the World Health Organization, evidence pertaining to five potential components of policies was identified and reviewed: foods available, the food environment, health education, health services and counselling, and family and community outreach.

RESULTS

A limited number of evaluations have examined the impact of school nutrition standards and have shown a positive impact on food availability and student nutrient intake. Results have shown that behaviourally focused nutrition education, especially when combined with food services and other initiatives, may affect students' eating habits positively but may not decrease obesity levels. Evidence pertaining to other potential policy subcomponents, such as limiting food marketing in schools, coordinating all food services and providing nutrition-related health services, is limited or lacking.

CONCLUSION

Conceptually, comprehensive school nutrition policies comprising all five policy components offer an integrated and holistic approach to school nutrition. They could provide an umbrella to guide all school actions pertaining to nutrition and serve as a framework for accountability. Does conceptualization match reality? Further research is needed to determine how policy components affect implementation and outcomes.

Healthy and unhealthy eating at lower secondary school in Norway

AIMS

To assess adolescents' eating/drinking habits of a selection of healthy and unhealthy food items at school, variations in gender and socioeconomic status in these eating habits, and variations between the schools.

METHODS

A cross-sectional study among 2870 adolescents (mean age: 15.5 years) within the Fruits and Vegetables Make the Marks (FVMM) project. A survey questionnaire was completed by the pupils in the classroom in the presence of a trained project worker. One school lesson (45 minutes) was used to complete the questionnaire. A total of two healthy (fruit and vegetables (FV), water) and five unhealthy (candy and/or potato chips, sweet bakery, instant noodles, regular soft drinks, and diet soft drinks) food items were assessed by food frequency questions. All variables were dichotomised to less than once a week and once a week or more.

RESULTS

Several pupils reported to consume snacks (33%), sweet bakery (36%) and regular soft drinks (24%) at school at least once a week. The proportion of pupils who reported to eat FV at least once a week (40%) was low. Girls and pupils with plans of higher education had a more favourable intake of healthy versus unhealthy food items at school. In two-level variance component analyses the proportional school variation ranged from 3.4% (diet soft drinks) to 30.7% (noodles).

CONCLUSIONS

A large number of adolescents consume unhealthy food items at school and few eat FV. Large differences were observed between groups of pupils and between the schools in consumption of these foods.

Dietary habits and nutrient intake of Finnish adolescents

OBJECTIVE

To evaluate food and nutrient intake and especially eating during the school day among Finnish secondary-school pupils.

DESIGN

Cross-sectional study. Data were collected using a structured questionnaire mailed to home and by 48 h dietary recall interviews performed at schools in 2007.

SETTING

Twelve schools in three cities in Finland.

SUBJECTS

The seventh grade pupils (a total of 1469 at the mean age of 13.8 years). Questionnaire data were available from 726 pupils and dietary data from a subgroup of 40 % (n 306).

RESULTS

According to the questionnaire data, 40 % of the girls and 28 % of the boys reported eating fresh vegetables daily and the respective figures for fruit were 32 % and 23 %. Altogether, 71 % of the adolescents reported having school lunch every day. The average intake of sucrose was higher and the average intakes of fibre, iron, folate and vitamin D were lower than recommended. School lunch provided around 20 % of daily energy intake, while the recommended daily energy intake level is one-third. However, the school lunch as consumed was nutritionally superior to the other daily meals. Snacks provided 41 % of the daily energy. The most common sources of sucrose were sugary drinks.

CONCLUSIONS

Low consumption of fruit and vegetables and abundant consumption of sucrose-rich drinks and snacks are the main problems in the diet of Finnish adolescents. The nutritional quality of the school lunch is good, but the supply of healthy snacks must be improved in schools. Schools can promote healthy eating habits by making healthy choices easy during the school day.

The diet of adolescents can be improved by school intervention

OBJECTIVE

To decrease the intake of sucrose, increase the intake of fibre and the consumption of fruit and vegetables among secondary-school pupils.

DESIGN

Intervention study among eighth grade pupils during one school year. Data were collected by questionnaires and from a subgroup of pupils by 48 h dietary recall at baseline in spring 2007 and after the intervention in 2008.

SETTING

Twelve secondary schools were randomly allocated to intervention (IS) and control schools (CS) within three cities. Intervention included nutrition education and improvement of the food environment focusing particularly on the quality of snacks at school.

SUBJECTS

A total of 659 pupils completed the questionnaires and the dietary recall was obtained from 287 pupils both at baseline and follow-up.

RESULTS

The frequency of consumption of rye bread increased (P = 0.03) and that of sweets decreased (P = 0.006) among girls in the IS. The intake of sucrose fell among IS pupils, from 12.8 % to 10.5 % of the total energy intake (P = 0.01). Intake of fruit (g/MJ) remained the same in IS, whereas it decreased in CS (P = 0.04).

CONCLUSIONS

Sugar intake can be lowered by improving the quality of snacks, but it is more difficult to increase fibre intake and fruit and vegetable consumption unless the content of school lunches can be modified. It is the responsibility of the adults working in schools to create a healthy environment and to make healthy choices easy for pupils.

Socio-economic and demographic variations in school lunch participation of French children aged 3-17 years

OBJECTIVE

To assess school canteen attendance in a French nationally representative sample of children and to analyse its association with the socio-economic and demographic characteristics of the children and their families.

DESIGN

Data from the second French national cross-sectional food consumption survey (INCA2), performed in 2006-2007, were used. Information on usual weekly school canteen attendance was collected through a self-reported questionnaire, and demographic and socio-economic variables through a face-to-face questionnaire. The associations between school canteen attendance and the socio-economic and demographic variables were investigated by multivariate logistic regression analyses.

SETTING

The INCA2 sample was representative of the children aged 3-17 years in France.

SUBJECT

Analysis was performed on 1413 schoolchildren who completed the school canteen attendance questions.

RESULTS

Some 65·6 % of schoolchildren aged 3-17 years had school lunch at least once weekly. This rate of attendance was positively correlated with age. Whatever the school level, school canteen attendance was positively associated with the educational level of the caregiver/parent. In pre- and elementary-school children, enrolment at the school canteen was also higher when the caregiver/parent worked, or in single-parent families. In secondary-school children, school lunch participation decreased with children living in more densely populated areas and increased with the level of the household's living standards.

CONCLUSIONS

School canteen attendance was positively associated with children's socio-economic background. This could reduce the effectiveness of the forthcoming school meal composition regulations designed to improve the diet of children from deprived backgrounds, who are more likely to have unhealthy food habits.

Differences in school environment, school policy and actions regarding overweight prevention between Dutch schools. A nationwide survey

Background

Schools are regarded as an important setting for the prevention of overweight. This study presents a nationally representative picture of the obesogenity of the school environment, the awareness of schools regarding overweight, and actions taken by the schools aiming at overweight prevention. In addition, differences between school levels were studied.

Methods

In 2006-2007, questionnaires were sent to all Dutch secondary schools (age group 12-18 years). Prevalences of the outcome variables were calculated for the schools in total and by school level. The association between school level and outcome variables were analysed by a log linear regression.

Results

Unhealthy foods and drinks are widely available at secondary schools. One third of the schools indicated that overweight has increased among students and half of the schools agreed that schools were (co)responsible for the prevention of overweight. Only 3% of the schools have a policy on overweight prevention. Small differences were observed between vocational education schools and higher education schools. The presence of vending machines did not differ by school level, but at vocational education schools, the content of the vending machines was less healthy.

Conclusion

This study describes the current situation at schools which is essential for the development and evaluation of future overweight prevention policies and interventions. In general, secondary schools are not actively involved in overweight prevention and the nutritional environment at most schools could be improved. The small differences between school levels do not give reason for a differential approach for a certain school level for overweight prevention.

Policies that restrict sweetened beverage availability may reduce consumption in elementary-school children

Objective

We investigated whether having a policy regarding the availability of sweetened beverages in school was associated with children’s purchase and total weekly and daily consumption of sweetened beverages.

Design

Data were obtained from 10 719 children aged 9–13 years and 2065 elementary schools in the Early Childhood Longitudinal Study–Kindergarten cohort. Multilevel logistic regression was used to determine the magnitude and significance of relationships between the availability of different beverages and purchase of sweetened beverages at school and overall consumption of beverages.

Results

The purchase of sweetened beverages by children in school was strongly associated with the administrative policy of sweetened beverage availability. Compared with children in schools without an administrative policy that allowed sweetened beverages, children in schools with the policy were three times more likely to be either occasional or frequent consumers of sweetened beverages.

Conclusions

A policy of availability of sweetened beverages makes an independent contribution to children’s purchase and consumption of sweetened beverages in the 5th grade year.

What maternal factors influence the diet of 2-year-old children living in deprived areas? A cross-sectional survey

Objective

To investigate the maternal factors associated with poor diet among disadvantaged children.

Design

Survey of 300 mothers of 2-year-old children from areas of high deprivation in Scotland (response rate 81 %). A diet quality score was derived from reported consumption of carbohydrates, protein, fruit and vegetables, dairy products and restriction of sugary fatty foods.

Results

Most children (85 %) were classified as having a poor quality diet (low diet quality score). Mothers’ general knowledge about healthy eating was high, but did not predict the quality of the children’s diet. Lower frequencies of food preparation and serving, such as cooking with raw ingredients, providing breakfast daily and the family eating together, were also associated with a poorer diet. Regression modelling identified five significant factors. An increased risk of a poor diet was associated with mothers being unlikely to restrict sweets (OR = 21·63, 95 % CI 2·70, 173·30) or finding it difficult to provide 2–3 portions of fruit daily (OR = 2·94, 95 % CI 1·09, 7·95). Concern that the child did not eat enough increased the risk of a poor diet (OR = 2·37, 95 % CI 1·09, 5·16). Believing a healthy diet would help the child eat more reduced the risk of having a poor diet (OR = 0·28, 95 % CI 0·11, 0·74), as did providing breakfast daily (OR = 0·22, 95 % CI 0·05, 0·99).

Conclusions

Interventions to improve children’s diet could promote more positive intentions about preparing and serving of foods, particularly of specific meals at which the family eats together. The benefits of these behaviours to the child (improved diet, weight control) should be emphasised.

How to find information on national food and nutrient consumption surveys across Europe: systematic literature review and questionnaires to selected country experts are both good strategies

The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits, and subsequently reduced to nine surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all countries except for Liechtenstein, Luxembourg and Slovakia. Detailed results and references are given. A systematic search and questionnaires are equally good at identifying national surveys across countries. Literature searching provides globally accessible and objective information albeit limited, whereas the questionnaire provides information that, depending upon responders, can be more complete. A combination of both strategies is recommended.

Developing the IDEFICS community-based intervention program to enhance eating behaviors in 2- to 8-year-old children: findings from focus groups with children and parents

One purpose of 'identification and prevention of dietary- and lifestyle-induced health effects in children and infants' (IDEFICS) is to implement a standardized community-based multi-component healthy eating intervention for younger children in eight different countries. The present study describes important influencing factors for dietary behaviors among children aged 2-8 years old in order to determine the best approaches for developing the dietary components of the standardized intervention. Twenty focus groups with children (74 boys, 81 girls) and 36 focus groups with 189 parents (28 men, 161 women) were conducted. Only in two countries, children mentioned receiving nutrition education at school. Rules at home and at school ranged from not allowing the consumption of unhealthy products to allowing everything. The same diversity was found for availability of (un)healthy products at home and school. Parents mentioned personal (lack of time, financial constraints, preferences), socio-environmental (family, peer influences), institutional (school policies) and physical-environmental (availability of unhealthy products, price, season) barriers for healthy eating. This focus group research provided valuable information to guide the first phase in the IDEFICS intervention development. There was a large variability in findings within countries. Interventions should be tailored at the personal and environmental level to increase the likelihood of behavioral change.

Parents' and teachers' opinions about the school food policy in Belgian Flemish nursery schools

The partnership of parents, teachers, and schools is necessary to develop effective school food interventions. To gather parents' and teachers' opinions and perceptions about the school food policy, 884 parents and 70 teachers of preschoolers completed a questionnaire. School food policy is an issue of importance for parents and teachers: the majority agrees that schools should restrict the availability of snacks and soft drinks; however, to replace fruit juice and sugared milk drinks with sugarless alternatives will take special effort. Fruit is not always available at school, although parents would appreciate it. Parents of lower educational level are in general more permissive.

Obesity prevention in children and adolescents

Childhood and adolescent obesity has been increasing in most middle- and high-income countries, and, as with adult obesity, this has been driven by increasingly obesogenic environments, especially the food environment. This constitutes a "market failure," signaling the need for government interventions with policies, programs, and social marketing. Population prevention strategies are critical, and children and adolescents should be the priority populations. Food marketing to children is a central policy issue for governments to address, and comprehensive regulations are needed to provide substantive protection for children. Community-based intervention programs show some real promise in reducing childhood obesity, but the 2 big challenges ahead are to ensure that there is substantial ongoing funding so that the community capacity to promote healthy weights can be scaled up to a national level and to ensure that policies are in place to support these efforts. The social and cultural shifts that support healthy eating and physical activity occur differentially, and special efforts are needed to reduce the socioeconomic gradients associated with childhood obesity. A positive public health approach encompassing environmental, regulatory, sociocultural, and educational strategies offer the best chance of reducing obesity without increasing disordered eating patterns.

School meals in French secondary state schools with regard to the national recommendations

In 2001, a circular addressing both the composition of school meals and food safety issues was introduced in France to improve the nutrient composition of school meals and provided food-frequency guidelines to guarantee dietary balanced meals. The present study assesses the extent to which secondary state schools are familiar with and implement this circular. In 2005, a nationally representative sample of 1440 secondary state schools received a questionnaire on their catering service and the implementation of the circular's recommendations, and were requested to enclose all menus (lunches and dinners) served over 1 month. Menu analysis shows that progress is still required to achieve a meal composition in accordance with the food-group frequency guidelines appended to the circular. Some recommendations are followed by most of the schools, such as limiting high-fat products and providing plenty of raw fruits and vegetables, cooked vegetables and starchy foods. Other guidelines should be implemented further, especially with regard to the nutritional quality of main courses and dairy products, which are met by less than a third and a half of schools, respectively. Specific efforts are necessary for evening meals to ensure that the nutritional requirements of boarders are covered. Some recommendations, such as the food purchasing manager being trained in nutrition (38 % of schools) and the involvement of dietetic expertise when designing meals (6 %), seem to be linked to better dietary balance of meals. Implementation of the circular must therefore be promoted in schools and may require stronger regulatory nutrition standards and better cooperation between schools.