The ultra-processed food content of school meals and packed lunches in the United Kingdom (2008-2017)

Background

British children have the highest ultra-processed food (UPF) intake in Europe, which is linked to adverse health outcomes. Schools are posited as a setting for dietary intervention, yet the level of UPFs consumed at schools is currently unknown. This study aimed to describe the UPF content of school food in the UK, explore the UPF content of school meals and packed lunches (food from home) and examine whether UPF differs by children's household income.

Methods

A pooled cross-sectional analysis of primary (4-11 years, n = 1,895) and secondary schoolchildren (11-18 years, n = 1,408) from the UK's National Diet and Nutrition Survey (2008-2017) was conducted. Food diaries recorded student's meal-type (school meal/packed lunch). UPF intake was defined using the NOVA food classification system. Quantile regression models assessed the association between meal-type and lunchtime UPF intake (%kcal and % grams). Models were stratified by school phase (primary/secondary) and interacted meal-type with income.

Results

Schoolchildren consumed most of their lunch as UPF, with higher median intakes in secondary schoolchildren than primary schoolchildren (77.8 %kcal vs 72.6 %kcal). School meals were associated with lower median UPF intake (%kcal) in both primary (-20 percentage-points[pp] [95% CI -22.2, -17.4]) and secondary schoolchildren (-11pp [-16.0,-7.0]) compared with packed lunches. Results were similar when UPF %g was analysed. Overall, income was inversely associated with UPF content. However, in primary schoolchildren there was no significant income gradient in the UPF(%g) content of school meals.

Conclusions

In the first nationally representative study, we showed that on average UPF intake was high in all UK schoolchildren. Higher UPF intakes were observed in packed lunch consumers, secondary schoolchildren, and those with a lower income. Procurement policies must be revaluated to protect children from high UPF intake.

Funders: NIHR School for Public Health Research

Key messages

• In the first study of ultra-processed food content of UK school food, we show that children consumed around three quarters of their energy as ultra-processed food at lunch.

• Children who were older, took food from home or were from a low-income household were more likely to consume higher levels of ultra-processed food. Regulation is needed to protect these children.

The Healthy Start scheme and its association with food expenditure in low-income families in the UK

Background

The Healthy Start programme is a statutory benefit-in-kind in the United Kingdom (UK) which aims to enable low-income families to purchase fruit, vegetables, cow's milk and infant formula through the provision of vouchers. The scheme was introduced in 2006, however, the effect on food purchasing in participating households has not been evaluated within an eligible population. This study aimed to determine whether participation in the Healthy Start (HS) scheme is associated with differences in food purchasing in a representative sample of households in the United Kingdom.

Methods

Cross-sectional analysis of the Living Costs and Food Survey dataset (2010-2017). All households with a child (0-3 years) or pregnant woman were included in the analysis (n = 4,869). Multivariable quantile regression was used to compare the expenditure and quantity of fruit and vegetable, infant formula and total food purchases between Healthy Start participating, eligible non-participating, nearly-eligible and ineligible households.

Results

54% (n = 475) of eligible households participated in Healthy Start. After accounting for covariates, no significant difference was found in the quantity or expenditure of fruit and vegetable purchases between Healthy Start participating and non-participating households. Fruit and vegetable expenditure (£/week) was found to be higher in nearly eligible (β1.60; 95% CI 0.79, 2.41) and ineligible households (β2.56; 95% CI 1.77, 3.35) compared to Healthy Start eligible households.

Conclusions

The present study did not demonstrate significant differences in the fruit and vegetable expenditure of HS participating and non-participating households. The analysis demonstrates that inequalities in fruit and vegetable purchasing persists in the UK. Improved participation and increased voucher value may be needed to promote well-being and counteract the harmful effect of poverty on fruit and vegetables purchasing.

Key messages

The study found no evidence of different food purchases between Healthy Start participating and non-participating households. Increased voucher value may be needed to counteract food-price inflation. The paper reflected persistent socioeconomic inequalities in the UK, indicating the Healthy Start scheme does not sufficiently counteract the harmful effects of poverty on food purchasing.

Half of children entitled to free school meals did not have access to the scheme during COVID-19 lockdown in the UK

OBJECTIVES

The objectives of the study were to investigate access to free school meals (FSMs) among eligible children, to describe factors associated with uptake and to investigate whether receiving FSMs was associated with measures of food insecurity in the UK using the Coronavirus (COVID-19) wave of the UK Household Longitudinal Study.

STUDY DESIGN

The study design was cross-sectional analyses of questionnaire data collected in April 2020.

METHODS

Six hundred and thirty-five children who were FSM eligible with complete data were included in the analytic sample. Accessing a FSM was defined as receiving a FSM voucher or a cooked meal at school. Multivariable logistic regression was used to investigate (i) associations between characteristics and access to FSMs and (ii) associations between access to FSMs and household food insecurity measures. All analyses accounted for survey design and sample weights to ensure representativeness.

RESULTS

Fifty-one percent of eligible children accessed a FSM. Children in junior schools or above (aged 8+ years) (adjusted odds ratio [AOR]: 11.81; 95% confidence interval [CI]: 5.54, 25.19), who belonged to low-income families (AOR: 4.81; 95% CI: 2.10, 11.03) or still attending schools (AOR: 5.87; 95% CI: 1.70, 20.25) were more likely to receive FSMs. Children in Wales were less likely to access FSMs than those in England (AOR: 0.11; 95% CI: 0.03, 0.43). Receiving a FSM was associated with increased odds of recently using a food bank but not reporting feeling hungry.

CONCLUSIONS

In the month after the COVID-19 lockdown, 49% of eligible children did not receive any form of FSMs. The present analyses highlight that the voucher scheme did not adequately serve children who could not attend school during the lockdown. Moreover, more needs to be done to support families relying on income-related benefits, who still report needing to access a food bank. As the scheme may be continued in summer or in a potential second wave, large improvements will be needed to improve its reach.