The role of food parcel use on dietary intake: perception of Dutch food bank recipients:a focus group study

OBJECTIVE: To gain insight in Dutch food bank recipients' perception on the content of the food parcels, their dietary intake and how the parcels contribute to their overall dietary intake. DESIGN: Eleven semi-structured focus group discussions were conducted. Focus group topics were based on Andersons food insecurity definition: the lack of availability of nutritionally adequate foods and the assured ability to acquire foods in socially acceptable ways. Data were coded and analysed with Atlas.ti 7.0 software, using the framework approach. SETTING: Seven food banks throughout the Netherlands. PARTICIPANTS: A total of 44 Dutch food bank recipients. RESULTS: Food bank recipients were not always satisfied with the amount, quality, variation and type of foods in the food parcel. For the participants who could afford to, supplementing the food parcel was reported as main reason for buying foods, and price was the most important aspect in selecting these foods. Participants were not satisfied with their dietary intake; they mainly reported not having enough to eat. The content of the food parcel importantly influenced participants' overall dietary intake. Finally, participants reported struggling with their feelings of dissatisfaction, while also being grateful for the foods they receive. CONCLUSIONS: This study suggests that, despite their best efforts, food banks are not meeting food bank recipients' needs. Our results provide valuable directions for improving the content of the food parcels by increasing the quantity, quality and variation in the foods supplied. Whether this also improves the dietary intake of recipients needs to be determined

Improving dietary intake during lunch through the provision of a healthy school lunch at Dutch primary schools : Design of a pretest-posttest effectiveness study

Background: Since there is a shift from eating lunch at home to eating lunch at primary schools in the Netherlands, providing a school lunch may be an important opportunity to improve the diet quality of Dutch children. Therefore, the aim of this Healthy School Lunch project is to encourage healthy eating behavior of children at primary schools by offering a healthy school lunch, based on the guidelines for a healthy diet. In this study, two research questions will be addressed. The first research question is: What and how much do children consume from a self-served school lunch and how do they evaluate the lunch? The second research question is: Do children compensate healthier school lunches by eating less healthy outside school hours? The purpose of this paper is to report the rationale and study design of this study. Methods: In the Healthy School Lunch project children in grades 5-8 (aged 8-12 years) of three primary schools in the Netherlands will receive a healthy school lunch for a 6-month period. To answer research question 1, lunch consumption data will be collected at baseline and again at 3- A nd 6-months. This will be measured with lunch photos and questionnaires among children. To answer the second research question, a quasi-experimental, pre-test post-test intervention-comparison group design (3 intervention schools and 3 comparison schools) will be carried out. Potential compensation effects will be measured with a single brief questionnaire among parents at the three intervention and three comparison schools at month 6 of the lunch period. The school lunch will also be evaluated by parents (discussion groups) and teachers and support staff (brief questionnaires). Discussion: Results of this study will provide valuable information to influence future school lunch interventions and policies. Trial registration: This study is registered at the Netherlands trial register (NTR): Trialregister.nl, Trial NL7402 (NTR7618), registered retrospectively at 2018-11-13.</p

Exploring the effects of a healthy school lunch on cognitive performance in Dutch primary school children within the Healthy School Lunch project

The ‘Healthy School Lunch’ project (PPS Een gezonde schoollunch - TKI AF-16098) aimed to study the feasibility and impact of offering a healthy school lunch in Dutch primary schools. In the first phase of the project we studied the support for a healthy school lunch among a wide range of stakeholders and we explored what they thought a healthy school lunch should look like. The next phase aimed to study the effects of a healthy school lunch on dietary intake and cognitive performance. In order to investigate the effects of providing a healthy school lunch on the dietary intake of children during lunch, a longitudinal intervention study with three schools was designed, where a healthy school lunch was offered for six months. Due to various financial and methodological reasons that were not fully considered when starting this project, it was not possible to combine the dietary intake and cognition study in the school lunch intervention. Instead, we explored the possibilities and requirements to perform a solid experimental cross-over study on the effects of a healthy school lunch on cognitive performance within the Healthy School Lunch Project. This process is described in the current report. We started with a review of the literature on the effects of a healthy school lunch on cognitive performance of children. Studies on the immediate and transient effects of a healthy school lunch versus skipping lunch showed, on a variety of cognitive measures, small and inconsistent effects on alertness and working memory of children. Studies on the long-term effects of a healthy school lunch versus habitual lunch showed small improvements in concentration and language processing ability of children. Given the restriction that long term effects of a school lunch on cognitive performance could not be examined within the scope of this project, the focus shifted to understanding immediate effects. A well-designed study to capture immediate effects of a healthy school lunch on cognitive performance of children within our project would require a strictly controlled cross-over design in a school setting. The intervention should consist of an ad libitum buffet-style healthy school lunch, compared with a control condition in which children eat ad libitum from a provided lunch comparable to the common relatively unhealthy packed school lunch of Dutch children. Finding an adequate measure for cognitive performance is hampered by the great variation of previously used measures across studies. These ranged from relatively indirect measures of concentration and disengagement to standardized computerized tests assessing specific cognitive domains such as alertness and higher-level executive functions. Hence, a comprehensive battery of tests would be advisable to explore various potential effects. Power calculations would be needed to determine the sample size of such a study, but it is clear that large numbers of children would be needed, given the small expected effects and methodological challenges. As more than one participating school would be needed, multilevel statistical models would be required to handle grouped and individual children’s data. More research on the effects of a healthy school lunch on cognition in primary school children would be very useful. However, a well-designed study that would provide convincing evidence of the effects of a healthy school lunch on cognitive performance in primary school children, would require a high cost set-up that places a very high burden on both the children and the schools. Therefore, we decided that it is not realistic to perform this study within the Healthy School Lunch project. In this report we would like to share our findings, considerations and recommendations to researchers of future studies on the effect of healthy school lunches on cognitive performance in children

Is the transition from primary to secondary school a risk factor for energy balance-related behaviours? A systematic review

Abstract Objective: The substantial changes in the physical and social environment during the transition from primary to secondary school may significantly impact adolescents’ energy balance-related behaviours (i.e. dietary behaviour, sedentary behaviour, sleep behaviour, and physical activity). This is the first review systematically summarising evidence on changes in four energy balance-related behaviours of adolescents across the school transition from primary to secondary school. Design: For this systematic review the electronic databases Embase, PsycINFO and SPORTDiscus were searched for relevant studies from inception to August 2021. PubMed was searched for relevant studies from inception to September 2022. Inclusion criteria were: i) longitudinal studies reporting ii) one or more energy balance-related behaviours iii) across the school transition i.e. with measurement(s) during both primary and secondary school. Setting: Transition from primary to secondary school Participants: Adolescents across the transition from primary to secondary school. Results: Thirty-four studies were eligible. We found strong evidence for an increase in sedentary time, moderate evidence for a decrease in fruit and vegetable consumption, and inconclusive evidence for a change in total, light, and moderate-to-vigorous physical activity, active transport, screen time, unhealthy snack consumption, and sugar sweetened beverages consumption among adolescents across the school transition. Conclusions: During the transition from primary to secondary school, sedentary time and fruit and vegetable consumption tend to change unfavourably. More high-quality, longitudinal research is needed specifically on changes in energy balance-related behaviour across the school transition, especially regarding sleep behaviour. (Prospero registration: CRD42018084799

Understanding the system dynamics of obesity-related behaviours in 10- to 14-year-old adolescents in Amsterdam from a multi-actor perspective

Introduction and MethodsTo develop an understanding of the dynamics driving obesity-related behaviours in adolescents, we conducted systems-based analysis on a causal loop diagram (CLD) created from a multi-actor perspective, including academic researchers, adolescents and local stakeholders.ResultsThe CLD contained 121 factors and 31 feedback loops. We identified six subsystems with their goals: (1) interaction between adolescents and the food environment, with profit maximisation as goal, (2) interaction between adolescents and the physical activity environment, with utility maximisation of outdoor spaces as goal, (3) interaction between adolescents and the online environment, with profit maximisation from technology use as goal, (4) interaction between adolescents, parenting and the wider socioeconomic environment, with a goal focused on individual parental responsibility, (5) interaction between healthcare professionals and families, with the goal resulting in treating obesity as an isolated problem, and (6) transition from childhood to adolescence, with the goal centring around adolescents’ susceptibility to an environment that stimulates obesity-related behaviours.DiscussionAnalysis showed that inclusion of the researchers’ and stakeholders’ perspectives contributed to an understanding of how the system structure of an environment works. Integration of the adolescents’ perspective enriched insights on how adolescents interact with that environment. The analysis further showed that the dynamics driving obesity-related behaviours are geared towards further reinforcing such behaviours

A system dynamics and participatory action research approach to promote healthy living and a healthy weight among 10–14-year-old adolescents in Amsterdam: The LIKE programme

This paper describes the design of the LIKE programme, which aims to tackle the complex problem of childhood overweight and obesity in 10–14-year-old adolescents using a systems dynamics and participatory approach. The LIKE programme focuses on the transition period from 10-years-old to teenager and was implemented in collaboration with the Amsterdam Healthy Weight Programme (AHWP) in Amsterdam-East, the Netherlands. The aim is to develop, implement and evaluate an integrated action programme at the levels of family, school, neighbourhood, health care and city. Following the principles of Participatory Action Research (PAR), we worked with our population and societal stakeholders as co-creators. Applying a system lens, we first obtained a dynamic picture of the pre-existing systems that shape adolescents’ behaviour relating to diet, physical activity, sleep an

Improving local food environments and dietary habits in adolescents by engaging with stakeholders in the Netherlands

The purpose of this article is to describe a series of recent studies from the authors and many of their colleagues aimed at improving the food environments of adolescents in the Netherlands and thereby improving their food choices. These studies are performed in the wider context of national and local strategies for the prevention of overweight and obesity in the Netherlands. Interventions were developed with local stakeholders and carried out in schools, supermarkets and low income neighbourhoods. We conclude that current national policies in the Netherlands are largely ineffective in reducing the prevalence of overweight and obesity. Local integrated programs in the Netherlands, however, seem to result in a reduction of overweight, especially in low-income neighborhoods. It is impossible to say which elements of such an integrated approach are effective elements on their own. We found very little evidence for effectiveness of separate interventions aimed at small changes in the food environment. This suggests that such interventions are only effective in combination with each other and in a wider systems approach. Future studies are needed to further develop the practical methodology of implementation and evaluation of systems science in combination with participatory action research

Impact of nutrition education on nutritional knowledge and intentions towards nutritional counselling in Dutch medical students:An intervention study

Objective Management of diet-related chronic diseases may benefit from improved nutrition education of medical students. This study aims to investigate the effects of a nutrition education course on nutritional knowledge and intentions towards nutritional counselling in Dutch medical students. Design This is a pre-post intervention study with a comparison group. Participants completed self-reported questionnaires on nutritional knowledge and intentions towards nutritional counselling. Participants In total, 118 medical students (64.4% undergraduate, 73.2% women) were recruited from two medical schools in the Netherlands (n=66 intervention group, n=52 comparison group). Intervention The intervention group completed a 25-hour course in nutritional counselling (the Students Experienced in Lifestyle and Food (SELF) course) in addition to the standard medical curriculum. The comparison group followed the standard medical curriculum. Outcome measures Self-reported nutritional knowledge and intentions towards nutritional counselling, including attitude, self-efficacy and social support. Results Nutritional knowledge (B: 2.42, 95% CI 1.81 to 3.02), attitude in men (B: 0.50, 95% CI 0.13 to 0.87) and self-efficacy (B: 0.78, 95% CI 0.62 to 0.95) significantly increased in the intervention group compared with the comparison group. No significant differences were found for social support (B: 0.20, 95% CI -0.02 to 0.43) and attitude in women (B: 0.08, 95% CI -0.24 to 0.31) between the two groups. Conclusions The SELF course increased medical students' nutritional knowledge and stimulated their intentions towards nutritional counselling. Future research is needed to evaluate the long-term impact of nutrition education interventions on physician practice patterns and patient outcomes

Development of a health promotion action with mothers aiming to support a healthy start in life for children using Participatory Action Research

Health inequalities arise already during the first thousand days of a child’s life. Participatory action research (PAR) is a promising approach, addressing adverse contexts that impact health inequalities. This article describes the experience of mothers involved in a PAR process to develop a health promotion action that supports both children’s and mothers’ health. It also describes the experiences of mothers who attended the developed action and trainers who facilitated it. The PAR process resulted in the development of a sustained action called Mama’s World Exercise Club aimed at promoting the health of mothers and their children. Results showed that the PAR process empowered the mothers and gave them a sense of pride at playing a useful role in their community. The developed action was highly valued by other mothers in the neighbourhood and widely implemented. These positive results can be ascribed to the strong collaboration between the researchers and the mothers, and the willingness of local stakeholders to support the action. Future studies should investigate if the results of this study sustain over a longer period of time and improve health outcomes of children and mothers in the long run