The Packed Lunch Project: Parent Survey

The Packed Lunch Project revolves around parents’ preference for providing packed lunches for their children in primary schools. Our study aims to gain an insight into parents' viewpoints in order to inform our knowledge and understanding of this key aspect of child nutrition. As part of this study we designed an online survey; the data collected is summarised in this report

Food in Schools - making the better choice

A guide for secondary schools about supporting students to make better decisions when it comes to choosing what to eat for lunc

“I Control What I Eat and I'm Sensible with What I Eat, Apart from School” – A Qualitative Study of Adolescents’ Food Choices and the School Environment

Objectives Adolescent obesity is a significant issue in the UK, with 36% of 11 to 15 year olds classified as overweight or obese. Schools are seen as a sound setting to address this phenomenon. Mandatory School Food Standards have endeavoured to improve the nutritional profile of school food provision. However students often choose micronutrient poor, energy dense options. This study aimed to explore how and why secondary school students make their food choices within the school environment. Methods Seven focus group interviews were conducted with students (n = 28) aged 13–14 years in a school in Northern England. Development of the focus group schedule was informed by the socio-ecological model and food choice process model. Question topics included school food provision, students’ food choices and the role of friends and family in students’ food choices. Discussions were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach: an iterative process of reading and re-reading transcripts, coding of nodes and grouping of nodes into unique themes. NVivo12 software was used to facilitate data management. Results Six initial themes emerged; (1) home environment, (2) food knowledge, (3) food choice factors, (4) food autonomy struggle, (5) social influences and (6) home versus school. Findings suggest that adolescents juxtapose the school and home food environments, in terms of food provision, food choices, as well as food-related rules and customs. Students identified food choices at home as being a structured and clearly defined process, with parents and caregivers acting as nutritional gatekeepers. In contrast, students depicted school food choices as being less straight-forward, determined by factors including social influences and school food choice parameters (e.g., time, queues, cost). Students reported choosing less “healthy” items at school than at home, and justified this by reportedly adopting perceived healthier choices/behaviours at home. Conclusions Both the school and home environment (in)directly influence adolescents’ school food choices. Further research is needed to understand these contrasting environmental influences, and how adolescents manage and integrate their food choice behaviours in different environments

Availability and Nutritional Content of High Energy and High Protein Milk for Malnourished Older Adults

Objectives Malnutrition in older adults reduces quality of life and is increasing in prevalence in many countries. Fortified milk (milk powder added to whole milk), typically forms part of guidelines globally for adults at risk of malnutrition. Protein-enriched fresh milk (PEM) may be a simpler option as it is ready to use. This study aims to investigate the availability and nutritional content of fortified milk and PEM. Methods The 7 largest supermarket chains (by UK market share) were surveyed in-store and online in a large city over 2 weeks in December 2019. Two were discount retailers and 3 did not offer online shopping. For each chain, a large, mid-size and convenience store type were randomly selected, if present within the city. In total 15 stores were visited (5 large, 7 mid-size and 3 convenience). Price and nutritional information were recorded on a pro forma for all milk powders and PEMs in-store and online. The energy & protein content of a 200 ml portion of fortified milk (made as per guidelines with milk powders found) and cost/g of protein was considered and compared with PEM and standard whole milk. Results Six brands of skimmed milk powder (SMP), 1 brand of whole milk powder (WMP) and 3 brands of PEM were found. SMP was the most available (5 large & 5 mid-sized stores), followed by PEM (2 large and 1 mid-sized store), whilst WMP was only found online. The 3 convenience stores and 2 discount retailers did not stock any milk powders or PEM. Energy in 200 ml portions ranged from 90 – 224 kcals and protein from 8.0 – 14.2 g. Fortified milk made with SMP had the highest protein content (Mdn = 13.8 g, IQR = 13.5 – 14.2 g), double that of standard whole milk. Fortified milk made with WMP had the highest energy content (224 kcals) but less protein than fortified milk made with SMP (12.0 g). PEM had the lowest energy (Mdn = 96 kcals, IQR = 90 – 98 kcals) and lowest protein content (Mdn = 9.4 g, IQR = 8.0 – 10.0 g). Cost/g of protein was highest for fortified milk made with WMP (Mdn = 2.5p, IQR = 2.3 – 2.7p), followed by PEM (Mdn = 2.0p, IQR = 1.9 – 2.5p) and lowest for fortified milk made with SMP (Mdn = 1.8p, IQR = 1.8 – 2.2p). Conclusions Based on nutritional content, availability and price, the preferred option found was fortified milk made with SMP; enriched fresh milks did not compare favourably for any of these criteria. Convenience and discount stores had poor availability of the products surveyed

Perspectives on Fruit and Vegetable Consumption and Government Dietary Guidelines: Content Analysis of Comments on News Websites

Background: News websites are an essential source of medical news for the public. Many websites offer users the opportunity to leave comments, which may provide rich insights into public perspectives on health issues. With an established role in public health, fruit and vegetable (FV) consumption is central to the government’s dietary guidelines. However, FV intake continues to fall short of government recommendations. Objective: Using comments from news websites, this study aims to explore public perspectives on FV intake and related government dietary guidelines. Methods: Data comprised 2696 web user comments generated in response to substantial media coverage for a meta-analysis examining FV consumption and the risk of all-cause mortality, cardiovascular disease, and total cancer. Using an inductive thematic approach, the data were analyzed and coded in an iterative process. Results: Four overarching themes emerged: personal factors, rejection, lack of knowledge, and food landscape, each with component subthemes. The lack of clarity around government dietary health guidelines was apparent, and this, along with emergent personal factors, may hinder better consumption. Rejection was also evident, as was a quality versus quantity of life debate. Conclusions: There are gaps in the public’s understanding of government guidelines, which may act as a constraint to better compliance. Further work should examine this issue and rejection and the possibility of public fatigue related to dietary health information and news. Similarly, future work should also explore targeted interventions with a specific emphasis on health literacy

Adolescents’ dietary behaviour: The interplay between home and school food environments.

In the UK, school food standards have looked to improve the nutritional profile of school food provision and the choices made; however, adolescents' choices tend to bias towards micronutrient poor and energy dense options. This study aimed to explore how adolescents make their school food choices, along with how they engage with their environments whilst selecting food. Seven focus group interviews took place with adolescents (n = 28; 13–14 years) in a secondary school in Northern England. Discussions with participants were audio-recorded, transcribed verbatim and then analysed using an inductive thematic approach. Six themes emerged from the data: (1) parents' and adolescents' roles in the home food environment, (2) burgeoning food autonomy, (3) school food choice factors, (4) social aspects of school food, (5) home versus school, (6) food knowledge & beliefs. Adolescents identified two distinct environments during the focus group discussions: the home and school environments. Adolescents juxtaposed the two, in terms of food provision, food choices, rules and customs surrounding food choice. This juxtaposition emerged as an indirect but important influence on adolescents' school food choices. The school and home environments both (in)directly influence adolescents' school food choices, which involve an integration of multiple, often conflicting influences. Adolescents may adopt a number of unhelpful dietary rationalisations as they try to manage and reconcile these influences. Consultation, together with consideration of relevant food choice models, is required to identify opportunities to influence adolescents’ food choices at school