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

Breakfast barriers and opportunities for children living in a Dutch disadvantaged neighbourhood

The objective of this study was to explore parents', children's, and experts' beliefs and experiences about breakfast motivation, opportunity, and ability and elicit their thoughts on effective interventions to encourage healthy breakfast consumption. The setting was a disadvantaged neighbourhood in Rotterdam, the Netherlands. Focus groups with mothers and children and semi-structured individual interviews with experts were conducted. Interview guides were developed based on the motivation, opportunity, and ability consumer psychology model. Thirty-two mothers of primary school children participated in five group discussions, eight focus groups were conducted with 44 children, and nine experts participated in interviews. Data from expert interviews and group discussions were coded and thematically analysed. The following themes emerged from the focus groups: (1) generally high motivation to have breakfast, (2) improved performance at school is key motivator, (3) limited time hinders breakfast, and (4) lack of nutritional knowledge about high quality breakfast. Experts mentioned lack of effort, knowledge, and time; financial constraints; and environmental issues (food availability) as barriers to breakfasting healthily. Several ways to encourage healthy breakfasting habits were identified: (1) involvement of both children and parents, (2) role models inspiring change, and (3) interactive educational approaches. Experts perceived more problems and challenges in achieving healthy breakfast habits than did mothers and children. Lack of opportunity (according to the children and experts) and ability (according to the experts) were identified, although the motivation to eat a healthy breakfast was present. Predominant barriers are lack of time and nutritional knowledge. Overall, findings suggest educational and social marketing approaches as interventions to encourage healthy breakfast consumption

Een verzorgde lunch op de basisschool: wat kost dat en wat mag dat volgens ouders kosten?

Kinderen in de basisschoolleeftijd eten te weinig groente, fruit en volkorenproducten. Melk en yoghurt worden steeds vaker vervangen door alternatieven met veel suiker [1]. Dit zien we ook terug in de lunchtrommels op basisscholen: er zijn grote verschillen in de samenstelling en kwaliteit van broodtrommels tussen kinderen op school en tussen scholen onderling [2–4]. De invoering van het continurooster op steedsmeer basisscholen maakt de introductie van een verzorgde schoollunch mogelijk. Er zijn echter nog veel vragen over een verzorgde schoollunch in Nederland. Een daarvan is: wat is de voorkeur van ouders? En daaraan gekoppeld de vragen: wat kost dat en wat zijn ouders bereid ervoor te betalen? Dit artikel geeft een beeld van de voorkeuren van ouders met betrekking tot een verzorgde schoollunch en de kosten ervan, en van de betalingsbereidheid van ouders

Content of lunchboxes of Dutch primary school children and their perceptions of alternative healthy school lunch concepts

OBJECTIVE: To investigate the content of lunchboxes of primary school children and to examine children's support and preferences for alternative healthy school lunch concepts. DESIGN: A cross-sectional study among Dutch children from seven primary schools. The content of the lunchboxes was assessed by photographs. Support and preferences for alternative lunch concepts were examined via a self-reported questionnaire. Linear regression analyses were used to investigate the associations between children's support and preferences and sex, educational group and migration background. SETTING: The Netherlands. PARTICIPANTS: Primary school children. RESULTS: A total of 660 children were included (average 9.9 years old). Most lunchboxes contained sandwiches and a drink. Few lunchboxes contained fruit or vegetables. The alternative school lunch concepts elicited mixed support among children. The lunch concepts 'Sandwiches prepared by the children themselves' and a 'hot lunch buffet' had the highest mean support, while the concept 'a healthy lunch brought from home' was the most preferred concept. Small significant differences were observed depending on sex, educational group and migration background. CONCLUSION: Lunchboxes of Dutch children contained sandwiches and a drink but rarely fruit and vegetables. Among different alternatives, children reported the highest support for the preparation of their own sandwiches in class or a hot lunch buffet. Future studies should investigate if these alternative lunch concepts improve the dietary intake of children

Reading food experiences from the face : effects of familiarity and branding of soy sauce on facial expressions and video-based rppg heart rate

Food experiences are not only driven by the food’s intrinsic properties, such as its taste, texture, and aroma, but also by extrinsic properties such as visual brand information and the consumers’ previous experiences with the foods. Recent developments in automated facial expression analysis and heart rate detection based on skin color changes (remote photoplethysmography or RPPG) allow for the monitoring of food experiences based on video images of the face. RPPG offers the possibility of large-scale non-laboratory and web-based testing of food products. In this study, results from the video-based analysis were compared to the more conventional tests (scores of valence and arousal using Emojis and photoplethysmography heart rate (PPG)). Forty participants with varying degrees of familiarity with soy sauce were presented with samples of rice and three commercial soy sauces with and without brand information. The results showed that (1) liking and arousal were affected primarily by the specific tastes, but not by branding and familiarity. In contrast, facial expressions were affected by branding and familiarity, and to a lesser degree by specific tastes. (2) RPPG heart rate and PPG both showed effects of branding and familiarity. However, RPPG heart rate needs further development because it underestimated the heart rate compared to PPG and was less sensitive to changes over time and with activity (viewing of brand information and tasting). In conclusion, this study suggests that recording of facial expressions and heart rates may no longer be limited to laboratories but can be done remotely using video images, which offers opportunities for large-scale testing in consumer science

The effect of a default-based nudge on the choice of whole wheat bread

Consumer choices are often influenced by the default option presented. This study examines the effect of whole wheat bread as a default option in a sandwich choice situation. Whole wheat bread consists of 100% whole grain and is healthier than other bread types that are commonly consumed, such as brown or white bread. A pilot survey (N = 291) examined the strength of combinations of toppings and bread type as carrier to select stimuli for the main study. In the main experimental study consisting of a two (bread type) by two (topping type) between-subjects design, participants (N = 226) were given a free sandwich at a university stand with either a relatively unhealthy deep-fried snack (croquette) or a healthy topping. About half of the participants were offered a whole wheat bun unless they asked for white bun, and the other half were offered a white bun unless they asked for a whole wheat bun. Regardless of the topping, the results show that when the whole wheat bun was the default option, 108 out of 115 participants (94%) decided to stick with this default option. When the default of bread offered was white, 89 out of 111 participants (80%) similarly chose to stick with this default. Across conditions, participants felt equally free to make a choice. The attractiveness of and willingness to pay for the sandwich were not affected by default type of bread. This study demonstrated a strong default effect of bread type. This clearly shows the benefit of steering consumers towards a healthier bread choice, by offering healthier default bread at various locations such as restaurants, schools and work place canteens

A qualitative study exploring the perceptions of children, parents and school staff towards the development and implementation of school lunch provision within primary schools in the Netherlands

Background: There is no tradition of serving school lunches in primary schools in the Netherlands. Most children tend to bring their own packed lunch, however these are often nutritionally suboptimal. While school lunch provision can aid healthy eating behavior amongst children, its introduction would constitute a profound change for children, parents and school staff. Therefore, this qualitative study aims to explore children’s, parents and school staffs’ perceptions of both the current lunch situation and the implementation of school lunch provision within primary schools in the Netherlands. Methods: In this qualitative study we conducted nine interviews with school principals, 98 interviews with children, and held six focus groups with teachers and six with parents at primary schools in two Dutch cities. The data was analysed via iterative coding. Results: The results showed that most children and parents are satisfied with the current lunch situation, although existing school food policies are not always put in place. Most teachers felt that children had insufficient time to consume their lunch in the current situation. The children were generally positive about the idea of a school lunch, and stressed that it was important to have the ability to choose. While both parents and school staff saw school lunch provision as an opportunity to educate families about healthy food options, they also expressed concern about who would be responsible, as well as the financial and organizational implications of its introduction. Conclusions: Perceptions of children, parents and school staff about a school provided lunch are mixed. A complex intervention such as a new school lunch program is difficult to envisage for all parties involved and more research is needed regarding the effects, organization, logistics and the costs of school lunch provision in the Netherlands

The effect of a default-based nudge on the choice of whole wheat bread

Consumer choices are often influenced by the default option presented. This study examines the effect of whole wheat bread as a default option in a sandwich choice situation. Whole wheat bread consists of 100% whole grain and is healthier than other bread types that are commonly consumed, such as brown or white bread. A pilot survey (N = 291) examined the strength of combinations of toppings and bread type as carrier to select stimuli for the main study. In the main experimental study consisting of a two (bread type) by two (topping type) between-subjects design, participants (N = 226) were given a free sandwich at a university stand with either a relatively unhealthy deep-fried snack (croquette) or a healthy topping. About half of the participants were offered a whole wheat bun unless they asked for white bun, and the other half were offered a white bun unless they asked for a whole wheat bun. Regardless of the topping, the results show that when the whole wheat bun was the default option, 108 out of 115 participants (94%) decided to stick with this default option. When the default of bread offered was white, 89 out of 111 participants (80%) similarly chose to stick with this default. Across conditions, participants felt equally free to make a choice. The attractiveness of and willingness to pay for the sandwich were not affected by default type of bread. This study demonstrated a strong default effect of bread type. This clearly shows the benefit of steering consumers towards a healthier bread choice, by offering healthier default bread at various locations such as restaurants, schools and work place canteens

Which factors promote and prohibit successful implementation and normalization of a healthy school lunch program at primary schools in the Netherlands?

Background: A school provided healthy lunch might help to improve the nutritional quality of children’s lunches. However, in the Netherlands, school lunch programs are not common. The aim of this study was to identify factors that promote or inhibit the implementation of a school lunch program at primary schools, from the viewpoint of school professionals. Methods: A cross-sectional online survey was conducted among 204 primary school professionals. The normalization process theory and its four constructs (i.e. coherence, cognitive participation, collective action, reflective monitoring) were used to develop questions and interpret findings. Descriptive statistics were used for 14 multiple choice questions (yes, no, don’t know) and thematic content analysis for qualitative responses. Results: Participants had a shared understanding about how a lunch program differed from current practices. Most participants had the same view on the rationale for implementation (coherence), such as equality among children. Sixty percent expected that a healthy school lunch will contribute to healthier eating by the children. Participants showed different degrees of cognitive participation (46% indicated that healthy school lunch is good idea). Commitment depended on their belief whether providing a healthy lunch was part of their responsibility as school and 30% expected a large effect on their daily work (collective action). When appraising school lunch implementation (reflective monitoring), participants’ concerns focused on feasibility and adaptability of a program in their own school. Conclusions: The introduction of a school lunch program will require substantial effort, although there is considerable support and understanding about potential benefits. The findings point to a number of preconditions for large-scale introduction, including the need for support—both financially and organizationally—bottom-up involvement of teachers, children and parents and freedom to adapt the program