PhD ThesisMany children do not eat a healthy diet. In 2005, the nutritional content of
school lunches in England received wide criticism. In 2006, a major policy
change led to legislation specifying what food and drink could, and could not, be
served in schools. This thesis considers the impact of the implementation of
food and nutrient-based standards on children’s dietary intake at lunchtime and
in their total diet, if the impact was equitable across the socio-economic
spectrum, and if school lunch take-up changed.
Methods
Data collected pre and post-policy implementation in children aged 4-7y and 11-
12y were analysed. In the 4-7y olds, dietary data were collected on four
consecutive days using an observational method in 12 primary schools, in
Newcastle upon Tyne, UK (n=385 in 2003-4; n=632 in 2008-9). In 11-12y olds,
dietary data were collected from two consecutive 3-day food diaries followed by
a researcher-led interview in six middle schools, in Northumberland, UK (n=298
in 1999-2000; n=215 in 2009-10). Linear mixed effect models were used to
analyse the effects of year (pre and post-policy), lunch type (school or homepacked
lunch), level of socio-economic deprivation, and the interaction(s)
between these factors on children’s total dietary intake. Logistic regression was
used to examine the change in school lunch take-up by year and level of
deprivation.
Results
At lunchtime, children who ate a school lunch post-policy implementation
consumed a lower per cent energy from fat, saturated fat and absolute amounts
of sodium. In the 4-7y olds, mean calcium (mg), vitamin C (mg) and iron (mg)
intakes increased; in 11-12y olds, non-starch polysaccharides (g) and iron (mg)
decreased. A child’s lunch type was associated with change in the total dietary
intake in 4-7y olds; post-policy implementation children eating a school lunch
had a healthier total diet compared with children eating a home-packed lunch.
In 11-12y olds, there was limited evidence found that lunch type was associated
with change in total diet. In both age groups children’s total dietary intake from
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per cent energy saturated fat and non-milk extrinsic sugars remained above the
recommended guidelines. There was some evidence that post-policy
implementation, lunch type and level of deprivation were associated with
differences in per cent energy from non-milk extrinsic sugars and vitamin C
(mg) intake in the total diet of 4-7y olds; there was no such evidence found in
11-12y olds. Post-policy implementation, school lunch take-up decreased in
both age groups.
Conclusions
The implementation of school food and nutrient-based standards in England
has been associated with positive changes in children’s dietary intake at
lunchtime. These changes were reflected in the total diets of the 4-7y olds but
evidence was more limited in 11-12y olds. A key strength of this study is the
unique evaluation of national policy enabled by the availability of preimplementation
data. A key limitation is the use of repeat cross-sectional
surveys; this limits the extent to which change in children’s diets can be
attributed to the policy. Future regulation of school lunches should be evaluated
prospectively. To improve children’s diets in all their complexity, future
interventions also need to consider the social, environmental and behavioural
contexts in which food choices are made or directed, both in and outside of the
school environment.All Saints Educational
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