Abstract
BackgroundChildren spend a considerable amount of time at school and consume at least one meal/day. This study aimed to investigate if a free, healthy school meal every day for one school year was associated with children’s intake of healthy foods at school, weight status and moderating effects of socio-economic status.MethodsA non-randomized study design with an intervention and a control group was used to measure change in children’s dietary habits at lunchtime. In total, 164 children participated; 55 in the intervention group and 109 in the control group (baseline). Intervention-children were served a free, healthy school meal every school day for one year. Participating children completed a food frequency questionnaire at baseline, at five months follow-up and after one year. Children’s anthropometrics were measured at all three timepoints. Intervention effects on children’s Healthy food score, BMI z-scores, and waist circumference were examined by conducting a Repeated Measures Multivariate ANOVA. Moderating effects of children’s gender and parental socio-economic status were investigated for each outcome.ResultsA significant intervention effect on children’s outcomes (multivariate) between baseline and after one year (F = 2.409, p < 0.001), and between follow-up 1 at five months and after one year (F = 8.209, p < 0.001) compared to the control group was found. The Univariate analyses showed a greater increase in the Healthy food score of the intervention group between baseline and follow-up 1 (F = 4.184, p = 0.043) and follow-up 2 (F = 10.941, p = 0.001) compared to the control group. The intervention-children had a significant increase in BMI z-scores between baseline and follow-up 2 (F = 10.007, p = 0,002) and between follow-up 1 and 2 (F = 22.245, p < 0.001) compared to a decrease in the control-children. The intervention-children with lower socio-economic status had a significantly higher increase in Healthy food score between baseline and follow-up 2 than the control-children with lower socio-economic status (difference of 2.8 versus 0.94), but not among children with higher socio-economic status.ConclusionsServing a free school meal for one year increased children’s intake of healthy foods, especially among children with lower socio-economic status. This study may contribute to promoting healthy eating and suggests a way forward to reduce health inequalities among school children.Trial registrationISRCTN61703361. Date of registration: December 3rd, 2018. Retrospectively registered.
Highlights
Children spend a considerable amount of time at school and consume at least one meal/day
The intervention group consisted of 55 children from 6th grade, while the control group consisted of 109
No significant difference in Healthy food score was found between the intervention and control children with a higher Socio-economic status (SES)
Summary
Children spend a considerable amount of time at school and consume at least one meal/day. This study aimed to investigate if a free, healthy school meal every day for one school year was associated with children’s intake of healthy foods at school, weight status and moderating effects of socio-economic status. Healthy dietary habits established early in life tend to persist into adulthood and thereby promote lifelong health [2, 3]. In a public health perspective, schools are ideal settings to promote healthy eating habits early in life since children consume at least one main meal per day at school. Among the Nordic countries, Denmark has similar school meal arrangement as Norway (i.e. packed lunch from home), while Sweden and Finland have served a warm school meal every day for several years, free of cost for the children [14]
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