Policy driven improvement of the school food environment for the Bulgarian first-graders in the period 2008–2016

Abstract

AbstractIntroduction:The disbalanced school food environment may be a significant factor contributing to the childhood obesity epidemic observed in the last decades worldwide and in Bulgaria. Policy measures targeting to improve the food and beverage availability at the school premises, to include nutrition education in the school curriculum and to implement initiatives aiming to promote a healthy lifestyle among children and their families, all have the potential to help lowering the prevalence of childhood obesity and improve the well-being and health of the children.The aim of the present study is to assess the policy driven improvement of the school food environment for the Bulgarian first-graders within the period 2008–2016.Materials and methods:Three cross-sectional studies among 7-year-old schoolchildren in Bulgaria were carried out on nationally representative samples of about 3500 children selected from the same sample of primary schools in the years 2008, 2013 and 2016 as part of the WHO European Childhood Obesity Surveillance Initiative (COSI). The present study is based on the data collected through questionnaire on the school environment characteristics.Results:Within the nationally representative sample of schools from 2008 to 2016 there is decrease in the percentage of schools with availability at their premises of salty snacks (from 73.7% to 32.3%), sweet snacks (from 76.5% to 49.7%), cold drinks with sugar (from 68.2% to 10.1%) and fruit juices with sugar (from 69.3% to 8.7%), paralleled by increase in the proportion of schools offering vegetables (from 17.9% to 59.8%) and fresh fruits (from 36.9% to 87.4%). Most of the schools have nutrition education as a separate class or included in the curriculum (92.4% of the schools in 2008 and 91.5% in 2016). There is marked increase in the proportion of schools that have initiatives to promote healthy lifestyles (from 42.4% in 2008 to 68.3% in 2016).Discussion:The legislative and policy measures initiated within the period 2008–2016 have led to significant improvement in the profile of foods and drinks available at the school premises, as well as higher involvement of the schools in initiatives promoting healthy lifestyles. These positive changes in the school food environment have probably important role for the trend for plateauing in the prevalence of overweight and obesity among 7-year-old schoolchildren observed within the same study.