Policy v. practice: school food practices do not reflect healthy food guidance in New Zealand primary schools.

The Third School Nutrition Dietary Assessment Study: Summary and Implications

School food environments and policies can play a pivotal role in inculcating healthy food habits among young people. This cross-sectional survey explored teachers’ and parents’ views of the role of school food environments and policies in promoting healthy food consumption among Indian adolescents. Thirty-two teachers and 280 parents from five private, English-speaking, secondary schools in Kolkata, India took part in a short questionnaire survey which included closed and open answer questions. Descriptive and chi-square analyses were performed to compare the responses of parents and teachers. Thematic data analysis underpinned by Template Analysis Technique was employed to examine the qualitative responses. The easy availability and accessibility of energy-dense, nutrient-poor foods, the limited availability of nutritious foods, the absence of written food policies, and inflated prices of nutritious foods were reported as problems in the Indian school food environment. However, the respondents also noted that schools restricted the sale of sugar-sweetened beverages and adopted hygienic food practices. Novel ideas for creating healthy school food environments and effective school canteen policies were also captured during the survey. These findings point to the need to create effective school food policies in Indian secondary schools to help adolescents eat healthily at school. Future research is required to test the feasibility of the implementation of school food policies.

Dietary habits established during childhood and adolescence influence behaviours in adulthood and may impact health later in life. Primary and secondary schools have the unique ability to reach almost all children and young people during the first two decades of their lives, making them ideal settings for influencing health. Healthy Active Learning (HAL) is a 5-year joint government initiative between Sport NZ, the Ministry of Health, and the Ministry of Education which seeks to improve the wellbeing of students through healthy eating and drinking, and quality physical activity in schools. A baseline evaluation of HAL undertaken by Massey University commenced in July 2020. School leaders, teachers, and parents and family were invited to complete surveys and participate in focus groups. Measures included an evaluation of the healthy food environment, including food policies, practices, and food availability (menus). Surveys were created using online survey software, and focus groups were facilitated by two experienced qualitative researchers. Food environment and food availability surveys were completed by 257 and 173 schools, respectively. Most schools had a healthy food and drink policy (82.9%); 59.2% of these schools stipulated water and milk only policies. Barriers to implementing a healthy food and drink environment included convenience and ease of access to processed and ready-to-eat foods, resistance from parents, and loss of profits. Survey responses from 1060 teachers (including 184 responses from principals/school leaders) were received. Teachers agreed that their schools saw healthy eating and drinking as a key part of student wellbeing (84.4%), yet only 57.4% of teachers felt that they upheld their school food policy. Food insecurity was identified from 53 teacher focus groups (n = 307 teachers) as a key barrier to implementing food policy. Support from the nutrition promotion workforce may help schools achieve a healthy food environment in an equitable way.

The Healthy Food and Drink Policy was implemented in Western Australian government schools in 2007. The aim of the present study was to assess the compliance of Western Australian school canteen menus with the policy a decade after its introduction. The traffic-light system that underpins the Healthy Food and Drink Policy categorises foods and drinks into three groups: 'green' healthy items, 'amber' items that should be selected carefully and 'red' items that lack nutritional value. Canteen menus were collected online and each menu item was coded as a green, amber or red choice. Western Australia.ParticipantsOnline canteen menus from 136 primary and secondary government schools. The majority of audited school menus met policy requirements to include ≥60 % green items (84 %) and ≤40 % amber items (90 %), but only 52 % completely excluded red items. Overall, approximately half (48 %) of school canteen menus met all three traffic-light targets. On average, 70 % of the menu items were green, 28 % were amber and 2 % were red. Primary-school canteen menus were more likely than those from secondary schools to meet the requirements of the policy. While the sampled Western Australian government school canteen menus were highly compliant with most of the requirements of the Healthy Food and Drink Policy, many offered red foods and/or drinks. Providing all schools with further education about identifying red items and offering additional services to secondary schools may help improve compliance rates.

Local government policies on healthy food promotion and obesity prevention: results from a national Australian survey

School food policies and services have the potential to influence the food practices and eating behaviours of adolescents which in turn may affect their lifestyles and health in adulthood. The aim of this qualitative investigation was to describe the opinions of adolescents, their parents, nutrition educators and school principals about the prevailing food environment and canteen policies in Indian schools. Fifteen adolescents aged 14-15 years, 15 parents, 12 teachers and 10 principals from 10 private schools in Kolkata, India participated in semi-structured interviews. The interview questions were primarily based on the existing literature related to school food environments and policies. Audio recordings were transcribed verbatim and assessed thematically. Throughout the 52 interviews, a number of inadequacies of the school food environment and policies were revealed. These included the absence of written food policies, the widespread supply of unhealthy foods, inadequate provision of healthy foods, misleading messages about food communicated by school authorities, lack of cleanliness in the school canteen and the high cost of canteen food. Current school food environments do not appear to promote healthy eating among adolescents. Therefore, it is important to upgrade the quality of food services in Indian schools through adoption of healthy eating policies.

Food policies can make healthier foods more accessible for the population. In this study, progress on implementing recent policies and commitments of the government and food companies was monitored. Sub-studies were conducted following INFORMAS (International Network for Obesity/non-communicable diseases, Research, Monitoring and Action Support) protocols: benchmarking government implementation of healthy food policies; the impact of a voluntary advertising code on the exposure of children to unhealthy food marketing; the impact of healthy food and drink policies on retailers in district health boards and on the beverage environments in leisure centres; supermarket retail environments; food composition and display of the ‘Health Star Rating’; and commitments of food companies to nutrition. The level of implementation of food policy by the New Zealand government has not improved over nine years. The voluntary Children and Young People’s Advertising Code is too weak to have an impact on the exposure of children to unhealthy food marketing. Improvements to the beverage environment in leisure centres occurred where sufficient support was available, and all District Health Boards adopted a healthy food policy. There is considerable variation in the actions of the major food companies: in 2019 the Health Star Rating was displayed on 94% of private label products but only 25% of packaged foods overall; one-third of supermarkets did not have a check-out free of junk food, and two-thirds of the major food companies improved on their nutrition commitments since 2017. New Zealand’s food environments are largely unhealthy and policy implementation is low. Where policies, codes and commitments by government and food industry do exist, the progress on implementing these is patchy and there are many remaining gaps. There is considerable scope for the government, food companies, and local setting to make major changes towards a healthier, more equitable food environment with food policy in the form of mandatory regulations required to ensure real progress.

The school food environment plays an important role in shaping students’ dietary choices, which often influence future dietary behaviours. We surveyed primary and secondary schools in Hawke’s Bay, New Zealand, to measure the comprehensiveness and strength of food policies, describe the culture of food provision, and identify barriers to improving school food environments. Fifty-one schools were included in the final analysis, with 58.8% having a food policy, most of which used a generic template. Schools with food policies and those participating in the free and healthy lunch programme were more likely to have a strong culture around healthy eating. Common barriers to healthy eating were food outlets near school and resistance from students. Secondary schools reported facing more barriers to implementing healthy eating cultures, were more likely to use food as classroom rewards and to sell food to students, most of which was unhealthy. Hawke’s Bay schools participating in food provision programmes are successfully improving their food environments through improved culture and delivery of healthy food; however, more action is needed to strengthen the wording and guidance in food policies and reduce the provision of unhealthy food in schools before effective change can be achieved.

Childhood obesity and overweight rates in New Zealand are considerably higher than that globally with one in three children aged between 2-14 years being overweight or obese(1). Children’s dietary knowledge and food preferences are influenced by various factors including the food environment. Schools are an excellent setting to influence children’s dietary behaviours since they have the potential to reach almost all children during the first two decades of their lives. However, previous analyses indicate many school canteens and food providers do not supply foods that promote healthy eating and nutrition behaviours (2,3). The Ministry of Health (MoH) recently implemented a ‘Food and Drink Guidance for Schools’ which utilises a traffic-light framework dividing foods into three categories: ‘green’, ‘amber’, and ‘red’(4). The aim of this study was to assess primary school canteen food menus against the newly implemented MoH Guidance. A convenience sample of 133 primary school canteen menus were collected in 2020 as part of the baseline evaluation of the Healthy Active Learning initiative across New Zealand. Four researchers (three nutritionists and one dietitian) developed a menu analysis toolkit to undertake the analysis of all menus collected. The toolkit provided a breakdown of commonly packaged foods and meals/menu items available to purchase within schools based on Health Star Ratings, ingredients, and/or standard recipes. Assumptions were created for menu items requiring additional detail to be categorised according to the guidance through consensus by all four researchers. Primary school menus were coded by two researchers, and intercoder reliability was ensured by independent coding and cross-checking of 10% of menus. Descriptive and inferential analyses were conducted using IBM SPSS and P<0.05 denoted significance. Analyses of canteen menus revealed that most menu items belonged to the less healthy amber (41.0%) and red (40%) food categories. Low decile schools had a lower percentage of green food items (8.6%) and a higher percentage of red food items (48.3%) compared to high decile schools (p = 0.028). Similarly, schools in low deprivation areas had a significantly higher percentage of green food items (14.2%) compared to high deprivation areas (8.6%) (p = 0.031). Sandwiches, filled rolls, and wraps were the most commonly available items (86%) followed by baked foods and foods with pastry (71%). Sugar-sweetened beverages were just as prevalent as water on school food menus (54% each). Over half of in-house catered canteen menu items were classified as 'red’ foods (55.3%). This study highlights that most school canteens were not meeting the guidelines for healthy food and drink provision outlined by the MoH. Improving school food availability for children in socioeconomically deprived areas needs to be prioritised to reduce inequities. Findings suggest the need for more robust national policies and mandated school guidance to improve the food environments in New Zealand schools.

Public health programs and policies can positively influence food environments. In 2016, a voluntary National Healthy Food and Drink Policy was released in New Zealand to improve the healthiness of food and drinks for hospital staff and visitors. However, no resources were developed to support policy implementation. This study aimed to design, develop, and test a new web-based tool to support food providers implementing the National Healthy Food and Drink Policy in New Zealand. The Double Diamond model, a structured framework with 4 design phases, was used to design and develop a web-based tool. Findings from our previous research, such as (1) systematic review of barriers and facilitators to workplace healthy food policy implementation; (2) scoping review of current tools and resources available in New Zealand, Australia, and Canada; (3) interviews with food providers and public health nutrition professionals; and (4) food and drink availability audit results in New Zealand hospitals were used in the "Discover" (understanding of current gaps) and "Define" (prioritizing functions and features) phases. Subsequent phases focused on generating ideas, creating prototypes, and testing a new web-based tool using Figma, a prototyping tool. During the "Develop" phase, project stakeholders (11 public health nutrition professionals) provided feedback on the basic content outline of the initial low-fidelity prototype. In the final "Deliver" phase, a high-fidelity prototype resembling the appearance and functionality of the final tool was tested with 3 end users (public health nutrition professionals) through interactive interviews, and user suggestions were incorporated to improve the tool. A new digital tool, Healthy Kai (Food) Checker-a searchable database of packaged food and drink products that classifies items according to the Policy's nutritional criteria-was identified as a key tool to support Policy implementation. Of 18 potential functions and features, 11 were prioritized by the study team, including basic and advanced searches for products, sorting list options, the ability to compile a list of selected products, a means to report products missing from the database, and ability to use on different devices. Feedback from interview participants was that the tool was easy to use, was logical to navigate, and had an appealing color scheme. Suggested visual and usability improvements included ensuring that images represented the diverse New Zealand population, reducing unnecessary clickable elements, adding information about the free registration option, and including more frequently asked questions. Comprehensive research informed the development of a new digital tool to support implementation of the National Healthy Food and Drink Policy. Testing with end users identified features that would further enhance the tool's acceptability and usability. Incorporation of more functions and extending the database to include products classified according to the healthy school lunches program policy in the same database would increase the tool's utility.

School food in <scp>E</scp>ngland: Are we getting it right?

BackgroundDespite global recommendations to prioritise policies that create healthy food environments within education institutions, the implementation of effective healthy school food policies has proved challenging for many countries. This study examined the experience of Samoa subsequent to the 2012 introduction of a stronger policy to improve the healthiness of school food environments. Our aim was to identify opportunities to strengthen healthy school food policy implementation in Samoa and other comparable contexts.MethodsWe used a qualitative case study approach, underpinned by policy science theory. In 2018, we conducted in-depth semi-structured interviews with 30 informants, coupled with analysis of relevant documents, to generate a detailed understanding of the relevant policy implementation processes in Samoa, and the perspectives and capacities of key implementation actors. Data collection and analysis were guided by the Health Policy Analysis Triangle, supplemented by other policy theories relevant to policy process.ResultsSamoa’s school food policy operationalizes international ‘best practice’ recommendations. We found health policymakers and leaders in Samoa to be strongly committed to improving school food environments. Despite this, there continued to be challenges in ensuring compliance with the school nutrition standards. Key issues that negatively impacted the policy’s effectiveness were the lack of priority given to school food by stakeholders outside of health, the high prevalence of unhealthy food in the areas immediately surrounding schools, vendor knowledge and capacity, and the high degree of agency exercised by actors in and around the school. We noted several opportunities for policies to be effectively implemented and sustained. Respondents identified community-level leaders as potentially pivotal stakeholders, particularly where school governance arrangements draw heavily on community representation.ConclusionsSustained and effective implementation of healthy school food policies requires continued engagement from political and community leaders, beyond initial commitment. There is potential to capitalize on political will for diet-related NCD prevention by more clearly demonstrating the institutional and operational requirements for effective and sustained implementation. Strong incentives for compliance and effective enforcement mechanisms are also likely to be crucial to success.

IntroductionIn England, over 1 in 5 children start primary school overweight or obese, increasing to 1 in 3 leaving primary school. Schools offer a unique opportunity to influence childhood obesity,...

Many countries and institutions have adopted policies to promote healthier food and drink availability in various settings, including public sector workplaces. However, studies reporting barriers and facilitators experienced by food vendors and caterers in providing healthy and nutritious foods and drinks have not been collated and synthesised, representing a significant gap in workplace health promotion knowledge. Our objective was to systematically synthesise evidence on barriers and facilitators relative to the implementation of and compliance with healthy food and drink policies aimed at the general adult population in public sector workplaces internationally. Nine scientific databases, nine grey literature sources, and government websites in key English-speaking countries were searched between April and June 2021. All identified records (n = 8559) were assessed for eligibility. Studies reporting barriers and facilitators were included irrespective of the study design and methods used, but they were excluded if they were published before the year 2000 or in a non-English language. Methodological strengths and limitations of the included studies were assessed with the CASP Qualitative Studies Checklist. Drawing on a thematic synthesis approach, primary findings were generated through research question-led coding and theme development. Forty-one studies were eligible for inclusion, and they were mainly from Australia, the United States, and Canada. The most common workplace settings were healthcare facilities, sports and recreation centres, and government agencies. Generally, poorly reported data collection and analysis methods were observed. Preliminary findings suggest that although vendors encounter challenges, there are also factors that support healthy food and drink policy implementation in public sector workplaces. Generated codes indicate that barriers and facilitators fall into five broad categories of financial ramifications, availability of healthier products, existence of supporting tools and resources, institutional leadership support, and communication between stakeholders. Understanding barriers and facilitators to successful policy implementation will significantly benefit stakeholders interested in or engaging in healthy food and drink policy development and implementation.

ObjectivesThis study examined associations between high school students' lunch patterns and vending machine purchases and the school food environment and policies.MethodsA randomly selected sample of 1088 high school students from 20 schools completed surveys about their lunch practices and vending machine purchases. School food policies were assessed by principal and food director surveys. The number of vending machines and their hours of operation were assessed by trained research staff.ResultsStudents at schools with open campus policies during lunchtime were significantly more likely to eat lunch at a fast food restaurant than students at schools with closed campus policies (0.7 days/week vs. 0.2 days/week, p < .001). Student snack food purchases at school were significantly associated with the number of snack machines at schools (p < .001) and policies about the types of food that can be sold. In schools with policies, students reported making snack food purchases an average of 0.5 ± 1.1 days/week as compared to an average of 0.9 ± 1.3 days/week in schools without policies (p < .001). In schools in which soft drink machines were turned off during lunch time, students purchased soft drinks from vending machines 1.4 ± 1.6 days/week as compared to 1.9 ± 1.8 days/week in schools in which soft drink machines were turned on during lunch (p = .040).ConclusionSchool food policies that decrease access to foods high in fats and sugars are associated with less frequent purchase of these items in school among high school students. Schools should examine their food-related policies and decrease access to foods that are low in nutrients and high in fats and sugars.