Healthy School Lunch Research Articles

Lunchbox content and dietary outcomes of Dutch primary school children explored by sociodemographics

Abstract Background Most children fail to meet recommended guidelines for a healthy diet. Children living in low socioeconomic areas are less likely to have healthy eating behaviours. In this study we investigated the food Dutch primary school children bring from home, and their dietary, health and school related outcomes explored by sociodemographics. Methods 5 primary schools, with high deprivation scores and a high percentage of overweight, have been included in this study (ClinicalTrials.gov NCT06058325). With observations in September 2023 we mapped the content of lunchboxes, including snacks, of children. Questionnaires for all parents and children in grade 5-8 focused on dietary and health outcomes of children and perceived class factors. Preliminary baseline data were analysed using descriptive statistics. Exploratory analyses will be conducted to show differences by sociodemographics (e.g. age, sex, parental financial stress). Results 297 lunchboxes were observed, 98.7% contained sandwiches, half being brown bread. Most children brought fruit from home for either lunch or morning snack, 13.8% not at all. 21.9% brought vegetables. 135 children completed the questionnaire: 43.0% boys, mean age 9.3 years old (SD 1.12). Children ate fruit and vegetables on an average of 5.9 (SD 1.69) and 4.9 (SD 2.23) days a week. Whereas 80% of children eats fruit every day at school, only 20% of children eats vegetables every day at school. Most children perceived their health as good (89.3%) and felt happy (89.6%). On a scale of 1 (low) to 5 (high), they rated concentration, social climate and comfort in class an average of 3.8 (SD 1.05), 4.3 (SD 1.07) and 4.3 (SD 0.92) respectively. Conclusions Lunchboxes of Dutch primary school children mainly contain sandwiches. Whereas most children eat fruit at school, the majority of children do not eat vegetables at school. A healthy school lunch might increase vegetable consumption of children and could affect health and school related outcomes. Key messages • Most Dutch primary school children eat sandwiches during lunch at school, but in half of the cases this is not brown bread as recommended by nutritional guidelines. • Most Dutch primary school children bring fruit to eat as snack or lunch, but no vegetables to eat at school. The majority also self-reported the lack of eating vegetables at school on a daily basis.

Co-creation and implementation of a healthy lunch at Dutch primary schools in disadvantaged neighbourhoods: design of a cluster randomised cross-over effectiveness study

IntroductionThe majority of children fails to have a healthy diet. Providing a healthy lunch at school is a way to target all children, regardless of ethnic and socioeconomic background. This...

Parents face several barriers in providing a healthy school lunch for their primary school children: A survey of Victorian (Australian) parents.

This paper aims to explore Victoria parents' perceptions of their current practices and barriers in providing school lunches for their primary school children. Respondents were asked via an online survey about their lunch provision practices, perceptions of the healthiness of school lunches, and barriers to providing healthy school lunches. Data were analysed using different statistical techniques: Chi-square test, Spearman correlation analysis, Mann-Whitney U test, and Kruskal-Wallis test. In total, 359 respondents completed the survey. Most respondents (84%) reported their child takes a home-packed lunch to school every day. Most respondents provided fruits (94%), vegetables (57%), and sandwiches (54%) every day for school lunches, whilst other core food items such as milk, meats, and legumes were provided less frequently. A substantial proportion of respondents provided some discretionary food items frequently (e.g., the proportion of respondents providing selected discretionary food items daily or 3-4 times/week: salty crackers-50%, sweet cookies/biscuits-40%, chips-20%). Respondents strongly agreed or agreed with several barriers; examples include not packing certain foods due to food spoilage concerns (50%) (school-related), the allocated time at their child's school is not enough to eat and enjoy school lunch (48%) (school-related), need more meal ideas (61%) (parent-related), healthy foods take more time to prepare (51%) (parent-related), and children request easy-to-eat food for school lunches (50%) (child-related). Core food score (an indicator of frequency of preparing/packing core food) was negatively correlated with parent-related and child-related barrier scores, whilst discretionary food score (an indicator of frequency of preparing/packing discretionary food) was positively correlated with these barrier scores. Overall, home-packed lunches remain the main option in primary schools in Victoria, and parents face several challenges in providing healthy lunches for their primary school children. SO WHAT?: The findings suggest the need for strategies from school leaders, education authorities, and policymakers to improve the quality of lunch content and address the barriers faced by parents.

Health, wellbeing and nutritional impacts after 2 years of free school meals in New Zealand.

In 2020, a government-funded healthy school lunch program was introduced in a quarter of New Zealand schools, selected due to high levels of socio-economic barriers. This study assesses the impact of the introduction of the school lunch program from family (whānau), student and school principal perspectives. Across four schools, we conducted five focus groups (two with secondary students and three with family members) and four school principal interviews. Participating schools represented a range of contexts: primary and secondary, schools with cooks in on-site kitchens and schools receiving meals delivered by external caterers. Thematic analysis was used to develop themes describing the health, wellbeing and nutritional impact of the program. Family participants were 82% Indigenous Māori and self-identified as having 'borderline' (73.5%) or no financial security (8.8%). Seven positive impact themes were identified: improved food security, enhanced equity, increased appreciation of healthy foods for students, enhanced mana (wellbeing) for all, reduced financial hardship/stress for families, opportunities for nutritional learning and recognition that appreciation and uptake happen over time. Four negative impact themes were identified: low uptake that created food waste, perception that healthy food is not palatable for students, lack of knowledge of the program and loss of agency for students. This is the largest intervention in nutrition and food security for children implemented in New Zealand since the 1930's. The first 2 years have offered wellbeing and financial benefits for students and families, particularly when school environments promote uptake. More involvement of students and family members in the program planning is essential.

Not Just a Free Lunch a logic model and evidence review for the Ka Ora, Ka Ako | Healthy School Lunch programme

Ka Ora, Ka Ako provides free, healthy lunches for 220,000 learners in low-equity New Zealand schools. Costing over $260 million annually, it represents the largest government investment in child nutrition in generations. Early evaluations indicate success in achieving programme aims of delivering nutritious food, improving learners’ wellbeing, and easing financial stress for families. However, international evidence and emerging local data indicate the programme can achieve the above and more. This article presents a programme logic model drawing on local data and a review of relevant international literature on universal school food provision with the aim of identifying potential long-term outcomes and impacts at multiple levels: for learners, wh`ānau, schools, communities, and food systems. Findings indicate that the Ka Ora, Ka Ako programme has the potential to:• improve children’s nutrition and educational outcomes, as well as improve child and wh`ānau food security;• enrich school learning environments; • boost local economies (through creation of jobs paying a living wage) and enhance local foodscapes (including availability and affordability of healthy foods) through food system engagement in schools, with whänau and communities; and• increase food system resilience (e.g., shorter supply chains and relationship building), and encourage broader food system transformation (e.g., reformulation, waste and packaging solutions) with leverage from new procurement models.While Ka Ora, Ka Ako can contribute to these pathways, some implementation areas within the programme demand further attention to achieve optimal results. Recognised areas for improvement include ensuring high quality of food, providing more avenues for engagement from children and parents, addressing perceived challenges to integrate Ka Ora, Ka Ako effectively with mātauranga Māori, and improving waste management. Given the high potential for Ka Ora, Ka Ako to contribute to multiple beneficial outcomes, continued investment and expansion of the programme is warranted.

Acceptability, Helpfulness, and Utility of the Healthy Lunch Box Booklet (HLBB) for Parents and School-Age Children.

Purpose: School lunches are of poor nutritional quality in Canada. Parents play an important role in the preparation of school lunches for young children. This study aimed to evaluate the acceptability and helpfulness of the Healthy Lunch Box Booklet (HLBB) to support parents in packing healthy school lunches for their children.Methods: The HLBB was distributed at four schools in London, Ontario to students in full-day Kindergarten to Grade three. Parents were asked to complete an online survey from April to November 2019.Results: Parents (n = 58) reported the HLBB to be helpful (96.3%) and found the sections on new school lunch and snack ideas and nutritional information (e.g.,label reading) particularly useful. Some parents also stated that the HLBB created opportunities to interact with their children regarding school lunch preparation. In terms of perceived impacts, parents reported increased confidence (68.6%) and learning something new (79.6%) about school lunch preparation and felt that their children's diet was impacted accordingly.Conclusions: The HLBB was found to be an acceptable and useful nutrition resource that supports parents in packing healthy school lunches for their children and therefore warrants further study.

Introduction

The articles in this issue of Culture, Agriculture, Food and Environment represent a diverse set of both empirical and conceptual interventions into the relationship between food, sustainability, and local socio-economic conditions. Despite this diversity, a few key themes emerge, which will be familiar to anyone working on food, agriculture, and sustainability in anthropology and cognate fields: a tension between financial pressures, climate change, and cultural values; racism as an undercurrent of many of the policies and practices around food provision; and sites of food production, exchange, and consumption as sites of placemaking, community formation, and care. In her article, Micah Trapp examines the intersection of race, food, and health in the context of school food programs, which have received widespread attention in recent years in both popular media and academic literature. Trapp's detailed study shows how even relatively young students are keenly aware of what constitutes a healthy school lunch, and they are able to articulate compelling explanations for what makes lunches less healthy, such as the addition of preservatives on otherwise tasty pre-sliced apples. Through Trapp's vivid and sensitive ethnography, healthiness emerges as racially coded and disciplinary, with students' performances of more diverse understandings of health offering a necessary alternative to a hegemonic vision of nutrition that serves both whiteness and capital. Given this relationship between racism and food provisioning, findings by Karen Rignall and colleagues – that alternative food hubs in the US South face significant challenges in their attempts to integrate racial justice concerns in their operations – might not come as a surprise. Their analysis of this tendency, however, yields an interesting and important conclusion: justice-oriented initiatives often fall into what the authors refer to a “justice trap,” incorrectly assuming that what counts as “justice” is both self-evident and widely transposable across contexts. Like nutrition, approaches to alternative food systems must take into account the diverse experiences and ideologies of food justice. Dorji Wangchuk analyzes the ways Brokpa yak farmers in Bhutan have responded to both climatic and sociopolitical changes in the region. Drawing on interviews and participant observation with herders and other stakeholders around the villages of Merak and Sakteng, Wangchuk highlights several challenges for yak farmers, from conflicting views on the value of cultural conservation versus environmental conservation apparent in debates around land ownership to the rapidly changing climate of the Himalayas. Through Wangchuk's account, the sustainability of yak farming in Bhutan emerges as a multi-faceted issue inextricable from global climatic changes, national land management policies, and local social and cultural values. In a similar vein, but in a very different empirical context, Margaret du Bray and colleagues adopt the notion of “lifeways” to consider how farmers in the Eastern Snake Plane aquifer region of Idaho understand and respond to changing landscapes of agricultural water– both physical and political. This approach lets them explore the way different identities and values intersect, as members of a particular religious group, as members of particular local communities, as people facing different levels of financial pressure as farming becomes less profitable, and as people with distinct and sometimes divergent commitments to environmentalism. Yue Gu and Robin Rodd investigate the social attributes of a live poultry stall in Wuxi, China. There has been, perhaps unsurprisingly, a flurry of interest in the biopolitics of wet markets over the past few years, but this article turns our attention away from the wet market as a whole and toward the individual stalls that constitute these larger entities. In doing so, Gu and Rodd are able to untangle some of the competing narratives about what wet markets are – culinary oases versus petri dishes – highlighting the deeply political nature of these sites and the different ways their futures are debated. Sophie D'Anieri also examines the tension between the marginality and the centrality of particular spaces in contemporary global capitalism. Drawing on feminist ethnographic methods, she shows how kitchens and gardens play an important role in the daily lives of Mexican immigrants working in the Wisconsin dairy industry. She theorizes these sites as “pericapitalist” spaces – both within and at the margins of capitalism – that are fundamental to her interlocutors' practices of care and worldmaking. Finally, in line with the journal's new book review policy, Supurna Banerjee has brought two recent books on the gendered political ecologies of tea production into productive conversation with each other, Tea and Solidarity by Mythri Jegathesan and Everyday Sustainability by CAFE's own Debarati Sen. Banerjee's review teases out an important thread running between two otherwise very different books, namely that the dynamics of neoliberalism are not a mere frame within which the politics of the plantation economy should be understood, but are in fact “constitutive” of the lived experiences of workers on and around those plantations.

Nutrient-Level Evaluation of Meals Provided on the Government-Funded School Lunch Program in New Zealand

Approximately 1 in 6 children in New Zealand are living in households facing poverty and 14% of the population is food insecure. The Ka Ora, Ka Ako|Healthy School Lunches program aims to reduce food insecurity by providing access to a nutritious lunch every school day. This study analyzed the nutritional content of Ka Ora, Ka Ako meals and compared them to national and international standards. Meals were selected at random from approved menus. The suppliers covered by the 302 meals analyzed provide 161,699 students with a lunch (74.9% of students on the program). The meals were analyzed using Foodworks 10 nutrient analysis software. The nutrient content was compared against the New Zealand/Australia Nutrient Reference Values (NRVs) and to nutrient-level standards for international school lunch programs. A total of 77.5% of nutrients analyzed exceeded 30% of the recommended daily intakes. Protein, vitamin A and folate met the NRV targets and a majority of the international standards (55/57). Energy, calcium, and iron were low compared to NRVs and international standards (meeting 2/76 standards). Carbohydrates were low compared to international standards. The findings have been used to inform the development of revised nutrition standards for the program, which will be released in 2022.

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

To investigate the content of lunchboxes of primary school children and to examine children's support and preferences for alternative healthy school lunch concepts. 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. The Netherlands. Primary school children. 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. 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.

Systems Mapping of the New Zealand Free and Healthy School Lunch Programme: Perspectives from Lunch Providers.

As part of the COVID-19 economic recovery package, the Aotearoa New Zealand Government rolled out a universal free and healthy lunch programme to the 25% least advantaged schools nationwide. This study explored experiences of school lunch providers in the Hawke’s Bay region. The aim was to create a systems map identifying points of intervention through which the lunch programme could be improved to meet the goal of reducing child food insecurity. Twelve lunch providers were interviewed to generate casual loop diagrams which were examined and integrated to form a single systems map. Seven themes arose during analysis: teacher support, principal support, nutrition guidelines and government support, supply chain, ingredient suppliers, student feedback and food waste. Teacher support was important for getting students to try new foods and eat the nutritious lunches. Principal support was a strong theme impacting opportunities for broader student engagement. This study employed systems science to highlight the importance of support from different stakeholders within the lunch programme to achieve the goal of reduced child food insecurity. Further work is needed to ensure the programme meets the wider goals of the government and community, and to determine the potential broader benefits of the programme.

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

BackgroundA 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.MethodsA 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.ResultsParticipants 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.ConclusionsThe 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.

Impact of Maternal Nutrition Education on Dietary Practices of School Going Children (3-6 years of age)

Nutrition (Nutritional) education is a kind of education that is important to improve the health status of people. School children are undergoing rapid mental and physical development. Therefore, an appropriate diet is critical throughout this stage of life to ensure normal and healthy growth. As a result, nutrition education should begin at a young age for children Objective: To evaluate the impact of nutrition education of mothers on the dietary habits of school-going children aged 3-6 years Methods: A Quasi-Experimental study was executed on 77 children of class playgroup to class 1 studying in the Government girl’s school of Garhi Shahu, Lahore. Firstly, anthropometric data were collected through the children and secondly socio-demographic and dietary knowledge of mothers of selected children were noted through pre-designed questionnaires and interview method. The mothers were then given 45 minutes of nutrition education and a dietary change course, and some informative dietary guidelines leaflets and a weekly healthy kid’s school lunch planner were given to the mothers which they were requested to implement in the daily routine of children. After three months again the anthropometrics and questionnaires were assessed and compared with the initial findings Results: After nutrition education, the percentage of children who followed the servings of healthy food groups and avoided consumption of harmful meals (fast, fried, processed foods), unhealthy beverages (carbonated drinks), and intake of fruits and vegetables increased dramatically. After the intervention, the percentage of children who followed recommended nutritional, lifestyle, and physical activity guidelines, as well as healthy school lunch practices, improved statistically significantly (P<0.005). The percentage of children who skipped meals on daily basis was 20% decreased to 8%. Before the intervention, 63% of mothers say that their children consumed breakfast regularly and after the intervention, it increases to 75%. The children's anthropometric status improved significantly, with a P<0.005 significance level Conclusions: In this study, nutrition education had a significant impact on the school-going children in their anthropometry measurements, healthy school lunch boxes, and awareness of their mothers about healthy eating practices. Seminars and camps should be arranged in schools to educate the mothers and the students at a young age regarding their health and healthy eating to reduce the nutritional deficiencies and diseases

Nourishing Hawke’s Bay: He wairua tō te kai – food security, health behaviours and wellbeing in children in regional New Zealand

ABSTRACT Our current food system is failing to deliver on equitable health outcomes, wellbeing and food security and the Hawke’s Bay region of New Zealand has high inequities and one the highest levels of childhood obesity nationally. This articlereports baseline quantitative data from 2087 students (aged 9 or 13) from 41 primary and secondary schools, including schools participating in the Ka Ora, Ka Ako Healthy School Lunch programme. Students answered an online survey covering food security, general wellbeing (WHO-5), eating behaviours and physical activity and were measured/weighed for body size. 16.8% of students experienced food insufficiency in the home and 31.3% of 13-yr-olds did not eat breakfast. Overall, only 12.9% met the national vegetable intake guidelines and 39.6% met fruit intake guidelines. Students in high advantage schools (decile 8–10) were twice as likely to meet the vegetable intake guidelines. 47.1% of 13-year old girls were at risk of reduced wellbeing. 54.6% of students had a healthy weight and 44.5% experienced overweight or obesity; in low advantage (decile 1–3) schools 64.4% experienced overweight or obesity. The data form a baseline for an evaluation of multiple public health initiatives underway in Hawke’s Bay to improve food environments and nutritional wellbeing.

"Mummy, Can I Join a Sports Club?" A Qualitative Study on the Impact of Health-Promoting Schools on Health Behaviours in the Home Setting.

Information regarding school-based health-promoting interventions’ potential effects in the home environment is scarce. Gaining more insight into this is vital to optimise interventions’ potential. The Healthy Primary School of the Future (HPSF) is a Dutch initiative aiming to improve children’s health and well-being by providing daily physical activity sessions and healthy school lunches. This qualitative study examines if and how HPSF influenced children’s and parents’ physical activity and dietary behaviours at home. In 2018–2019, 27 semi-structured interviews were conducted with parents from two HPSFs. Interviews were recorded and transcribed, and data were coded and interpreted through thematic analysis. HPSF resulted in various behavioural changes at home, initiated by both children and parents. Parents reported improvements in healthy behaviours, as well as compensatory, unhealthy behaviours. Reasons for behavioural change included increased awareness, perceived support to adopt healthy behaviours, and children asking for the same healthy products at home. Barriers to change included no perceived necessity for change, lack of HPSF-related information provision, and time and financial constraints. Both child-to-adult intergenerational learning and parent-initiated changes play an important role in the transfer of health behaviours from school to home and are therefore key mechanisms to maximise school-based health-promoting interventions’ impact.

The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study.

BackgroundGood nutrition affects children’s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children’s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones.ObjectiveThe aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices.MethodsThis population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project.ResultsThis study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention.ConclusionsThe opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent.International Registered Report Identifier (IRRID)DERR1-10.2196/30899

Application of Multi-Objective Evolutionary Algorithms for Planning Healthy and Balanced School Lunches

A multi-objective formulation of the Menu Planning Problem, which is termed the Multi-objective Menu Planning Problem, is presented herein. Menu planning is of great interest in the health field due to the importance of proper nutrition in today’s society, and particularly, in school canteens. In addition to considering the cost of the meal plan as the classic objective to be minimized, we also introduce a second objective aimed at minimizing the degree of repetition of courses and food groups that a particular meal plan consists of. The motivation behind this particular multi-objective formulation is to offer a meal plan that is not only affordable but also varied and balanced from a nutritional standpoint. The plan is designed for a given number of days and ensures that the specific nutritional requirements of school-age children are satisfied. The main goal of the current work is to demonstrate the multi-objective nature of the said formulation, through a comprehensive experimental assessment carried out over a set of multi-objective evolutionary algorithms applied to different instances. At the same time, we are also interested in validating the multi-objective formulation by performing quantitative and qualitative analyses of the solutions attained when solving it. Computational results show the multi-objective nature of the said formulation, as well as that it allows suitable meal plans to be obtained.

Lifetime cost-effectiveness and equity impacts of the Healthy Primary School of the Future initiative

BackgroundThis study estimated the lifetime cost-effectiveness and equity impacts associated with two lifestyle interventions in the Dutch primary school setting (targeting 4–12 year olds).MethodsThe Healthy Primary School of the Future (HPSF; a healthy school lunch and structured physical activity) and the Physical Activity School (PAS; structured physical activity) were compared to the regular Dutch curriculum (N = 1676). An adolescence model, calculating weight development, and the RIVM Chronic Disease Model, calculating overweight-related chronic diseases, were linked to estimate the lifetime impact on chronic diseases, quality adjusted life years (QALYs), healthcare, and productivity costs. Cost-effectiveness was expressed as the additional costs/QALY gained and we used €20,000 as threshold. Scenario analyses accounted for alternative effect maintenance scenarios and equity analyses examined cost-effectiveness in different socioeconomic status (SES) groups.ResultsHPSF resulted in a lifetime costs of €773 (societal perspective) and a lifetime QALY gain of 0.039 per child versus control schools. HPSF led to lower costs and more QALYs as compared to PAS. From a societal perspective, HPSF had a cost/QALY gained of €19,734 versus control schools, 50% probability of being cost-effective, and beneficial equity impact (0.02 QALYs gained/child for low versus high SES). The cost-effectiveness threshold was surpassed when intervention effects decayed over time.ConclusionsHPSF may be a cost-effective and equitable strategy for combatting the lifetime burden of unhealthy lifestyles. The win-win situation will, however, only be realised if the intervention effect is sustained into adulthood for all SES groups.Trial registrationClinicaltrials.gov (NCT02800616). Registered 15 June 2016 – Retrospectively registered.

The Family Meal Project: Assessing the Relationship between Healthy Food Consumption and School Lunch Intake in Elementary School Children

Identify the relationship between school lunch intake and daily food choices.

Improving dietary intake during lunch through the provision of a healthy school lunch at Dutch primary schools: design of a pretest-posttest effectiveness study

BackgroundSince 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.MethodsIn 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- and 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).DiscussionResults of this study will provide valuable information to influence future school lunch interventions and policies.Trial registrationThis study is registered at the Netherlands trial register (NTR): trialregister.nl, Trial NL7402 (NTR7618), registered retrospectively at 2018-11-13.

P90 - Wellness in the Schools (WITS): Evaluating a Program that Promotes Healthy School Lunch and Active Recess

Background (Background, Rationale, Prior Research, and/or Theory): A positive school lunch and recess experience promotes healthy behaviors. Objective: To evaluate the two-year impact of WITS programming on school lunch consumption, physical activity levels, and pro-social behaviors at recess. Study Design, Setting, Participants, Intervention: Quasi-experimental, matched-control study in 14 NYC public elementary schools with second and third graders. WITS programming provides scratch-cooked, less processed school lunch and organized activities at recess by placing trained chefs and coaches in the school. Outcome Measures and Analysis: School lunch consumption, as well as physical activity and pro-social behaviors at outdoor and indoor recess, were measured using standardized tools and protocols. Data were collected at three time points (no baseline): Time 0 (early intervention), Time 1 (one school year post intervention) and Time 2 (two school years post intervention) and compared using Repeated Measures Analysis of Variance. Results: For school lunch consumption, there were early intervention effects. Students in the WITS schools ate more vegetables and fruit at Time 0 than students in control schools (.27 cups vs. .18 cups, P < .05), with the same differences found at Time 1 and Time 2. However, students in WITS schools ate less entrée (42% of portion versus 46%, P < .05) and drank less milk (29% of portion versus 38%, P < .05) at Time 0, with these differences also remaining through Time 2. Outdoor recess had no difference in physical activity levels. Indoor recess had a higher percentage of WITS students vigorously active (46% vs. 3% at Time 1, P < .05; 29% vs. 4% at Time 2, P < .05; and was not measured at Time 0). Pro-social behavior scores were higher in WITS schools at all time points for outdoor and indoor recess (P < .05). Conclusions and Implications: WITS programming changed school lunch consumption with both positive and negative results. WITS is a promising school-wide intervention. Further research is needed to better understand how students could eat more of all school lunch components and how to get students more physically active during outdoor recess. Funding: Wellness in the Schools.