What is on plates for school meals: focusing on animal- vs. plant-based protein foods.

BACKGROUND/OBJECTIVES: This study aimed to analyze the potential of school meals in South Korea as a sustainable tool to reduce carbon emissions by focusing on animal- vs. plant-based protein foods. MATERIALS/METHODS: By using a stratified proportional allocation method, 536 out of the 11,082 schools nationwide were selected including 21 kindergartens, 287 elementary-, 120 middle- and 108 high schools. A total of 2,680 meals served for 5 consecutive days (June 21-25, 2021) were collected. We analyzed the average serving amounts of protein foods (animal- vs. plant-based) per meal and then, calculated the estimated average amounts of carbon emission equivalents per meal by applying the conversion coefficients. The t-test and analysis of variance were used for statistical analyses (α = 0.05). RESULTS: The average serving amount of animal-based protein foods per meal was 12.5 g, which was approximately 3 times higher than that of plant-based ones (3.8 g) (P < 0.001); the Meat-group had the highest average amount of 17.0 g, followed by Egg-group (9.6 g), Fish-group (7.6 g), and Beans-and-Nuts-group (3.8 g) (P < 0.05). Specifically, pork (25.1 g) was ranked first, followed by poultry (19.6 g), processed meat products (18.0 g). The estimated average amount of carbon emission equivalents of animal-based protein foods per meal was 80.1 g CO2e, which was approximately 31 times higher than that of plant-based ones (2.6 g CO2e) (P < 0.001); the Meat-group had the highest average amount of 120.3 g CO2e, followed by Fish-group (44.5 g CO2e), Egg-group (25.9 g CO2e), and Beans-and-Nuts-group (2.6 g CO2e) (P < 0.05). Specifically, processed meat products (270.8 g CO2e) were ranked first, followed by pork (91.7 g CO2e), and processed fish products (86.6 g CO2e). CONCLUSIONS: The results implied that school meals with plant-based alternatives could be a sustainable tool to improve carbon footprint.

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 (whanau), 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 Maori 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.

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.

Using behavioural insights to reduce sugar in primary school children's packed lunches in derby; A cluster randomised controlled trial.

Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools were randomised to intervention (n = 8) or control (n = 9) using blocked random allocation. In the intervention group, parents of children who brought packed lunches to school in years 3-6 (age 7-11 years) received three bundles of materials (including packed lunch planner, shopping list, information on sugar content of popular lunchbox items and suggestions for healthier swap alternatives) in bookbags/lunchboxes over a 4-week period. Control parents received no materials. Photos of lunchbox contents were taken at baseline, immediately post-intervention and at three-month follow-up. A parental survey aimed to assess capability, opportunity and motivation for packing a healthier lunchbox. No intervention effects were observed for primary outcomes (presence and number of sugary snacks or chilled sugary desserts). The intervention had a significant impact on one secondary outcome (increased number of healthier "swap" items suggested in intervention materials) immediately post-intervention, but this effect had disappeared at three-month follow-up. No intervention effects were found on survey variables. Parent comments revealed that materials were either received positively (as they reinforced existing behaviours) or negatively (as they were not perceived to be helpful or appropriate). The results of this study suggest that providing educational materials and resources to parents of primary school children in Derby was not sufficient to increase provision of healthier packed lunches. Future research should investigate how behavioural science can support families to improve the nutritional content of primary school children's lunchboxes.

Investigating differences between traditional (paper bag) ordering and online ordering from primary school canteens: a cross-sectional study comparing menu, usage and lunch order characteristics.

OBJECTIVE: To assess differences between traditional paper bag ordering and online ordering from primary school canteens in terms of menu, usage and lunch order characteristics. DESIGN: A cross-sectional study. SETTING: New South Wales (NSW) primary schools that offered both paper bag and online canteen ordering. PARTICIPANTS: Students (aged 5-12 years) with a lunch order on the day of the observation. RESULTS: Across the six school canteens, 59-90 % of all available items were listed on both the online and paper menus, with no significant differences in the nutritional quality ('Everyday'/'Occasional') or nutritional content (kJ/saturated fat/sugar/sodium) of menu items. In total, 387 student lunch orders were placed, containing 776 menu items. Most orders (68 %) were placed online. There were no significant differences between order modality in the quantity of items ordered or the cost of orders, or the nutritional quality of orders based on the classification system of the NSW Healthy School Canteen Strategy ('Everyday'/'Occasional'). However, nutritional analysis revealed that paper bag orders contained 222 fewer kJ than online orders (P = 0·001), 0·65 g less saturated fat (P = 0·04) and 4·7 g less sugar (P < 0·001). CONCLUSIONS: Online canteens are commonly used to order canteen lunches for primary school children. This is the first study to investigate differences between traditional paper bag ordering and online ordering in this setting. Given the rapid increase in the use of online ordering systems in schools and other food settings and their potential to deliver public health nutrition interventions, additional research is warranted to further investigate differences in ordering modalities.

Stakeholder Generated Ideas for Alternative School Food Provision Models in Australia Using the Nominal Group Technique.

Good nutrition is important for children's learning, growth, and development, yet food intake during school hours does not align with recommendations. In Australia, most school children currently bring a packed lunch from home, but what if there was a different way? This project aimed to engage a diverse range of stakeholders to (1) generate, refine and prioritize ideas for novel models of food provision to Australian children within school hours, and (2) to determine and rank the potential barriers and facilitators to changing the school food provision system. This study used nominal group technique virtual workshops-three idea generation workshops (n = 21 participants) and one consensus workshop (n = 11 participants). School lunch prepared onsite was the top ranked food provision model option based on impact and achievability. Potential barriers (n = 26) and facilitators (n = 28) to changing the school food system were generated. The top ranked barrier and facilitator related to government support. This study highlights that there is an opportunity to explore partnerships and utilize existing skills and infrastructure to introduce a universal school-provided lunch model in Australia. The next steps should focus on building the business case capturing the social value of investing in school lunches, including considering parent-paid and subsidized options.

[An analysis of policy interventions regarding school lunch programs and their role in the healthy nutrition of children in Córdoba, Argentina]. / Análisis de la intervención de la política de comedores escolares y el rol en la nutrición saludable de niños y niñas de Córdoba, Argentina.

The aim of this article is to analyze school lunch programs and their role in the healthy nutrition of children in Córdoba, Argentina from 2013 to 2018. A descriptive, cross-sectional study was conducted that included a sample of 10 schools in 2013 and 10 different schools in 2018. A survey of school lunch programs and 24-hour nutrition reminders was carried out with 341 children. The nutritional value of school lunch programs decreased over the study period, particularly among schools in contexts of greater social vulnerability. Significant reductions in average calcium and energy intake were also observed. Indicators of chronic malnutrition, overweight, and excess calcium and vitamin A and C intakes worsened among children attending school lunch programs. Regarding the association between school lunch program attendance and low height for age/risk of low height for age, the odds ratio was not statistically significant. We argue for the necessity of promoting policies that seek urgent improvements in child nutritional indicators from a rights-based perspective.

El objetivo fue analizar la intervención de la política de comedores escolares y el rol en la nutrición saludable de niños y niñas de Córdoba, Argentina en los años 2013 y 2018. Estudio descriptivo y trasversal. La muestra incluyó diez escuelas en 2013 y diez diferentes en 2018. Se realizó un relevamiento de comedores escolares y recordatorios alimentarios 24 hs a 341 niñas y niños. Los aportes nutricionales de los comedores escolares descendieron entre ambos periodos, en especial, en las escuelas insertas en contexto de mayor vulnerabilidad. También se observó una reducción significativa de la ingesta media de calcio y energía total. En las niñas y los niños asistentes a los comedores escolares se encontraron indicadores de desnutrición crónica, exceso de peso e ingestas de calcio, vitamina A y C deficitarios. En la asociación entre la asistencia al comedor escolar y el indicador baja talla/riesgo de baja talla, el odds ratio no fue estadísticamente significativa. Resulta necesario impulsar una política que busque de manera urgente mejoras de los indicadores de nutrición infantil, considerando un enfoque de derechos.

Análisis de la intervención de la política de comedores escolares y el rol en la nutrición saludable de niños y niñas de Córdoba, Argentina / An analysis of policy interventions regarding school lunch programs and their role in the healthy nutrition of children in Córdoba, Argentina

RESUMEN El objetivo fue analizar la intervención de la política de comedores escolares y el rol en la nutrición saludable de niños y niñas de Córdoba, Argentina en los años 2013 y 2018. Estudio descriptivo y trasversal. La muestra incluyó diez escuelas en 2013 y diez diferentes en 2018. Se realizó un relevamiento de comedores escolares y recordatorios alimentarios 24 hs a 341 niñas y niños. Los aportes nutricionales de los comedores escolares descendieron entre ambos periodos, en especial, en las escuelas insertas en contexto de mayor vulnerabilidad. También se observó una reducción significativa de la ingesta media de calcio y energía total. En las niñas y los niños asistentes a los comedores escolares se encontraron indicadores de desnutrición crónica, exceso de peso e ingestas de calcio, vitamina A y C deficitarios. En la asociación entre la asistencia al comedor escolar y el indicador baja talla/riesgo de baja talla, el odds ratio no fue estadísticamente significativa. Resulta necesario impulsar una política que busque de manera urgente mejoras de los indicadores de nutrición infantil, considerando un enfoque de derechos.

ABSTRACT The aim of this article is to analyze school lunch programs and their role in the healthy nutrition of children in Córdoba, Argentina from 2013 to 2018. A descriptive, cross-sectional study was conducted that included a sample of 10 schools in 2013 and 10 different schools in 2018. A survey of school lunch programs and 24-hour nutrition reminders was carried out with 341 children. The nutritional value of school lunch programs decreased over the study period, particularly among schools in contexts of greater social vulnerability. Significant reductions in average calcium and energy intake were also observed. Indicators of chronic malnutrition, overweight, and excess calcium and vitamin A and C intakes worsened among children attending school lunch programs. Regarding the association between school lunch program attendance and low height for age/risk of low height for age, the odds ratio was not statistically significant. We argue for the necessity of promoting policies that seek urgent improvements in child nutritional indicators from a rights-based perspective.

Medical certification reduces the number of children requiring allergen elimination diets for school lunches.

BACKGROUND: Following the increase in the number of children with food allergies, support systems are now required for school lunches, but a large-scale factual investigation has not been carried out. OBJECTIVE: We evaluated the features of elimination diet due to food allergy and the support system in kindergartens and schools. METHODS: A prefecture-based questionnaire survey regarding measures for food allergies in school lunches of all kindergartens, public elementary schools, and public junior high schools (631 facilities) was conducted in Oita Prefecture, Japan. RESULTS: The recovery rate of the questionnaire was 99.5%, which included 106,008 students in total. A total of 1,562 children (1.5%) required elimination diets. The rate of children on elimination diets in kindergartens and elementary/junior high schools that required medical certification by a physician was 1.2% (324 among 27,761 children), which was significantly lower than the 1.8% of children (1,227 among 68,576 students) on elimination diets at the request of guardians without the need for medical certification (p < 0.0001). A total of 43.9% of the kindergartens and schools said that they would contact guardians if symptoms were observed after accidental ingestion, while a low 8.1% stated that they provided support to children themselves, including the administration of adrenaline auto-injectors. CONCLUSION: Medical certification reduces the number of children requiring elimination diets, but it has not been adequately implemented. Furthermore, waiting to contact guardians after symptoms are observed may lead to the delayed treatment of anaphylaxis. Cooperation between physicians and teachers is desired to avoid the overdiagnosis and undertreatment of children with food allergies.

Energy and nutrient intakes of Swedish children in relation to consumption of and habits associated with school lunch.

AIMS: School lunches are provided free in Sweden, although some children choose not to eat school lunch. The aim of this study was to analyse Swedish children's total energy and nutrient intakes on weekdays by the frequency of school lunch consumption and to analyse energy and nutrient intakes from school lunches by sex. Factors associated with children's school lunch habits were also studied. METHODS: Children in grades 2 and 5 ( n=1905) completed a food diary (school lunch data available for 1840 children) and the mean energy and nutrient intakes per day and per school lunch were calculated. The children also completed questions on the frequency of school lunch consumption and school lunch habits. Logistic regression was used to assess factors associated with school lunch habits. RESULTS: Children who reported eating school lunch every day had significantly higher energy and absolute nutrient intakes than children reporting eating school lunch less than five times a week, but not standardized for energy. Boys had significantly higher energy and absolute nutrient intakes from school lunches than girls, but not standardized for energy. Younger children and children who liked school lunches had higher odds of eating school lunch every day. Children in grade 5, those with a foreign background and those disliking school lunches had higher odds of omitting the main lunch component. CONCLUSIONS: Regular school lunch consumption was associated with a higher total intake for most nutrients, but not a better nutrient density. School lunch habits were associated with age, ethnic background and liking school lunches.

Medical certification reduces the number of children requiring allergen elimination diets for school lunches

BACKGROUND: Following the increase in the number of children with food allergies, support systems are now required for school lunches, but a large-scale factual investigation has not been carried out. OBJECTIVE: We evaluated the features of elimination diet due to food allergy and the support system in kindergartens and schools. METHODS: A prefecture-based questionnaire survey regarding measures for food allergies in school lunches of all kindergartens, public elementary schools, and public junior high schools (631 facilities) was conducted in Oita Prefecture, Japan. RESULTS: The recovery rate of the questionnaire was 99.5%, which included 106,008 students in total. A total of 1,562 children (1.5%) required elimination diets. The rate of children on elimination diets in kindergartens and elementary/junior high schools that required medical certification by a physician was 1.2% (324 among 27,761 children), which was significantly lower than the 1.8% of children (1,227 among 68,576 students) on elimination diets at the request of guardians without the need for medical certification (p < 0.0001). A total of 43.9% of the kindergartens and schools said that they would contact guardians if symptoms were observed after accidental ingestion, while a low 8.1% stated that they provided support to children themselves, including the administration of adrenaline auto-injectors. CONCLUSION: Medical certification reduces the number of children requiring elimination diets, but it has not been adequately implemented. Furthermore, waiting to contact guardians after symptoms are observed may lead to the delayed treatment of anaphylaxis. Cooperation between physicians and teachers is desired to avoid the overdiagnosis and undertreatment of children with food allergies.

The contribution of school meals to energy and nutrient intake of Swedish children in relation to dietary guidelines.

BACKGROUND: In Sweden, school meals are served free of charge and Swedish law states that school meals must be nutritious. Nevertheless, data on children's energy and nutrient intake from school meals are scarce. OBJECTIVE: The aim was to describe the contribution of school meals to Swedish children's nutrient and energy intake during weekdays and compare this to the reference values based on the Nordic Nutrition Recommendations (NNR), which have been adopted as the official Swedish recommendations. DESIGN: A cross-sectional food consumption survey was performed on 1,840 Swedish children attending Grade 2 (mean age 8.6) and Grade 5 (mean age 11.7). The children's nutrient and energy intake was compared to the reference values based on the NNR. RESULTS: The mean intake from school meals of energy, carbohydrates, dietary fiber, polyunsaturated fatty acids (PUFA), and vitamins D and E did not reach the reference values and the intake of saturated fatty acids (SFA) and sodium exceeded the reference values in both age groups (significant differences, all p≤0.001). Additionally, the pupils in Grade 5 did not reach the reference values for folate, potassium, calcium, magnesium, iron, selenium, and zinc (significant differences, all p≤0.001). Standardized for energy, dietary fiber, PUFA, and vitamins D and E did not reach the reference values, whereas the reference values for SFA and sodium were exceeded in both age groups (significant differences, all p≤0.001). CONCLUSIONS: The study pointed to some central nutrients in need of improvement as regards school meals in Sweden, namely the quality of fat, dietary fiber, sodium, vitamin D, and iron. Some of these results may be attributed to the children not reporting eating the recommended number of calories, the children omitting some components of the meal, or underreporting, as a consequence of which the reference values for several nutrients were not met.

Society of Behavioral Medicine (SBM) position statement: SBM supports retaining healthy school lunch policies.

Schools are recognized as venues for population-based health promotion and chronic disease prevention initiatives targeting children, and the school food environment is a central component. The Healthy, Hunger-Free Kids Act of 2010 utilized research-based findings and expert recommendations to significantly improve school lunch standards in the kindergarten to twelfth grade (K-12) setting to enhance the nutritional intake and ultimately the health of children. The new guidelines include increasing the availability of whole grains, fruits, and vegetables; requiring children to select a fruit or vegetable daily; and restricting serving sizes. There is currently no evidence that the revised standards have increased school lunch plate waste. However, there is evidence that children are consuming more healthful foods. The Society of Behavioral Medicine (SBM) supports retaining current school lunch standards set by the Healthy, Hunger-Free Kids Act of 2010. SBM also supports increasing the evidence-based by evaluating the implementation and impact of the school lunch revisions.

Japanese and American public health approaches to preventing population weight gain: A role for paternalism?

Controlling population weight gain is a major concern for industrialized nations because of associated health risks. Although Japan is experiencing rising prevalence of obesity and overweight, historically they have had and continue to maintain a low prevalence relative to other developed countries. Therefore, Japan provides an interesting case study of strategies to curb population weight gain. In this paper we explore Japanese approaches to obesity and diet through observational and ethnographic interviews conducted between June 2009 and September 2013. Nineteen interviews were conducted at four companies and three schools in Tokyo, as well as at a central Tokyo community health care center and school lunch distribution center. Interviewees included physicians, a Ministry of Health bureaucrat, human resources managers, welfare nurses employed by health insurance organizations, school nurses (also government employees), school nutritionists, and a school counselor. We highlight the role of culture and social norms in encouraging healthful behavior in Japan, focusing on the Ministry of Health, Labor, and Welfare's metabolic syndrome screening program (implemented in 2005) and the Japanese national school lunch program. The Japanese government prescribes optimal body metrics for all Japanese citizens and relies on institutions such as schools and health insurance organizations that are in some instances closely affiliated with the workplace to carry out education. Japan's socio-cultural approach leads us reflect on the cultural and social conditions that make different policy prescriptions more politically feasible and potentially effective. It also provokes us to question whether limited behavioral modifications and "nudging" can lead to broader change in an environment like the United States where there are fewer broadly shared socio-cultural norms regarding acceptable health behavior.

Effect of obesity on the Satisfaction with School Lunches and the Behavior of Leaving Lunch Food in Elementary School Children / 대한지역사회영양학회지

The purpose of this study was to investigate the effects of obesity on the satisfaction with school lunches and school lunch leftovers of elementary school children in the Kyeonggi area. The study was carried out on 235 children(male : 111, female :124) in December of 2000. The results are summarized as follows. A Rohrer index was used to define obesity. The proportions of severe underweight, underweight, normal, overweight, and obese were 0.9%, 16.6%, 57.9%,17.0%, and 7.7% respectively. For the data analysis, the subjects were divided into 3 groups : an underweight group(Rohrer index 109 including severe underweight), a normal group(Rohrer index 110-140), and an obese group(Rohrer index 141 including overweight). With regard to the satisfaction with school lunches, the proportions of children who were satisfied, neutral, and unsatisfied were 27.2%, 59.6% and 13.2% respectively. The proportion of the satisfaction with school lunches was significantly higher in the male group than in the female group(p<0.05), and the proportion of the dissatisfaction with school lunches was significantly increased with obesity index(p<0.05). The largest proportion of children who were satisfied with school lunches answered they felt hungry(56.3%) and the food tasted good(42.2%). Children sho were not satisfied with school lunches answered that the food was not tasty(93.5%), they did not have ant appetite(9.7%), and others. The children not finishing school lunches(leftovers) occasionally or always were 47.7% of the subjects. The behavior of leaving lunch foods was not significantly related to the gender or the frequency of eating snacks, wile it was positively related with dissatisfaction with school lunches(p<0.01), obesity index(p<0.05), and the decreased frequency of eating meals per day(p<0.01). The reasons of school lunch leftovers were food dislikes(67.9%), excess of quantity(39.3%), tastelessness(31.3%), poor appetite(13.4%), and other. The children eating meals twice, 3 times, and 4 times per day were 18.7%, 74.9%, and 6.4% of the subjects respectively. The proportions of the obese and the satisfaction with school lunches were not changed significantly according to the frequency of eating meals, while the proportion of children leaving school lunches was significantly higher in the group of eating meals twice per day than in the other groups(p<0.01). The frequency of eating snacks was not related to the obesity index, the proportion of school lunch leftovers, or the frequency of eating meals, while the proportion of satisfaction with school lunches was significantly higher in the group of eating snacks 1-2 times per day than in the other groups(p<0.01). In conclusion, it is necessary to have children enjoy school lunches with efforts to improve the food's taste in the school food services and to reexamine the serving sizes for the children, in addition to the nutrition education for the children to eat a variety of foods.