Relationships between social spending and childhood obesity in OECD countries: an ecological study.

OBJECTIVES: The burden of childhood obesity is clustered among children in low-socioeconomic groups. Social spending on children-public welfare expenditure on families and education-may curb childhood obesity by reducing socioeconomic disadvantages. The objective of this study was to examine the relationship between social spending on children and childhood obesity across the Organisation for Economic Cooperation and Development (OECD) countries. DESIGN: Ecological study. SETTING: Data on social spending on children were obtained from the OECD Social Expenditure Database and the OECD educational finance indicators dataset during 2000-2015. Data on childhood obesity were obtained from the NCD Risk Factor Collaboration database. PARTICIPANTS: Aggregated statistics on obesity among children aged 5-19 years, estimated for OECD 35 countries based on the measured height and weight on 31.5 million children. OUTCOME MEASURES: Country-level prevalence of obesity among children aged 5-19 years. RESULTS: In cross-sectional analyses in 2015, social spending on children was inversely associated with the prevalence of childhood obesity after adjusting for potential confounders (the gross domestic product per capita, unemployment rate, poverty rate, percentage of children aged <20 years and prevalence of childhood obesity in 2000). In addition, when we focused on changes from 2000 to 2015, an average annual increase of US$100 in social spending per child was associated with a decrease in childhood obesity by 0.6 percentage points for girls (p=0.007) and 0.7 percentage points for boys (p=0.04) between 2000 and 2015, after adjusting for the potential confounders. The dimensions of social spending that contributed to these associations between the changes in social spending on children and childhood obesity were early childhood education and care (ECEC) and school education for girls and ECEC for boys. CONCLUSION: Countries that increase social spending on children tend to experience smaller increases in childhood obesity.

A repeated cross-sectional survey assessing changes in diet and nutrient quality of English primary school children's packed lunches between 2006 and 2016.

OBJECTIVE: Mandatory school meal standards were introduced in 2006 in England; however, no legislation exists for packed lunches. This study analyses provision of foods and nutrients in packed lunches in 2016 to highlight differences in diet and nutrient quality since 2006. DESIGN: Two cross-sectional surveys of children's packed lunches were conducted in 2006 and 2016. Data were analysed using multilevel regression models taking into account the clustering of children within primary schools. SETTING: Data were collected from 1148 children who attended 76 schools across England in 2006 and from 323 children attending 18 schools across England in 2016. PARTICIPANTS: Children were included if they regularly ate a packed lunch prepared at home (approximately half of children take a packed lunch to school) and were aged 8-9 years (in year 4), for both surveys. OUTCOME MEASURES: Data collected in both years included provision of weight and type of food, nutrients and proportion of lunches meeting individual and combined school meal standards. RESULTS: Frequency of provision and portion size of some food types changed substantially between surveys. Frequency of provision of confectionery in lunches reduced by 9.9% (95% CI -20.0 to 0.2%), sweetened drinks reduced by 14.4% (95% CI -24.8 to -4.0%), and cakes and biscuits not containing chocolate increased by 9.6% (95% CI 3.0 to 16.3%). Vegetable provision in lunches remained low. Substantial changes were seen in the percentage of lunches meeting some nutrient standards: non-milk extrinsic sugars (19%, 95% CI 10 to 29%), vitamin A (-8%, 95% CI -12 to -4%), vitamin C (-35%, 95% CI -42 to -28%) and zinc (-8%, 95% CI -14 to -1%). CONCLUSIONS: Packed lunches remain low quality with few meeting standards set for school meals. Provision of sugars has reduced due to reductions in provision and portion size of sugary drinks and packaged sweet foods; however, provision of some nutrients has worsened.

Dietary fibre and cardiovascular health: a review of current evidence and policy.

Dietary fibre comprises many different, mainly plant-based, compounds that are not fully digested in the human gut. Insoluble fibres include cellulose, hemi-celluloses and lignin and soluble fibres include pectins, ß-glucan and hydro-colloids. In the UK, the daily recommended amount has increased to 30 g but only 13 % of men and 4 % of women meet this recommendation. Currently the mean intake for adults is 21 g for men and 17 g for women. There is a wealth of epidemiological evidence based on systematic reviews of trials and cohorts to support the higher fibre recommendation. This includes evidence of reductions in the risk for CVD (both heart disease and stroke) and lower risk of type 2 diabetes, lower blood pressure, lower LDL-cholesterol, as well as some cancers. Beneficial effects of fibre operate via a diverse range of mechanisms throughout the digestive system including the mouth, stomach and small and large intestine; some of which are still not completely understood. The updated recommendation for fibre is a long way from a typical British diet and requires several daily portions of fruit and vegetables and wholegrain foods. Improving dietary fibre intakes will require a variety of actions and policies from stakeholders; however, there is currently more of a focus on reducing sugar than increasing fibre. In order to increase the number of adults meeting the fibre recommendation, social marketing and labelling of high-fibre foods are warranted as well as reformulation and wider availability of wholegrain versions of popular foods.

Preschool and School Meal Policies: An Overview of What We Know about Regulation, Implementation, and Impact on Diet in the UK, Sweden, and Australia.

School meals make significant contributions to healthy dietary behaviour, at a time when eating habits and food preferences are being formed. We provide an overview of the approaches to the provision, regulation, and improvement of preschool and primary school meals in the UK, Sweden, and Australia, three countries which vary in their degree of centralisation and regulation of school meals. Sweden has a centralised approach; all children receive free meals, and a pedagogical approach to meals is encouraged. Legislation demands that meals are nutritious. The UK system is varied and decentralised. Meals in most primary schools are regulated by food-based standards, but preschool-specific meal standards only exist in Scotland. The UK uses food groups (starchy foods, fruit and vegetables, proteins and dairy) in a healthy plate approach. Australian States and Territories all employ guidelines for school canteen food, predominantly using a "traffic light" approach outlining recommended and discouraged foods; however, most children bring food from home and are not covered by this guidance. The preschool standards state that food provided should be nutritious. We find that action is often lacking in the preschool years, and suggest that consistent policies, strong incentives for compliance, systematic monitoring, and an acknowledgement of the broader school eating environment (including home provided food) would be beneficial.

Sugars and health: a review of current evidence and future policy.

The automation of the process of extracting sugars in the 1900s reduced cost and increased availability of sugars leading to a dramatic rise in consumption, which reached a peak in the 1970s. There are different definitions for sugars not naturally available in foods, and free sugars is the term used by WHO. The epidemiological evidence of the associations between sugars and obesity and type 2 diabetes mellitus is fairly strong and consistent, particularly for sugar sweetened drinks in adults. The Department of Health in the UK and many other countries have recently updated their recommendations for free sugars as a result of this scientific evidence. In the UK the recommended amount of free sugars is currently 5 % of energy (reduced from 10 %), which is difficult to meet and very different from current British dietary patterns. Reducing intakes of free sugars is a challenge and will necessitate a range of different actions and policies. Public Health England has put forward eight suggestions but the four most likely to improve dietary behaviour based on available evidence are social marketing, reduction of marketing of high sugar foods and drinks to children, reformulation and reductions in portion size and a sugar excise tax. Any action taken needs to be evaluated to check inequalities are not widened. The new childhood obesity strategy has incorporated some but not all of these strategies and may not go far enough. It is likely that government policies alone will not be sufficient and a change in the food culture is necessary to see real progress.

Evaluation of the impact of school gardening interventions on children's knowledge of and attitudes towards fruit and vegetables. A cluster randomised controlled trial.

Involvement of children in gardening has the potential to increase liking of fruit and vegetables (FV) and consequently, intake, but research results are mixed. School gardening led by external specialists such as the Royal Horticultural Society (RHS) could have more impact than teacher-led gardening on children's knowledge of, and attitudes towards, FV. Data from a cluster randomised controlled trial were used to compare a RHS-led school gardening intervention with a teacher-led gardening intervention amongst 7-10 year olds in 21 London schools. A short questionnaire was developed and used to identify children's knowledge and attitudes towards FV consumption before the garden intervention and 18 months afterwards. Results from multilevel regression models, both unadjusted and adjusted for baseline responses and socio-demographic factors, were reported. Attitudes to FV intake were compared between groups. Change in FV knowledge was used to predict change in FV consumption assessed using 24-hour food diaries. In comparison with the RHS-led group (n = 373), teacher-led children (n = 404) were more likely to agree they ate lots of fruit (p < 0.009) and tried new fruits (p = 0.045), but RHS-led gardening was associated with a greater increase in the total number of vegetables recognised (p = 0.031). No other differences in improvements in attitudes, or associations between change in FV recognition and intake were found. In relation to improvements in children's recognition and attitudes towards eating FV, this trial produced limited evidence that gardening activity packages led by external specialists (RHS-led) provide additional benefits over those led by teachers trained by the RHS. Indeed, the latter were potentially more effective.