The Health Education Trust

School Meals Study main findings:

Payment system
This study showed that the majority of schools operated a cash cafeteria system, although almost a quarter of schools have adopted a smart card system for meal payments.

Free meals
Nationally 14% of children are entitled to free school meals, but only 80% of these free meals are being consumed2, meaning that those at greatest risk are missing out. When consumed free school meals make a greater contribute to the daily intake of fat, dietary fibre, calcium, vitamin C and folate than for those who pay for their food3.

77% of children who received free school meals had to show some sort of identification so other pupils knew who they were, the smart card system prevented this from occurring. This is one a reason why all free meal entitlements are not taken up.

Smart cards
Over two thirds of schools who used the smart card system allowed parents to view their child’s intake, and over a quarter of schools had a point system for choosing healthier options, which could be converted into vouchers or gifts. Pupils attending these schools did choose healthier options – low fat starches, soft drinks and low fat main meals, but in this study, there was no effect on the intakes of chips or high fat meals.

Breakfast and break time
Most schools offered food and beverages during morning break and some offered a breakfast service. 50% offered high fat processed foods e.g. burgers, hotdogs, pies and pasties. Nearly half of these schools offered fruit during the morning break. Offering food at breakfast and morning break is beneficial by providing children with energy and nutrients to maximise their learning throughout the day, especially for those who skip breakfast. These results suggest that this potential is yet to be fully realised.

Cooking practices
All schools used vegetable oil for frying, with most frying their chips, rather than using oven cooked chips that are lower in fat. Most used oven cooking for breaded fish, meat products and potatoes (not chips). Most schools provided chips that were likely to retain less fat – thick, straight and medium cut.

Most caterers used spreading fats on sandwiches, with only a small number using low or reduced fat spreads. This is a key way to reduce the overall fat content of a sandwich and an easy change for caterers to make. Most caterers used semi-skimmed or skimmed milk or milk powder in cooking.

A quarter of schools were adding butter to cooked vegetables and potatoes, a standard catering practice that adds unnecessary saturated fat and calories to otherwise low energy foods! Similarly, over 50% of catering staff regularly added salt during cooking, even to vegetables, which like butter is an unnecessary addition. However, it may be necessary to look at other ways to ensure the vegetables on offer are sufficiently appealing to encourage uptake by children. 15% of pupils had no access to table salt, some schools provided reduced sodium varieties, and some actually charged for salt sachets. Other schools provided salt cellars at the cash register, or children had to ask for salt.

A third of schools had policies to make healthier options cheaper, although this study suggests that this did not affect food uptake. Sometimes meal deals – burger, chips and fizzy drinks, offset the small reduction in the price of a jacket potato.

Contracts/catering guidelines
Many schools could not supply formal documents that define the quality of their school catering and the steps in place for meals to meet the National Nutritional Standards. The school catering specifications tended to be non-specific so they could be interpreted in many different ways, some stated the importance of healthy eating, but failed to mention how this could be delivered to the children or how standards could be monitored.

Poor references, if any, were made to the nutrient content of meals, and few listed requirements to reduce the fat, sugar and salt content and increase the fibre content of a meal. When nutrient standards were set there tended to be no guidelines on how to achieve these.

Probably the most well known national guideline for fruit and vegetable consumption is ‘5 a day’, however no document stated the required portion size (80g) in order to achieve this. Nearly 50% of schools were involved in fruit and vegetable promotion over the previous 12 months, this helped to increase the availability of fruit juices.

The majority of catering staff were unable to identify any type of nutrition standards. Only a small number of staff had been involved in nutrition training over the previous 12 months, staff that had been trained were more likely to regularly serve low fat main dishes and sandwiches.

Where a reduction in fat (with quantities specified) was mandatory within the contract specifications then fewer high fat meals were available. This shows that contracts do have an influence on what is offered in school canteens and the authors quite rightly point out that more detailed and specific contracts may help schools to ensure their meal provision matches nutrition guidelines.

The report recommends that Contract specifications should be improved making them more specific, contain quantities, be monitored and easier to follow, they should ensure that staff are regularly trained on healthy eating topics and stipulate the need to follow guidelines. A combination of this should help improve the quality of food offered to children. Uptake by the children is the next hurdle.

Food availability
Although nutrition standards were not provided in most (83%) of the caterers contracts a large proportion of the schools met the standards for every meal at the beginning of service, but the quality reduced over the lunch period, so children who enter the dinning room towards the end of lunchtime e.g. after a lunchtime activity, may be consuming an inferior meal. This was usually due to the reduction in the availability of starchy foods. The provision of water also reduced over the lunchtime period, although not to the same extent.

Some caterers said that they provided chips and fast foods to cater for the children’s preferences and as a way to prevent them from leaving the school grounds at lunchtime.

It appears from these results that those schools who considered the opinions of their pupils and governors, seemed to serve more chips and beans as well as slightly more fruit, and were less likely to offer bread, sandwiches and starches that are not cooked in oil.

Vending machines
Schools selling snacks and drinks at lunchtime in the dining room offered more sweets and chocolate, sandwiches, desserts and lower fat dishes such as curry and rice, beef stew, chilli con carne and roast lamb, than the schools that had no vending facilities – no explanation was discovered for this finding.

What do pupils actually eat?
A wide variety of foods were regularly available, however uptake did not match availability especially for the ‘healthier’ options.

High fat and high calorie items were offered on most days, along with fruit, vegetables and baked beans. However the uptake of fruits and vegetables did not match their availability; only 3% of children chose fruit and 6% chose vegetables. The favourite food choices were high fat main meals and chips and other potatoes cooked in oil.

Children who spent more money tended to consume more calories (click to graph below), although this did not effect the overall nutritional quality of their overall intake (i.e. percent calorie contribution from fat, saturated fat, protein and carbohydrate).

Pupils who spent £1.49 or less chose bread and low fat starches, chips, and crisps and savoury snacks more often and soft drinks less often compared with those who spent £1.50 or more. Pupils who received free school meals chose desserts and milk more often than pupils who paid for their meals.

The reports overall conclusions are:-

• Most schools meal provision met the National Nutrition Standards at the beginning of meal service, but less than half did by the end of the meal service.
• Neither the range of foods made available, nor the food selections made by pupils complied with the Balance of Good Health.
• None of the set meals on offer met all of the Caroline Walker Trust guidelines for measuring nutrient content of school meals.
• The methods used by schools in this study to encourage healthier food choices had little effect on children’s food choices.
• More than half of pupils chose high fat main meals, chips, potatoes cooked in oil and soft drinks. Fat provided 41% of energy and saturated fat 14%, both of which are way above targets – 35% and 11% respectively. The salt content per meal was about 2.4g, the target is less than 2g.
• Although caterers were providing some healthier meals, children were opting for the large variety of ‘unhealthy’ high fat foods that were also on offer.

The authors conclude that the National Nutritional Standards for school meals, coupled with the present model of food service, failed to encourage children to select combinations of foods that were likely to contribute to a healthy diet. It is one thing to provide the right nutritional mix of foods, but far more needs to be considered if we are to encourage our children to change their eating habits and select the healthier choices. According to this report, current catering practices, current contract specifications, and any current school involvement in nutrition-related health programs appear to be having little positive influence on the overall food environment in schools and the (largely unhealthy) food choices of pupils.

Report Recommendations:-

This report clearly shows that the current Nutrition Standards alone are insufficient to guarantee children eat a healthy school lunch and two key points are made by the authors:

1. We should not expect school children to make healthy food choices at lunchtime if they are being offered chips and burgers or their equivalent most days of the week. Adults do not make healthy choices, as is evident from the latest National Diet and Nutrition Survey – why should we expect school children to behave differently? They are even less well equipped than adults in terms of knowledge and understanding of the health consequences of poor dietary choices.
2. No amount of exhortation or affordable bribery is going to encourage the majority of children to make healthy food choices.

The study recommends therefore that “The most likely way to ensure healthy eating in schools is to constrain choice to healthy options, manipulate recipes, use modern presentation techniques with which pupils can identify (e.g. the “fast food” approach, vending machines with healthier options), and encouragement through reward.”

A number of key recommendations have been made by the authors, based on current evidence:-

• National Nutritional Standards for school food: these must be compulsory in all schools, and should include both food-based and nutrition based guidelines. The report recommends that new guidelines be developed and take a ‘whole-school approach’.
• Lunch choices: children must be choosing meals that conform to the balance of good health. (See BOGH page)
• Choice restriction: the authors recommend that pupils choice should be restricted to a range of healthier options that, over a week, provide a healthy balance (e.g. restricting the number of days that chips are offered, as opposed to a complete ban).
• Thorough records: adequate nutrition specifications should be documented and set in every school. These guidelines should be continually monitored.
• Improve knowledge: ensure that head cooks/catering managers are trained and fully aware of current standards. Provide resources to compliment this training. It was clear from this report that many head cooks and catering managers did not know the current nutrition standards.

Further suggestions that the authors recommend adopting:- Pupils should not be allowed out of the premises at lunchtimes to avoid the ‘competition’ with local fast food outlets during the school day. Smart cards are recommended since they have to potential to ‘assist’ the process of improving healthier meal uptake in several ways: children who receive free meals are not recognised; pupils food choices can be monitored by schools, parents and at national level; the balance of the meal selected can be instantly verified. A Whole School Approach will ensure children are given consistent messages about diet and health throughout their school life. Monitoring new standards should be fundamental and become a part of the annual school report.