Nutritional dimensions of school meals

Dr Wendy Wrieden and Professor AS Anderson

Diet and Health

Scotland has a poor health record with very high rates of cancer, coronary heart disease and stroke; diseases that are linked to factors such as smoking, excessive drinking and poor diet

(Morrison et al. 1997). There is evidence that dietary patterns of adulthood are learned in childhood (Krebs-Smith et al. 1995) and that poor diet in children may be linked to disease in later life (Department of Health 1994). "The usual Scottish diet consumed by children is also that which would now be expected to be conducive to the development of adult chronic disease" (Scotland's Health: A challenge to us all. The Scottish Diet. p44)

Health and well-being during the childhood years can also be linked to diet. For example, it is well established that dental problems such as decay and erosion are a result of frequent sugar intake and consumption of carbonated drinks. Experience of tooth decay in 5 year olds in Scotland is considerably higher than for the United Kingdom as a whole (Pitts 2000). In terms of general well-being (to which nutrition undoubtedly contributes), recent reports from the west of Scotland have shown that only 47 per cent of eleven year olds reported their health as good (Sweeting & West 1998).

Current Dietary Intake

The National Diet and Nutrition Survey of 4-18 year olds found that three-quarters of the Scottish children did not eat green leafy vegetables during the 7 day recording period (compared with approximately a half of English children); only a third (33 per cent) ate salad vegetables and a quarter ate citrus fruit (Gregory et aI. 2000). Scottish children eat around two portions per day of fruit and vegetables compared to the recommended five portions (Bolton-Smith 1991; Wrieden 1996; Scottish Executive Health Department 2001).

Research also shows a marked social divide in food choices and that although fruit consumption has increased in the more affluent sectors of society it has shown little change in the least affluent (Wrieden 2001b). Consumption of foods targeted by the Scottish Diet Action Plan (oil- rich fish, bread and breakfast cereals) was less frequent in the lower income groups Joint Health Surveys Unit 2000).

School Food

In England, the Department of Education and Employment (1997) recommended that the nutritional guidelines for school meals set out by the Caroline Walker Trust (Sharp 1992) be used as a benchmark to review the progress of school meal contracts. The guidelines are set for ingredients, which aid a good quality diet and have an important role in the maintenance of health. In Scotland, guidance is given in the Scottish Diet Action Plan Model Nutritional Guidelines (The Scottish Office 1996) for pre-fives and primary school children (no specific information is given for secondary schools).

Recent research in Scotland, however has shown that school lunches currently provide a poor nutrient profile (Wrieden et ai. 2000; Armstrong et ai. 2001) when compared with recommended standards set by the Department of Education and Employment (1997). This is particularly worrying for children receiving free lunches. Many families depend on children getting their main meal at school and it is well established that the lunchtime school meal is an important contributor to overall food intake for many children (Ruxton et al. 1996). In Dundee and Glasgow a substantial number of schools have over 50 per cent of children eligible for free school meals.

It is worth noting that whilst school lunches are under the spotlight the issues of food in schools (vending machines, tuck shops and breakfast clubs) must be viewed as a whole with the impact of sponsorship and advertising carefully considered. Realistic nutritional standards for school meals in Scotland are needed and parents should be made aware of the nutritional value of the school meal offered to their children.

Putting into practice

We know that children do not always eat what they are given, particularly in primary schools where there might be a choice of only two set meals. Pupils can have the required food put on their plate but the days when teachers forced children to eat what they did not want in the first place have now gone and would be considered undesirable in most circles. The situation could arise where caterers prepare and serve for example, cabbage, and then have to throw it away. This is not good economics. What is needed is some kind of involvement from the customers, i.e., the children. In Sweden and Finland, where a free school meal system has been in place for many years we have been told that a variety of fruits, vegetables and breads are available at meals so that pupils are able to choose what suits them best. Providing just one vegetable or one fruit a day is not enough. A selection of favourites should be served so that the majority of children find something they like.

Children also need food education of a practical nature. It is unlikely, for example, that children will suddenly start eating vegetables just because they are available. However, work done with primary school children where they were involved in fruit and vegetable tasting sessions shows such lessons are a key element in encouraging change in consumption. There is also evidence from secondary schools that it is possible to change the balance of what is eaten by restricting choice to a certain degree. For example, the removal of confectionery from a cash cafeteria led to increased uptake of fruit. Children need to have suitable meals available and be encouraged to eat them. Suitable provision needs to go hand in hand with education.

In addition the quality of the food served needs to be monitored. Serving large baked potatoes or rolls to small children is likely to lead to waste. Similarly the provision of underdone potatoes or overcooked disco loured green vegetables is unlikely to encourage consumption. The foods supplied for the school meals also need to have strict quality specifications to avoid the use of, for example, low quality meat (implicated in some recent food scares) or high salt soup mixes.

School caterers in Scotland are limited by budgets and have to balance what children will eat with what they should eat. However, despite sterling efforts by some catering contractors there are no legislative guidelines for them to follow and they are more likely to have to put other factors first. For example a recent report (Scottish Consumer Council 2001) suggests that caterers responsibilities are about food provision, helping pupils stay in school, giving clients an enjoyable experience and being cost effective as well as offering "food that is as nutritious as possible" - no mean feat for the most dedicated caterer.

The need to set the standards in law

The universal provision of free school meals will only be effective as a means of improving the health of Scotland's children if these meals are of a consistent standard that meets current dietary guidelines for health. It is, in most cases, the only meal in a child's day that the government has the ability to prescribe without being accused of limiting freedom of choice. If done carefully and with full consultation it has the potential to transform the diet of our young people. However if standards are not set the free school meal is open to market and economic considerations alone. This could lead to a low cost, low quality, low nutritional value meal which would be a backward step from the current efforts of many caterers to produce healthy meals that children will enjoy. The resources need to be available for realistically priced meals that meet minimum legal standards with resources for monitoring and enforcing. This is the only way to ensure that all children get the same provision. Local authorities and caterers can not be left to set the standards themselves, as there will be different priorities according to the resources available and the whims of local politicians and councils. The long-term health of our children should be a priority and thus needs to be part of a national strategy to improve diet and health.

References

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Bolton-Smith, C (1991) "The Chief Scientist reports... The diets of Scottish men and women in relation to nutritional recommendations for health." Health Bulletin 49: 264-272.

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(b) Wrieden, W., Connaghan, J.P. and Tunstall-Pedoe, H. (2001). "Ten-year trends in dietary intake by deprivation index in an area with a high coronary heart disease mortality." Journal of Epidemiology and Community Health 55 (Supplement 1): A33.

Wrieden, W., Bell, A. and Main, R (2000). "Nutritional value of different types of school meals." Proceedings of the Nutrition Society 59: 73A.

(a) Wrieden, W., Bell, A. and Longbottom, P.J. (2001). "Food and nutrient content of meals chosen by secondary pupils under two different types of school meals provision." Proceedings of the Nutrition Society 60(OCB): 206A.

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