Abstract
Background: School food standards (SFS) are a legal requirement for state-funded schools in England and are designed to promote healthy eating in pupils. However, state-funded academies/free schools established between 2010 and 2014 are exempt from this legislation. To complement the SFS, the government launched the School Food Plan (SFP) in 2013, which outlines voluntary actions that schools can take to support healthy eating and increase school meal uptake. There has been little evaluation of the SFS and SFP in secondary schools.
Objectives: To compare implementation and costs of the SFS and SFP, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the SFS legislation.
Methods: An observational, multiple methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11-15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools.
The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed SFS/SFP implementation and costs using researcher observation, document analysis, and surveys with staff/governors, school, and pupils. Dietary intake and dental outcomes were measured online by 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups. We used multilevel analyses to explore variation in pupil outcomes across the SFS-mandated and SFS-non-mandated school groups. Data were analysed using the Framework approach.
Results: Thirty-six schools (13 SFS-mandated, 23 SFS-non-mandated), 2,453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of SFS and implemented 41% of SFP actions, with no differences across SFS-mandated/non-mandated schools. There was a wide variation in annual costs of the SFS and SFP reported by schools (mean of £195 per pupil).
Pupils in SFS-mandated schools had lower lunch intakes of free sugar than in SFS non-mandated schools (adjusted mean difference=-2.78 g, 95% CI: -4.66 g, -0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the SFS-mandated group had lower fruit and vegetable intake at all timepoints, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24-hours. There were no differences in dental outcomes between the two groups.
Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing SFS compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value-for-money and taste, and disliked the lunchtime experience. Little time was afforded to healthy eating education within the curriculum.
Limitations: There were high levels of missing data for some study elements, including assessment of some SFP actions and cost data.
Conclusions: In the secondary school context, the current SFS are difficult to comply with and the SFP has not achieved the desired outcomes. We found no evidence to show that SFS legislation has positively influenced nutritional intake.
Future research: We need to develop healthy secondary school food provision models that meet pupils’ preferences, and better understand how to situate the food and healthy eating agenda in secondary schools.
Funding and study registration: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in XXX Journal; Vol. XX, No. XX. See the NIHR Journals Library website for further project information. Trial registration number ISRCTN 68757496 (registered 17th October 2019).
Objectives: To compare implementation and costs of the SFS and SFP, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the SFS legislation.
Methods: An observational, multiple methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11-15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools.
The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed SFS/SFP implementation and costs using researcher observation, document analysis, and surveys with staff/governors, school, and pupils. Dietary intake and dental outcomes were measured online by 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups. We used multilevel analyses to explore variation in pupil outcomes across the SFS-mandated and SFS-non-mandated school groups. Data were analysed using the Framework approach.
Results: Thirty-six schools (13 SFS-mandated, 23 SFS-non-mandated), 2,453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of SFS and implemented 41% of SFP actions, with no differences across SFS-mandated/non-mandated schools. There was a wide variation in annual costs of the SFS and SFP reported by schools (mean of £195 per pupil).
Pupils in SFS-mandated schools had lower lunch intakes of free sugar than in SFS non-mandated schools (adjusted mean difference=-2.78 g, 95% CI: -4.66 g, -0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the SFS-mandated group had lower fruit and vegetable intake at all timepoints, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24-hours. There were no differences in dental outcomes between the two groups.
Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing SFS compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value-for-money and taste, and disliked the lunchtime experience. Little time was afforded to healthy eating education within the curriculum.
Limitations: There were high levels of missing data for some study elements, including assessment of some SFP actions and cost data.
Conclusions: In the secondary school context, the current SFS are difficult to comply with and the SFP has not achieved the desired outcomes. We found no evidence to show that SFS legislation has positively influenced nutritional intake.
Future research: We need to develop healthy secondary school food provision models that meet pupils’ preferences, and better understand how to situate the food and healthy eating agenda in secondary schools.
Funding and study registration: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in XXX Journal; Vol. XX, No. XX. See the NIHR Journals Library website for further project information. Trial registration number ISRCTN 68757496 (registered 17th October 2019).
| Original language | English |
|---|---|
| Journal | NIHR Journals Library |
| Publication status | Accepted/In press - 16 Oct 2023 |
Bibliographical note
Not yet published as of 22/04/2024.Keywords
- dietary intake
- free sugars
- dental health
- school food
- adolescents
- food standards
