BackgroundLunch is an important part of a healthy diet, which is essential for the development, growth and academic performance of school-aged children. Currently there is an increasing number of Dutch primary schoolchildren who are transitioning from eating lunch at home to school. There is limited knowledge about the current quality of the lunches consumed by primary schoolchildren in the Netherlands and whether there are any differences between lunches consumed at home or at school. To investigate differences in content and quality of lunches consumed by Dutch primary schoolchildren at home and at school.MethodsCross-sectional study among 363 Dutch primary schoolchildren aged 4–12 years based on the first two years of the 2012–2016 Dutch National Food Consumption Survey. Demographic characteristics were obtained through a questionnaire. Diet was assessed with two non-consecutive 24-h dietary recalls. Quality of lunches was assessed on their nutritional quality whether they fitted the nutritional guidelines. ‘Nonparametric tests were used to examine the content and quality of the lunches between place of consumption and parental educational position.ResultsThe most consumed lunch products among primary schoolchildren were bread, dairy products and sugar-sweetened beverages. Fruit and vegetable consumption was very low. Consumption of milk and other dairy products was higher among children who eat lunch at home than children who eat lunch at school (p < 0.01). Consumption of sugar-sweetened beverages was higher among children who eat lunch at school than children who eat lunch at home (p < 0.01), and at school a higher proportion of the drinks did not fit within the Dutch dietary recommendations (p < 0.01).ConclusionsThe current content of the lunches consumed by Dutch primary schoolchildren leaves room for improvement, especially regarding fruit and vegetables. The statistically significantly higher consumption of sugar-sweetened beverages and lower consumption of milk and dairy products at school vs. home is worrisome, as currently more children in the Netherlands are transitioning to having lunch at school.

Background Dietitians play an important role in the intervention and prevention of being overweight and obesity. More and more blended care interventions are being implemented. The present study aimed to evaluate the delivery by Dutch dietitians of a multicomponent, evidence‐based weight‐loss programme ( SMART size), including counselling for relapse prevention. The aim of this qualitative study was to identify facilitators and barriers to the delivery of SMART size. Methods Nine semi‐structured interviews were conducted with 10 dietitians who participated in a larger implementation study. Each interview was recorded and transcribed verbatim. Determinants of theory of implementation, including characteristics of the user, the innovation, organisational context and setting, and innovation strategy guided interviews and analysis. Data were coded and analysed using the framework approach. Results According to dietitians, the SMART size intervention had a positive influence on patients. The main implementation facilitators were the availability of implementation materials, such as a manual, training in relapse prevention and social support from other dietitians. The main barriers to implementation were organisation and financial reimbursement of cooking classes, the belief that patients need more individual counselling in the starting phase, and the unsuitability for people with low levels of health literacy. Conclusions Most dietitians considered that implementation of the SMART size intervention consisting of e‐health, written information and cooking classes and face‐to‐face counselling is challenging but feasible. Further development of the SMART size intervention and implementation tools is needed to lower experienced barriers. It is also recommended that a version of the intervention to be developed that is suitable for patients with lower levels of health literacy.

Background Since there is a shift from eating lunch at home to eating lunch at primary schools in the Netherlands, providing a school lunch may be an important opportunity to improve the diet quality of Dutch children. Therefore, the aim of this Healthy School Lunch project is to encourage healthy eating behavior of children at primary schools by offering a healthy school lunch, based on the guidelines for a healthy diet. In this study, two research questions will be addressed. The first research question is: What and how much do children consume from a self-served school lunch and how do they evaluate the lunch? The second research question is: Do children compensate healthier school lunches by eating less healthy outside school hours? The purpose of this paper is to report the rationale and study design of this study. Methods In the Healthy School Lunch project children in grades 5–8 (aged 8–12 years) of three primary schools in the Netherlands will receive a healthy school lunch for a 6-month period. To answer research question 1, lunch consumption data will be collected at baseline and again at 3- and 6-months. This will be measured with lunch photos and questionnaires among children. To answer the second research question, a quasi-experimental, pre-test post-test intervention-comparison group design (3 intervention schools and 3 comparison schools) will be carried out. Potential compensation effects will be measured with a single brief questionnaire among parents at the three intervention and three comparison schools at month 6 of the lunch period. The school lunch will also be evaluated by parents (discussion groups) and teachers and support staff (brief questionnaires). Discussion Results of this study will provide valuable information to influence future school lunch interventions and policies. Trial registration This study is registered at the Netherlands trial register (NTR): trialregister.nl, Trial NL7402 (NTR7618), registered retrospectively at 2018-11-13.

The SMARTsize intervention embeds an evidence-based portion control intervention in regular dietetic care. This intervention was evaluated to explore (1) which patients participated, (2) the implementation process, and (3) the outcomes of the intervention. The intervention was evaluated with an observational study design including measures at baseline, and three, six, and nine months after the start of the program. Data concerning the process (participation, dose delivered, dose received, satisfaction) and the outcomes (self-efficacy, intention, portion control strategies, and Body Mass Index (BMI) were collected with forms and questionnaires filled out by dietitians and patients. Descriptive analyses, comparison analyses, and cluster analyses were performed. Patients were mainly obese, moderately to highly educated women of Dutch ethnicity. Use of the intervention components varied from 50% to 100% and satisfaction with the SMARTsize intervention was sufficient to good (grades 7.2–8.0). Statistically significant (p < 0.001) improvements were observed for self-efficacy (+0.5), portion control strategies (+0.7), and BMI (−2.2 kg/m2), with no significant differences between patients with or without counselling. Three clusters of patients with different levels of success were identified. To conclude, implementing an evidence-based portion control intervention in real-life dietetic practice is feasible and likely to result in weight loss.

Kinderen in de basisschoolleeftijd eten te weinig groente, fruit en volkorenproducten. Melk en yoghurt worden steeds vaker vervangen door alternatieven met veel suiker [1]. Dit zien we ook terug in de lunchtrommels op basisscholen: er zijn grote verschillen in de samenstelling en kwaliteit van broodtrommels tussen kinderen op school en tussen scholen onderling [2-4]. De invoering van het continurooster op steeds meer basisscholen maakt de introductie van een verzorgde schoollunch mogelijk. Er zijn echter nog veel vragen over een verzorgde schoollunch in Nederland. Een daarvan is: wat is de voorkeur van ouders? En daaraan gekoppeld de vragen: wat kost dat en wat zijn ouders bereid ervoor te betalen? Dit artikel geeft een beeld van de voorkeuren van ouders met betrekking tot een verzorgde schoollunch en de kosten ervan, en van de betalingsbereidheid van ouders. Eten op school In het onderzoek 'Eten op school' doen Wageningen University & Research en de Vrije Universiteit Amsterdam met verschillende partners onderzoek naar een verzorgde schoollunch op Nederlandse basisscholen (www.etenopschool.org). Via gesprekken gevoerd met