The impact of, and views on, school food intervention and policy in young people aged 11–18 years in Europe: A mixed methods systematic review

Abstract

Summary Understanding the social and environmental influencers of eating behaviours has the potential to improve health outcomes for young people. This review aims to explore the effectiveness of school nutrition interventions and the perceptions of young people experiencing a nutrition focused intervention or change in school food policy. A comprehensive systematic search identified studies published between 1 December 2007 to 20 February 2020. Twenty‐seven studies were included: 22 quantitative studies of nutrition related outcomes and five qualitative studies reporting views and perceptions of young people (combined sample of 22,138 participants, mean ages 12–18 years). The primary outcome was nutrition knowledge/dietary behaviours, with secondary outcomes exploring body mass index (BMI) and wellbeing. Due to the heterogeneity of studies, a narrative results description is presented. The findings demonstrate that school nutrition programmes can be effective in reducing sugar, sugar sweetened beverages (SSB) and saturated fat and increasing fruit and vegetable (FV) intake. The lived experiences of young people in a school context provide valuable insights that should be considered in the development of effective school food policy and interventions. This review affirms the significant role that schools can play in supporting good nutrition in all young people and provides opportunities to inform the school food agenda.

School-Based Nutrition Interventions in Children Aged 6 to 18 Years: An Umbrella Review of Systematic Reviews

“…Characteristics of the 13 included reviews overall (i.e., all primary studies reported in the review irrespective of study design and other study characteristics) are described in Table 1. Of these, two reviews synthesised results for nutrition education interventions [26,44], three for food environment interventions interventions [24,25,45], one for HPS nutrition interventions [22], and seven synthesised other types of nutrition interventions [20,21,23,[28][29][30]46]. Included reviews were published between 2011 and 2021.…”

“…The number of primary studies included within reviews ranged from 10 to 100. Of the 13 reviews, three reviews restricted the inclusion criteria for country, and one review each included only primary studies from developed countries [44], the United Kingdom (UK) and Europe [29], and middle-income countries [30]. Eleven reviews focused on interventions conducted solely in school-based settings [20][21][22]24,25,[28][29][30][44][45][46], and two reviews included interventions conducted across multiple settings (e.g., school, home, community), where results for the school setting were reported separately [23,26].…”

“…Of the 13 reviews, three reviews restricted the inclusion criteria for country, and one review each included only primary studies from developed countries [44], the United Kingdom (UK) and Europe [29], and middle-income countries [30]. Eleven reviews focused on interventions conducted solely in school-based settings [20][21][22]24,25,[28][29][30][44][45][46], and two reviews included interventions conducted across multiple settings (e.g., school, home, community), where results for the school setting were reported separately [23,26]. Of the 13 reviews, seven reviews only included RCTs (individual or cluster) as part of their eligibility criteria [20,22,23,26,28,30,44], whereas six included a range of study designs (e.g., RCTs and non-randomised trials), where results for the RCTs were reported separately [21,24,25,[45][46][47].…”

“…For example, a recently published umbrella review of school-based nutrition programs by the WHO synthesised any type of review (including scoping and literature reviews) that synthesised studies of any design (e.g., RCTs and non-randomised trials), implementing any intervention for diet-related outcomes up to 2019 [19]. This review did not, however, report the results of RCTs independently, and a number of systematic reviews have been published since [25,[28][29][30]. An umbrella review of high-quality systematic reviews restricted to RCTs as the gold standard of effectiveness is required to update the evidence base regarding school-based nutrition interventions to inform current policy and practice.…”

‘Pizza every day – why?’: A survey to evaluate the impact of COVID‐19 guidelines on secondary school food provision in the UK

“…Incorporating whole systems approaches and multilevel interventions in schools to promote healthy eating has been associated with increased healthy food choices (Townsend & Foster, 2013). Prioritising healthy food provision and nutrition education as a consistent part of the school agenda can have a positive impact on children and young people's wellbeing, learning and academic performance (Rose et al, 2021; WHO, 2006), whilst addressing food insecurity (Defeyter & Mann, 2020).…”