How Healthy Are Our Schools?

This article about nutrition in UK schools was first published in the NHD Magazine May 2017 supplement.

Creating a healthy school environment which encourages nutritious food choices has numerous benefits for children; it can support general health and growth, improve dental health, reduce the risk of gaining excess weight, foster longer term healthy habits, improve energy and mood levels and also optimise learning. Schools have opportune contact with families and the ability to signpost them to healthy lifestyle information. Schools can also help to reduce the gap of food poverty and health inequality by providing access to healthy food during the school day and by running initiatives such as breakfast clubs; which have been associated with improved educational attainment, better school attendance and improved general health¹.

School Food Standards

In the UK school meals are free for children from reception to year 2 and also for those who receive certain income support or tax credits as outlined in the Education Act 1996². In England the government run “School Fruit and Vegetable Scheme” provides 4-6 year old pupils in state-funded schools with a free daily piece of fruit or vegetable outside of lunchtime, although it is not mandatory for schools to participate in this scheme³. Some pupils are also eligible to receive up to 250ml of free or subsidised milk products each school day via the school milk subsidy scheme⁴.  

English local authority schools, academies which opened before 2010 and certain free schools must adhere to the “School Food Standards” outlined in the updated “School Food Plan” which was implemented in England in 2015, and all remaining schools can sign up to these standards voluntarily^3,5. These standards aim to improve the nutrition and dietary habits of school aged children with an emphasis on creating a positive environment for meals and educating children about sustainable healthy choices and the importance of a varied and balanced diet; this is supported by Ofsted recognised award schemes to encourage active participation in this scheme such as “The Children’s Food Trust Excellence Award” and “The Food for Life Partnership”⁵.

The School Food Standards work alongside the “Government Buying Standards for Food and Catering Services” and applies to all food provided in schools up to 6pm including: breakfast clubs, snacks at mid-morning break, school lunches, after school clubs, vending machines and tuck-shops⁵. However, they do not apply to parties, fundraising events, cookery sessions or celebrations of religious/cultural occasions⁴. These standards also provide specific guidance on appropriate portion sizes for different age groups, how to manage food allergies and intolerances and signposting to resources such as: example menus, recipes, checklists, information on interpreting food labels and cooking tips for school caterers⁵.

Specifically, the School Food Plan recommends^3,5:  

• Plenty of fruit, vegetables and unrefined starchy foods
• Some meat, fish, eggs, beans, milk and dairy (and dairy-free alternatives) daily
• Limiting foods and drinks high in fat, sugar and salt
• Increasing the iron, zinc and calcium content of school menus
• Free drinking water to be available at all times
• Hot lunches to be available when possible to encourage at least one hot meal per day for pupils
• Facilities to be available for those who bring in packed lunches
• Detailed guidance for school lunch standards (as outlined below)

Picture reference available here.

Tackling Childhood Obesity in Schools

Obesity is an increasingly important issue to be aware of in a school setting; figures from 2014 – 2015 in England reported that more than a fifth of children in reception were overweight or obese (22.6% for boys, 21.2% for girls), and roughly a third of children in year six were overweight or obese (34.9% boys, 31.5% girls)⁶. This is worrying as childhood obesity is related to numerous health risks as outlined in table 1.

In order to tackle the issue of increasing childhood obesity levels, in 2016 the World Health Organisation (WHO) released its “Report of the Commission on Ending Childhood Obesity” which highlights “health, nutrition and physical activity for school aged children” as one of it’s core areas for improvement⁹.

Specific recommendations within this report include:

• Promoting healthy school environments
• Health and nutrition literacy as a core part of the curriculum
• Physical activity in schools including good quality PE
• Develop healthy standards for food and drink provided in schools
• Cookery classes for pupil and their parents or guardians
• Regularly monitoring children’s growth at school or the family’s GP to identify those who need extra support or input
• Banning the marketing of unhealthy food and drinks in areas where children and adolescents gather including schools, in line with Resolution 63.14 from the World Health Assembly¹⁰ as school aged children, and particularly adolescents, are vulnerable to marketing strategies of unhealthy options

In response to this the UK government also released its “Childhood Obesity: A Plan for Action” in 2016¹. Working with schools is described as a vital part of this plan with 4 of the 14 main areas targeted to improve are directly linked to health promotion within school:

• Encouraging an hour of physical activity per day for all children:
  Research shows that physical activity levels start to reduce from the age that children start school, which is worrying as physical activity has numerous benefits such as improved: fitness, healthier bones and joints, mood, sleep quality and academic performance1,10. Therefore all primary school children should receive at least 30 minutes of physical activity within school time via activity at break times, extra-curricular clubs, PE, active classes or other physical activity opportunities; and the remaining 30 minutes should occur outside of school. The proceeds from the soft drinks industry levy is to provide extra funding for promoting physical activity in schools. This will be taken into account during Ofsted inspections and the new healthy schools rating scheme. Public Health England will be devising further advice for the academic year of 2017- 2018 about how schools can utilise all relevant resources to create a healthier lifestyle for its pupils.
• Improving sport and physical activity programmes in schools:
  From September 2017 all primary schools in England should have access to good quality local and national sport and physical activity programmes which may include strategies to promote walking and cycling to school. These programmes will be co-ordinated by county sports partnerships, national governing bodies of sport, the Youth Sport Trust and other relevant providers.
• Creating a healthy rating scheme for primary schools
  A voluntary Ofsted recognised scheme for UK primary schools will be introduced in September 2017 to encourage healthier eating and more physical activity, which will include an annual competition to celebrate schools with the best projects for promoting health and tackling obesity. In 2017 Ofsted also plans to produce a best practice report to provide guidance for schools on healthy eating, physical activity and reducing obesity levels.
• Making school food healthier
  The Department for Education in the UK plans to update the current School Food Standards to include the most recent evidence-based guidelines on nutrition (for example the updated recommendations on carbohydrates and sugar). The Secretary of State for Education will also run a campaign to encourage all schools to adhere commit to the School Food Standards, as some academies and free schools are not currently required to follow this scheme³. Also, 10 million pounds per year from the soft drinks levy has been proposed to set up more healthy breakfast clubs in the UK.

Conclusion

Schools clearly play an important role in influencing the nutrition, health and wellbeing of children. Hopefully the recent emphasis on this in school specific guidelines which aim to tackle the global health issue of childhood obesity will result in improved compliance with school food standards in order to optimise the health of all pupils and set them up for lifelong healthy habits.  

References

1. HM government (2016) “Childhood Obesity – A Plan for Action”
2. The Education Act 1996
3. Department for Education (2016) “School Food in England” 
4. Rural Payments Agency “Calculate your school milk subsidy” (updated 2017)
5. School Food Standards (2015) 
6. Health and Social Care Information Centre (2015) “Health Survey for England 2014”
7. Public Health England (2017) “ Health risks of childhood obesity” 
8. Childhood Obesity Foundation “What are the Complications of Childhood Obesity?” 
9. World Health Organisation (2016) “Report of the Commission on Ending Childhood Obesity” 
10. World Health Assembly (2010) “63.14 on the Marketing of Food and Non-alcoholic Beverages to Children”
11. The Requirements for School Food Regulations 2014