RESEARCH. School Meals in Primary Schools in England. M Nelson, J Nicholas, S Suleiman, O Davies, G Prior, L Hall, S Wreford, J Poulter

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1 RESEARCH School Meals in Primary Schools in England M Nelson, J Nicholas, S Suleiman, O Davies, G Prior, L Hall, S Wreford, J Poulter King s College London TNS Social Research Nutrition Works! Research Report RR753

2 Research Report No 753 School Meals in Primary Schools in England M Nelson, J Nicholas, S Suleiman, O Davies, G Prior, L Hall, S Wreford, J Poulter King s College London TNS Social Research Nutrition Works! The views expressed in this report are the authors and do not necessarily reflect those of the Department for Education and Skills or the Food Standards Agency King s College London ISBN

3 Table of contents EXECUTIVE SUMMARY...5 INTRODUCTION...5 OVERALL FINDINGS...5 DETAILED FINDINGS...6 METHODS...8 DISCUSSION AND CONCLUSIONS...9 LOOKING AHEAD INTRODUCTION BACKGROUND AIMS AND OBJECTIVES PROJECT OVERVIEW NATIONAL NUTRITIONAL STANDARDS: HISTORICAL PERSPECTIVE CAROLINE WALKER TRUST GUIDELINES FOR SCHOOL MEALS OVERVIEW OF SCHOOL MEALS SERVICES SAMPLING, RECRUITMENT, DATA COLLECTION AND CODING SAMPLING AND RECRUITMENT DEVELOPMENT OF DATA COLLECTION TOOLS AND PILOTING DATA COLLECTION DATA PREPARATION LIMITATIONS DATA CHECKING STATISTICAL ANALYSIS THE CATERING SERVICE, COOKING PRACTICES AND THE EATING ENVIRONMENT THE SCHOOL MEALS SERVICE THE EATING ENVIRONMENT COOKING PRACTICES HEALTHY EATING ACTIVITY CONSULTATION STAFF TRAINING SCHOOL PARTICIPATION IN SPECIAL INITIATIVES CONTRACTS AND SPECIFICATIONS RESPONSE RATE CONTENT OF DOCUMENTATION GOOD PRACTICE CONCLUSION FOOD PROVISION MEETING THE NATIONAL NUTRITIONAL STANDARDS INVENTORY ANALYSIS FOOD PROVISION AND THE NUTRITIONAL STANDARDS SET MEALS AND THE CWT GUIDELINES FOOD CHOICES OF PRIMARY SCHOOL PUPILS AT LUNCHTIME FOOD CHOICES OF PRIMARY SCHOOL CHILDREN EATING HABITS WHAT FACTORS WERE ASSOCIATED WITH FOOD CHOICES? NUTRIENT CONTENT OF SCHOOL MEALS AND THE CWT GUIDELINES DISCUSSION AND CONCLUSIONS SURVEY REPRESENTATIVENESS AND QUALITY OF DATA THE CATERING SERVICE, COOKING PRACTICES AND EATING ENVIRONMENT ANALYSIS OF SPECIFICATIONS NATIONAL NUTRITIONAL STANDARDS INVENTORY AND TRAY CHECK OVERALL CONCLUSIONS LOOKING AHEAD...92

4 9 ACKNOWLEDGEMENTS REFERENCES APPENDICES (SEE SEPARATE VOLUME)...96 APPENDIX A1. SCHOOL CATERER TELEPHONE INTERVIEW...96 APPENDIX A2. SEMI-STRUCTURED TELEPHONE INTERVIEW WITH BURSAR/HEAD/LA...96 APPENDIX A3. EATING ENVIRONMENT ASSESSMENT...96 APPENDIX A4. PORTION WEIGHTS BOOKLET...96 APPENDIX A5. MEAL RECORD BOOKLET...96 APPENDIX A6. SCHOOL MEAL CHECKLIST...96 APPENDIX A7. SPECIFICATIONS ANALYSIS TOOL (PART 1 QUANT)...96 APPENDIX A8. SPECIFICATIONS ANALYSIS TOOL (PART 2 - QUAL)...96 APPENDIX A9. FOOD INVENTORY...96 APPENDIX A10. VISIBILITY QUESTIONNAIRE...96 APPENDIX A11. TRAY CHECK...96 APPENDIX A12. MAJOR CHANGES IN SCHOOL MEALS PROVISION POST APPENDIX A13. THE 9 COMPULSORY ELEMENTS OF THE NATIONAL NUTRITIONAL STANDARDS...96 APPENDIX A14. CLASSIFICATION OF FOODS IN 19 FOOD GROUPS...96 APPENDIX A15. A WORKED EXAMPLE FOR THE ANALYSIS OF FOOD PROVISION...96 APPENDIX A16. COMPARISON OF NUTRIENT INTAKES WITH 2005 CWT GUIDELINES...96 APPENDIX A17. GUIDELINES FOR GOOD PRACTICE IN WRITING SPECIFICATIONS...96 List of tables Table 1.1. The national nutritional compulsory standards: At least one item from each food group must be available every day Table 1.2. Additional recommendations for school lunches...17 Table 1.3. Summary of Caroline Walker Trust nutritional guidelines for school meals #...18 Table 1.4. Organisation and types of documentation defining the school meals service...19 Table 1.5. Types of contractual agreements for provision of school meals services Table 1.6. Types of subsidies operating between schools/las and providers...20 Table 2.1. Profile of issued sample, eligible and participating schools compared with all primary schools in England Table 2.2. Response by GOR, school stage and school type and urban/rural locality: primary schools in England...24 Table 2.3. Multiple deprivation score (MDS) for the issued sample, ineligible, refused, and participating primary schools in England Table 2.4. Main reasons given for non participation in 87 primary schools in England...25 Table 2.5. Data collection tools, main purpose and level of collection of data in 151 primary schools in England...26 Table 2.6. Distribution by school year, age and gender of pupils participating in the study in 151 primary schools in England Table 3.1. Provision of the school meals service in 151 primary schools in England...37 Table 3.2. Delegation of funding in 151 primary schools in England Table 3.3. Type of contract or service level agreement (SLA) in 151 primary schools in England Table 3.4 Number and percent of schools with various types of service in 151 primary schools in England Table 3.5. Number and percent of schools with two or less, or three or more choices of protein, vegetable, starch, dessert and drink options in 143* primary schools in England...38 Table 3.6. Number and percent of school meal and free school meal uptake in 150* primary schools in England...39 Table 3.7 How children paid for their school meals in 151 primary schools in England...40 Table 3.8. How pupils entered the dining room in 151 primary schools in England...41 Table 3.9. Assessment by interviewers of the eating environment in 151 primary schools in England Table Number and percent of schools where children were able to purchase food in the dining room at lunchtime or other times of the day in 151 primary schools in England...43 Table Number and percent of schools where children were able to purchase food not in the dining room at lunchtime or other times of the day in 151 primary schools in England...43 Table Usual methods of cooking fish and chicken/turkey products in 148* primary schools in England...43 Table Usual methods of cooking potato products in 148* primary schools in England...44

5 Table Number and percent of school caterers who used salt in cooking in 148* primary schools in England...45 Table Examples of different types of healthy eating activities reported by caterers in 93 primary schools in England...46 Table Examples of different types of fruit and vegetable promotions as reported in 80 primary schools in England...46 Table 3.17 Number and percent of schools reporting participation in initiatives in 151 primary schools in England...47 Table Number and percent of schools reporting participation in Food in Schools programmes in 151 primary schools in England Table 4.1. Specifications related to healthy eating within contractual documentation obtained for 112 primary schools in England Table 5.1. Number and percent of school lunch services failing to meet one or more compulsory standards on one or more days at the beginning and end of service in 146 primary schools in England Table 5.2. Number and percent of school lunch services that failed to meet each standard or component of a standard every day at the beginning and end of service in 146 primary schools in England Table 5.3. Relationship between type of catering provider and whether the school lunch service met all the compulsory standards...63 Table 5.4. Number and percent of school caterers who were able to recall each nutritional standard or component of a standard in 103 primary schools in England...63 Table 5.5. Estimated frequency of formal monitoring of the lunchtime service in 100 primary schools...64 Table 5.6 Infant, junior and either average portion sizes in 149* primary schools in England compared to those recommended...65 Table 5.7. Foods and food groups on offer in 151 primary schools in England, as a percentage of all foods or food groups offered, and number of items offered on average per day in each food group across all schools...66 Table 5.8. Number and percent of 151 primary schools in England offering foods from different food groups, according to number of days offered per week, and mean number of days on which food from food group was offered...67 Table 5.9. Number of days per week on which specific food groups were offered in 112 primary schools in England according to whether the specification was mentioned, was deemed mandatory or was not mentioned in the contract/service level agreement...71 Table Summary of factors associated with the provision of healthier and less healthy foods in 151 primary schools in England Table 6.1. Foods and food groups* chosen by pupils in 151 primary schools in England, as a percentage of all foods or food groups chosen, and number of items chosen on average per pupil in each food group across all schools...74 Table 6.2. Energy and nutrient content and percent energy from macronutrients of school meals as chosen and as eaten by infant pupils in 151 primary schools in England, together with the CWT (1992) guidelines and percent of meals meeting the guidelines...79 Table 6.3. Energy and nutrient content and percent energy from macronutrients of school meals as chosen and as eaten by junior pupils in 151 primary schools in England, CWT (1992) guidelines, and percent of meals meeting the guidelines Table 6.4. Percent of 7058 primary school pupils whose meals met CWT guidelines Table 6.5. Energy and nutrient content and percent energy from macronutrients of 6 441* primary school meals as eaten in 148 primary schools in England, by meal price or in receipt of a free school meal Table 6.6. Percent of pupils whose meals* met CWT guidelines for specific nutrients: all pupils and those who met six or more guidelines, by infant and junior Table 6.7. Predictors of high CWT score in pupils in 151 primary schools in England, based on stepwise multiple regression analysis...86

6 List of figures Figure 1. The Balance of Good Health Model Figure 2. Foods offered in 151 primary schools in terms of the Balance of Good Health...69 Figure 3. Percent of pupils choosing specified foods in 151 primary schools in England...75 Figure 4. Comparison of food groups offered with food groups chosen by pupils in 151 primary schools in England...75 Figure 5. Foods offered to and chosen by pupils in 151 primary schools in relation to the Balance of Good Health...76 Figure 6. Percent of 7058 English primary school pupils whose intakes from school lunch provided a given percentage of the RNI for vitamin A Figure 7. Percent of 7058 English primary school pupils whose intakes from school lunch provided a given percentage of the RNI for iron Figure 8. Food choice profiles of infants and juniors attending 151 primary schools in England, according to whether or not their food choice met 6 or more of the CWT guidelines...85 Figure 9. Food choice profiles of pupils attending 151 primary schools in England, according to whether or not their food choices met the six most discriminating CWT guidelines (folate, non-starch polysaccharides, percent energy from fat, 30% of energy EAR, calcium, vitamin C)...86 The views expressed in this report are those of the authors and do not necessarily reflect those of the Department for Education and Skills or the Food Standards Agency.

7 Executive summary Introduction Following concern about the quality of children s diets and the contribution of school meals, statutory National Nutritional Standards were reintroduced in April These standards set out the frequency with which school caterers must provide items from the main food groups (meat, fish and alternative sources of protein, starchy foods, milk and dairy foods, fruit and vegetables). They apply to all maintained schools in England. The Department for Education and Skills (DfES) and the Food Standards Agency (FSA) commissioned a survey to assess compliance with the standards, to assess whether the food provided met the guidelines set by the Caroline Walker Trust (CWT), 7 to measure food consumption in primary school pupils, and to compare nutrient intakes to the CWT guidelines. This report presents the findings from a nationally representative sample of 151 primary schools in England which provided information about catering practice and food provision at lunchtime, and information on the food selections of primary school pupils age 4-12 years. This research study was commissioned before the start of the school food transformation programme. This report was preceded by School Meals in Secondary Schools in England, published in Overall findings The study had 3 main aims: To assess whether the food provided by the school caterer met the statutory 2001 National Nutritional Standards, set out in the regulations and associated guidance, for all the children throughout the service period. To assess whether the food provided met the guidelines set out by the Caroline Walker Trust in To identify the food consumption and nutrient intakes of primary school children from school meals, and to compare these to the Caroline Walker Trust guidelines. In 146 of the 151 schools, it was possible to collect data on food provision over 5 consecutive days. These data were needed to address the first aim. Of these 146 schools, 34 (23%) met all of the compulsory standards at the beginning of service over 5 days. This fell to 25 schools (17%) by the end of service. The standards most commonly failed were starchy food cooked in oil or fat not to be served more than 3 times a week (failed by 53%), and fruit based desserts to be served twice a week (failed by 33%). The additional recommendation to provide drinking water was met by 140 schools (96%) at the beginning of service and by 139 schools (95%) at the end of service. The additional recommendation to provide drinking milk was met by 39 schools (27%) at the beginning of service, falling to 31 schools (21%) by the end of service. With regard to the second aim, it was not possible to evaluate food provision in relation to the Caroline Walker Trust guidelines because meals were served so as to allow pupils choices within meal components (main dish, vegetable, starchy food, dessert), rather than as fixed items comprising a set meal

8 Regarding the third aim, pupils food choices did not conform to the Balance of Good Health. 8 They chose too many foods containing fat and foods and drinks containing sugar, and too few fruits and vegetables and milk and dairy products. The majority of pupils chose foods that met the CWT guidelines for energy (70%), protein (97%) and vitamin C (67%). About half of pupils chose meals that met the guidelines for non-starch polysaccharides (NSP), vitamin A, folate, calcium, and for percent energy from fat, carbohydrate and nonmilk extrinsic sugars (NMES). 45% met the guideline for percent energy from saturated fat, and 24% met the guideline for iron. The number of pupils whose consumption met the CWT guidelines was substantially lower than the number whose food choices met the guidelines because pupils did not eat all of the food chosen. While more than half met the guidelines for energy (57%), protein (89%), and vitamin C (55%), only about half met the guidelines for percent energy from fat, carbohydrate and NMES, and fewer still met the guidelines for percent energy from saturated fat, vitamin A (39%), calcium (37%), folate (32%), NSP (30%) and iron (15%). Detailed findings The study had objectives designed to achieve the main aims and, in addition, to identify factors related to catering provision and the school environment that were associated with the provision and consumption of healthier foods. The main findings are described below. Catering service, cooking practices and the eating environment The catering service was usually provided by a Direct Service Organisation (DSO)/Local Authority (LA) provider (60%), or a contractor appointed by the LA (21%). 7% of schools appointed a contractor directly and in 3% of schools the service was provided in-house. The most common type of contract was fixed cost/fixed price (81%), followed by profit and loss/breakeven (11%). The majority of schools (92%) offered a prepaid cafeteria style service with choice. Schools reported that on average, 42% of pupils took a school meal, with uptake ranging from 11 to 99%. 17% of all pupils had applied for free school meals, and mean uptake was 85%. Overall, 34% of all meals served were free school meals. The average costs for paid meals and free school meals were 1.48 for infants and 1.49 for juniors. Most schools oven baked rather than fried chicken/turkey, fish and potato products, with the exception of chips which were deep fried in 90% of schools serving them. 96% of schools used vegetable oil for frying, and those schools using spread on bread or sandwiches used mainly sunflower (46%) or soft margarine (31%). Only 11% used low fat spread. 34% of schools used no salt at all in cooking, while 10% added salt to dishes and when cooking potatoes, rice, pasta and vegetables. Salt was not available to pupils in 91% of schools. 28% of caterers had completed some type of training in healthy eating/healthy cooking in the last 12 months. School participation in the Healthy Schools programme and the School Fruit and Vegetable Scheme (69% and 87% of schools respectively), training of lunchtime supervisory staff in the promotion of healthy eating, healthier products offered in tuckshops, and the display of materials to promote healthy eating in dining rooms showed that some schools were undertaking a number of different activities to promote healthy eating. Contracts and specifications 64% of head teachers were aware of some type of written documentation for their school meals service

9 66 documents were received, covering 112 schools (74% of schools sampled). The language used within documents tended to be imprecise, qualitative and open to interpretation. All of the documents contained some content relevant to healthy eating. 91% made reference to the National Nutritional Standards and 29% referred to Caroline Walker Trust (CWT) guidelines. There was little evidence of schools or LAs setting their own quantitative nutritional standards. There were few references to salt, obesity or use of sustainable procurement practices. There were few examples of elements of good practice in incorporating healthy eating into service specifications. Compliance with National Nutritional Standards 34 of 146 schools (23%) met all of the compulsory standards at the beginning of service over 5 days. This fell to 25 (17%) by the end of service. The standards most commonly failed were starchy food cooked in oil or fat not to be served more than 3 times a week (failed by 53%), and fruit based desserts to be served twice a week (failed by 33%). 96% of schools met the additional recommendation for drinking water and 27% for drinking milk at the beginning of service, falling to 95% and 21% respectively by the end of service. No associations were found between meeting the standards and the type of catering provider, type of contract, or whether the standards were monitored. Food provision The foods most commonly offered in schools were desserts, vegetables and fruit. Desserts and vegetables were offered 4-5 days per week in 99% of schools and fruit in 97%. 70% of schools offered higher fat main dishes 4-5 days per week, compared to 64% for lower fat main dishes. A third of schools (33%) did not offer soft drinks, 90% did not offer crisps and other savoury snacks, and 58% did not offer fruit juice. The profile of foods offered did not conform to the Balance of Good Health, with too many foods containing fat and foods and drinks containing sugar on offer to pupils at lunchtime. Schools in which the contract specification made reference to monitoring healthy eating practices, and schools in which caterers reported having run promotions to encourage healthy eating offered potatoes not cooked in oil or fat more often. Schools in which the head teacher was aware of the nutritional standards offered higher fat main dishes less often. Pupil food choices and nutrient intakes Information was collected on the lunchtime food choices of pupils. Desserts were the most commonly chosen food (chosen by 78% of pupils), followed by vegetables and salads (56% of pupils). Higher fat main dishes and chips and other potatoes cooked in oil or fat (chosen by 53% and 48% of pupils, respectively) were chosen nearly twice as often as lower fat main dishes and potatoes not cooked in oil or fat (29% and 25%, respectively). The profile of foods chosen did not conform to the Balance of Good Health, with too many foods containing fat and foods and drinks containing sugar, and not enough starchy foods, milk and dairy foods, or fruit and vegetables chosen. Pupils chose desserts, vegetables and salads, higher fat main dishes, chips and other potatoes cooked in oil or fat, pasta and other cereals and soft drinks proportionately more often when compared with the frequency with which these foods were offered.

10 Pupils chose more vegetables and salads in schools where the caterer had received some training in healthy eating/cooking, in schools where the caterer reported having run promotions to encourage healthy eating, and in schools where the lunchtime supervisors were observed to encourage healthy eating. Analysis of nutrient intakes against 1992 CWT guidelines suggested that for meals as chosen, mean intakes of most nutrients either met or were close to the recommendations, although percent energy from saturated fat was higher than recommended for both infants and juniors, and mean intakes of energy, folate, and iron were lower than recommended for juniors. Similarly, for meals as eaten, mean percent energy from saturated fat was higher then recommended, and mean intakes of energy, non-starch polysaccharides (fibre), calcium and iron were lower then recommended for both infants and juniors. Mean folate intakes in junior pupils were also low. Overall, less than 50% of meals as chosen and as eaten met individual CWT guidelines for non-starch polysaccharides, vitamin A, folate, calcium, iron, percent energy from fat and percent energy from saturated fat. Pupils whose meals met six or more CWT guidelines chose more baked beans, and fewer chips and other potatoes cooked in oil or fat, and main dishes. Less choice was associated with a healthier profile of foods being chosen by pupils, and also with a higher proportion of meals meeting 6 or more CWT guidelines. Methods A representative sample of 151 primary schools were recruited into the study. Response rates were 59% of the original sample, and 63% of schools eligible for inclusion. Data were collected at the school and pupil level. Pairs of interviewers from Taylor Nelson Sofres visited each school over five consecutive lunchtimes. They recorded all the food and drink items on offer each day, and assessed compliance with the National Nutritional Standards at the beginning of the lunch period and again 10 minutes before the end of service. Individual pupil s food choices were also recorded. Interviewers approached a pupil after he or she had collected lunch. After ascertaining their willingness to participate, the interviewer recorded what was on the pupil s tray, attached an identifying label to the tray, administered a brief questionnaire, and asked the pupil to return his or her tray with all leftovers to a weighing table set up in the school dining room. Ten pupils were asked to participate each lunchtime. Food choices of pupils were recorded. At the beginning of service, one of the interviewers collected from the catering staff two portions of a range of food and drink items. These items were weighed by the interviewers to establish typical portion sizes. Individual pupil leftovers were also weighed. Telephone interviews were conducted with the school caterer and a school representative (Head/Bursar/LA) by researchers at King s College London. These interviews ascertained the nature of catering provision in the school, uptake of paid and free school meals, whether there was any documentation for the school meals service, details on cooking methods and promotion of healthy eating, and monitoring procedures. The nutrient content of food from inventories and individual pupil s food choices were determined using data from the Food Standards Agency Nutrient Databank. Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS). Compliance with the National Nutritional Standards was assessed in relation to food provision. The nutrient profiles of the pupils food choices were compared with the 1992 Caroline Walker Trust (CWT) Guidelines. Food provision and pupil food choice was also assessed in terms of food groups and the Balance of Good Health.

11 Copies of school meal contracts or service level agreements were requested and obtained for 112 of the 151 schools (66 documents in total). A quantitative and qualitative analysis was conducted of the content specific to nutrition and healthy eating. Discussion and Conclusions Between one-quarter and one-third of energy and nutrients are provided by school meals on the days that they are eaten. School meals, therefore, have the potential to help make a significant contribution to nutrient intakes. The present findings show that many pupils were not making healthier food and drink choices at lunchtime, even though healthier options were available in most schools. This imbalance in selection is partly due to the failure of most schools to offer a distribution of foods that conformed to the Balance of Good Health. On balance, schools offered too many foods containing fat and foods and drinks containing sugar. When faced with such choices, pupils selected more of the less healthy options. A key finding is that less choice was usually associated with a healthier profile of foods being offered and hence being chosen. More choice was associated with the selection of meals that were less likely to meet the CWT guidelines, especially for folate, non-starch polysaccharides, percent energy from fat, calcium, percent energy from saturated fat, vitamin A and iron. However, as the number of schools on which these associations were based was small, this finding should be interpreted with caution. Catering service, cooking practices and the eating environment The types of catering providers and contracts observed in the present study were consistent with that expected to be found in primary schools in England. The type of service was primarily a cafeteria style with choice, where pupils were usually offered a two course meal with a drink. Pupils were given a wide range of choice, particularly in terms of dessert options, with schools typically offering fruit and yoghurt as well as items such as cakes and biscuits. Data showed that the majority of pupils chose the less healthy options when available. Many schools appeared to encourage or promote healthy eating. There were limited opportunities for pupils to purchase snacks and drinks at school, and nearly two-thirds of tuckshops offered healthier choices. Training of lunchtime supervisors in healthy eating and participation in schemes such as Healthy Schools and the School Fruit and Vegetable Scheme suggested that some schools were undertaking a number of different activities to promote healthy eating. Evidence of the promotion of healthy eating was seen in over half of school dining rooms. Many schools followed some healthier cooking practices. For example, most schools offered low calorie/no added sugar squash and low fat yoghurt, and salt was available to pupils in only a few schools. Few schools offered crisps or confectionery, and salad bars were common, usually offered as an extra which pupils could choose as well as the vegetable option on offer. However, there were also some less healthy practices. Schools frequently offered products high in salt and fat, such as processed potato products and processed chicken/turkey and fish products, and salt was used in cooking in two-thirds of schools. Despite this apparent emphasis on healthy eating, results showed that many pupils were not making healthier food and drink choices at lunchtime, even though healthier options were available in most schools. In some schools, pupils could have a dessert or fruit but not both. Few positive associations were found between practices intended to promote healthy eating and pupils choices.

12 Contracts and specifications Documents were obtained covering 74% of schools, ranging from very detailed specifications to vague guidance notes for cooks. Although virtually all made some reference to healthy eating, few schools or LAs specified their own mandatory quantitative guidelines relating to the nutritional quality of school meals, good catering practice, or to the tools and processes to be used in implementation and monitoring. Most documents referred to the nutritional standards, which are put forward by DfES as a minimum requirement. There was little evidence of schools setting additional standards. There was some evidence that caterers were considering the nutrient content of school meals, with a third of documents referring to CWT guidelines, and some reporting that foods or menus were submitted for nutrient analysis. The language used in documents demonstrated awareness of and commitment to the promotion of healthy eating, but few examples of good practice were found. Associations between contract specifications and food provision or pupil choices were generally weak and inconsistent. Compliance with National Nutritional Standards Primary schools performed poorly in terms of meeting the compulsory standards for food provision. Only 23% of school lunch services met all the standards every day at the beginning of service, falling to 17% at the end of service. Schools commonly failed the standards by serving starchy foods cooked in oil or fat (usually potato products such as hash browns) more than three times a week, and not serving fruit-based desserts at least twice a week. School caterers reported that lunch services and compliance with nutritional standards were monitored in the majority of schools, yet most schools failed to meet all of the compulsory standards. Compliance was commonly reported to be indirectly monitored via menus, so either the monitoring was not happening in practice, was ineffective, or caterers believed that their menus offered foods that would meet the standards. Food provision, pupil food choices and nutrient intakes Schools offered a wide variety of foods but neither the distribution of foods on offer nor the foods chosen by pupils conformed to the Balance of Good Health. Overall, schools offered too many foods containing fat and foods and drinks containing sugar. Although healthier options were on offer, pupils chose more of the less healthy options, for example choosing higher fat main dishes nearly twice as often as lower fat main dishes despite both options being offered equally often. Less choice within the meal on offer was usually associated with a healthier profile of foods being offered and hence being chosen. Mean nutrient intakes for both infants and juniors were lower than recommended in the CWT guidelines for a number of nutrients. Less than half of meals as eaten met the guidelines for non-starch polysaccharides, vitamin A, folate, calcium, iron, percent energy from fat, and percent energy from saturated fat. The food choices of pupils who met the six CWT guidelines most likely to be associated with a high CWT score were characterised by more baked beans, and fewer main dishes (both higher and lower fat) and chips and other potatoes cooked in oil or fat. Schools offering the least choice had the highest proportion of pupils choosing meals that met 6 or more of the CWT guidelines, whilst the smallest proportion was found in schools with cash cafeterias.

13 Looking ahead The evidence from the present study suggests a number of ways in which the food provision in schools at lunchtime may need to change if healthier meals are to be made available and consumed by school children in England. Many of these suggestions are similar to the recommendations made in the previous report, School Meals in Secondary Schools in England. 6 Since the publication of that report in 2004 and the commissioning of the present research, the DfES has published 35 recommendations for the transformation of school meals in both primary and secondary schools in England, based on the work of the School Meals Review Panel (SMRP). 4 Many of the suggestions made here and in the previous report have been addressed in the DfES recommendations. It was felt worthwhile to link the evidence from the present research with some suggestions for improvement that reflect, in part, the new recommendations. Evidence Neither the profile of foods on offer to pupils nor that chosen by pupils reflected the Balance of Good Health. This was true for both schools that met the current National Nutritional Standards and those that did not. The present food-based guidelines do not appear sufficient to ensure that foods containing fat and foods and drinks containing sugar are offered and chosen in accordance with the Balance of Good Health. Potential ways forward National Nutritional Standards for school food should not only be compulsory but should be based on a combination of food-based and nutrient-based guidelines. More than half of all meals eaten did not meet the CWT guidelines for non-starch polysaccharides, vitamin A, folate, iron, calcium, percent energy from fat and percent energy from saturated fat. Food-based standards alone do not appear to be sufficient to ensure that the CWT guidelines are met. Most schools reported that compliance with the Nutritional Standards was monitored, yet only 23% of schools met the standards every day at the beginning of lunchtime. One explanation for this is that the standards have been misinterpreted, and there is confusion amongst caterers and those planning menus as to which foods count towards which standards. National Nutritional Standards should be clear and easily measurable.

14 Evidence The majority of heads and caterers reported that compliance with the standards was monitored, yet less than a quarter of schools met the standards, suggesting that monitoring was either not happening or was ineffective. Caterers commonly reported that compliance to the standards was assessed by menu analysis. As less than a quarter of schools were meeting the standards, this was either not taking place in practice, the method was ineffective, or the catering providers believed that the foods and drinks they were providing met the standards. Potential ways forward Monitoring of the catering service (particularly compliance to the standards) should be compulsory, using a standard reporting framework supported by robust tools. A database of compliant menus should be made available. Training in monitoring for catering staff should be part of the training relating to healthy eating. A standard reporting format should be specified in monitoring requirements. Fewer schools met the standards at the end of service than at the beginning. Schools should ensure that foods that meet the standards are available to pupils throughout the lunchtime service. This links with the suggestions on monitoring. Nutrient intakes in primary school pupils were better than in secondary. This may in part reflect the fact that primary schools offered soft drinks, confectionery and savoury snacks, chips and other potatoes cooked in oil or fat less often, and vegetables/salad more often than secondary schools. The schools offering less choice were more likely to provide meals that met CWT guidelines. The range of choice should be restricted to a range of healthier options. Only 28% of catering staff had received training in healthy eating /cooking. Only 68% of school caterers questioned were aware of the National Nutritional Standards, and of those, only 4% were able to identify all the components whilst 46% were unable to name any. There was some evidence of healthier options being chosen where catering staff had had training in healthy eating/cooking. All head cooks and catering managers should receive training in healthy catering and how to meet the new standards.

15 Evidence Many schools were participating in government sponsored initiatives such as Healthy Schools and the National School Fruit and Vegetable Scheme. Potential ways forward For healthy eating messages to be effective and impact on health, it is likely that they need to be reflected in all aspects of school life, including teaching and food provision outside lunchtime. Therefore, schools should be encouraged to develop a whole school nutrition policy, to be made available to parents and carers. The school catering contracts or service level agreements examined offered only isolated examples of good practice in incorporating healthy eating into specifications, and language tended to be imprecise Contract documents should emphasise monitoring in order to ensure compliance with compulsory standards. Where necessary, schools should be given guidance on setting contracts.

16 1 Introduction 1.1 Background School meals make a vital contribution to the dietary intake of school children in England. Every day, over 3 million school meals are served. 1 There are 7,600,000 English primary and secondary school pupils and 43% of these take a school meal. In % of primary pupils were eligible for free school meals (FSMs), but it is estimated only 4 in 5 children took this up. 2 Data from the National Diet and Nutrition Survey (NDNS) of young people aged 4 to 18 years were analysed to examine the specific nutritional contribution of school meals. 3 In the primary sector school lunches provided between 22% and 33% of the daily intake of energy, fat, protein, iron and zinc, calcium, folate and vitamin C. There was also evidence that school meals helped to compensate for poor intakes of some nutrients. 4 For example, intakes of zinc and non starch polysaccharide (dietary fibre) were poor and sodium intakes high amongst primary girls, and school meals went some way to improving intakes. Not surprisingly, school lunch was especially important for those children who missed breakfast, estimated as 8% of all 8 to 16 year-old children, and rising to 9% in children living in poor households. 5 Nutrient intakes from school meals are a result of not only what is provided but also what is chosen by children. Both parts of this equation give cause for concern. Analysis of set meals provided in secondary schools revealed that none of these meals met the standards for the nutrient content set by the Caroline Walker Trust. 6 7 Data from the NDNS 3 showed that foods chosen and consumed by pupils from school lunches were very different from the balance recommended for good health. 8 Too few foods from the starch, fruit and vegetable and dairy groups were selected, whilst too many of the foods high in fat and sugar were chosen. A Consumers Association survey of primary and secondary schoolchildren s meal intake in 2002 found that pizza, chicken nuggets and fish cakes were among the most popular main courses. Chips and fried potato products were the most frequently consumed starchy foods, and baked beans the most popular vegetable. 9 School meals contributed, on average, less than one portion to their daily fruit and vegetable intake. The recommended intake for children and adults is at least five portions (about 400g) per day. 10 It is important to put school meal intakes into the context of the overall diet and health patterns for young children. NDNS data suggested that for many children average daily intakes of saturated fats, sugars and sodium were high and intakes of Vitamin A, riboflavin, folate, zinc, iron, magnesium, calcium and potassium were low compared to reference nutrient intakes (RNIs). Coupled with these high saturated fat and low micronutrient intakes has been the rise in the level of obesity in children. Since 1992 the number of school children in England who are overweight or obese has doubled in 3 boys and 1 in 4 girls were obese or overweight in 2002, 12 and these figures continue to worsen. Conservative estimates suggest that by in 5 boys and 1in 3 girls will be in the severely obese range and many more will be overweight. The chronic disease consequences of this epidemic are huge and are likely to result in accelerating rates of diabetes, heart disease and many cancers. 13 Concern about children s diets, what they are eating in school and the quality of school meal provision provides the context for this survey in primary schools. In addition, in 2001, statutory National Nutritional Standards for school lunches were re-introduced, 14 after an absence of 21 years. These standards stipulated the menu frequency of certain food groups. They are currently being revised. A new set of nutritional standards will come into force early in In order to understand the potential changes in the contribution of school lunches to

17 daily intake following the introduction of the 2001 standards, the Department for Education and Skills (DfES) and the Food Standards Agency (FSA) jointly commissioned a survey of school meals in a representative sample of English primary schools. It follows a parallel study of secondary schools conducted in The present study was designed to assess whether school meal providers were complying with the 2001 statutory standards, to identify food choices available to primary school children, and to assess food consumption and nutrient intake from the lunchtime meal in primary schools in This report presents the findings of that survey. 1.2 Aims and objectives Aims The study had 3 main aims: To assess whether the food provided by the school caterer met the statutory 2001 National Nutritional Standards, set out in the regulations and associated guidance, for all the children throughout the service period. To assess whether the food provided met the guidelines set out by the Caroline Walker Trust in To identify the food consumption and nutrient intakes of primary school children from school meals, and to compare these to the Caroline Walker Trust guidelines Objectives The main objectives were to: Recruit into the study a country-wide selection of 150 primary schools using appropriate sampling techniques Determine food provision, availability and visibility of food and drink within dining rooms and cafeterias in these primary schools Measure consumption of lunchtime meals in approximately primary pupils nationwide Evaluate food availability, food consumption and nutrient intake against National Nutritional Standards and guidelines for healthy eating in schools. Identify factors related to catering provision and the school environment that were associated with the provision and consumption of healthier foods Undertake additional analyses as appropriate and in consultation with the sponsors. 1.3 Project overview One hundred and fifty one primary schools in England participated in the mainstage of this project. Fieldwork was conducted from April through June Two trained interviewers from the market research company Taylor Nelson Sofres (TNS) visited each school over five consecutive lunchtimes and recorded the foods and beverages offered to pupils by the caterers. The food and beverage choices of approximately 10 pupils were recorded each lunch time and their leftovers were weighed. A total of pupils were approached to provide information on food chosen and eaten and complete a brief interviewer administered questionnaire. Information on catering practice and the lunch service was collected via a telephone interview with the head cook or catering manager. Information on the type of 14 15

18 contract for each school was collected via a telephone interview with the relevant person responsible for this contract (e.g. Head teacher, bursar, LA officer). Sixty-six copies of specifications or service level agreements were obtained, covering 112 (74%) of the 151 schools. A pilot study to test measuring instruments and logistics was conducted in ten schools in February 2005, prior to the mainstage study. 1.4 National Nutritional Standards: historical perspective The school meals service was introduced in 1906, provoked by concern about severe malnutrition and the realisation that many children were attending school underfed and unable to benefit from their education. The Second World War brought about a shift in Government policy from a service designed to benefit undernourished children to one that was intended to benefit all children. The first nutritional standards for school meals were set in 1941 covering energy, protein and fat. These were updated in 1955, and again in 1975 following publication of the Committee on Medical Aspects of Health s (COMA) report on Diet and Coronary Heart Disease. 16 The 1980 Education Act brought about major changes in the school meals service. The Act removed the obligation for LAs to provide school meals, except to those children entitled to free school meals. It also removed the obligation to meet any nutritional standards. LAs had autonomy over the price, type and quality of the meals they provided, if indeed they decided to continue providing meals. A potential benefit of this major change was to save money: net expenditure on the school meals service was over 400 million per year in 1980, and school meals were identified as an area where substantial savings could be made to public expenditure. Some LAs dismantled their catering services and today around 13% of schools have no kitchen facilities, and in these schools only sandwiches are provided to those entitled to free meals. It was not until 2001 that compulsory National Nutritional Standards for school meals were reintroduced, as a result of concerns about the quality of children s diets. Major changes in school meal provision post 1980 are summarised in Appendix A National Nutritional Standards for school lunches: compulsory standards and additional recommendations Data on food provision collected within this primary school survey were evaluated against the statutory Nutritional Standards for School Lunches which came into force in April Despite the climate of change these were the standards to which schools were operating during the period of study. They set out minimum standards, in terms of food groups, that school caterers must meet. Similar standards for secondary schools were used as the evaluative yardstick for the previous survey of secondary school meals. 6 The standards apply to lunches whether they are free or paid for. The Regulations for primary schools stipulate that at least one item from each of the food groups in the left-hand column of Table 1.1 must be available every day. There are also additional requirements, shown in the right-hand column. Together these comprise the compulsory standards.

19 Table 1.1. The national nutritional compulsory standards: At least one item from each food group must be available every day. Food group Starchy foods Vegetables and fruit Milk and dairy foods Meat, fish and alternative (non-dairy) sources of protein Additional Requirement Starchy food cooked in oil or fat should not be served more than three times a week. Both a fruit and a vegetable must be available. Fruit based desserts must be available twice a week a Fish must be served at least once a week. Red meat must be served at least twice a week. Cheese may be included in the protein group for primary children. The DfES produced guidance to school caterers on how to implement these standards. 15 Included in this guidance were additional recommendations regarding drinking water, drinking milk and provision of hot food (Table 1.2). Table 1.2. Additional recommendations for school lunches. The Secretary of State: Expects that drinking water should be available to all pupils every day, free of charge Strongly recommends that schools should offer some hot food, particularly in the Winter months Strongly recommends that drinking milk is available as an option every day Further recommendations given in the guidance for school caterers included serving oily fish as part of the once a week fish requirement and making milk free to pupils entitled to free school meals. The guidance also included recommended portion sizes (uncooked weights are specified) for primary school pupils. Ensuring that the National Nutritional Standards are met is the responsibility of the LA, or school governing body if the school meals budget has been delegated. 1.5 Caroline Walker Trust Guidelines for School Meals. In addition to monitoring compliance with the standards, school caterers are also advised to monitor the nutrient content of the meals they provide, either by the use of food composition tables (specialist computer software exists), or via laboratory analysis of samples. The results from the analysis may then be compared with the Caroline Walker Trust (CWT) Guidelines for School Meals. The CWT guidelines provide figures for the recommended nutrient content of an average school meal provided for children over a one-week period. The values are based on the recommendations contained in the COMA report Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. 17 The CWT guidelines were first released in 1992, 7 and an updated version of figures was released in September During the period of this study, primary schools would have been using the 1992 figures as a reference point. The more recent nutrient figures are similar to those released in 1992, but are updated to include figures for zinc, and also sodium following the release of new recommendations on salt intake. 19 Both sets of figures are set out in Table 1.3. a Editors Note: the proportion of fruit in fruit based desserts is not defined in the standards