The school setting can provide an environment that supports healthy behaviours, including the provision of food. School food activities, that is, school feeding, are commonplace globally, but not well understood in the Pacific Islands region. The aim of this research is to explore learnings associated within existing school food programmes (SFP), and adoption resistors in those Pacific Island Countries and Territories (PICT) without SFP, with the intent of improving current and future SFP interventions.

This observational cross-sectional study utilised four facilitated workshop sessions to explore SFP within an existing framework.

Pacific Islands region.

Fourteen participants representing the education and health sectors from eleven PICT, and two participants representing regional organisations.

Most countries reported some form of related policy, but key critical constraints to the use of SFP included local food environments, strategic alignment to organisational priorities, advocacy and organisational leadership, and community and cultural connections and collaboration. There are opportunities for integration of SFP into existing frameworks (i.e. Health Promoting Schools), increased collaboration, greater professional development and awareness activities, improved monitoring and evaluation, improved awareness of SFP and promotion of healthy eating for the wider school community.

Given the current health, social and economic challenges faced by countries and territories in the Pacific Islands region, SFP should be considered as an opportunity for food provision and associated nutrition education for students and their wider community. Further research is needed to understand the critical constraints of SFP in this region and how to support stakeholders to advocate for, develop and sustain SFP that are contextually and culturally appropriate.

In 2012, Massachusetts enacted school competitive food and beverage standards similar to national Smart Snacks. These standards aim to improve the nutritional quality of competitive snacks. It was previously demonstrated that a majority of foods and beverages were compliant with the standards, but it was unknown whether food manufacturers reformulated products in response to the standards. The present study assessed whether products were reformulated after standards were implemented; the availability of reformulated products outside schools; and whether compliance with the standards improved the nutrient composition of competitive snacks.

An observational cohort study documenting all competitive snacks sold before (2012) and after (2013 and 2014) the standards were implemented.

The sample included thirty-six school districts with both a middle and high school.

After 2012, energy, saturated fat, Na and sugar decreased and fibre increased among all competitive foods. By 2013, 8 % of foods were reformulated, as were an additional 9 % by 2014. Nearly 15 % of reformulated foods were look-alike products that could not be purchased at supermarkets. Energy and Na in beverages decreased after 2012, in part facilitated by smaller package sizes.

Massachusetts’ law was effective in improving the nutritional content of snacks and product reformulation helped schools adhere to the law. This suggests fully implementing Smart Snacks standards may similarly improve the foods available in schools nationally. However, only some healthier reformulated foods were available outside schools.

In England, standards for school meals included both foods and nutrients until 2015. School policies for packed lunches are generally food based; research is needed to determine whether these are adequate or whether a small number of nutrients would potentially improve their quality.

From dietary data obtained using a weighed dietary assessment tool, a diet quality score (DQS) for packed lunches was calculated using the number of standards met out of twenty-one (eight foods and thirteen nutrients). Multilevel regression analysis determined the foods and nutrients contributing to variation in the DQS.

Eighty-nine primary schools across the four regions of the UK (England, Wales, Scotland and Northern Ireland).

British schoolchildren (n 1294), aged 8–9 years, taking a packed lunch.

The optimal model included all eight foods and seven of the thirteen nutrients, explaining 72 % of the variance in DQS. Folate, Fe and vitamin C, together with the eight food groups, explained 70 % of DQS variation.

Ideally, policies for school packed lunches should include food-based standards plus recommendations based on a small number of nutrients.

Following an international workshop on developing the evidence base for policy relating to school food held in London, UK, in January 2012, the objectives of the present paper were (i) to outline a rationale for school food research, monitoring and evaluation in relation to policy and (ii) to identify ways forward for future working.

The authors analysed presentations, summaries of evidence, and notes from discussions held at the international workshop in London in 2012 to distil common themes and make recommendations for the development of coherent research programmes relating to food and nutrition in schools.

International, with an emphasis on middle- and high-income countries.

Overviews of existing school food and nutrition programmes from the UK, Hungary, Sweden, the USA, Australia, Brazil, China, Mexico and other countries were presented, along with information on monitoring, evaluation and other research to demonstrate the impact of school feeding on health, attainment, food sourcing, procurement and finances, in the context of interactions between the evidence base and policy decisions. This provided the material which, together with summaries and notes of discussions, was used to develop recommendations for the development and dissemination of robust approaches to sustainable and effective school food and nutrition programmes in middle- and high-income countries, including policy guidelines, standards, cost-effectiveness measures and the terms of political engagement.

School food and nutrition can provide a cohesive core for health, education and agricultural improvement provided: (i) policy is appropriately framed and includes robust monitoring and evaluation; and (ii) all stakeholders are adequately engaged in the process. International exchange of information will be used to develop a comprehensive guide to the assessment of the impact of school food and nutrition policy and supporting infrastructure.

To outline the evolution of school food standards and their implementation and evaluation in each of the four countries of the UK since 2000.

Review of relevant policies, surveys and evaluations, including country-specific surveys and regional evaluations.

UK: England, Wales, Scotland and Northern Ireland.

Primary and secondary schools and schoolchildren.

By September 2013 standards will have been introduced in all primary and secondary schools in the UK. Evaluations have varied in their scope and timing, relating to government forward planning, appropriate baselines and funding. Where standards have been implemented, the quality and nutritional value of food provided have improved. Emerging evidence shows improved overall diet and nutrient intake by school-aged children as a result.

The re-introduction of school food standards in the UK has not been centrally coordinated, but by September 2013 will be compulsory across all four countries in the UK, except in England where academies are now exempt. Provision of improved school food has had a demonstrable impact on diet and nutrition beyond the school dining room and the school gate, benefiting children from all socio-economic groups. Improved school food and dining environments are associated with higher levels of school lunch take up. Implementation of school food standards requires investment. It is critical to policy development that the value of this investment is measured and protected using planned, appropriate, robust and timely evaluations. Where appropriate, evaluations should be carried out across government departments and between countries.

To estimate the costs per relevant unit (pupils and meals) associated with improvements to school food and the potential economic and health gains that may result.

Calculation of costs per relevant unit (pupils and meals) based on (i) Department for Education expenditure to support improvements in school food, 2005–2011 and (ii) measures of the changes in the number of pupils taking school lunch and the number of meals served over the same time period; plus examples of the use of linked data to predict longer-term economic and health outcomes of healthier eating at school.

England.

Local authorities, government departments and non-departmental public bodies.

Analysis of investment over a 6-year period indicates that costs of setting up and maintaining a change organization such as the School Food Trust were low in relation to short-term benefits in nutrition and behaviour. Models that predict long-terms gains to the exchequer and to quality-adjusted life years need further elaboration.

Modest levels of government investment in the delivery and promotion of healthier school food is likely to yield both short-term and long-term benefits in relation to nutrition, learning, economics and health.

To provide an overview of school food and nutrition monitoring from 1980 to the Healthy Hunger-Free Kids Act of 2010 and data on school food availability in the USA.

A review of the history of school food and nutrition policy, monitoring and evaluation efforts in the USA over the past three decades.

USA.

School food service, school districts and schools nationwide.

The school food environment in the USA is governed by a patchwork of federal, state and local laws and policies. The federal government has primary authority over the school meal programmes and has recently issued updated regulations governing the food and nutrient requirements for meals sold or served through the National School Lunch and School Breakfast Programs. Competitive foods (i.e. foods and beverages sold/served outside the meal programmes) are governed primarily by state and district laws and policies, although new federal regulations are expected to set minimum standards in this area. The USA has a long history of data monitoring and evaluation funded by government and private foundations which has enabled decision makers to monitor progress and opportunities to improve the foods and beverages made available to students in school.

School food-related monitoring and evaluation research has been highly influential in influencing legislation and policy, leading to improvements in the foods and beverages available to children at school as part of planned meals and individual items sold outside the meal programmes. The lessons learned from the US experience provide insights that may be valuable for implementation, monitoring and evaluation of school food programmes in other countries.