School meals: Do government guidelines make the grade?

School meals have been the subject of intense debate, a degree of ridicule and much contention for years despite their obvious potential to be at the heart of every school's healthy-eating policy. Jamie Oliver, the latest in a line of celebrity chefs to criticise the 'terrible' standard of school meals, has suggested that problems lie with 'profit-making school caterers offering poor quality food'[1]. The government, however, claims that the new nutritional standards for school meals introduced in April 2001 'help all pupils to have nutritionally balanced school lunches'[2].

Recent evidence from a Consumers' Association-funded survey of children across England[3] shows that the food typically consumed at school lunch is of insufficient quality and quantity to achieve even basic food-based nutritional guidelines. Intakes of fruit, vegetables, red meat and dairy foods are low, while intakes of starchy foods with added fat, coated fish and meat products, pizza, cakes and biscuits are high. These food choices result in very low intakes of important nutrients by many children, particularly vitamin A, vitamin C, folate, iron, zinc and calcium. The nutritional value of foods eaten by children at school meals are not currently monitored or evaluated. Offering many choices on the menu each day allows children to choose similar meals and regularly opt out of foods such as vegetables.

Improving school meals is not especially difficult or costly, nor does it really require the involvement of a celebrity chef. This article assesses the current quality of school meals and effectiveness of existing government guidelines. It argues for a government commitment to impose and monitor quantified guidelines and offer support to schools, caterers and local education authorities (LEAs) to implement strategies which will really encourage healthy eating in schools.

Why have nutritional guidelines?

Providing school children with a health-promoting school lunch which would reinforce the messages about eating well conveyed in the classroom would seem a sensible and achievable goal in a wealthy Western country such as the UK. The nation's nutritional health is currently under intense scrutiny. Rates of obesity in children are rising at alarming rates and public health messages to eat more fruits and vegetables appear to be falling on deaf ears in many population groups.

The need for nutritional standards for food in schools, which contribute about a third of children's daily nutrient intake, 38 weeks a year for at least 11 years of their lives, would seem essential. One in five of our children (an estimated 1.8 million in total) are eligible for free school meals, but around 20 per cent do not take them[4]. Poor nutrition is known to contribute to inequalities of health and free school meals are an ideal opportunity to encourage eating well among children from poorer backgrounds. However, lack of regulation on the content of school meals for over 20 years and the subsequent decline in the quality of food served has contributed to a sharp decline in the numbers of families choosing school meals at all.

School food in many areas of the country is now provided by profit-making catering companies and there has been a squeeze on costs in all areas of public service catering. In many areas of the country there is now no school meals service at all. Many schools have sold their kitchens and dinner ladies have been deskilled, often now reduced to the role of heating up ready-prepared foods. School meals are frequently served on paper plates with plastic cutlery to children hurried through a crowded dining room. The skills of caterers have been devalued in much of our society and nowhere more so than in the arena of school meals where food quality, taste and presentation have been given shockingly low priority.

Nutritional regulations

In April 2001 the government reintroduced nutritional guidelines for school meals in England, 21 years after the previous nutritional standards were removed in The Education Act of 1980. Between 1941 and 1980 nutritional standards for school meals in this country had ensured that the meals provided offered approximately a third of the day's nutrient requirements for an average school-age child. Removal of these statutory standards allowed school meal providers to respond to consumer demand and reduce the costs of school meal production. In some cases, this has led to schools emulating high street fast food rivals in a bid to retain pupils' custom in school[5].

Nutritionists lobbied for many years for the reintroduction of nutritional standards and the publication Eating well at school was finally produced by the Nutrition Task Force in 1997[6]. The Nutrition Task Force had been set up in response to 'Health of the Nation', the Conservative government's 1992 strategy document for improving health. The group produced a range of important strategy documents for improving nutritional status in the UK - most of which were abandoned when the current Labour government came to power.

The standards used by the Nutrition Task Force were based on a 1992 report by the Caroline Walker Trust charity[7], which outlined quantitative standards that caterers could use to help plan varied and nutritious meals. The report's recommendations and the guidance for caterers, LEAs and schools were warmly welcomed by many.

However, with a change of government came a new policy document, Our Healthier Nation[8], which also pinpointed schools as an important forum for health promotion. Rejecting previous guidance associated with 'Health of the Nation', however, the government released a new white paper, Excellence in Schools, as the beginning of the new process to reintroduce school meals standards.

The consultation document, Ingredients for success[9], was widely circulated for comment in 1998. This consultation document proposed two possible methods of regulation of nutritional standards: the quantitative method previously adopted in Eating Well at School and widely endorsed by nutritionists, or a 'food-based' system which only required the serving of particular food types on specified occasions during the school week. Despite extensive support for the quantitative guidelines, these were only included in the final documentation as 'guidance', with regulation now on the basis of food-based standards. An outline of these standards is provided in Table 1.

The National Heart Forum, in its submission to the select committee reviewing the evidence and responses to consultation on nutritional standards for school meals, argued that standards based on nutrients provided a far more flexible system of introducing a balanced and varied diet[10]. Furthermore, simple, validated tools were already available to allow caterers to monitor and plan effectively. Caterers, however, successfully persuaded policymakers that the introduction of quantitative nutritional standards would be overly 'prescriptive' and 'a tyranny of numbers'. Quantitative standards, they argued, would ultimately lead to a lack of flexibility and non-compliance.

Monitoring school meal standards

Bitterly disappointed by this outcome, lobbyists have since sought assurance from the government that the new school meal standards would be properly monitored. However, despite a number of promises, progress on this has so far been slow. A December 2002 press release[11] suggested that the Food Standards Agency (FSA) had prompted the Office for Standards in Education (OFSTED) to take on this role (monitoring both school meals and packed lunches as well as tuck shops, breakfast and after schools clubs) as a new and separate inspection in schools. So far, however, plans for this monitoring role have not been outlined.

Nonetheless, FSA Wales has recently completed a large-scale market research survey looking at over 6,000 primary and 15,000 secondary school mealst12! in the country. The survey revealed that 35 per cent of primary school children had a portion of vegetables or salad on their plate. Yet, this disappointing figure paled into insignificance next to that for secondary school children: a mere four per cent chose a vegetable or salad for lunch. Even more alarmingly, only nine per cent of primary school children and one per cent of secondary school children chose a portion of fruit. Although the survey looked only at what was chosen, rather than what was actually eaten, it nevertheless indicates that existing guidelines designed to increase fruit and vegetable intakes are signally failing to deliver.

The aims of nutritional guidelines

It is established that a varied and balanced diet is an important way of protecting health and promoting proper growth and development in children. Guidance from the then Department for Education and Employment (DFEE) also claimed that nutritional standards 'in the short term can help children and young people to improve their concentration and fulfil their potential both inside and outside school'.

Nutrition surveys among school-age children in the UK typically show that many have diets high in the sorts of sugars that cause dental decay, and high in saturated fat and salt which can contribute to high blood pressure, stroke and coronary heart disease in later life. The diets of school-age children are also typically low in fruits and vegetables and many of the nutrients that these foods contribute such as vitamin C, vitamin A, and folates.

Iron and zinc intakes are lower than current reference values for many young people in the UK as intakes of iron- and zinc-rich foods (such as meat and meat products, oily fish and wholegrain cereals) are typically low. Meanwhile, many children who have swapped milk drinking for soft drink consumption face the 'double whammy' of poor bone health in later life and dental erosion caused by acids in carbonated and fruit-based drinks. Nutritional standards for school meals aimed to address these dietary insufficiencies by promoting the consumption of plenty of fruit and vegetables and fibre-rich starchy foods, moderate amounts of meat, fish (and alternatives) and dairy products, and reduced amounts of fat and sugar.

Food choices at school

To examine what foods were actually being eaten in schools following the implementation of the new nutritional guidelines, Consumers' Association commissioned a dietary intake survey among children in year six primary (ten to 11 years) and year ten secondary (14 to 15 years) in 16 different schools across England. The schools were located in both rural and urban with differing socio-economic status[13].

Children were asked to complete a two-day dietary record of everything they ate and drank and fill in a questionnaire with an interviewer, who was also able to check the detail of their dietary diary to ensure that the information given was complete. Overall, 246 dietary diaries were analysed by a qualified nutritionist and 198 individual 'school lunches' were evaluated. The composition of these school lunches was compared with both the food-based government standards, which are now regulation, and the Caroline Walker Trust quantitative guidelines. In addition, menus from all the participating schools were compared with the food-based standards and children were asked for comments on their choice of food in general and at school lunches in particular.

What did the children eat?

Foods typically eaten at primary school lunch were coated chicken, turkey and fish shapes, pizza, chips, potato waffles or other processed potato shapes, mashed potato and pasta, baked beans, cakes, cookies and ice cream. Among secondary school children, meals became much more difficult to define and lunch was frequently a combination of snacks and meal items purchased from the cafeteria that commonly included chips, sandwiches and rolls, coated chicken and turkey products, burgers, crisps, soft drinks and confectionery.

Did menus meet the guidelines?

Menus obtained from the schools showed that most caterers appeared to be offering a wide choice of foods daily. This meant that the food-based standards were achieved because of the variety of foods available. Children commented, however, that foods appearing on the menus were not always available and the lack of variety in the food choices made at school lunch by the majority of children did not reflect the items on offer. While vegetables, fruit and salads were officially available at all meals on most menus, few children appeared to choose these foods, or to eat them if they were on their plates.

Evidence from a number of other small surveys in London schools by undergraduate nutrition students[14] have observed that fruits and vegetables are rarely offered cut-up and in an easily accessible form at school meals, and that staff offer children little encouragement to have at least one item of fruit or vegetable at every meal.

Did meals meet the guidelines?

Overall, around two thirds of both primary and secondary school children had a starchy food cooked in fat as part of their school meal (mostly chips, smiley faces or other fat-added potato products), which is in line with guidance. Intakes of red meat and fish were, however, generally lower than recommended, with main meals commonly consisting of coated chicken and turkey products and pizza. Only half of primary children and 12 per cent of secondary children had a vegetable with their school lunch. Where they did, baked beans was the most popular choice. Ten per cent of primary school children and 21 per cent of secondary children had a fruit-based dessert.

The standards state that milk or dairy foods should be served every day, but less than a third of school lunches achieved this. Water or milk are suggested as the drinks of choice at school meals, but almost a quarter of primary school meals and nearly two-thirds of secondary school lunches included a soft drink. The meals eaten therefore fell short of the food-based standards with insufficient fruit and vegetables, red meat, fish and dairy foods consumed.

What about quantified standards?

Primary school meals provided substantially less energy, carbohydrate, fibre, iron, calcium, folate and vitamin A than is recommended for primary age children. Vitamin C intakes were less than recommended for about half of boys and a third of girls. No children in this sample had a school lunch which achieved the recommended amount of iron, less than ten per cent achieved the recommended amount of folate and less than 20 per cent ate school meals which provided recommended amounts of calcium or vitamin A (see Table 2 for more details).

As the above table illustrates, primary school children are not getting the nutritional value they need from school dinners. For all nutrients except fat, children consumed too little of the nutrient shown. In the case of fat, those not achieving the guideline consumed too much fat when expressed as a percentage of total energy.

Secondary school lunches showed similar patterns of low intakes compared to recommendations, with particularly alarming deficiencies in dietary fibre, folate, iron, calcium and vitamin A. Protein intakes were also worringly low for more than half of older boys and girls. Vitamin C intakes were, however, more likely to be adequate among secondary school children, especially boys, who frequently chose a vitamin C-fortified drink as part of their meal (see Table 3 for more details).

As the table illustrates, secondary children, like their counterparts in primary schools, are falling short of nutritional needs. For all nutrients except fat, children consumed too little of the nutrient shown. In the case of fat, those not achieving the guideline had too much fat when expressed as a percentage of total energy consumed.

School lunch versus packed lunch

About half of children take packed lunches to school rather than have school meals and these were also examined in the survey. Among primary school children, packed lunches generally provided more energy, fat and sugars than school lunches as well as more vitamin A from the margarine used in sandwiches. School lunches were, however, significantly higher in fibre and zinc and also provided more fruit and vegetable portions than packed lunches. Among secondary school children, however, no differences were observed between packed and school lunches, reflecting the more varied choices made in school cafeterias by older children.

No nutritional standards were established for packed lunches when nutritional standards for school meals were introduced as the government felt that attempts by school staff to control the quality of pupils' lunch boxes would be 'impractical and an unacceptable intrusion into family life'[15]. This so-called 'light touch' approach, however, seems at odds with overall nutrition policy, which highlights healthy schools as a cornerstone of promoting better health for the nation.

The content of most school packed lunches observed in the recent survey showed very little awareness among most parents of the need for any kind of balance and variety in the food provided - and this despite the enormous contribution that lunches clearly make to children's nutritional intake throughout their school career. Given that as many as half of all school children take packed lunches to school, it seems scandalous to waste such a golden opportunity to encourage children in this group to eat healthily.

Free school meals

There has always been particular concern about those children who are entitled to free school meals. It has been suggested that the contribution made by school meals to the overall daily food intake of these children may be even more important than it is for others. No particular evidence of this was found in the recent survey, but school meals do contribute a higher proportion of fruit and vegetables to the diet than packed lunches, which may be particularly important for this group.

In the light of continuing inequalities of health observed in the UK between those at the top and the bottom of the socio-economic scale, it would seem prudent to ensure that school lunches are nutritionally adequate. The Child Poverty Action Group identified stigma as a key factor in the poor uptake of free school meals, with a third of children and two-fifths of parents interviewed in their study highlighting embarrassment or fear of being teased as a reason for not taking free meals[16]. Despite government aims to encourage the uptake of free school meals, no initiatives have been put in place in England and Wales to reduce this stigma, although 'anonymity' for free school meals is a key recommendation in the new Scottish proposals for improving school meals[17]. Improving the quality and quantity of imaginative, tasty food at school lunch, however, remains the most positive way forward in encouraging all children to choose school lunches.

How children rate school meals

Children in the Consumers' Association survey reported mixed feelings about school meals. A number of children, particularly in primary schools, registered overall satisfaction with their meals - perhaps unsurprising when you consider that pizza and chips were the preferred choices. Older children, meanwhile, were more likely to regard school meals as being poor value for money.

The most common reason cited for not having school meals among younger children was disliking them, while older children were more likely to be influenced by friends and peers and to want the quickest option at lunchtime. Younger children felt that meals could be improved with more sauces, while older ones requested greater variety and improved quality of food. Children also commented on certain other factors which made school meals less attractive, as illustrated by the diary entry of one primary-aged girl:

'I think in my school the dinners is not very good because they don't have enough food for the last few classes. I don't think the food tastes very nice because they are hardly hot and don't change the food and have the same over and over.'

Some of these sentiments were echoed by a secondary school boy who commented:

'School have a menu on the wall but they never cook 90 per cent of the food. The only thing that changes is the healthy choice otherwise it's the same food every day.'

The cost of improvement

Concern over the nutrition of Scottish school children has given rise to the 'Hungry for Success' initiative[18], which aims to revitalise school meals by using quantified nutrient-based standards, mechanisms for monitoring standards and a programme of education and support for schools and teachers, parents and pupils. From August 2003, new guidelines will be implemented, monitored and encouraged. They are considered a sufficiently important part of Scottish health policy to warrant funding of circa L25 million.

The extra food costs associated with improving the nutritional standard of school meals have been estimated at between five and 15 per cent, (which translates into between 5p and 10p per meal)[19]. This is a clear acknowledgement that eating well in schools does not require a vast amount of extra money, but that current spending on food in schools is probably too low to provide appropriate meals for children. The cost of a school meal in England and Wales varies between LEAs, but is approximately L1.20 per day in primary schools with 'meal deals' in secondary schools often priced at between L1.50 and L2.00 per day. Research from Cardiff University recently suggested that the average spend on food for a primary school lunch is around between 32p and 38p a day[20], which is unlikely to be sufficient to achieve a nutritionally adequate and tasty lunch.

Other European countries such as Sweden and Finland take a wholly different approach to school meals. Meals are free to school students and a limited menu is provided to everyone, with both pupils and teachers eating together. In the US, both federal and state nutritional standards have been widely introduced for school meals, but weak monitoring of standards is suggested to have persuaded caterers to rely on 'fortified foods' to meet guidelines, rather than the provision of good food and appetising meals. This emphasises the need for education, monitoring of standards and a whole-school approach to eating well through good food.

Recommendations for policy

The results of the CA survey, coupled with longstanding observations about the quality of school meals and success (or otherwise) of food-based guidelines, demand a new policy direction. Outlined below are some recommendations:

* In order that school meals achieve the ideals of providing children with both a nutritionally appropriate lunch and a clear example of eating well in practice, quantitative nutritional standards need to be put in place. Food-based standards do not offer a sufficiently rigorous mechanism to ensure the nutritional value of school meals.

* The nutritional content of school meals should be monitored and evaluated by both caterers and schools (children, staff and governors) using simple menu-planning software that could be adapted from existing validated tools. Good practice can then be shared between schools and LEAs and schools can work with caterers, public health nutritionists and community dietitians to ensure that both the menus and the food eaten achieve the nutritional guidelines.

* The skills of caterers need to be exploited - it is perfectly possible to produce tasty, acceptable food for children which incorporates a variety of food groups and which moves away from the 'chicken nuggets and chips' system of food provision. Caterers should be encouraged to use their creativity and current food fashions to offer children combination dishes which incorporate vegetables and fruit as well as good sources of iron and zinc, so that 'opting out' of the vegetable portion becomes more difficult. Table 4 shows some examples of how this could be achieved.

* Children and young people should be consulted regularly about school meals in both primary and secondary schools and encouraged to comment on food choices and the eating environment.

* Government needs to acknowledge the pivotal role that school meals can play in the health of many vulnerable children and consider how they can support schools and caterers to improve the quality of food served. The use of cheap, processed meat and fish products is not good nutritional value for money.

* For primary school children, the choice of meals should be limited: food must be available for those with specific needs, but meals should be based around one key dish each day with variations for children with other requirements. This would ensure that a variety of foods are eaten.

* Schools should consider ways of improving the eating environment for school meals and be able to offer older children good food fast if this is a priority. Older children with limited time to queue and eat should be able to pick up pre-ordered takeaway food that compares well on price and taste with local competition, but which offers a healthier alternative to food bought from other outlets.

Conclusion

What children eat at school is obviously crucial in determining their nutritional intake and laying the foundations for their future health. It is therefore essential that schools provide tasty, nutritious meals that children actually want to eat. Though existing guidelines for the content of school meals may have laudable aims and objectives, all the available evidence suggests that they are fundamentally failing to shape children's food choices and successfully promote healthy eating in schools.

February 2003 saw the Food Standards Agency (FSA) announce a full-scale review of the provision of school meals in secondary schools[21]. The acknowledgement that a problem exists and the political will to tackle it are obviously welcome. However, since the nature of the problem has already been identified, it seems that prompt action, rather than a laborious review, is what is required. The FSA itself has decided to measure school meals against the nutrition-based Caroline Walker Trust standards. Yet, with the evidence already stacked up and children suffering from poor nutrition and jeopardising their future health in the meantime, it is now time for some decisive government intervention.