What’s for lunch? Developing, implementing and evaluating a healthy school lunch at Dutch primary schools.

Children’s dietary consumption patterns present significant opportunities for improvement, particularly in terms of nutritional quality. Only a small fraction of Dutch children follow recommended dietary guidelines, less than half of the children consumed fruits daily and only 25% of the children included vegetables in their daily diet. Healthy school lunches, represent a promising intervention in an ideal setting to improve the quality of all children’s diets, especially given that studies have shown that lunches consumed at school provide an important part of the foods and drinks that children consume per day. The Netherlands does not have a tradition of a school provided lunch, implementing a school lunch program would represent a significant shift. The overall aim of this thesis was to design and implement a school-provided lunch program in the Netherlands to improve eating habits of primary school children by considering the current lunch behaviours of children, preferences of children, parents, and school staff, as well as assessing the impact of the intervention on the lunch intake and compensation behaviour of the children outside school hours. Chapter 2 gives more insight and understanding whether there are differences in the content and quality of the current lunches consumed at home and at school during schooldays. The results showed that the most consumed lunch products among primary schoolchildren were bread, dairy products and sugar-sweetened beverages. Besides, the consumption of fruit and vegetables was very low. In Chapter 3 a qualitative study is described in which the perceptions of children, parents and school staff towards both the current school lunch situation and the development and implementation of a school lunch program within primary schools were investigated. The results showed that most children and parents are satisfied with the current lunch situation, although existing school food policies are not always put in place. Most teachers felt that children had insufficient time to consume lunch in the current situation. Chapter 4 shows the results of a cross-sectional study. The results of this study showed that most lunchboxes contained sandwiches and a drink. Few lunchboxes contained fruit or vegetables. The alternative school lunch concepts elicited mixed support among children. The lunch concepts ‘sandwiches prepared by the children themselves’ and a ‘hot lunch buffet’ had the highest mean support, while the concept ‘a healthy lunch brought from home’ was the most preferred concept. Chapter 5 shows the perceptions of parents for the same set of alternative healthy school lunch concepts from chapter 4 via a questionnaire. The highest parental support was found for the concepts “sandwiches prepared by the children themselves at school” and “school policy for a healthy lunch from home”. Chapter 6 describes the design of the study in which we investigated the impact of a self-served school lunch. Chapter 7 showed the results of a pretest-post-test study to investigate the effects and appreciation of the self-served school lunch on the dietary intake of the children among 3 primary schools in the Netherlands. At baseline 7.2% of the children consumed vegetables, which increased significantly at 3 months to 56.1% and at to 50.6% at 6 months of the intervention. The school lunch was well appreciated by the children and did not lead to any substantial compensation effects at home. The overall conclusions, methodological considerations and recommendations for policy, practice and research of this dissertation are summarized in the discussion. Overall, the findings of this dissertation demonstrates that a healthy school lunch intervention, tailored to the preferences of children, parents, and school staff, is a promising strategy to promote healthier dietary habits among primary school children.