Are COVID-19 school guidelines adversely impacting teenagers’ diets?

Posted by Kelly Rose, Graduate Tutor/PhD researcher at Teesside University

As a mum, a registered nutritionist and former schoolteacher, you may imagine where my focus has been in the past few months, during school closures and schools returning. Although, I felt blessed that my girls were home and safe, and we could enjoy time together, with enough food. My daily thoughts did include a darkness, thinking of those teenagers I knew who would not be having a nourishing, happy family life during the lockdown.

In the past two years of my PhD studies, I have discovered that political change, how well policy is implemented and willingness and capacity of headteachers to prioritise healthy food, all have a bearing on how successful school food is provided. In short: school food is a really important factor in the quality of a young person’s diet.

The pandemic is highlighting inequities and raising awareness of school lunches

Over the summer a coalition of organisations formed to tackle food poverty as part of the national food strategy [1,2]. Premier league footballer Marcus Rashford shared his own childhood experiences at the forefront of a campaign calling for free school meals to food insecure children. During the UK lockdown five million families were reported to be experiencing food scarcity, hunger and or issues with accessing enough food, with 3.2 million – that’s 11% of households! – suffering food insecurity.

Parents and young people in the UK have expressed their agreement that healthier diet is more important than ever and would like to see positive change as a result of the pandemic [3,4]. And a significant number of parents want their children to not only learn about nutrition and develop cooking skills in school, but also to have a healthy school lunch [2,3].

Back to school

As my daughter prepared to return to year 11, her school was providing regular updates on the changes they had made in adhering to the COVID-19 guidelines, it was clear that they were working hard to help pupils feel better about returning. Then, a menu came through – oh dear. My heart dropped as I saw three images on the page. A white bacon roll, a white bread sandwich and a pizza slice featured in colour… 

Many children are choosing to take in a packed lunch, but given the evidence over the past decade, the nutritional value may be even more of a concern [5,6]. However, it is also often socially unacceptable to bring in food from home for older teens in years 10 and 11. My school contacts have raised concerns about providing the same food services that they did before COVID, including the logistical challenge of keeping year groups separate in addition to the high levels of hygiene required. This has led some schools to significantly reduce the time that pupils have to eat. These changes may be hampering the ability of schools to serve healthy foods. 

Schools are absolutely an ideal environment to support and shape healthy habits for young people. But, are the expectations for schools to nourish young people, provide comprehensive health education, on top of the academic priorities too much especially in a global pandemic? With the restrictions of the COVID-19 regulations, how can nutrition remain a priority? And what about the existing national school food standards [7].

Is this a national issue?

I want to find out if my experience locally is mirrored nationally. As part of my PhD research I have developed a short questionnaire for students (16-18 year olds), parents of 11-18 year olds, and staff involved in education to complete.

Your help with this important investigation would be very much appreciated. Please complete the survey if you meet the criteria as below, or share with others.

• A young person (aged 16-18 years) attending secondary school or post 16 education in UK
• Parent of a young person (aged 11-18 years) who is attending secondary school or post 16 education in UK 
• Staff employed in a secondary school or post 16 education in UK. 

COMPLETE THE SURVEY HERE



References:

1. National food strategy part 1 – Recommendations in full: https://www.nationalfoodstrategy.org/wp-content/uploads/2020/08/8_NFS_Report_RecommedationsInFull.pdf
2. Sustain website: https://www.sustainweb.org/news/sep20-freeschoolmeals/
3. Covid-19 and Children’s Food: Parents’ Priorities for Building Back Better: https://www.sustainweb.org/resources/files/reports/Childrens_Food_Covid19_Briefing.pdf
4. Bite Back 2030:https://biteback2030.com/sites/default/files/2020-06/BB2030%20Covid-19%20Report%20V2%5B1%5D.pdf 
5. Spence, S., Delve, J., Stamp, E., Matthews, J.N., White, M. and Adamson, A.J., 2013. The impact of food and nutrient-based standards on primary school children’s lunch and total dietary intake: a natural experimental evaluation of government policy in England. PloS one, 8(10), p.e78298.
6. Evans, C.E.L., Greenwood, D.C., Thomas, J.D. and Cade, J.E., 2010. A cross-sectional survey of children's packed lunches in the UK: food-and nutrient-based results. Journal of Epidemiology & Community Health, 64(11), pp.977-983.
7. The Independent School Food Plan website: http://www.schoolfoodplan.com/

It’s not just teaching and curriculum that need a boost in September - what about school fruit and veg?

The School Fruit and Vegetable Scheme offers 2.3 million children aged 4 to 6 attending state-funded primary schools in England a free piece of fruit or veg each school day. It was suspended in March and after months of campaigning the Government finally confirmed the scheme will resume in the Autumn. But how could this Scheme go further to better meet Government aims?

Sofia Parente, Sustainable Food Places Policy & Campaigns Coordinator at Sustain: alliance for better food & farming

Credit: Pexels.com cottonbro

School holidays are upon us and this year, for the first time, 1.3 million UK children on free school meals will have access to support during July and August. Universal Infant Free School Meals and the School Fruit and Vegetable Scheme, suspended when schools closed in March, will be back in September. This should be cause for celebration but unfortunately, it’s not just teaching and curriculum needing a boost in September. Even in ‘normal times’ 80% of children were not eating their 5 A Day. Following lockdown, there’s been a massive decrease in fruit and vegetable intake reported by children receiving free school meals, according to a study from Northumbria University’s Healthy Living Lab. In this study just over half of pupils who would have received free school meals on site stated they had eaten no fresh vegetables across a three-day period following the UK’s COVID-19 lockdown. Vegetable intake dropped from just over two portions per day when children were attending school, to an average of half a portion per day at home. Almost half said they had eaten no fruit in the same period, yet many reported a large increase in their consumption of sugary drinks and snacks. 

As a school Governor and mother of two children in primary school, I’ve heard countless praises of the School Fruit and Vegetable Scheme. Children are naturally hungry mid-morning and fruit and vegetables are the perfect snack. By eating together in the classroom or playground, pupils try fruit and veg that they wouldn’t otherwise try at home. Only last week my niece (a fussy eater when it comes to veg) told me the first time she had ever tried sugar snap peas was in Year 2 when she had free fruit and veg at school. Teachers often integrate it in the curriculum too by using fruit and vegetables in numeracy and literacy lessons.

The reinstatement of the School Fruit and Vegetable Scheme is good news but still some way off when it comes to tackling historical low levels of fruit and veg consumption and under-investment in school food. It only reaches children in Key Stage 1 (pupils aged between 5 and 7) in England and there is no comparable scheme in Wales or Northern Ireland, although in Scotland some local authorities fund fruit in schools.

BIGGER

One of the best ways to ensure children increase access to fruit and vegetables at school is to bring back the scheme bigger and better and to introduce it to other nations in the UK. An efficient procurement process and network of delivery centres makes it possible to deliver 2.3 million pieces of fruit and vegetables to 16,600 schools in England every school day working out at around 8p per child per day. We’ve seen extraordinary progress in food and farming strategy this week. The first report from the National Food Strategy includes strong recommendations to address food poverty and inequality. And the Government’s obesity strategy has arguably some of the most ambitious new policies to date, particularly the 9pm advertising watershed for unhealthy food, with parallel restrictions online and on social media, along with constraints on promotions and progress on labelling. Expanding the scheme to all children in primary school using the set up already in place would be a remarkable value for money measure to help Government meet the ambitions of these two new strategies by helping to level off some of the inequalities in access to fresh fruit and vegetables and would be a game changer given the low levels of fruit and veg eaten by children. The latest evaluation of the scheme shows that while it leads to an increase in younger children eating fruit and veg, longer and integrated interventions would lead to long-lasting impact and sustained levels of consumption in older children.

Better

The first and easiest change to improve the scheme would be to increase the proportion of British seasonal fruit and veg produced to higher standards. According to the Soil Association, only 30-40% of this produce is grown in the UK. Why are we serving imported rock-hard apples to children in schools surrounded by apples in season in orchards in Kent and Somerset or to children anywhere in the UK come to that? This flagship Government procurement scheme should be supporting British farmers and traders, not least to support the aims of other Government departments, but to help the economy, especially now after Britain’s departure from the EU and the uncertainty in the food and farming sector triggered by COVID-19.

The School Fruit and Vegetable Scheme should be re-specified to provide a year-on-year percentage increase of seasonal and certified sustainable produce - such as the Organic or LEAF (Linking Environment And Farming) mark - to help drive towards the Government’s aims in the Environment Bill, Agriculture Bill and climate legislation. This would result in increased fruit and vegetable consumption and benefit British farmers, children and the environment.

Image: Credit: Pexels.com cottonbro

It is time to ban the sale of energy drinks to children in the UK

Guest post by Prof Amandine Garde, Dr Amelia Lake and Dr Shelina Visram

In 2016 in the UK alone we consumed 679 million litres of high sugar, high caffeine drinks known as “energy drinks”. Described as the fastest growing sector of the soft drink market, they have become a major public health concern and have been subject to both a House of Commons Science and Technology Committee Enquiry (April – December 2018) and a Department of Health and Social Care consultation (which closed on 21 November 2018).

In the report it published on Tuesday (4 December), the Committee found that “the current quantitative evidence alone is not sufficient to warrant a statutory ban”, though it noted that “societal concerns could justify a ban on the sale of energy drinks to children”. This conclusion is puzzling for several reasons.

Energy drinks and children

Firstly, a growing body of evidence has established that energy drinks consumption, particularly by children, is associated with a wide range of harmful effects.

• Whilst childhood and adolescence are periods of rapid growth requiring adequate sleep and good nutrition, energy drinks play a role in disrupting sleep (1 - see references below).
• It is established that energy drinks are highly erosive in terms of dental health: they have low pH and a high non-reducing sugar content (2).
• Consumption is also linked to increased energy intake and therefore obesity (3). Hence the proposal of the UK Government to ban the sale of energy drinks to children in the second iteration of its Childhood Obesity Action Plan, published in August 2018, and the public consultation that followed.
• However, energy drinks consumption is also linked to physical symptoms such as headaches, stomach aches and sleeping problems (with some evidence of a dose-response effect), as well increased risk-taking behaviours, including binge drinking, smoking, illicit drug use, screen time and poor dietary behaviours (4). Moreover, mixing energy drinks with alcohol increases the risk of injury and unsafe driving (5) and 6).

Secondly, the Committee has failed to engage with the fact that gathering “quantitative evidence” on the impact of energy drinks on child health would be unethical (other than the aforementioned studies, which tend to involve large-scale, school-based surveys).

To our knowledge, there have been no experimental studies involving children’s use of other age-restricted products such as alcohol, tobacco, aerosols, solvents, fireworks, knives, crossbows, petrol or even Christmas crackers (sales of which are restricted in England to those aged 12 and over). Why should energy drinks be subjected to a higher standard of evidence than any of these products?

Thirdly, the evidence base has not prevented other countries from regulating the sale of energy drinks to children. In Europe, Lithuania introduced a ban on the sale of these drinks to under 18s in 2016, followed by Latvia, whilst Norway and Sweden are reflecting on similar legislation.

It is therefore unclear why the Committee has concluded that existing evidence is insufficient to adopt a similar law in the UK. The rationale seems to lie in the absence of a “causal link” between energy drinks consumption and childhood obesity, tooth decay and other diet-related diseases. This arguably demonstrates a lack of understanding by the Committee of the strategies required to address complex and multifactorial nature of these diseases.

It is indeed difficult to establish a causal link between the various measures adopted and the burden of non-communicable diseases: no single policy option can realistically tackle broad phenomena, such as growing obesity rates or tooth decay, when taken in isolation.

Governments must ensure that public health is effectively protected, and they can invoke the precautionary principle in the event of any outstanding scientific uncertainty regarding the impact of energy drinks consumption on public health. Hence, probably, the acknowledgement from the Committee that “it would be legitimate for the Government to go beyond the evidence that is available at the moment and implement a statutory ban based on societal concerns and evidence, such as the experience of school teachers and pupils”.

The logic of their reasoning is nonetheless difficult to follow. There is no doubt that the Government should introduce legislation banning the sale of energy drinks to children, following the lead of Lithuania and Latvia. This would not amount to going beyond the evidence; it would be acting on the basis of existing evidence. It is this body of evidence that has prompted very real and major societal concerns of the effects of energy drinks on our children’s health.

Fourthly, the call of the Committee for more effective labelling measures should not be envisaged as providing an alternative to a ban on the sale of energy drinks to minors; it should only be viewed as complementing such a ban. This is all the more so as labelling could increase existing health inequalities. Children and young people from all backgrounds consume energy drinks. However, as the Committee has noted “energy drinks are consumed disproportionately by disadvantaged groups”.

There may indeed be a link between regular consumption of energy drinks and eligibility for free school meals (FSM), which is often used as an indicator of lower socio-economic status. The 2018 Health-Behaviour in School-Aged Children Survey found that, among those who reported that they drank at least one energy drink per day, 23% received FSM, whereas those who said that they never drank energy drinks or did less than once a week, 11% received FSM (compared to 13% of FSM recipients across the whole sample). A study conducted in schools in the South West England also found that being eligible for FSM was significantly associated with drinking energy drinks once a week or more (Richards and Smith, 2016).

Energy drinks have no place in a healthy diet

Finally, the Committee does not seem to be aware that the Government has a duty to protect the rights of all children to the enjoyment of the highest attainable standard of health and to adequate nutritious food. Energy drinks have no place in a healthy diet. Shifting the responsibility of protecting them onto business actors, such as food manufacturers or food retailers, is highly problematic, not only because a voluntary ban will fail to create the level playing field within which all these actors should operate, but also because it will fail to protect child health and their rights and cannot therefore contribute to an effective obesity prevention strategy.

The Responsibility Deal has failed; regulatory measures that apply to all and are duly enforced are required to address the growing burden of obesity, tooth decay and other diet-related diseases. The conclusion that a statutory ban would be too restrictive is ideological rather than grounded in evidence.

A statutory ban is the most likely measure to ensure that children and young people are effectively protected from the many harmful effects of energy drink consumption.


About the authors:

• Professor Amandine Garde, Professor of Law and Director of the Law & Non-Communicable Diseases Unit at the University of Liverpool. 
• Dr Amelia Lake, Associate Director of Fuse - the Centre for Translational Research in Public Health and Reader in Public Health Nutrition at Teesside University. Amelia is a Dietitian and registered Public Health Nutritionist. 
• Dr Shelina Visram, Programme Lead of the Complex Systems Research Programme for Fuse - the Centre for Translational Research in Public Health and Senior Lecturer in Public Health at Newcastle University.

The views expressed here are those of the authors and do not necessarily reflect those of the author's employer or organisation.

References:

1. Do sleeping habits mediate the association between time spent on digital devices and school problems in adolescence?
2. Short Communication: In vitro assessment of Erosive Potential of Energy Drinks
3. Systematic review of the literature on the effectiveness of product reformulation measures to reduce the sugar content of food and drink on the population's sugar consumption and health: a study protocol
4. Consumption of energy drinks by children and young people: a rapid review examining evidence of physical effects and consumer attitudes
5. Alcohol Mixed With Energy Drinks and Risk of Injury: A Systematic Review
6. Alcohol mixed with energy drink use among U.S. 12th-grade students: Prevalence, correlates, and associations with unsafe driving

Researching holiday hunger

Guest post by the Healthy Living Lab team, Faculty of Health and Life Sciences, Northumbria University

“Summer is here and the living is easy ….” well for most people it might be. However, for many families on low incomes, school holidays are challenging times. Over the past few years, the Healthy Living Lab at Northumbria University has undertaken research into the holiday clubs providing support to these families. We have had the privilege of working with clubs right across the UK from Scotland to the South of England. We have visited clubs based within a range of settings including schools, food banks, church halls and community centres. Research by the Healthy Living Lab is providing a significant insight into the location of holiday clubs, and crucially identifying gaps in provision and the outcomes for families and children attending the clubs.

During the school term, free school meals (FSM) act as a safeguard for children from low income families, but there is no additional state provision for these children during the school holidays. The term ‘holiday hunger’ has been used to describe the hardship that children and families on low incomes face during the summer break; when they do not have access to a free school lunch. Moreover, the increase in financial pressures during the school holidays has a more general impact on the quality of children’s lives, as families lack money for entertainment, socialising and educational or developmental activities (Gill & Sharma, 2004; Graham et al., 2016; Kellogg’s, 2015).

School holiday clubs can help to bridge this gap by providing food, activities and support. Many holiday clubs are staffed by volunteers, who have given up their summer to make sure that something important happens; that children have access to nutritious meals when free school meals aren’t available. There is also a good chance there will be activities happening within holiday clubs, and that the children attending are having a great time.

Research from the Healthy Living Lab team ascertained a need for holiday club provision for families on low incomes (Defeyter, Graham, & Prince, 2015). We have spoken to parents and children at holiday clubs, many of whom live below or just above the poverty line. Our findings highlight that, for many low-income families, the school holidays are difficult, especially the longer summer break. A member of staff at one holiday club breakfast club indicated that it wasn’t just children who benefited from the the holiday breakfast club as well, saying:

“Main thing is for the kids, but I think it’s really benefitted the adults as well, so urm yeah just making sure every-one’s getting food, which is really important ‘cause breakfast, the most important meal of the day (Female staff member; Club 5) (Defeyter, Graham, & Prince, 2015, p.5)

Whilst parents strive to ensure that their children are fed, many find it more difficult to manage during school holidays, as food bills increase and thereby the risk of low-income families experiencing food insecurity also increases. Moreover, we have spoken to staff and volunteers from school holiday clubs, who have told us that their clubs provide food, in addition to social, learning and support opportunities (Graham et al., 2016). Our research shows that holiday clubs not only provide financial support to low income families, through the provision of a free meal, but also provide a social outlet for parents and their children, as well as wider benefits for the community (Defeyter, Graham, & Prince, 2015).

Researching this area is challenging as it involves talking to families about sensitive issues such as their food and financial situation. But, this work is also invaluable as it draws directly on the experiences of parents, children, and holiday club staff ensuring their voices are heard.

The Healthy Living Lab Team is:

• Professor Greta Defeyter, Faculty Associate Pro Vice-Chancellor (Strategic Planning & Engagement), Faculty of Health and Life Sciences, and Director of Healthy Living
• Dr Pamela Graham - Vice Chancellor's Research Fellow
• Dr Louise Harvey-Golding - Senior Research Assistant
• Emily Mann - PhD Researcher
• Jackie Shinwell - PhD Researcher

References:

1. Gill, O., & Sharma, N. (2004). Food Poverty in the School Holidays. London.
2. Graham, P. L., Crilley, E., Stretesky, P. B., Long, M. A., Palmer, K. J., Steinbock, E., & Defeyter, M. A. (2016). School Holiday Food Provision in the UK: A Qualitative Investigation of Needs, Benefits, and Potential for Development. Frontiers in Public Health, 4(April 2014), 1–8. http://doi.org/10.3389/fpubh.2016.00172
3. Kellogg’s. (2015). Isolation and Hunger : the reality of the school holidays for struggling families. Manchester. Retrieved from http://pressoffice.kelloggs.co.uk/Going-hungry-so-their-children-can-eat-Third-of-parents-on-lower-incomes-have-skipped-meals-during-school-holidays
4. Defeyter, M. A., Graham, P. L., & Prince, K. (2015). A Qualitative Evaluation of Holiday Breakfast Clubs in the UK: Views of Adult Attendees, Children, and Staff. Frontiers in Public Health, 3(August). http://doi.org/10.3389/fpubh.2015.00199

Photo courtesy of Children in Scotland: http://www.childreninscotland.org.uk