Food and Nutrition: Primary School Children's Knowledge and Awareness - Essay Example

An Investigation Into Primary School Children's Knowledge And Awareness Of Food And Nutrition Whilst there is some evidence to show that primary aged children are aware of the importance of nutrition, there are also barriers to them implementing this in the choices they make whilst at school. There is competing evidence inferring that this might be due to the cognitive stage at which a child has reached or in the alternate there is research to suggest that this is due to external influences such as parental preferences, the impact of the media and peer pressure. The current view of experts is that the role of schools is paramount in providing information and education given that 20% of children's meals are consumed in the school (Flintoff, 2005). LITERATURE REVIEW A Nation-wide Public Health Issue: According to Purely Nutrition (n.d.), 27.7% of children under 11 years of age are in the overweight or obese category. On average young people eat less than the recommended 5 portions of fruit and vegetables per day and 20% of young people do not eat any fruit in a typical week. Further 58% of children between 7 and 10 years of age spend less than an hour per day participating in moderately intense activities. This is a nation-wide public health issue and a target has been set to reverse the year-on-year increase in obesity for children under 11 years of age by 2010. Historical Review: Local authorities have been under a duty to provide school meals since the Provision of Meals Act 1906 which resulted from the rejection of 60% of recruits for the Boer War due to ill health resulting from poor nutrition (Spear, 2007). School meals became mandatory in 1944 during rationing in the Second World War. However in 1980 the Education Act allowed local authorities to tender provision out. This resulted in a price war with nutritional value being the first victim (Spear, 2007). Nelson et al (2005) point out that a major incentive was saving money. In 1980 expenditure on school meals was approximately 400 million. By 2005 13% of schools had no kitchen facilities at all, having dismantled them. According to Flintoff (2005), 154m was lopped off the school meals budget since 1994. Government Action: The issue of poor diet and obesity in young people came to the public's attention following celebrity chef Jamie Oliver's 2005 television series - Jamie's School Dinners - indicating that the average spend on school dinners was 0.37 which is a dismal amount given that lunchtime makes an important contribution to the nutrition of primary school children in England. (Flintoff, 2005). Within weeks of Jamie's programme ending, then Education Secretary Ruth Kelly announced 220m between 2005 and 2008 to be spent on training, increased hours for cooks, equipment and a minimum spend of 0.50 at primary school and 0.60 at secondary school (Spear, 2007). In 2006 then Education Secretary Alan Johnson announced 240m to subsidise healthy ingredients until 2011 with an additional 2m of capital funding to establish regional training kitchens to share best practice (Spear, 2007). School meals therefore are targeted toward supporting the growth and development of primary school children, whilst also assisting in the establishment of a healthy choice lifestyle. However the Government was aware of the problem well before Jamie Oliver publicised it and was already taking action. The Education (Nutritional Standards for School Lunches) (England) Regulations 2000) introduced nutritional standards for school lunches in April 2001. The standards state the types of foods that should be available in schools from the 4 main food groups - starchy; vegetables and fruit; milk and dairy; meat, fish and alternatives - as well as the frequency with which these foods should be served (DfES 2006). At the same time the government's interim food-based standards came into force taking meals high in salt, fat, sugar or containing low-quality meat off the menu. Primary school standards are expected in September 2008 and final nutrition standards are due in September 2009 (Spear, 2007). Standards were implemented as research showed that children were making unhealthy choices at lunchtime. Further, school meals did not meet minimum nutritional needs even if children wished to make healthy choices. In 2005 the Government appointed the School Meals Review Panel (SMRP), to recommend new standards for school food. SMRP reported in October 2005 and recommended that there should be a prohibition on food high in fat, sugar and salt. In particular there should be a prohibition on meals composed of poor quality meat. Further, it set minimum levels of nutritional content for school lunches. The Consulting Primary School Children on Food at School report was based upon the findings of the Scottish Executive as part of the consultation process for the Schools (Nutrition and Health Promotion) (Scotland) Bill which was launched on 3rd May 2006 (Shoolbread, 2006). 52 primary school children aged between 5 and 12 years of age were consulted, as being representative of the primary-aged population in Scotland. Overall they found that the majority of children were aware of the benefits of eating 5 portions of fruit and vegetables daily, but they preferred non-healthy food. If given a choice they would more likely eat fruit than vegetables and would support a tuck shop which sold healthy snacks and drinks - particularly fresh smoothies. Children aged 6-8 were more likely to eat and enjoy school dinners, with older children being most dissatisfied with school dinners. The children identified the major barriers to choosing school dinners including poor quality of the food itself, the choices available and the service and attitudes of serving staff. They considered the staff and environment to be unhygienic and unpleasant - including crockery and cutlery. They complained about the noise and the length of time it took to be served (Shoolbread, 2006). The survey clearly suggested that schools would have to offer incentives for children to change their behaviour for example offering more interesting foodstuffs, exotic fruits and the popular food stuffs such as smoothies. Overall the perception of the canteen environment itself would have to be addressed before children would be more likely to change their attitudes. What was clear was that too many children were eating processed foods with high fat, sugar and salt content i.e. empty calories, too often. This was of particular concern, since such foodstuffs do not assist physiological or neurological development in children. Further many of these processed foods are heavily implicated in public health issues concerning children such as obesity, diabetes and tooth decay. Research also suggested that altering diet improved behaviour and performance - which is of particular importance in the classroom (DfES 2006). The Department for Education and Skills (DfES) established The School Food Trust (SFT) in September 2005 with a remit to transform school food and food skills, promote the education and health of children and young people and improve the quality of food in England's 21,500 schools by 2008. The standards from September 2007 cover food served at other times of the school day, for example, breakfast and after-school clubs, tuck shops, at mid-morning break or in vending machines. In England all children are to be offered a portion of fruit and a portion of vegetables daily, regular portions of oily fish and healthier drinks. There is to be a complete ban on chocolate products at lunchtimes and desserts are to be served only following a main course. Children are to have free access to drinking water throughout the day and schools are to ensure that healthier drink options are available for purchase, such as milk, fruit juices and yoghurt drinks (Frost and Parr, 2006). The SFT believes that a key aspect of transition in schools is to link healthy lifestyles into the curriculum through the subject areas and to encourage parents to provide healthy lunch boxes ie without confectionary, snacks and unhealthy drink choices. SFT's research also examines the impact of breakfast on cognitive function, the impact of lunch on behaviour and the economic and health benefits of school meals. Academic Studies: Buttriss's 2000 study into the public health implications in the diet and nutritional status of 4 to 18 year olds revealed that most young people led relatively inactive lives. Young people who subsist on benefits are most vulnerable since they have the lowest intake of vitamins, especially folates and Vitamin C - which suggests limited uptake of fruit and vegetables. Of particular concern was the fact that 13% of the age group surveyed had low vitamin D which is essential for healthy bone development. Mineral uptake was very poor with 25% of girls aged 11 to 14 lacking calcium whilst in all age groups/genders zinc uptake was also low. Although fat uptake was close to the recommended level of 35% of dietary energy there was still too much of it being derived from saturated fatty acids. This study also noted the high intake of sugar and salt across the demographic. In 2001 researchers Dixey, Sahota, Atwal and Turner reported on "Children Talking about Healthy Eating: Data from Focus Groups With 300 9-11-Y-Olds". They found that children understood the concept of a balanced diet and were aware of the relationships between diet and health. The children understood that dietary fat should not be a major part of a healthy diet and understood that fat caused heart problems. The children also understood anorexia in terms of being too thin was also a health implication. The researchers persuasively argued that children should be allowed to become more proactive in their own health education. It was felt that this would assist children to overcome social and peer pressures to be an idealised body weight. Edwards and Hartwell (2002) were concerned with how well children aged 8 to 11 years of age could identify everyday fruit and vegetables. They were also interested in how children themselves perceived "healthy eating". They found that children could more readily identify fruit and preferred fruit to vegetables. Again they found that cognitive development was important, as the children were better able to recognize vegetables the older the children were. The children were able to define "healthy eating" with most of them obtaining this information from school. They were also aware of current guidelines on a balanced diet although there was some confusion. Research undertaken by Hart, Bishop and Trudy (2002) examined 114 children, aged 7-11years. The researchers' special interest was to find a vector for ensuring that food nutrition messages were sent and received effectively. They evaluated responses in terms of age, gender and socio-economic status (SES). They deliberately discussed parental food rules. They found that many parents imposed restrictive food rules, but this was more commonly done in higher SES with children from low SES having 'free choice' with few food restrictions, food prescriptions or food deals'. Amongst reasons discussed for this was that parents/carers with low or fixed incomes tend not to waste food, and therefore buy only what they know their child/ren will consume. They also comment on cognitive development and its impact on a child's ability to recognise the difference between food-health and food-nutrients. Interestingly they point out that in order to benefit from healthy eating guidance young people must be motivated and understand the message. Motivation for young people is difficult since they have difficulty foreseeing consequences of their current actions in the future. Healthy food is seen as 'adult' and therefore automatically boring. In terms of cognitive ability, primary school children are in transition between pre-operational, concrete-operational and formal thought. A child's cognitive ability impacts on its ability to handle abstract concepts such as vitamins. Therefore the researchers recommend that when communicating healthy eating to this age group it is important to take this into account and ensure that the cognitive demand is not too high. External factors: The role of parents/carers is also important as they can be at alternative times gatekeepers of opportunity and serve to reinforce healthy eating dogma. According to Hart et al research by Shepherd and Dennison in 1996 indicated that advertising and peer pressure has more impact on adolescents than parents. Further in the USA children are becoming responsible for food purchasing at an earlier age; 10 year olds make up to 250 purchases a year (Robinson, 2000 - cited in Hart et al). Children also rely heavily on the media for information. Hart et al claim this may explain the prevalence of "simple but misleading ideas, such as 'sugar for energy' and 'chocolate is good'". The researchers point out that children are not homogenous and some of them do question the validity of the messages they receive. Having said that, the fact that younger children tend to take information at face value suggests a role for simplified healthy eating messages being delivered via popular media such as television. There is another implication here; whilst parents/carers are giving young people more financial independence and choice over nutrition young people are demonstrably not yet ready to make informed choices on nutrition, being heavily reliant on branding and the preferences of friends who often know little more than themselves about nutrition. Recent Findings: Primary school children consume up to 33% of their daily nutritional intake at lunchtime (Gregory et al, 2000), with 42.3% of primary school children opting for a school meal during term time and approximately 50% bringing their lunch from home (Nelson and Nicholas, 2006). Surveys which look specifically at packed lunches have consistently found that they are nutritionally poor value compared to school meals (Rogers et al, 2007 and Jefferson and Cowbrough, 2004). However the SFT found that there may be an indication that food standards are beginning to cross over to packed lunches, since there have been falls in the levels of total and saturated fat, sodium observed here while the intake of micronutrients is higher since Rogers et al completed their study (SFT, 2007). Adoption of food standards by schools may result in a widening nutritional gap for some children with packed lunches - especially those who are provided with confectionary and snack foods. As an example of this, a study into 136 8-10 year olds at 6 primary schools in Sheffield during 2007 found that school dinners provided more vegetables, fruit, extra bread and healthier drinks than children who consumed packed lunches. 65% of packed lunches contained confectionary whilst 28% contained both confectionery and a snack. Further 31% of drinks in packed lunches did not comply with the healthier drinks food-based standard found in school meals. Overall school meals met the 2008 nutrient standards for carbohydrate, non-milk extrinsic sugars, total fat, fibre, sodium, vitamin A and vitamin C. However packed lunches were more likely to meet the nutrient standard for calcium. Where schools actively promote consistency in meals - be they provided by the school or from home - there is a greater chance that more children will eat better quality food (SFT, 2007). However, it is not clear from the research papers examined whether proactive promotion of healthy eating in itself will be sufficient to overcome children's personal preferences in food. In 2007 Ellis and Ellis evaluated the impact of a traffic light nutrition tool on the knowledge, attitudes and behaviour of children aged 5 to 7 in a primary school. 69 children were tested 3 weeks before they received nutritional education and then again 3 weeks afterward. The tool was based on recommendations made by the House of Commons Health Select Committee on Obesity. Foods were colour coded, and children could freely eat any green food, amber foods in moderation and rarely eat red foods. The children's knowledge increased and they increasingly refused red foods - but also green foods. The researchers concluded that the increased refusal of green foods was due to the children misunderstanding some aspects of the nutritional message. They put this down to a lack of whole school involvement and weak parental support. Interestingly, they did not suggest that most green foods are bland and not as filling as children in this age group prefer (ie confectionary and snacks) which may well explain the fall off in interest. The Expert Group on Hydration (EGH) which offers guidance on the importance of hydration for health and academic performance recently warned in its publication Drinking in Schools that the over-emphasis on food had resulted in the importance of hydration being overshadowed. EGH argue that children of secondary school age should be drinking 2 litres of fluid per day. Dehydration can impact on health - headaches, lack of concentration and digestive problems - and subsequently on the ability to study. However, the study found that only 13% of the 82 secondary schools surveyed had a specific hydration policy in place. This research has been echoed by the British Nutrition Foundation (BNF) which found that young people should be drinking between 1.1 and 1.5 litres of liquid (around eight to 10 cups) in addition to water provided in food or made by the body. Research undertaken by Leeds University indicated that the ability to undertake arithmetic was impaired before thirst began if dehydration was between 1% and 2%. Further, dehydration can lead to infections of the urinary tract, constipation and a dry cough. BNF believe that all schools should have a hydration policy in place as part of its review of its school meals system and also as part of its national curriculum. This should be reflected in the stocks stored in vending machines, ensuring a strong balance between water, fruit juice, dairy drinks and low calorie drinks to encourage children to drink more often. There should be no restrictions on access to fluids and toilet facilities in school. Further they argue that blanket bans on allowing children to bring drinks to school are 'unhelpful and inappropriate'. In particular, children should be encouraged to drink before, during and after PE lessons. Given that 2/3 of schools do not allow drinking during lesson times, some children are going 5 hours or more without hydration. Whilst there are reports that the take up of school meals fell following the introduction of standards, there is also evidence that some local authority caterers saw an increase in demand for school meals (SFT, n.d.). This reversal in trend took place where there was improved quality with no increase in cost, better facilities, a wider choice of healthy options and a whole-school approach to proactively marketing school meals. As a role model of excellence the SFT refers to Barking Abbey Comprehensive School, a specialist sports and humanities college with 1,850 pupils. The school moved to an in-house catering system keeping processed food to a minimum. The children have access to healthy salad bars and the school has not sold a fizzy drink or crisps in 3 years. Students are encouraged to drink water throughout the school day. In particular, not only were all stakeholders involved from the beginning the strategy has not increased the cost of meals, which cost approximately 0.90 each (SFT, n.d.). Conclusion: It is often easy to overlook the fact that the concern is not only with ensuring young people receive sufficient nutrients and energy. The current priorities are to ensure that all citizens understand the importance of dietary balance and live less sedentary lifestyles. In the 7 year period from 2000's National Survey to the 2007 survey undertaken by Ellis and Ellis one receives the impression that very little has changed. Children still have shaky knowledge of what "healthy eating" means, remain generally averse to green vegetables and are not involved in moderate exercise for at least one hour per day as recommended in 2004 by the Chief Medical Officer. This strongly indicates that the message is not getting through to those external stakeholders with most influence on young people - parents/carers, advertisers and schools. Even when children understand "healthy food" they are not necessarily motivated to ingest it - particularly if it is green and a vegetable. The SFT believe that school meals are economical enough to persuade parents to allow their children to have lunch at school, where they can be sure the food is more nutritious than a packed lunch. However, SFT does not quote the evidence which makes it clear that it is solely economic reasons why some parents resist school lunches. There are parents who remain ignorant of the role of food standards on development, and others who know and choose to do nothing. There are also parents who consider their viewpoint to be paramount since only they "know" what their child/ren prefer to eat - as opposed to what their children should be eating. The question then remains how to ensure these "hard to reach" demographics are influenced by food standards The SFT believes that strengthening schools will lead to a drip down effect on packed lunches, particularly if more children are encouraged to take a school lunch. In fact the SFT believes that it will be possible to effectively force parents to improve the nutritional value of packed lunches by insisting that all food eaten at school complies with the nutritional standards (SFT, 2007). This may well be achievable with sufficient structure, money and public education thrown at it. However, schools and indeed parents/carers do not exist in a vacuum. What happens to those children who do not attend mainstream schools (privately educated, home schooled) What happens to children's diets at weekends, during holidays and while they are truanting How much control do schools and parents/carers have over choices made by children when they are not supervised List of References Andrew Shoolbread. (2006). Consulting Primary School Children on Food at School; as part of: Consulting Children on the proposed Schools (Nutrition and Health Promotion) (Scotland) Bill. Research undertaken by the Scottish Out of School Care Network on behalf of the Scottish Executive Department of Health. (2004). At least five a week: Evidence on the impact of physical activity and its relationship to health. 29 April 2004. TSO. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4080994 Expert Group on Hydration. (n.d.). Drinking in Schools: A Report on Best Practice for Hydration in Schools. http://www.experthydration.com/DrinkinginSchoolsFINAL.pdf Gregory et al (2000). National Diet and Nutrition Survey of Young People aged 4 to 18 years. London: The Stationary Office. http://www.schoolfoodtrust.org.uk/UploadDocs/Library/Documents/sft_baseline_survey.pdf Ian Young. (1993). Healthy eating policies in schools: an evaluation of effects on pupils' knowledge attitudes and behaviour. Health Education Journal, Vol. 52, No. 1, 3-9 (1993) Health Education Board for Scotland, Edinburgh J S A Edwards, J. S. A and H H Hartwell (2002) Frit and Vegetables. Attitudes and knowledge of Primary School Children. Journal of Human Nutrition & Dietetics, Volume 15,Number 5, October 2002 , pp. 365-374(10). Blackwell Publishing. Available at: http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1365-277X.2002.00386.x Jefferson and Cowbrough (2004). School Lunch Box Survey. Community Nutrition Group, British Dietetic Association/ Food Standards Agency. John-Paul Flintoff . (2005). "Jamie Oliver: It's time to cut the crap. Once, Jamie Oliver was just a dab hand with a chopper. Now, he's every parent's best friend". The Sunday Times March 20, 2005. http://www.timesonline.co.uk/tol/life_and_style/food_and_drink/article432258.ece Judy Buttriss (2000) Diet and nutritional status of 4 - 18 year old: Public health implications. Nutrition Bulletin, Volume 25,Number 3, September 2000 , pp. 209-217(9). Blackwell Publishing Judy Buttriss (2002) Nutrition, Health and School Children. Available at: BNF: (2003). Nutrition, Health and Schoolchildren. http://www.nutrition.org.uk/home.aspsiteId=43§ionId=464&parentSection=341&which= Justina Frost and Alison Parr: A whole-school approach to healthy eating. Primary Headship. Sep 2006. http://www.teachingexpertise.com/articles/a-whole-school-approach-to-healthy-eating-1002 K. H Hart, J. A Bishop, H Truby. (2002). An Investigation into School Children's Knowledge and Awareness of Food and Nutrition. Journal of Human Nutrition and Dietetics 15 (2), 129-140 M Nelson, J Nicholas, S Suleiman, O Davies, G Prior, L Hall, S Wreford, and J Poulter. (2005). School Meals in Primary Schools in England. King's College: London Thursday 29 June 2006. Available at: http://www.dfes.gov.uk/research/data/uploadfiles/RR753.pdf Nelson and Nicholas. (2006). First Annual Survey of Take Up of School Meals in England. Purely Nutrition. http://www.purelynutrition.com/pf-home.html Rachael Dixey, Pinki Sahota, Serbjit Atwal and Alex Turner (2001) Children Talking About Healthy Eating: Data from Focus Groups with 300 9-11 Years Olds Rogers, Ness, Hebditch, Jones, Emmett (2007). Quality of Food Eaten In English Primary Schools: School Dinners Vs Packed Lunches. European Journal of Clinical Nutrition, 61, 856-864. Rona M Ellis and Robert C T Ellis. (2007). Impact of Traffic Light Nutrition Tool in a Primary School. The Journal of the Royal Society for the Promotion of Health. Vol. 127, No. 1, 13-21. South East Public Health Observatory (SEPHO). Childhood obesity. Last reviewed November 2007. http://www.sepho.org.uk/Topics/childhoodObesity.aspx The Chartered Institute of Environmental Health (CIEH). Classy Food. Publication Date: 05 January 2007 . http://www.cieh.org.uk/ehp1/article.aspxid=3013 The School Food Trust. (2007). Children's Lunchtime Choices Following The Introduction Of Food-Based Standards For School Lunch; Observations From Six Primary Schools in Sheffield. Available at: http://www.schoolfoodtrust.org.uk/UploadDocs/Contents/Documents/childrens_lunchtime_choices.pdf Read More