Diet or Disease?
The case for School Meals guidelines
Nutritional standards for school meals were laid down by the Department of Education and Science until the Education Act of 1980. This Act left it to the local authorities to determine their own nutritional standards for their school meals services, and LEAs were not obliged to introduce such standards. Besides the end of the obligation to meet national nutritional standards for meals, authorities were also released from the obligation to provide a “set meal”, and increasingly encouraged to open the service to competitive tendering. At the same time the climate in which both local and national public expenditure has been operating has become progressively controversial, so that the criteria of cost effectiveness are being applied increasingly to services such as schools catering.
Two developments have been noted. Local authorities do not necessarily make their caterers, “in-house” or private, aware of what objectives the service should meet. The social services element of the provision continues, but even those meals provided free (for children by definition’n.cedy’) are not required to meet a common nutritional or other standard. In this context, caterers have informed us, a free-choice cafeteria system coupled with the need to generate business, has tended to result in the easy option of providing popular fast-food items such as burgers and chips.
Secondly, this development and the numbers of school children who opt to cat out of school at lunch time has generated growing concern over the diets of young people in this country A focus for this came in April 1986 in reports of the findings of the DHSS survey”The Diets of British School Children”(1), coverage of which included comments such as these: “The main finding is that children eat more chips, crisps and other potato products than any other single food … young people’s diet has become so unbalanced that they now depend for a significant proportion of their total daily intake of nutrients on these three foods~ chips, cakes and biscuits, of which they eat three times the average household’s consumption … with the result that consumption of other more nutritious foods such as fish, lean meat, vegetables and fruit is cut to a minimum”(2).
Another study (3) has also revealed, among 11 to 12 year olds, great confusion over what constitutes healthy eating, a lack of familiarity with and thus use of fresh vegetables, and an immediate preference for”fast-food”, high in saturated fats and sugars. It is now feared that the establishment of this dietary pattern will lead to high blood cholesterol levels and obesity, both risk factors in coronary heart disease, and all the consequent problems of diet-related disease later in life.
There is now a need for an up-to-date school meals service which takes account of both current eating patterns and recent nutritional recommendations.
Current Views on Nutrition
The years since the 1980 Act have seen the publication of two crucial reports -by the National Advisory Committee on Nutrition Education, published by the Health Education Council in 1983, and by the Government’s own Committee on Medical Aspects of Food Policy in 1984 -which laid down authoritative quantified dietary guidelines for the nation (4). In the case of the COMA Report in particular these guidelines were intended for all aged five and above. There is also an increasing public awareness of the relation between diet and health. This has led to an acceptance of the need for:
0 a reduction in the level of total fats, particularly saturated fats, in the diet, accompanied by an increase in polyunsaturated fats;
a reduction in the level of salt in the diet;
This current dietary advice represents a major shift from earlier assumptions, including those which informed the school meals service. For example, balanced eating is now a case of avoiding common diet-related diseases and not, as in the post-war years, a strategy to prevent deficiencies.
Current Eating Patterns
While views on recommended diets (and their partial acceptance by sections of the public) have been changing, so too have meal patterns. The economic recession has compelled more women into full or part-time work to provide economic support for families hit by unemployment, and this trend has given rise to a less formalised meal pattern and approach to meal planning and preparation.
The seven years since 1980 have also seen an expansion in outlets for highly-promoted take-away foods, and other opportunities to eat outside the home. This affects the types of foods children will be familiar with, and also the style and setting in which they are presented.
Among the continuing high numbers of families existing on long-term benefits, some recent studies (5) have described the practical difficulties of maintaining a healthy diet on a low income, even assuming that the appropriate foods are readily available; food expenditure was the main flexible item in the household budget. These are the considerations which need to be taken into account now during discussions of the school meals service.
Implications for School Meals
The Coronary Prevention Group believes that in the face of persistent long-term unemployment and the current levels of slate benefits, the school meals service is as important now as it was when pioneered in 1890. In addition to those children who rely on the school service for their only proper meal of the day, the DHSS survey found that children derive 30% of their energy from school meals.
Contemporary nutritional recommendations would be critical of the old service -and nor would its manner of presentation be appropriate now eating patterns are more varied. If those children opting to eat”junk food”off the premises are to be attracted back, then the school service will have to compete with high street outlets in terms of style as well as price, content and variety.
These observations on the changed atmosphere of 1987 lead CPG to the conclusion that an excellent opportunity now exists to review the school meals system, its function, objectives and purpose.
Our contribution to that review is in the form of the following points and recommendations.
The school meals service is a vital social service for some. It is also a major opportunity to achieve, in conjunction with classroom education, healthy eating habits and awareness of diet and health for all.
This requires the re-introduction of quantified national guidelines for nutritional standards for school meals. Such a measure is needed to demonstrate the government’s commitment to enabling an environment in which options for healthy living can be made. It would also provide guidelines for LEAs on standards to use for the service, and enable the submission of tenders from private caterers on the basis of known objectives. Finally the working group would set out some pointers as to how these aims can be achieved.
1. There needs to be extensive menu and recipe development – the suggestions in Appendix A should be designed on a local basis to allow for different regional and cultural eating patterns. This can be achieved by the gradual phasing in of unrefined foods such as wholemeal flour, cereals and pulses, and a reduction in fat, sugar and salt contents by, for example, offering fewer chips, paying closer attention to cooking oils etc. The indications are that this can be achieved within a realistic budget.
2. In-service training of school meal officers, cooks, school lunch supervisors and teaching staff is essential.
3. Classroom education and participation is vital in implementing these guidelines. Liaison between all those responsible for organising school meals and nutrition education must be encouraged so that consistent messages are taught.The “hidden curriculum” in school life should reinforce and not undermine the healthyeating idea. Further, the practice as well as the theory should be put over through practical demonstrations and leaching of cookery. This is particulary important where foods, or their preparation, is unfamiliar.
4. A positive commitment to nutrition education and health education throughout the curriculum is essential. This is reinforced by the recommendation of the Government’s own Committee on Medical Aspects of Food Policy that the process of education in habits of eating that will minimise the risk of cardiovascular disease and obesity should be started in schools. (COMA 1984 p.11). We recommend that all schools should be required to include nutrition education within their curriculum policy statements.
5. Thought and attention needs to be given to the presentation of food to make it attractive, since it is insufficient to change guidelines alone to achieve nutritional change. This applies to surroundings as well as presentation, for example by promoting a more relaxed, informal atmosphere in the eating area at lunch time. Despite the problems involved there are some encouraging examples of good practice around the country (6).
6. Parental involvement should be extended, for example, by having open days and tasting sessions. Several LEAS have successfully held “taste-ins” for parents and children to try out new foods which it proposed to introduce. This is also an opportunity to introduce the uses to which healthy food can be put in cooking and an emphasis on its role in the control of bodyweight as one means to sell it.
7. Local Authority purchasing consortia should co-operate in developing nutritional specifications for all the major commodities and processed foods commonly used in school meals. This would be most efficiently done if they joined in the collaborative efforts now being mounted by other public sector organisations involved in catering. In this way there could be substantial cost savings as well as nutritional gains.
CPG recommends that local Dietitians be contacted for advice and support, whilst bearing in mind that this advice must be implemented within the budgetary constraints of the school meals service. Gradual implementation of these guidelines is recommended with the system being monitored at a local level by the school meals organisation.
CPG ALSO RECOMMENDS THAT THESE QUANTIFIED GUIDELINES BE REVIEWED EVERY 2-3 YEARS. FINALLY CPG BELIEVES THESE CONCLUSIONS AND RECOMMEND-ATIONS LIE WITHIN THE FRAMEWORK OF THE WORLD HEALTH ORGANISATION’S REPORT ON THE PRIMARY PREVENTION OF CORONARY HEART DISEASE (7). THAT IS TO SAY THAT A VALUABLE ROLE CAN BE PLAYED BY ALL PUBLIC AGENCIES IN PROMOTING LIFESTYLES WHICH REDUCE THE RISK OF CORONARY HEART DISEASE AND OTHER FATAL DISEASES KNOWN TO BE TOO COMMON IN THIS COUNTRY’HEALTH FOR ALL BY THE YEAR 2000′ SET A TARGET OF A REDUCTION OF AT LEAST 30% IN MORTALITY FROM STROKE AND HEART DISEASE (8). THESE PROPOSALS FOR THE SCHOOL MEAL SERVICE WOULD MAKE AN IMPORTANT CONTRIBUTION TO MEETING THAT GOAL.
Recommended Nutritional Standards for School Meals
ENERGY: NOT LESS THAN 30% OF THE RECOMMENDED DAILY ALLOWANCE (RDA)
The DHSS survey, ‘The Diets of British School-children,’ shows that at present, children derive 30% of their energy from school meals. Although average daily energy intakes were about 10% lower than the DHSS recommendations, a finding common to recent British surveys of food intakes, these children show no signs of undernutrition. They were, on average, on or above the standards for height and well above the standards for weight regardless of energy intake. Therefore we see no reason to alter the percentage of energy being derived from school meals.
FAT: BETWEEN 33% AND 35% OF ENERGY, I.E. APPROXIMATELY 32g PER MEAL
COMA (1984) recommends that no more than 35% of energy should be derived from fat. Previous school meal guidelines (1975) recommend that fat should provide 33% of energy. We therefore take these two figures as upper and lower limits.
SUGAR. THIS SHOULD PROVIDE NO MORE THAN 10% OFTOTAL CALORIES PER SCHOOL MEAL, I.E. NO MORE THAN 25g OF ADDED SUGAR AT THE MEAL
NACNE, the Royal College of Physicians’ Report on Obesity and the British Medical Association recommend that the consumption of all added sugars be reduced by 50%. As the average intake of all added sugars in the UK is at present estimated to be approximately 46kg per head per year or 20% of calories, a reduction to 10% is advised.
FIBRE: 30% OF THE DAILY FIBRE INTAKE SHOULD BE PROVIDED BY THE SCHOOL MEAL WHICH IS EQUAL TO APPROXIMATELY 8g.
NACNE recommends a daily fibre intake of 30g, or 12g per thousand calories. As breakfast can be a major supplier of daily fibre we suggest that just under a third need be provided by the school meal.
IRON: NOT LESS THAN 35-40% OF THE RECOMMENDED DAILY ALLOWANCE
The average iron intake of boys and girls, from ‘The Diets of British Schoolchildren’, showed intakes below the RDA. At present the school meal provides approximately one third. If therefore the school meal provided 35-40% this would enable the majority of children to attain the RDA.
PROTEIN AND CARBOHYDRATE
Although no specific recommendations have been made for protein and total carbohydrate, we would concurwith NACNE that 11% of total energy be derived from protein. Therefore 54% of total energy would be supplied by carbohydrate, of which not more than 10% should be provided by added sugars.
VITAMIN A: NOT LESS THAN 35% OF THE RECOMMENDED DAILY ALLOWANCE
This intake should be maintained in order to safeguard against any deficiencies which may arise.
VITAMIN C: NOT LESS THAN 50% OF THE RECOMMENDED DAILY ALLOWANCE
The DHSS survey ‘The Diets of British Schoolchildren’ showed that the school meal is at present providing 50% of the RDA for vitamin C. Although the vast majority of children met their RDA for vitamin G we would recommend that this level be maintained to assist absorption from the proposed increased iron content of the meal. We would draw attention to the need for care over cooking methods to preserve this heat sensitive vitamin, and the recommendation refers to food as freshly prepared.
VITAMIN D
Attention should also be paid to the vitamin D content of the diet and vitamin D rich foods should be used in school meals where appropriate.
REFERENCES
- “The Diets of British School Children’ April 1986, DHSS.
- DAILY TELEGRAPH 3 April 1986 p.9.
- Estelle Rice, “School Meals: A Vehicle for Healthy Food Choice” HEALTHY VISITOR no. 7 vol 59 July 1986.
- National Advisory Committee on Nutrition Education (NACNE), “Proposals for Nutritional Guidelines for Health Education in Britain,” 1983, Health Education Council. Committee on Medical Aspects of Food Policy (COMA), “Diet and Cardiovascular Discase,” 1984, DHSS.
- FA Hanes and AE de Looy. “Can I Afford to Diet? The Effect of Low Income on People’s Eating Habits,” 1986, British Dietetic Association; T Lang and I Cole-Hamilton, “Tightening Belts: A Report o the Impact of Poverty on Food,” London Food Commission 1986, “New Society” 3 October 1986 p.22
- For some other detailed examples of good practice see Jane Brown, “School Lunch: The Crunch,” 1986, Cambridge Health Authority.
- World Health Organisation,” Primary Prevention of Coronary Heart Disease,” ‘Euro Reports and Studies no. 98, 1984.
- Faculty of Community Medicine, “Health for All by the Year 2000,” 1986 p.18.
THIS REPORT HAS BEEN PRODUCED BY A WORKING PARTY, CONVENED BY THE CORONARY PREVENTION GROUP, WHICH REPRESENTS A WIDE RANGE OF EXPERIENCE IN THE FIELDS OF NUTRITION AND PUBLIC AND PRI1ATE SECTOR CATERING. MEMBERS OF THE WORKING PARTY WERE:
Mr. Christopher Bone, Contracts Director, Gardner Merchant Ltd.
Mr. Brian Bushell, Technical Development Manager, Compass Services (UK) Ltd.
Mrs. Anne Carter, Education Officer (Catering), Nottinghamshire County Council
Ms. Anne Dillon, Director, The Coronary Prevention Group
Mr. John Grigg, Administrator, British Dietetic Association
Mr Gerald Imison, Assistant Secretary, Assistant Masters and Mistresses Association
Ms. Maggie Sanderson, Lecturer, Department of Applied Chemistry and Life Sciences, Polytechnic, of North London
Mr. Donald Watson, Resources OfficerThe Coronary Prevention Group (Secretary to the Working Party)
The Coronary Prevention Group is grateful for their work.