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Healthy food environment – Dossier Food
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Collection
Onderzoek voedselomgeving en voedselgedrag Amsterdam
In deze collectie worden onderzoeken over voedselomgeving en voedselgedrag gedeeld in opdracht van of uitgevoerde door GGD Amsterdam.
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Amsterdam Approach Healthy Weight
In Amsterdam, 1 in 5 children and young people are overweight or obese. This has serious consequences for their health in the short and long term. That is why the municipality is investing heavily in preventing and reducing obesity in children, with a focus on the horizon: all Amsterdam children at a healthy weight by 2033.
In order to grow up healthy, children need the commitment of everyone. Firstly, that of the child and the parents themselves, but also that of professionals in education, care, welfare and neighborhood organizations, sports clubs and companies. With the Amsterdam Healthy Weight Approach, the City of Amsterdam is working with other parties on a healthy weight for Amsterdam's youth.
In the 'Meerjarenplan' you can read more about the 2018-2021 commitment per part of the Amsterdam Healthy Weight Approach. -
Article
Superlijst Gezondheid 2020
Supermarkten spreken zonder uitzondering de intentie uit om de gezonde keuze te vergemakkelijken. Bij Lidl, Dirk, Coop en Ekoplaza is die ambitie het best vertaald in beleid en praktijk. Geen enkele supermarkt heeft echter adequate doelstellingen voor verkoop van gezonde producten en in de wekelijkse folders domineren ongezonde producten. Toch biedt bijna elke supermarkt in dit onderzoek wel een goed voorbeeld dat andere supermarkten kan inspireren.
Zo’n 70 procent van ons dagelijks voedsel komt uit de supermarkt. Supermarkten hebben daarmee grote invloed op ons voedingspatroon. De afgelopen jaren hebben supermarkten (gezamenlijk) toezeggingen gedaan om gezond voedsel de makkelijke keuze te maken, onder meer vastgelegd in het Nationaal Preventieakkoord.
Superlijst is een tweejaarlijks terugkerende vergelijking van supermarkten, die inzichtelijk maakt wat supermarkten doen om hun klanten te helpen kiezen voor gezond en duurzaam. In deze eerste editie belichten we het thema Gezondheid. De centrale vraag in dit onderzoek is: in hoeverre stimuleert de supermarkt als omgeving voor dagelijkse voedselkeuzes een gezond voedingspatroon?
Om daarvan een beeld te krijgen heeft Questionmark een onderzoeksmethode opgesteld in samenwerking met Diabetes Fonds, Hartstichting, Maag Lever Darm Stichting en Nierstichting en onder toeziend oog van een Raad van Wetenschappers. Voorafgaand aan het onderzoek kregen supermarkten de gelegenheid commentaar te geven op deze methode. In juni 2020 is de definitieve versie gepubliceerd en begon de onderzoeksperiode, die liep tot 19 augustus. De onderzoeksmethode richt zich op de doelstellingen die supermarkten zichzelf voor gezondheid hebben gesteld, het aandeel gezonde producten in het assortiment en in de reclamefolder, en de mate waarin supermarkten op de winkelvloer de gezonde keuze makkelijk maken. Het beeld dat uit het onderzoek naar voren komt laat zich samenvatten in vier hoofdbevindingen.
Bron: Questionmark (2020), Superlijst Gezondheid 2020: Welke supermarkt maakt gezond de makkelijke keuze?, Amsterdam: Stichting Questionmark.
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Article
Gezonde voeding, gezonde wereld
De drie grootste uitdagingen op het gebied van gezondheid en welzijn zijn obesitas, ondervoeding en klimaatverandering. Volgens de Lancet Commission vertegenwoordigen zij samen een wereldwijd syndemisch syndroom, drie pandemieën die onderling verbonden zijn en geïntegreerde oplossingen vereisen op lokaal, nationaal, Europees en internationaal niveau. Op 3 april bespraken Europese beleidsmedewerkers en wetenschappers hoe een samenhangende voedselbeleidsagenda kan worden opgesteld van lokaal naar Europees niveau. Ook de WRR was aanwezig en gaf een presentatie op basis van haar rapport Naar een voedselbeleid.
Nu de onderhandelingen voor EU-budgetten opnieuw worden bepaald, is het wellicht ook een goed moment om het landbouwbeleid te verbreden naar voedselbeleid? Josta de Hoog, senior onderzoeker bij de WRR, vindt van wel. ‘De manier waarop ons voedsel wordt geproduceerd is sterk veranderd. Vroeger ging het voedsel van boer naar bord, daar zaten geen of weinig schakels tussen. Nu komt het eten op ons bord via een complex netwerk. Naast de agrarische sector spelen bijvoorbeeld ook de voedselindustrie, de supermarkten en de horeca een grote rol. Toch hebben veel overheden nog altijd het klassieke landbouwbeleid. Wat we nodig hebben is een verbreding waarin ook duurzaamheid en gezondheid een plaatst krijgt. Verder zal het beleid gericht moeten zijn op alle spelers in de huidige voedselketen. Voedselbeleid vraag dan ook om een interdepartementale aanpak.' Het pleidooi voor een geïntegreerde aanpak sluit aan bij het rapport Naar een voedselbeleid dat de WRR in 2014 publiceerde en het Nederlands pleidooi voor een voedselbeleid op Europees niveau (zie bijvoorbeeld Fresco en Poppe 2016) en wat naast de agrarische sector ook de distributie, detailhandel, levensmiddelenindustrie en horeca beslaat.
Bron: website WRR
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Article
Aanpak Gezond Gewicht 2017 Outcome Monitor
Staat van Gezonde - Leefstijl van Amsterdamse Kinderen.De gemeente Amsterdam zet zich met de Amsterdamse Aanpak Gezond Gewicht in om kinderen gezond op te laten groeien. Het doel is meer kinderen op gezond gewicht en minder kinderen met (ernstig) overgewicht. Ieder jaar monitoren we of de situatie in de stad verbetert, gelijk blijft of verslechtert sinds de start van het programma in 2013. De cijfers worden vergeleken met referentiejaar 2012.
Behandeld in Commissie Zorg & Sport 30 maart 2017
Behandelend ambtenaar: Henriette Rombouts, henriette.rombouts@amsterdam.nl
Voor meer informatie klik hier
amsterdam.nl/aanpakgezondgewicht
amsterdam.nl/zoblijvenwijgezond
ggd.amsterdam.nl
ggdgezondheidinbeeld.nl
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Article
Aanpak gezond gewicht 2016 / Uitvoeringsplan 2017
Het jaarverslag 2016 van de Amsterdamse Aanpak Gezond Gewicht. Dit jaarverslag bevat de belangrijkste resultaten van 2016. In het afgelopen jaar heeft u de voortgang van de inspanningen integraal kunnen volgen op www.uitvoeringgezondgewicht.nl. In dit verslag nemen wij u mee langs een aantal hoogtepunten uit de verschillende onderdelen van de aanpak. De financiële verantwoording van de aanpak in 2016 is opgenomen in de Jaarrekening en het jaarverslag van de GGD. De outcomemonitor AAGG, alsook het Uitvoeringsplan 2017 zijn te raadplegen via de website: www.amsterdam.nl/zoblijvenwijgezond
Behandeld in Commissie Zorg & Sport 23 mei 2017 en 18 april 2017
Behandelend ambtenaar: Henriette Rombouts, henriette.rombouts@amsterdam.nl
Voor meer informatie klik hier
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Article
Neighbourhood fast food exposure and consumption: the mediating role of neighbourhood social norms
The association between the residential fast food environment and diet has gained growing attention. However, why the food environment affects food consumption is under-examined. This study aimed to investigate neighbourhood social norms with respect to fast food consumption as a potential mediating pathway between residential fast food outlet exposure and residents’ fast food consumption.
Background: The association between the residential fast food environment and diet has gained growing attention. However, why the food environment affects food consumption is under-examined. This study aimed to investigate neighbourhood social norms with respect to fast food consumption as a potential mediating pathway between residential fast food outlet exposure and residents’ fast food consumption.
Methods: A correlational study was conducted in which a nationwide sample of 1038 respondents living across The Netherlands completed a survey. Respondents reported their fast food consumption (amount/week) as well as perceived descriptive and injunctive norms regarding fast food consumption in their neighbourhood. Fast food outlet exposure was measured by the average count of fast food outlets within a 400 m walking distance buffer around the zip-codes of the respondents, using a retail outlet database. Regression models were used to assess associations between residential fast food outlet exposure, fast food consumption, and social norm perceptions, and a bootstrapping procedure was used to test the indirect -mediation- effect. Separate analyses were performed for descriptive norms and injunctive norms.
Results: There was no overall or direct association between residential fast food outlet exposure and residents’ fast food consumption. However, fast food outlet exposure was positively associated with neighbourhood social norms (descriptive and injunctive) regarding fast food consumption, which in turn were positively associated with the odds of consuming fast food. Moreover, results of the bootstrapped analysis provided evidence of indirect effects of fast food outlet exposure on fast food consumption, via descriptive norms and injunctive norms.
Conclusions: In neighbourhoods with more fast food outlets, residents were more likely to perceive fast food consumption in the neighbourhood as more common and appropriate. In turn, stronger neighbourhood social norms were associated with higher fast food consumption. Acknowledging the correlational design, this study is the first that implies that neighbourhood social norms may be a mediating pathway in the relation between the residential fast food environment and fast food consumption. Future research may examine the role of neighbourhood social norms in other contexts and explore how the changing food environment may shift our consumption norms.
Source: Van Rongen, S., Poelman, M. P., Thornton, L., Abbott, G., Lu, M., Kamphuis, C. B. M., Verkooijen, K., & De Vet, E. (2020). Neighbourhood fast food exposure and consumption: the mediating role of neighbourhood social norms. International journal of behavioral nutrition and physical activity, 17(1), [61]. https://doi.org/10.1186/s12966-020-00969-w
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Article
Healthy is (not) tasty? Implicit and explicit associations between food healthiness and tastiness in primary school-aged children and parents with a lower socioeconomic position
Many people implicitly (automatically) believe that unhealthy foods are tastier than healthy foods, even when they explicitly (deliberately) report that they don't. It is unclear whether this ‘unhealthy = tasty intuition’ is already present in childhood. Children from families with a lower socioeconomic position (SEP) consume poorer diets than children from families with a higher SEP. Paradoxically, populations with a lower SEP are underrepresented in research and least reached by lifestyle interventions. This study explored implicit and explicit associations between healthiness, tastiness and liking of foods in primary school-aged children and parents with a lower SEP.
Many people implicitly (automatically) believe that unhealthy foods are tastier than healthy foods, even when they explicitly (deliberately) report that they don't. It is unclear whether this ‘unhealthy = tasty intuition’ is already present in childhood. Children from families with a lower socioeconomic position (SEP) consume poorer diets than children from families with a higher SEP. Paradoxically, populations with a lower SEP are underrepresented in research and least reached by lifestyle interventions. This study explored implicit and explicit associations between healthiness, tastiness and liking of foods in primary school-aged children and parents with a lower SEP. These associations and an estimate of dietary intake were assessed with implicit association tests and paper-and-pencil questionnaires, developed and adapted specifically for this target group. Participants were recruited at Dutch food banks. Results of 37 parent-child dyads indicated that children and parents implicitly associated healthy foods and tastiness more strongly with each other than healthy foods and not tasty (D = −0.19, p =.03 and D = −0.46, p <.001, respectively). Explicitly, parents showed similar results, while children rated pictures of unhealthy foods as tastier than pictures of healthy foods. Following the discrepancy between our hypotheses, results, and more unhealthy eating habits that often prevail in families with a lower SEP, potential explanations are discussed. We address the possibility that an internalised social norm was exposed, rather than an intrinsic belief. We propose that this research calls for in-depth qualitative research on food-related preferences and norms in the everyday life of low SEP families.
Source: van der Heijden, A., te Molder, H., de Graaf, C., & Jager, G. (2020). Healthy is (not) tasty? Implicit and explicit associations between food healthiness and tastiness in primary school-aged children and parents with a lower socioeconomic position. Food Quality and Preference, 84, [103939]. https://doi.org/10.1016/j.foodqual.2020.103939
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Article
Can healthy checkout counters improve food purchases? Two real-life experiments in dutch supermarkets
Most snacks displayed at supermarket checkouts do not contribute to a healthy diet. We investigated the effects of introducing healthier snack alternatives at checkouts in supermarkets on purchasing behavior. In Study 1, we investigated the effect of completely substituting less healthy with healthier snacks (one supermarket). In Study 2, we investigated the effect of placing and discounting healthier snacks while the less healthy snacks remain in place (two supermarkets).
Most snacks displayed at supermarket checkouts do not contribute to a healthy diet. We investigated the effects of introducing healthier snack alternatives at checkouts in supermarkets on purchasing behavior. In Study 1, we investigated the effect of completely substituting less healthy with healthier snacks (one supermarket). In Study 2, we investigated the effect of placing and discounting healthier snacks while the less healthy snacks remain in place (two supermarkets). In both studies, the number of purchased snacks (per 1000 customers) was used as the outcome variable. Results for Study 1 showed that the absolute number of purchased checkout snacks was 2.4 times lower (95% confidence interval (CI): 1.9–2.7) when healthier snacks instead of less healthy snacks were placed at the supermarket checkouts. Results for Study 2 showed that when additional healthier snacks were placed near the checkouts, the absolute number of healthier purchased snacks increased by a factor of 2.1 (95% CI: 1.3–3.3). When additional healthier snacks were placed near the checkouts and discounted, the absolute number of healthier purchased snacks increased by a factor of 2.7 (95% CI: 2.0–3.6), although this was not statistically significant higher than placement only (ratio: 1.1, 95% CI: 0.7–1.9). Purchases of less healthy snacks did not decline, and even slightly increased, during the intervention period (ratio: 1.3, 95% CI: 1.1–1.5). If supermarkets want to promote healthier snack purchases, additional healthier products can be positioned near the checkouts. However, this does not discourages the purchase of less healthy snacks. Therefore, to discourage unhealthy snack purchases at supermarket checkouts, a total substitution of less healthy snacks with healthier alternatives is most effective.
Source: Huitink, M., Poelman, M. P., Seidell, J. C., Kuijper, L. D. J., Hoekstsra, T., & Dijkstra, C. (2020). Can healthy checkout counters improve food purchases? Two real-life experiments in dutch supermarkets. International Journal of Environmental Research and Public Health, 17(22), 1-15. [8611]. https://doi.org/10.3390/ijerph17228611
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Article
Can unhealthy food purchases at checkout counters be discouraged by introducing healthier snacks? A real-life experiment in supermarkets in deprived urban areas in the Netherlands
The checkout area in supermarkets is an unavoidable point of purchase where impulsive food purchases are likely to be made. However, the product assortment at the checkout counters is predominantly unhealthy. The aim of this real life experiment was to investigate if unhealthy food purchases at checkout counters in supermarkets in deprived urban areas in the Netherlands can be discouraged by the introduction of the Healthy Checkout Counter (HCC). In addition, we examined customers’ perceptions towards the HCC.
Background: The checkout area in supermarkets is an unavoidable point of purchase where impulsive food purchases are likely to be made. However, the product assortment at the checkout counters is predominantly unhealthy. The aim of this real life experiment was to investigate if unhealthy food purchases at checkout counters in supermarkets in deprived urban areas in the Netherlands can be discouraged by the introduction of the Healthy Checkout Counter (HCC). In addition, we examined customers’ perceptions towards the HCC.
Methods: The HCC was an initiative of a leading supermarket chain in the Netherlands that consisted of displays with a selection of healthier snacks that were placed at the checkouts. We used a real life quasi-experimental design with 15 intervention and 9 control supermarkets. We also performed a cross-sectional customer evaluation in 3 intervention supermarkets using oral surveys to investigate customers' perceptions towards the HCC (n=134). The purchases of unhealthy and healthier snacks at checkouts were measured with sales data.
Results: During the intervention period, customers purchased on average 1.7 (SD: 0.08) unhealthy snacks per 100 customers in the intervention supermarket and 1.4 (SD: 0.10) in the control supermarket. Linear regression analyses revealed no statistically significant difference in the change during the control and intervention period of sales of unhealthy snacks between the control and intervention supermarkets (B = − 0.008, 95% CI = − 0.15 to 0.14). The average number of healthier snacks purchased was 0.2 (SD: 0.3) items per 100 customers in the intervention supermarkets during the intervention period. Of the intervention customers, 41% noticed the HCC and 80% of them were satisfied or very satisfied with the intervention.
Source: Huitink, M., Poelman, M. P., Seidell, J. C., Pleus, M., Hofkamp, T., Kuin, C., & Dijkstra, S. C. (2020). Can unhealthy food purchases at checkout counters be discouraged by introducing healthier snacks? A real-life experiment in supermarkets in deprived urban areas in the Netherlands. BMC Public Health, 20(1), [542]. https://doi.org/10.1186/s12889-020-08608-6
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Article
Nudging and social marketing techniques encourage employees to make healthier food choices
Currently, many studies focus on how the environment can be changed to encourage healthier eating behavior, referred to as choice architecture or "nudging." However, to date, these strategies are not often investigated in real-life settings, such as worksite cafeterias, or are only done so on a short-term basis.
Background: Currently, many studies focus on how the environment can be changed to encourage healthier eating behavior, referred to as choice architecture or "nudging." However, to date, these strategies are not often investigated in real-life settings, such as worksite cafeterias, or are only done so on a short-term basis.
Objective: The objective of this study is to examine the effects of a healthy worksite cafeteria ["worksite cafeteria 2.0" (WC 2.0)] intervention on Dutch employees' purchase behavior over a 12-wk period.
Design: We conducted a randomized controlled trial in 30 worksite cafeterias. Worksite cafeterias were randomized to either the intervention or control group. The intervention aimed to encourage employees to make healthier food choices during their daily worksite cafeteria visits. The intervention consisted of 14 simultaneously executed strategies based on nudging and social marketing theories, involving product, price, placement, and promotion.
Results: Adjusted multilevel models showed significant positive effects of the intervention on purchases for 3 of the 7 studied product groups: healthier sandwiches, healthier cheese as a sandwich filling, and the inclusion of fruit. The increased sales of these healthier meal options were constant throughout the 12-wk intervention period.
Conclusions: This study shows that the way worksite cafeterias offer products affects purchase behavior. Situated nudging and social marketing-based strategies are effective in promoting healthier choices and aim to remain effective over time. Some product groups only indicated an upward trend in purchases. Such an intervention could ultimately help prevent and reduce obesity in the Dutch working population. This trial was registered at the Dutch Trial Register (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5372) as NTR5372.
Source: Velema, E., Vyth, E. L., Hoekstra, T., & Steenhuis, I. H. M. (2018). Nudging and social marketing techniques encourage employees to make healthier food choices: a randomized controlled trial in 30 worksite cafeterias in The Netherlands. The American Journal of Clinical Nutrition, 107(2), 236-246. https://doi.org/10.1093/ajcn/nqx045
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Article
Sowing Seeds for Healthier Diets: Children's Perspectives on School Gardening
School gardening programmes are among the most promising interventions to improve children's vegetable intake. Yet, low vegetable intake among children remains a persistent public health challenge. This study aimed to explore children's perspectives, experiences, and motivations concerning school gardening in order to better understand and increase its potential for health promotion.
School gardening programmes are among the most promising interventions to improve children's vegetable intake. Yet, low vegetable intake among children remains a persistent public health challenge. This study aimed to explore children's perspectives, experiences, and motivations concerning school gardening in order to better understand and increase its potential for health promotion. Using participant observation and semi-structured interviews, we provided 45 primary schoolchildren (9-10 years) from Amsterdam, who participated in a comprehensive year-round school gardening programme, the opportunity to share their experiences and ideas on school gardening. Children particularly expressed enjoyment of the outdoor gardening portion of the programme as it enabled them to be physically active and independently nurture their gardens. Harvesting was the children's favourite activity, followed by planting and sowing. In contrast, insufficient gardening time and long explanations or instructions were especially disliked. Experiencing fun and enjoyment appeared to play a vital role in children's motivation to actively participate. Children's suggestions for programme improvements included more autonomy and opportunities for experimentation, and competition elements to increase fun and variety. Our results indicate that gaining insight into children's perspectives allows matching school gardening programmes more to children's wishes and expectations, thereby potentially enhancing their intrinsic motivation for gardening and vegetable consumption.
Source: Nury, E., Sarti, A., Dijkstra, C., Seidell, J. C., & Dedding, C. (2017). Sowing Seeds for Healthier Diets: Children's Perspectives on School Gardening. International Journal of Environmental Research and Public Health, 14(7), [688]. https://doi.org/10.3390/ijerph14070688
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Article
Oorzaken en gevolgen van dieet patronen van Amsterdamse jongeren met verschillende achtergronden
Overgewicht en daaraan gerelateerde gezondheidsproblemen komen bovengemiddeld vaak voor bij Amsterdamse kinderen uit de lagere sociaaleconomische (SES) klasse en bij kinderen van niet-Nederlandse oorsprong. Over de exacte oorzaak is weinig bekend, maar voeding lijkt een belangrijke factor. Binnen het NUTRABCD-project onderzoekt het lectoraat Gewichtsmanagement de voedingspatronen van Amsterdamse kinderen. Op basis van de onderzoeksresultaten wordt het voor de professional in de gezondheidszorg duidelijker welke groepen kinderen het belangrijkste zijn om op te focussen.
DOELSTELLING
Resultaten uit dit onderzoek bieden professionals in de gezondheidszorg meer inzicht in de relatie tussen voedingspatronen en gewichtsontwikkeling en de belangrijkste, sociaaleconomische voorspellers.
Daarnaast wordt een screeningstool ontwikkeld, waarmee op een snelle manier de energie-inname van een kind in kaart kan worden gebracht. Dit alles biedt de professional in de gezondheidszorg aanknopingspunten om een goed beeld te krijgen welke groepen jonge kinderen (en hun ouders) de belangrijkste doelgroepen zijn voor voedingsinterventies.
METHODE
De gebruikte data is afkomstig van de ABCD-studie (Amsterdam Born Children and their Development). Het NUTRABCD-onderzoek bestaat uit twee delen. Het eerste deel start met het vastleggen van een aantal voedingspatronen van vijfjarigen in Amsterdam.
Per voedingspatroon kijken de onderzoekers naar de relatie met etniciteit, SES en gewicht op vijf- en tienjarige leeftijd. En wordt bepaald welke sociaal-economische factoren het voedingspatroon van een vijfjarige het beste voorspellen.
In het tweede deel wordt een screeningstool ontwikkeld waarmee op een snelle manier de energieinname van een kind in kaart kan worden gebracht. De tool is gebaseerd op de verzamelde voedingsdata van Amsterdamse kinderen en kan makkelijk worden toegepast door professionals in de gezondheidszorg.
RESULTAAT
Het NUTRABCD-onderzoek geeft inzicht in de sociaal-economische factoren/voorspellers van voedingspatronen, die zijn gerelateerd aan overgewicht op vijf- en tienjarige leeftijd. En het biedt een screeningstool waarmee op een snelle manier de energieinname van een kind in kaart kan worden gebracht. Het draagt op deze manier bij aan effectievere bestrijding van overgewicht bij kinderen in een lagere SES-klasse. -
Article
Vegetable-rich snacks for adolescents: A way for increasing vegetable intake?
Vegetable intake of Dutch adolescents is too low. Whereas 250g per day is recommended, current consumption for adolescents aged 14-18 years is 87g/day for girls and 103g/day for boys. In The Netherlands, vegetables are mainly eaten at dinner. As adolescents like to eat snacks during the day, serving vegetable-rich snacks may be an effective strategy to increase their vegetable intake.
Aim: To investigate adolescents’ appreciation and buying behaviour of vegetable-rich snacks in a real life setting.
Methods: After a baseline period of three weeks, three vegetable-rich snacks were added for 3 weeks to the school canteen assortment of 6 high schools: cauliflower nuggets (period 1), and vegetable balls and vegetable wraps (period 2). Advertising did not refer to the healthiness or vegetable ingredients of the snacks. Sales of the products were monitored and students completed questionnaires to evaluate the products after period 1 (n=833) and period 2 (n=227).
Results: The sales of the nuggets and balls was 9-9.5% of the sold snacks in the test period. Wrap sales was 6.4% of the bread-like products. Whereas 66% of the students noticed the nuggets in the canteen, only 14-20% noticed the balls or wraps (p<0.001). Only 10% of the respondents actually bought the vegetable-rich products. They bought the products 3-6 times during the 3-week test period, but gave relatively low liking scores (3.8-4.6 on a 10-point scale). Future buying intention was higher for the wraps (20%; p<0.001) than for the other two products (~11%). Pricing was perceived as right for the balls, whereas the other two products were perceived as too expensive.
Conclusions: It remains a challenge to increase vegetable intake by vegetable-rich snacks that are appreciated by adolescents. A longer introduction period, clear communication, enhancing the taste, and competitive prices may be needed to increase the consumption of vegetable-rich snacks.
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Article
Improving dietary intake during lunch through the provision of a healthy school lunch at Dutch primary schools: design of a pretest-posttest effectiveness study
Since there is a shift from eating lunch at home to eating lunch at primary schools in the Netherlands, providing a school lunch may be an important opportunity to improve the diet quality of Dutch children. Therefore, the aim of this Healthy School Lunch project is to encourage healthy eating behavior of children at primary schools by offering a healthy school lunch, based on the guidelines for a healthy diet.
Since there is a shift from eating lunch at home to eating lunch at primary schools in the Netherlands, providing a school lunch may be an important opportunity to improve the diet quality of Dutch children. Therefore, the aim of this Healthy School Lunch project is to encourage healthy eating behavior of children at primary schools by offering a healthy school lunch, based on the guidelines for a healthy diet.
In this study, two research questions will be addressed.
- The first research question is: What and how much do children consume from a self-served school lunch and how do they evaluate the lunch?
- The second research question is: Do children compensate healthier school lunches by eating less healthy outside school hours? The purpose of this paper is to report the rationale and study design of this study.
Methods: In the Healthy School Lunch project children in grades 5-8 (aged 8-12 years) of three primary schools in the Netherlands will receive a healthy school lunch for a 6-month period. To answer research question 1, lunch consumption data will be collected at baseline and again at 3- A nd 6-months. This will be measured with lunch photos and questionnaires among children. To answer the second research question, a quasi-experimental, pre-test post-test intervention-comparison group design (3 intervention schools and 3 comparison schools) will be carried out. Potential compensation effects will be measured with a single brief questionnaire among parents at the three intervention and three comparison schools at month 6 of the lunch period. The school lunch will also be evaluated by parents (discussion groups) and teachers and support staff (brief questionnaires).
Discussion: Results of this study will provide valuable information to influence future school lunch interventions and policies.
Source: Kleef et al. 2020. Improving dietary intake during lunch through the provision of a healthy school lunch at Dutch primary schools: design of a pretest-posttest effectiveness study. BMC Public Health. https://doi.org/10.1186/s12889-020-08807-1
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Article
Healthier in primary school: school lunches and more physical exercise
The government encourages primary schools to help children live healthier. A healthy school lunch and more physical exercise during school time can help in this regard. Research shows that there is support for this among parents, children, and schools. It is also feasible as long as these parties are involved in the organisation.
The government encourages primary schools to help children live healthier. A healthy school lunch and more physical exercise during school time can help in this regard. Research shows that there is support for this among parents, children, and schools. It is also feasible as long as these parties are involved in the organisation.
Parents are willing to help pay for the costs (€1.75 per child per day), but that will not cover all the costs (€2.40 per child per day for the selfmade lunch and €4.50 for the school lunch with exercise activities). Support is therefore needed to provide financial support for less wealthy families in this regard.
For a self-prepared lunch, children themselves make a healthy lunch at school. This requires at least 30 minutes to do so. A caterer can purchase and deliver the required goods. The school can also do this itself, but that requires good coordination. Additional physical exercise activities can be organised by scheduling brief exercise intervals during the classes. Educational co-workers, such as those from the after-school care services, as well as neighbourhood sport coaches can help when it comes to sport and play activities.
By making their own lunches, children end up eating more fruit, vegetables and whole-wheat bread as well as drinking more milk and water. More exercise activities and self-made lunches will contribute to children having a healthier weight. The percentage of overweight children between the ages of 4 and 18 could decrease from 13.5% to 10.2% by 2040, and the percentage of obese children from 2.8% to 2.3%. This decrease could contribute to fewer adults being overweight, obese, or diabetic in future. However, for that to happen, the children would have to maintain their change in behaviour as adults. To help children in this regard, school lunches and exercise activities could be supplemented by activities in secondary school and in their neighbourhood.
This study was carried out in response to previous successful projects with healthy school lunches and more physical exercise in primary schools.
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Article
Exploring the effects of a healthy school lunch on cognitive performance in Dutch primary school children within the Healthy School Lunch project
The ‘Healthy School Lunch’ project (PPS Een gezonde schoollunch - TKI AF-16098) aimed to study the feasibility and impact of offering a healthy school lunch in Dutch primary schools.
The ‘Healthy School Lunch’ project (PPS Een gezonde schoollunch - TKI AF-16098) aimed to study the feasibility and impact of offering a healthy school lunch in Dutch primary schools. In the first phase of the project we studied the support for a healthy school lunch among a wide range of stakeholders and we explored what they thought a healthy school lunch should look like. The next phase aimed to study the effects of a healthy school lunch on dietary intake and cognitive performance. In order to investigate the effects of providing a healthy school lunch on the dietary intake of children during lunch, a longitudinal intervention study with three schools was designed, where a healthy school lunch was offered for six months. Due to various financial and methodological reasons that were not fully considered when starting this project, it was not possible to combine the dietary intake and cognition study in the school lunch intervention. Instead, we explored the possibilities and requirements to perform a solid experimental cross-over study on the effects of a healthy school lunch on cognitive performance within the Healthy School Lunch Project. This process is described in the current report. We started with a review of the literature on the effects of a healthy school lunch on cognitive performance of children. Studies on the immediate and transient effects of a healthy school lunch versus skipping lunch showed, on a variety of cognitive measures, small and inconsistent effects on alertness and working memory of children. Studies on the long-term effects of a healthy school lunch versus habitual lunch showed small improvements in concentration and language processing ability of children.
Given the restriction that long term effects of a school lunch on cognitive performance could not be examined within the scope of this project, the focus shifted to understanding immediate effects. A well-designed study to capture immediate effects of a healthy school lunch on cognitive performance of children within our project would require a strictly controlled cross-over design in a school setting. The intervention should consist of an ad libitum buffet-style healthy school lunch, compared with a control condition in which children eat ad libitum from a provided lunch comparable to the common relatively unhealthy packed school lunch of Dutch children. Finding an adequate measure for cognitive performance is hampered by the great variation of previously used measures across studies. These ranged from relatively indirect measures of concentration and disengagement to standardized computerized tests assessing specific cognitive domains such as alertness and higher-level executive functions. Hence, a comprehensive battery of tests would be advisable to explore various potential effects. Power calculations would be needed to determine the sample size of such a study, but it is clear that large numbers of children would be needed, given the small expected effects and methodological challenges. As more than one participating school would be needed, multilevel statistical models would be required to handle grouped and individual children’s data. More research on the effects of a healthy school lunch on cognition in primary school children would be very useful. However, a well-designed study that would provide convincing evidence of the effects of a healthy school lunch on cognitive performance in primary school children, would require a high cost set-up that places a very high burden on both the children and the schools. Therefore, we decided that it is not realistic to perform this study within the Healthy School Lunch project. In this report we would like to share our findings, considerations and recommendations to researchers of future studies on the effect of healthy school lunches on cognitive performance in children.
Source: Bron: Dijkstra, C., van der Haar, S., van Bergen, G., van Kleef, E., & Vingerhoeds, M. (2020). Exploring the effects of a healthy school lunch on cognitive performance in Dutch primary school children within the Healthy School Lunch project. (Wageningen Food & Biobased Research report; No. 2041). Wageningen Food & Biobased Research. https://doi.org/10.18174/519945
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